INTRAUTERINE DEVICES/PELVIC INFECTIONS
 Women who have had an intrauterine device (IUD) in place for five or more years are five times more likely to develop a severe pelvic infection than are women not using IUDs. The risk of infection was even higher in IUD users who had more than one sexual partner. (American Medical News, May 18, 1984, p. 10) Copyright Phylis Austin

WALKING DURING LABOR
 Walking during labor can be beneficial to both mother and fetus according to a British study. Women who walked had shorter labors, required less pain medication, and the fetus was in better condition at the time of birth. Apgar scores of babies whose mothers had been allowed to walk were higher at both one and five minutes, and there were fewer fetal heart rate abnormalities. (British Medical Journal 2:591-593, 1978) Copyright Phylis Austin

PREGNANCY/UNDERWEIGHT MOTHERS
 Underweight mothers have more complications in childbirth than normal weight mothers, and are more likely to have premature deliveries. The rate of primary cesarean sections, midforceps delivery, extended medial episiotomy and postpartum endometritis was increased in the study of 100 women who were 20 to 40 percent underweight. The premature delivery rate was 23 percent, compared to 11 percent for normal weight women. Postpartum endometritis was twice as common in the underwent women. However, the underweight women showed a one percent rate of toxemia, compared to a 8.1 percent rate in controls. (American Journal of Obstetrics and Gynecology 94:595-596, February 15, 1966) Copyright Phylis Austin

CHORIONIC VILLUS SAMPLING (CVS)/MISCARRIAGE
 Chorionic villus sampling (CVS), a biopsy of the placenta, is coming into more frequent use as a method to check for fetal abnormalities. It can be done much earlier in the pregnancy than can amniocentesis, and the results are available in less than a week. Some physicians are now becoming alarmed that the rate of spontaneous abortion after CVS is significantly higher than with amniocentesis. A study of nearly 2,000 women showed an abortion rate of about 4.4 percent after CVS; after amniocentesis is felt to be about 0.5 percent. (Medical Tribune 25(36)25, December 26, 1984) Copyright Phylis Austin

VAGINAL DOUCHING
 While douching may be an effective treatment for some diseases, routine douching is probably not wise. Adverse effects of habitual douching include destruction of the natural vaginal flora, irritation, ulceration, and air embolism.
There is disagreement over whether a douche should be acidic or alkaline. Dr. Glynn states that alkaline douches encourage the flow of vaginal secretions, while acid solutions coagulate secretions. For this reason itching from vulvovaginitis is more readily treated with an alkaline douche. However, other researchers report that alkaline douches encourage the growth of disease- causing organisms.
The proper position for douching is lying in the bathtub, with knees bent. The douche bag should be hung at about shoulder height. If the bag is too high the excessively high pressure may allow fluid to enter the cervix, causing peritonitis. With the valve closed, insert the nozzle into the vagina with a slight pressure on the back of the vagina. Gently, but firmly squeeze the labia around the nozzle tip. Open the valve, allowing the solution to flow into the vagina until a sensation of fullness is present. Close the valve but retain the solution in the vagina for one minute to allow the solution to reach all the vaginal folds. Release the vaginal lips to allow fluid to drain, and repeat until the solution is used up. (Postgraduate Medicine 76(8)93-97, December 1984) Copyright Phylis Austin

BIRTH CONTROL/FIBROCYSTIC DISEASE OF THE BREAST
 Women who have previously used oral contraceptives are more likely to develop fibrocystic disease of the breast after menopause. (American Journal of Epidemiology 120:87-96, 1984) Copyright Phylis Austin

CASTOR OIL/LABOR STIMULATION
 It is sometimes necessary to induce labor in women with premature rupture of the membranes. Oxytocin has been used for this purpose for several years. Adverse effects of oxytocin include jaundice of the newborn, an increase in risk of hemorrhage after labor, and an increase in the number of Caesarean and forceps deliveries. In addition, the use of oxytocin stimulation requires hospitalization and specially trained personnel.
A study of 196 patients with premature rupture of the membranes reveals that 75 percent of the patients who were given two ounces of castor oil went into labor. The time between the administration of the castor oil and the onset of labor varied from 1 to 13 hours, with an average of four hours.
A 1959 study reported a marked increase in uterine activity after administration of castor oil. The effects of castor oil were best in women who were having their first babies. Some of the women given castor oil failed to go into labor, or required further stimulation with oxytocin, but there were three times as many Caesarean sections in mothers not given castor oil than in those given it.
Castor oil induced labor, just as oxytocin induced labor, may not be as effective as spontaneous labor, but it may serve an important role when labor must be induced. (Journal of Nurse- Midwifery 29(6)366-370, November-December 1984) Copyright Phylis Austin

CAFFEINE/PLACENTAL BLOOD FLOW
 Two cups of coffee decreased intervillous placental blood flow in the last trimester in 20 pregnant mothers. (American Journal of Obstetrics and Gynecology 147(8)939-942, 1983) Elimination of caffeine should be routine during pregnancy. Reduction in blood flow can slow brain growth, possibly permanently, in the unborn child. Copyright Phylis Austin

ECLAMPSIA/UNDERWEIGHT
 Underweight pregnant women are apparently at a slightly increased risk of developing eclampsia of pregnancy according to a New York study. (Obstetrics and Gynecology 64:315-318, September 1984) Copyright Phylis Austin

VITAMIN A/BIRTH DEFECTS
 Accutane, a vitamin A derivative, is known to induce birth defects. Common defects include small, absent or malformed ears, cleft palate, heart defects, cortical blindness, abnormalities of the heart and blood vessels and others. Some researchers are now urging that we take a second look at the effects of large doses of vitamin supplements. (Journal of Pediatrics 105(4)583-584, October, 1984) Copyright Phylis Austin

IRON/PRENATAL SUPPLEMENTS
 A study done by the University of Colorado Health Sciences Center of Denver, Colorado, reveals that iron in prenatal supplements is poorly absorbed. Iron absorption may be inhibited by calcium carbonate and/or magnesium oxide. (Obstetrics and Gynecology 61(3)356, March 1983) Copyright Phylis Austin

MENTAL DEVELOPMENT/SMOKING MOTHERS
 Infants of mothers who smoked during pregnancy show higher rates of hyperactivity, shorter attention spans, and lower scores on reading and spelling tests than did children whose mothers did not smoke during the pregnancy. (Obstetrics and Gynecology 64(5)601-607, November 1984) Copyright Phylis Austin

PANTY SHIELDS/PANTY LINERS/VAGINAL INFECTION
 Women who use panty shields or liners may be at increased risk of vaginal infection reports Marilynne McKay, an Emory University dermatologist. She states that the liners may increase perspiration and retain moisture, which will in turn encourage dermatitis and provide an environment favorable for the growth of yeast organisms. The adhesive may produce chafing and perfumes used in many liners may be irritating to the skin. (American Family Physician 109:283, March 1985) Copyright Phylis Austin

INFERTILITY/INTRAUTERINE DEVICE
 Women who use intrauterine devices (IUDs) to prevent pregnancy may be rendered permanently sterile according to a Washington State study. The Dalkon Shield was associated with the greatest possibility of infertility, but all IUDs apparently have the potential to produce infertility. (New England Journal of Medicine 312:937-941, April 11, 1985) Copyright Phylis Austin

TAMPONS/VAGINAL LESIONS
 Tampons may induce vaginal mucosal drying, layering and/or ulcerations. These symptoms were seen more frequently in women who used tampons containing rayon polyacrylate than in those using cotton tampons. (Obstetrics and Gynecology 66:31, 1985) Copyright Phylis Austin

ROUTINE EPISIOTOMY
 Many physicians routinely perform an episiotomy (surgical incision of the vulvar orifice in an attempt to widen the opening for the baby) with every delivery. They state that the episiotomy prevents tears which may be difficult to repair, prevents injury to the baby's head, and shortens the second stage of labor. However, many women suffer severe discomfort for weeks or even months after childbirth. A Connecticut study reveals that 67 of 100 women delivered without episiotomy suffered no tear at all, and 16 had tears which did not require repair (a painful procedure). Six had first degree lacerations which did require suturing and eleven suffered second degree lacerations. No women in the study suffered third or fourth degree lacerations. Every child in the study was followed up and found to be in good health, having sustained no injury due to lack of episiotomy. Copyright Phylis Austin

AMBULATION/OXYTOCIN
 Four physicians from Finland compared oxytocin versus walking in prolonged labor. The women who were allowed to walk experienced a shorter second stage of labor, while women given oxytocin suffered more overly strong contractions. The authors feel that under some circumstances walking may be an alternative to oxytocin. (European Journal of Obstetrics, Gynecology, and Reproductive Biology 20:199-208, 1985) Excessively strong contractions can cause a reduction in blood flow to the baby. Copyright Phylis Austin

CHILDBIRTH/PERINEAL MUSCLE FUNCTION
 Some obstetricians have felt that episiotomy was helpful to prevent loss of perineal muscle function after childbirth. This study reveals that regular physical exercise is the secret to efficient perineal muscles. Women who exercised after childbirth had better perineal muscle function than those who did not. These researchers report that trauma sustained during childbirth has little effect on the perineal muscle function after one year. They point out that women who have had caesarean sections sometimes show poor muscle function, and they did not sustain injury to the perineum during delivery. Pain after episiotomy is is often more severe than pain after spontaneous laceration. The authors feel that "any form of muscular exercise improves perineal muscle function." (The Lancet 2:124-125, July 20, 1985) We conclude from this study that episiotomy is usually not needed in childbirth, even with the first birth. Copyright Phylis Austin

BIRTH CONTROL PILLS/CROHN'S DISEASE
 Several recent studies have suggested a high risk of inflammatory disease in women who use oral contraceptives. One study revealed a twofold greater incidence of Crohn's disease in oral contraceptive users than in nonusers; another study revealed a 40 percent larger incidence in oral contractive users. Risk decreases after oral contraceptives are stopped, disappearing after about four years. The longer the oral contraceptives are used, the greater the risk. (Gastroenterology 89:1046-1049, 1985) Copyright Phylis Austin

BIRTH DEFECTS/GOLD
 Gold, given to women suffering from arthritis, may produce birth defects. It is generally not considered safe to adminster gold during pregnancy. (Australian Pediatric Journal 16:194-195, 1980) Copyright Phylis Austin

LACTATION SUPPRESSION
 Women who do not wish to breastfeed their newborn infants are given medications to suppress milk production. Women in this study were divided into two groups. One group was treated with medication and the other was instructed in physical measures including a tight fitting bra put on within six hours of delivery and worn for five days, removed only for showering; ice application to the breasts for 15-20 minutes four times a day for five days; avoiding breast stimulation and keeping warn water off the breasts during showering. As a whole, women who were given medication produced milk longer than those using the simple treatment. (JOGN 14:302- 310, July-August, 1985) Copyright Phylis Austin

UTERINE CANCER/INTRAUTERINE DEVICES
 Long-term use of an intrauterine device may lead to the development of uterine cancer. This is only a preliminary report and further studies should be carried out, but women who have had an IUD in place for a long time should be aware of this possibility. (Asia-Oceania Journal of Obstetrics and Gynaecology 10(3)347-357, September, 1984) Copyright Phylis Austin

PRENATAL CALCIUM SUPPLEMENTS/GALLSTONES IN INFANTS
Calcium supplements during pregnancy may induce gallstones in infants and young children. The two year-old daughter of a woman given calcium carbonate and vitamin D during the last four months of the pregnancy required surgical removal of gallstones which were found to be made up entirely of calcium carbonate. This is the first case reported of pure calcium carbonate gallstones. (Journal of Pediatric Surgery 20:143-144, April, 1985) Copyright Phylis Austin

INDUCTION OF LABOR/BREAST PUMP
 A study carried out at the State University of New York at Stony Brook compared nipple stimulation and oxytocin infusion as a means of inducing labor. An electric breast pump was applied to one breast at a time, and alternated to the other side every 15 minutes. The nipple stimulation group had a significantly shorter interval between the stimulation and the onset of labor than did the oxytocin group. No differences were noted in the length of labor or delivery in the two groups. (Journal of Reproductive Medicine 31(2)116-118, February, 1986) It should also be borne in mind that oxytocin stimulated labor is not an entirely normal contraction, and may not be as gentle on the baby and placenta as breast stimulation contraction. Copyright Phylis Austin

BIRTH CONTROL PILLS/PREGNANCY OUTCOME
 Women who have used oral contraceptives within three months of becoming pregnant are more likely to gain excessive weight during their pregnancy. They are more likely to have postmature infants, and have an increased incidence of neural tube defects. (European Journal of Obstetrics, Gynecology and Reproductive Biology 22:77- 83, 1986) Copyright Phylis Austin

PREGNANCY/DIABETES/EXERCISE
 Diabetic control during pregnancy may improved by a walking program, according to a San Diego study. Pregnant women who walked for 20 minutes (about one mile) after each meal had a better fetal outcome than a control group which did not exercise. (Diabetes 54(Suppl 1)115A, May 1986) Copyright Phylis Austin

ALCOHOL/SMOKING/TEA/PRETERM DELIVERY
 Pregnant women who consume more than two alcoholic beverages per day have about a 3-fold risk of early delivery. Women who smoke ten or more cigarettes daily are also more likely to deliver a preterm infant. Women in this Yale University study who delivered early were also likely to have consumed four or more cups of tea per day. (Early Human Development 7:239-250, 1982) Early delivery places an infant at a disadvantage, and sometimes initiates lifelong health problems. Copyright Phylis Austin

EPISIOTOMY/PRETERM INFANTS
 Many midwifery and obstetrics books recommend the utilization of an episiotomy for delivery of small, preterm infants. Those who advocate this feel that it reduces the risk of intracranial hemorrhage, and decreases compression on the infant's head. A Liverpool, England study to evaluate this theory revealed no benefit from episiotomy. (European Journal of Obstetrics, Gynecology and Reproductive Biology 22:17-21, 1986 Copyright Phylis Austin

HOSPITAL ADMISSIONS/LABOR PROGRESS
 A study carried out in Finland suggests that women who are admitted to the hospital for labor too early may suffer adverse effects on the course of labor. The process of admission, and intervention of medical personnel may lead to an increased caesarean section rate, lower Apgar scores in infants, and increased medical expenses. (European Journal of Obstetrics, Gynecology and Reproductive Biology 22:85-94, 1986) Copyright Phylis Austin

DEAFNESS/BIRTH CONTROL PILLS
 A 25-year-old female suffered sudden deafness in the left ear after being placed on birth control pills. She had roaring in the ear for three days before the onset of deafness. She had no other medical problems. Five days after the pills were discontinued she reported return of her hearing.
In 1968 and 1971 other cases of sudden hearing loss were related to the contraceptive pill. (Journal of Laryngology and Otology 100:701-706, June 1976) Copyright Phylis Austin

CAFFEINE/BIRTH DEFECTS
 Caffeine increases the ability of various agents to cause birth defects. A dose as low as 0.1 mg/egg increased teratogenicity in laboratory chickens. (Toxicology Letter 29:65-68, 1985) Copyright Phylis Austin

PERINEAL MASSAGE/EPISIOTOMY/LACERATIONS
 Women who massaged their perineum at least four times per week were shown to have a lower incidence of lacerations and fewer episiotomies during delivery. It is felt that massage helps to maintain the flexibility of the perineum Journal of Nurse Midwifery 31(3)128-34, May-June, 1986) Copyright Phylis Austin

ROUTINE INTRAVENOUS HYDRATION/LABOR
 IV fluids are common during labor. A New Haven, Connecticut study questions its routine use. IV dextrose may lead to rebound hypoglycemia, jaundice, increased lactic acid and lower blood pH levels in the newborn. It may also cause fluid overload in the mother. The authors conclude that permitting a woman in labor to take clear fluids (such as water) during labor is less harmful to her and her infant than to give IV fluids. (Journal of Nurse Midwifery 31(4)171-176, July-August 1986) Copyright Phylis Austin

BIRTH CONTROL PILLS/CHLAMYDIA INFECTION
 Dr. Lawrence Sanders, Jr., of the Centers for Disease Control, reports that women who take oral contraceptives are at increased risk of chlamydia infection. Women who used birth control pills were 1.6 times more likely to develop chlamydia infection than women who did not use contraceptives. (Contraceptive Technology Update June 1986, p. 68-71) Copyright Phylis Austin

SMOKING DURING PREGNANCY/CHILDHOOD CANCER
 Cancer risk for children of mothers who smoke during pregnancy may be 50 percent higher than for children of nonsmoking mothers. Risk for Wilms tumor, non-Hodgkin's lymphoma and acute lymphocytic leukemia is approximately double in these children. (The Lancet 1:1350-1352, June 14, 1986) Copyright Phylis Austin

CAFFEINE/PREGNANCY
 A relatively small amount of caffeine consumed during pregnancy and lactation has been shown to cause central nervous system impairment in laboratory animals. These changes may not be expressed immediately after birth. (Biology of the Neonate 49:277-283, 1986) Report after report of injury to unborn animals by even small amounts of caffeine given to mothers cause us to feel that all obstetricians should advise their patients not to use caffeine during pregnancy. Copyright Phylis Austin

IN UTERO SACCHARINE EXPOSURE/BLADDER CANCER
 Infants whose mothers use saccharin during pregnancy are at increased risk of later developing bladder cancer. Aspartame has replaced saccharin as a sweetener in gum and tooth pastes. Saccharin is known to enhance the cancer-producing ability of other substances. (Cancer Letters 32:151-154, 1986) Copyright Phylis Austin

BIRTH CONTROL PILLS/BIRTH DEFECTS
 Use of oral contraceptives has been associated with an increased risk of leg or arm defects in infants. Infants with abnormalities were more likely to have been conceived while the mother was taking birth control pills. (American Journal of Obstetrics and Gynecology 155:1072-8, 1986) Copyright Phylis Austin

SHOULDER DYSTOCIA/SQUATTING
 Mothers having difficulty giving birth because of shoulder dystocia may benefit from a flat-footed squatting position. The tuberosities are pulled further apart in this position, resulting in a wider pubic angle. (American Journal of Obstetrics and Gynecology 154(4)964, April 1986) Copyright Phylis Austin

PLACENTA EXTRACTS
 Placenta extract injections claimed by some to be the fountain of youth may cause an immune bullous (bubble-like) skin condition, according to a report given at the Joint Meeting of the European Society for Dermatologic Research and the Society for Investigative Dermatology. (Dermatology News 19(8)1,10, September, 1986) Copyright Phylis Austin

JAUNDICE/PREGNANCY/CHARCOAL
 Jaundice (yellowish color of the skin due to bile pigments), is known to have an adverse effect on reproduction. Whatever the cause of the jaundice, it leads to decreased fertility rates, increased miscarriage wastage, and increased rate of premature deliveries. A study of Gunn rats demonstrated that giving a diet consisting of 10 percent activated charcoal was effective in reducing plasma bilirubin levels as much as 40 percent, increasing the rates of fertilization and successful pregnancy. Forty-eight percent of the jaundiced rats given charcoal produced live offspring, while only seven percent of the control animals successfully concluded their pregnancy. (Pediatric Pharmacology 3(2)78-85, 1986) Copyright Phylis Austin

MATERNAL SMOKING/ALLERGY IN CHILDREN
 Children of mothers who smoke are at fourfold risk of developing allergic disease by the time they are a year-and-a-half old (Journal of Allergy and Clinical Immunology 78:898-904, 1986) Copyright Phylis Austin

TAMPON USE/VAGINAL ULCERATIONS
 Tampons may lead to ulcerations of the vagina, and superabsorbent tampons are a particular risk. These tiny ulcerations are more likely to occur if a tampon is used sometime other than during a menstrual period. (Obstetrics and Gynecology 55 (2)149-156, 1980) Copyright Phylis Austin

ASTHMA/MOTHER'S AGE
 Children born to young mothers are more likely to develop asthma later in life than are the children of mothers at least 20 years of age. (Pediatric News 20(10)26, October, 1986) Copyright Phylis Austin

PASSIVE SMOKING/BIRTH WEIGHT
 It has been known for some time that infants whose mothers smoked during pregnancy had lower birth weights. Now a study reveals that smoking fathers have a very similar effect. In a study of 500 women it has been shown that the average infant birth weight decreased 120g per pack of cigarettes, pipe or cigar equivalent, smoked per day by the father. (The Lancet, August 23, 1986, p. 415-417) Copyright Phylis Austin

MORNING SICKNESS
 The cause of nausea and/or vomiting of pregnancy remains a mystery, but a recent study has shown a relationship between the side of the corpus luteum and morning sickness. The corpus luteum is a temporary endocrine gland formed form a ruptured ovarian follicle. If the corpus luteum is on the right side nausea and vomiting are more common. (Acta Obstet Gynecol Scand 65:427-428, 1986) Copyright Phylis Austin

SITTING DURING LABOR
 The upright position during labor leads to a shorter duration of the second stage in women having their first infants, and in the 5- to 10-cm dilation period in women who have had previous children. (Obstetrics and Gynecology 69:67-73, January, 1987) Copyright Phylis Austin

CAESAREAN SECTION/DYSTOCIA
 Dystocia, difficult childbirth, often leads to caesarean section. A study comparing over 1000 women in Ireland and the United States having their first infants revealed a significantly higher rate of caesarean section in the United States, but this higher rate produced no benefit for the infants. In fact, some evidence suggested the opposite. The authors of the study suggest that half of the caesareans performed in low-risk pregnancies could safely be avoided. (The Lancet, March 7, 1987, p. 548-551) Copyright Phylis Austin

NAUSEA AND VOMITING OF PREGNANCY
 Women who suffer nausea and vomiting of pregnancy have a higher rate of good pregnancy outcomes. A study of over 400 women revealed that those who did not have nausea and/or vomiting had higher rates of infant death. (American Journal of Obstetrics and Gynecology 155:1017-1022, November, 1986) Copyright Phylis Austin

INEFFECTIVENESS OF PELVIMETRY
 A Canadian study revealed that pelvimetry, an x-ray procedure many women undergo during labor, is of little value in determining whether or not a woman will be able to deliver her infant vaginally. This kind of test has been relied upon millions of times in American women during labor to determine whether to perform a cesarean section. (Journal of the Canadian Association of Radiology 31(1)42-44, 1980) The test exposes mother and infant to radiation, with little or no possible benefit. Mothers should steadfastly refuse the x-rays as there are other tests, more reliable, that carry no risks. The same can be said for sonograms until at least 30 years have passed, giving adequate time to evaluate the hazards and benefits. Copyright Phylis Austin

SEXUAL ACTIVITY DURING PREGNANCY
 A study of uterine activity and fetal heart rate changes during sexual activity revealed changes that under other circumstances would be considered ominous by attending physicians. Uterine activity increased and several fetal heart rate changes were observed. Sexual intercourse during pregnancy has previously been associated with premature rupture of the membranes, increased risk of infection and low birth weights. (Acta Obstetrica Gynocologica Scandanivaca 65:853-855, 1986) Copyright Phylis Austin

NIPPLE STIMULATION/ABRUPTION PLACENTAE
 A patient who was stimulating her nipples while in the hospital developed sudden vaginal bleeding. Examination revealed that the patient had suffered abruption placentae (premature separation of the placenta). This pregnancy complication, while relatively uncommon, accounts for many perinatal deaths, and may lead to the death of the mother if not treated promptly and properly. (American Journal of Perinatology 4(2)94-97, April 1987) Nipple stimulation is known to stimulate uterine activity and is sometimes used to induce or hasten delivery. Copyright Phylis Austin

PREGNANCY/MERCURY/IN UTERO BRAIN DAMAGE
 Women who eat mercury-containing fish during the pregnancy may cause brain injury in their infants. Mercury is a known cause of cerebral palsy, but smaller amounts of mercury may induce subtle brain damage, with developmental delay and abnormal reflexes. Methyl mercury crosses the placental barrier freely, and is found in both fresh and salt water fish. (Pediatric News 21(3)31, March, 1987) Copyright Phylis Austin

VEGAN DIET/PREECLAMPSIA
 A vegan diet (free of all animal products) is not only adequate to maintain a normal pregnancy, but may decrease the risk of preeclampsia. Preeclampsia has previously been associated with a diet high in fast foods with high saturated fat levels, and with rapid gain in weight. (Southern Medical Journal 80(6)692-697, June, 1987) Copyright Phylis Austin

LEG CRAMPS DURING PREGNANCY
 Calcium supplements have been given for leg cramps during pregnancy, but several studies are questioning the effectiveness of this. In one study 50 of 65 patients given placebos had good response, while only 48 of 64 patients improved on calcium supplements. In this study, carried out in Sweden, vitamin C was used as the placebo. Both the calcium and vitamin C group showed improvement in symptoms, irrespective of which substance they were receiving. (International Journal of Vitamin and Nutrition Research 57:179-183, 1987) Copyright Phylis Austin

COFFEE CONSUMPTION/LOW BIRTH WEIGHT
 Mothers who consume coffee during pregnancy may produce a growth retardation in their fetuses. As caffeine consumption increases so does the risk of growth retardation. (American Journal of Epidemiology 126(5)813-21, 1987) Tea, colas, or caffeine-containing drugs may produce the same effects. Copyright Phylis Austin

ASPIRIN USE DURING PREGNANCY/CHILD INTELLIGENCE QUOTIENT/ATTENTION DEFICIT
Children of women who take aspirin during the first half of pregnancy have been shown to have lower I.Q. scores and attention deficits. Previous studies have shown excess aspirin use during pregnancy to be associated with oral clefts, both major and minor anomalies, and central nervous system defects. Lower doses have been shown to reduce learning ability and produce overactivity. (Teratology 35:211-219, 1987) Copyright Phylis Austin

HYPERTHERMIA/FETUS
 Hyperthermia (high body temperature ) has been shown to be capable of producing birth defects. The defects in the fetus vary with the amount of fever elevation and the stage of the fetus during exposure. Adverse effects include abortion, stillbirth, congenital malformations and embryonic resorption. Mental retardation, spina bifida, changes in muscle tome, and neurogenic arthrogryposis (limb defects) have occurred in association with hyperthermia in humans, while animal studies have demonstrated microcephaly (small eyeballs), and clubfoot. Pregnant women should not be given fever treatment and should avoid hot tubs and sauna baths. (Obstetrical and Gynecological Survey, August, 1987,p. 512-513) Copyright Phylis Austin

UNNECESSARY CESAREAN SECTIONS
 Dr. Sidney Wolfe, of the Public Citizen Heath Research Group reports that C-section rates have increased from 5.5 percent of all deliveries in 1970 to 21.4 percent in 1986. C-sections are now the most frequently done hospital-based operation in the United States, with estimates of 1 million operations in 1987.
Maternal death rates following c-section are two to four times higher than after a vaginal delivery and infection rates are six or more times greater after a c-section.
A study of various hospitals showed a range of c-section rates from 12.4 percent to 42.05 percent. The Public Citizen Health Research Group states that half of the 900,000 c-sections done in the country in 1986 were unnecessary and suggests that pregnant women carefully question both their obstetricians and the hospital as to their c-section rates and practices. (Health Letter 3(11)1-5, November, 1987) This investigation should be done before the seventh month of pregnancy to insure an adequate response, as hospitals are prone to give out vague information concerning this subject. Copyright Phylis Austin

EPIDURAL ANESTHESIA/FORCEPS DELIVERY
 Two independent studies have revealed that epidural analgesia given during labor increased rates of forceps delivery. A study from the Medical College of Wisconsin revealed higher rates of low forceps, midforceps and vacuum extraction delivery in women who had been given epidural analgesia.
Infants born to mothers who had received epidural analgesia had lower Apgar scores. It has previously been shown that infants born by midforceps delivery have about a six point lower I.Q. score at seven years of age, compared to those born by spontaneous vaginal delivery (Obstetrics and Gynecology 69:770, 1987; Texas Medicine 83:45-47, April 1987) Copyright Phylis Austin

CAFFEINE USE DURING PREGNANCY/LOW BIRTH WEIGHT
 Mothers who consume caffeine, whether in the form of coffee, tea, colas or various drugs, run the risk of delivering an infant with low birth weight. A study from the Massachusetts Department of Public Health reveals that caffeine may cause growth retardation. (American Journal of Epidemiology 126(5)813-21, 1987) Copyright Phylis Austin

C-SECTION RATE/PAYMENT SOURCE
 A California study reveals a significant relationship between the incidence of C-section and the method of payment for medical services. Patients who have private insurance were more likely to have undergone C-section, while those on the Medicaid program, or those in prepaid health plans or health maintenance organizations had lower rates. Women who were responsible for the medical bills themselves had the lowest incidence of C-sections. (American Journal of Public Health 78(1)96-97, January 2988) Copyright Phylis Austin

BIRTH CONTROL PILLS/CERVICAL CANCER
 There has been a marked increase in the incidence of cancer of the cervix in the under-35 age group. There is some suggestion that this increase may be due to changes in the cervix which are associated with the use of birth control pills. (British Medical Journal 295:1446-1447, December 5, 1987) Copyright Phylis Austin

DIURETIC EXPOSURE IN UTERO/RENAL STONES
 An infant whose mother was given Lasix, a diuretic, during the pregnancy was observed to have renal stones at the time of delivery. This may be added to the list of reasons women should not be given diuretics during pregnancy. (Pediatrics 81(5)712-714, May 1988) Copyright Phylis Austin

ASPIRIN USE IN PREGNANCY
 Aspirin use during pregnancy may result in lower birth weight of the offspring. Women who take aspirin throughout the pregnancy have infants with increased perinatal mortality rates, and aspirin may increase neonatal jaundice. (Journal of the National Medical Association 80(5)545-552, 1988) Copyright Phylis Austin

HOSPITALIZATION FOR TWIN PREGNANCIES
 Still another study shows that the practice of admitting a mother of twins to the hospital several weeks prior to delivery does not benefit the infants. (Acta Obstetrica Gynecologica Scandinavica 66:361-364, 1987) Copyright Phylis Austin

BIRTH TRAUMA/GROWTH HORMONE DEFICIENCY
 A study from Belgium suggests that children who suffer birth trauma or who are delivered after induced labor may suffer injury to the pituitary gland which is sufficient to produce later growth hormone deficiency. In 1972 a study suggested that infants who presented in the breech position (hips rather than head first) had higher incidences of growth hormone deficiency. This study suggests that even mild trauma at the time of birth may cause injury to the pituitary gland. (European Journal of Obstetrics, Gynecology, and Reproductive Medicine 26:329-334, 1987) Copyright Phylis Austin

TAP WATER/MISCARRIAGES/BIRTH DEFECTS
 According to the California Department of Health Services, women in San Francisco and Silicon Valley who drink bottled water have lower miscarriage rates and decreased incidence of birth defects than those who consume tap water. Four studies of over 5,000 women revealed higher than expected miscarriage and birth defect rates in women in this area. Solvents in the ground water may be responsible. (Internal Medicine News 3(12)3, June 15-30, 1988) Copyright Phylis Austin

BAKER'S YEAST/CROHN'S DISEASE
 A yeast-free diet may be helpful to individuals who suffer from Crohn's disease. A British study revealed that Crohn's sufferers often have antibodies to Saccharomyces cerevisiae (baker's yeast). (British Medical Journal 297:1105-1106, October 29, 1988) Copyright Phylis Austin

LABOR PAIN RELIEF
 A Chattanooga nurse reports that heating a blanket for two or three minutes in a microwave oven and applying to the back or pubic area is comforting to a woman in labor. (Nursing88(9)109, September 1988). Be careful not to set the blanket on fire! Copyright Phylis Austin

GINSENG/VAGINAL BLEEDING
 Use of a face cream containing ginseng induced postmenopausal vaginal bleeding in a 44-year-old woman. Because many cosmetics contain ginseng it is wise to be aware of this possibility. (American Journal of Obstetrics and Gynecology 159(5)1121-1122, November, 1988) Copyright Phylis Austin

FETAL HEART ARRHYTHMIAS/MOTHER'S CAFFEINE USE
 Pregnant women who use excessive amounts of caffeine may produce heart rate abnormalities in their unborn babies. An infant born to a woman who consumed caffeine during labor contained caffeine and the heart had an irregular heart rhythm. (British Medical Journal, March 4, 1989) Copyright Phylis Austin

FETAL MONITORING/CAESAREAN SECTIONS
 Mothers who are monitored by electronic fetal monitoring equipment during labor are more likely to undergo cesarean section than are those who do not have the monitoring. Electronic fetal monitoring was carried out on about 47.7 percent of all live births occurring in the United States in 1980. Several studies have shown no benefit from electronic fetal monitoring in either low-risk or high-risk pregnancies, and this study suggests an adverse effect from this procedure. The authors conclude from their study that monitoring has played a significant role in the increase in cesarean sections seen in recent years. (American Journal of Public Health 78:1170-1174, September 1988) Copyright Phylis Austin

EXERCISE DURING PREGNANCY/PAIN TOLERANCE DURING LABOR
 Women who exercise during pregnancy have higher pain tolerance levels during delivery according to a study from Italy. The women in this study utilized an exercise bicycle. Prolactin levels, cortisol, and human growth levels were lower in the exercised group during labor than in the non-exercised group. The authors conclude that physical conditioning during pregnancy reduces pain sensation during labor, producing lower stress levels. (American Journal of Obstetrics and Gynecology 160:707-12, March 1989) Copyright Phylis Austin

PUSHING DURING LABOR
 Joyce Roberts, C.N.M., Ph.D. reports that mothers who are permitted to push when they feel the urge, rather than when instructed by medical staff, deliver healthier newborns. A three year study demonstrated that allowing the mother to choose her delivery position, and having medical personnel act as supportive caregivers, rather than directors was better for the baby. (Medical Tribune 20(14)6, May 10, 1989) Copyright Phylis Austin

HIGH FAT DIET DURING PREGNANCY/CANCER IN OFFSPRING
 Dr. Bruce Walker, professor of anatomy at Michigan State University, reported at the meeting of the American Association for Cancer Research, that mothers who take a high-fat diet during pregnancy may increase their child's chance of later developing cancer of the reproductive system. Over half of the offspring of rats given a high fat diet developed reproductive system tumors, while only 21 percent of those on a low fat diet did so.
These studies have important implications for humans as women are often encouraged by their physicians to take diets high in whole milk, cheese, eggs, and red meat during pregnancy, and these foods are all high in fat. (Montgomery Advertiser, May 25, 1989) Copyright Phylis Austin

PASSIVE SMOKING/LOW BIRTHWEIGHT INFANTS
 Infants of mothers who are exposed to the cigarette smoke of other people are at increased risk of having low birth weight. (The Lancet 2:54-55, July 1, 1989) Copyright Phylis Austin

PRENATAL CARE
 A Public Health Service panel of experts has recommended several changes in prenatal care. They point out that the United States ranks a disgraceful 17th in infant mortality, despite spending a higher portion of its gross national product on medical care than any other nation.
The panel recommends that prenatal visits be decreased from the usual 13 or 14 to 9 or 10, that blood pressure screening, urine tests, blood typing tests and breast and pelvic examinations be decreased. (American Medical News, October 13, 1989) Copyright Phylis Austin

LOW BIRTH WEIGHT INFANTS/EPISIOTOMY
 Obstetric textbooks have routinely advocated the use of episiotomy in the delivery of low birth weight infants, claiming that it reduces the risk of brain damage. A recent study showed no differences in low birth weight infants born with the use of episiotomy and those born without the use of an episiotomy. Mothers often suffer significant discomfort from episiotomy, and may have permanent sequelae. (International Journal of Gynecology and Obstetrics 31:135-140, 1990) Copyright Phylis Austin

CAFFEINE/PREGNANCY
 The offspring of laboratory animals whose mothers consumed caffeine during pregnancy demonstrated neurochemical, physical and behavioral changes. These changes may persist even into adulthood. (Annals of New York Academy of Sciences 562:327-339, 1989) Copyright Phylis Austin

BEDREST FOR TWIN PREGNANCIES
 Obstetricians have traditionally placed women carrying twins at complete bed rest several weeks before the estimated delivery date, in the belief that it would delay delivery, permitting the infants to be more mature at delivery. Several studies have recently shown this theory to be incorrect. The latest report comes from the University of Adelaide Department of Obstetrics and Gynecology, of Queen Victoria Hospital, where studies demonstrated no significant differences in outcome of the pregnancies whether the mothers were placed at bed rest or not. The authors conclude there is no reason to confine a mother to bed. (The Lancet 335:267-269, February 3, 1990) Copyright Phylis Austin

VAGINAL DOUCHING/ACUTE PELVIC INFLAMMATORY DISEASE
 Many women douche routinely in an attempt to "clean out" the vagina. A study from the Department of Obstetrics and Gynecology at the University of Washington Medical School shows that douching may lead to acute pelvic inflammatory disease. The more frequently a woman in the study douched the more likely she was to have pelvic inflammatory disease. (Journal of the American Medical Association 263(14)1936-1941, April 11, 1990) Douching should probably be reserved for the treatment of disease, rather than used as a cleaning procedure. The body has its own cleaning mechanisms and douching interferes with this function. Copyright Phylis Austin

LABORATORY TESTS
 Doctors who receive financial benefit from ordering laboratory tests for their patient are more likely to order them than are doctors who receive no benefit according to a study from Harvard School of Public Health and Boston University Health Policy Institute. (New England Journal of Medicine 322(15)1059-1063, April 12, 1990) EDITORIAL NOTE: Before submitting to laboratory tests the patient should ask what the doctor expects to find from the test, what the potential adverse effects are, and what risk is associated with not undergoing the test. Copyright Phylis Austin

COFFEE USE DURING PREGNANCY/DIABETES MELLITUS IN CHILDREN
Mothers who consume caffeine during pregnancy may be increasing their child's risk of developing insulin dependent diabetes mellitus. (British Medical Journal 300:642-643, March 10, 1990) Copyright Phylis Austin

FEBRILE SEIZURES IN CHILDREN/MATERNAL SMOKING/ALCOHOL USE
Mothers who use alcohol or smoke during their pregnancy or after the birth of their child, may be increasing their child's risk of suffering febrile seizures (seizures which develop during a fever). Febrile seizures are most common between six months and five years of age, with the greatest incidence from six months to three years of age. It has been estimated that from two to five percent of children suffer at least one seizure before they reach the age of five years.
A study from the Department of Epidemiology at the School of Public Health and Community Medicine, at the University of Washington in Seattle, reveals that the use of alcohol by the mother during pregnancy and cigarette smoking both increased the risk of febrile seizures. (American Journal of Epidemiology 132:462-473, 1990) Copyright Phylis Austin

LENGTH OF PREGNANCY
 Health care providers have used a formula to calculate due date for pregnant women based on the concept that the average pregnancy lasted for 280 days. Many women have undergone induced labor or surgical delivery when they exceeded this limit. A recent study demonstrates that first time mothers deliver an average of eight days later than date estimated, while mothers who have previously given birth deliver an average of three days later. This study suggests that many infants considered post-mature may not be at all, and that watchful waiting may be utilized to allow for the body's own processes. (Obstetrics and Gynecology 75:929, June 1990) Copyright Phylis Austin

URINARY STRESS INCONTINENCE/VAGINAL CONES
 An exercise program using cones has been shown helpful in the treatment of urinary stress incontinence. Pelvic floor exercises have enabled many women to avoid surgery for stress incontinence, but many women find the exercises difficult to carry out properly. The use of cones has been shown helpful for these women. The cones are inserted into the vagina, and women are instructed to contract the muscles to retain the cone for 15 minutes at a time, twice a day. (Australian and New Zealand Journal of Obstetrics and Gynecology 30:157-160, 1990) Copyright Phylis Austin

HEMOGLOBIN LEVELS IN PREGNANCY/ABNORMALITIES OF PLACENTA
 Earlier studies have shown a relationship between high maternal hemoglobin levels and low birth weight. A recent study suggests that high hemoglobin levels may hinder circulation in the placenta. (Acta Obstetrica Gynecologica Scandinavica 69:127-133, 1990) This decreased blood flow may decrease nutrition for the growing infant. Mother Nature knows what she is doing! Copyright Phylis Austin

AMNIOCENTESIS/EAR INFECTIONS
 A study of four-year-old children whose mother had undergone amniocentesis (withdrawal of the fluid from the womb during pregnancy as a diagnostic procedure) revealed that these children were more likely to have ear infections than infants not subjected to this procedure. They were also more likely to have hearing abnormalities. (British Journal of Obstetrics and Gynecology 97:32- 40, January, 1990) Copyright Phylis Austin

BREAST CANCER/CHEMOTHERAPY
 A study from the National Institutes of Health suggests that women with breast cancer whose tumor is less than 1 cm in diameter and who have no evidence of spread to the lymph nodes do not receive significant benefit from the use of chemotherapy. (Science 248:1602, 1990) Copyright Phylis Austin

MATERNAL SMOKING/CHILDHOOD ASTHMA
 Children whose mothers smoke are more likely to develop asthma than those children whose mothers do not smoke. Passive smoke exposure doubles the risk of childhood asthma. (Pediatrics 85:505, April 1990) Copyright Phylis Austin

DENTAL FILLINGS/FETUS
 A new study from the Karolinska Institute in Sweden reveals that dental fillings in pregnant women may allow mercury to pass through the fetal placenta, and collect in the infant brain. (Your Health 29(25)23, December 4, 1990) Copyright Phylis Austin

OBSTETRIC MEDICATION/ADDICTION IN CHILDREN
 At least one earlier study has suggested that certain medications given to the mother during labor and delivery may cross the placental barrier and enter the child's system. This medication may make the child more likely to develop an addiction later on in life. A new study from Sweden supports this concept. A study comparing siblings whose mothers received certain types of drugs during labor revealed that these drug-affected children are more likely to later develop a drug addiction. Opiates, barbiturates, and nitrous oxide were particularly likely to have been used in the birth of children who later became addicted. (British Medical Journal 301:1067-70, November 10, 1990) Copyright Phylis Austin

VAGINAL CANDIDIASIS/PLASTIC CAR SEATS
 Factors which are known to predispose women to vaginal candidiasis infections include diabetes mellitus, high estrogen levels, diet, antibiotic use, obesity, and moisture in the perineal area. Three physicians from Norfolk, Virginia, suggest that plastic car seats may increase moisture in the perineal area, and contribute to vaginal infections. (Journal of Family Practice 31(1)16, 17, 1990) Copyright Phylis Austin

BREAST FEEDING/DELIVERY ROOM
 Delivery room routines may have a marked influence on the success of the first breast-feeding session according to a study from Sweden. One group of infants in the study group were treated in the routine manner, being taken from their mothers about 20 minutes after birth for weighing, measuring, and other nursing functions. The other group of infants were allowed to lie naked on their mother's abdomen for an hour after birth. Infants in the uninterrupted contact group began searching for the mother's breast about 20 minutes after birth, and most of them nursed for the first time about 50 minutes after birth. This group of infants had a higher percentage of infants who had the correct sucking technique, decreasing later breast feeding problems.
The authors of the study also noted that pethidine hydrochloride had an adverse effect on the infant's ability to nurse. They caution that drugs used during labor be carefully evaluated. (The Lancet 336:1105-1107, November 3, 1990) Copyright Phylis Austin

PRENATAL X-RAY EXPOSURE/CHILDHOOD CANCER
 A study from Stockholm, Sweden, suggests that children who are exposed to x-rays before birth are more likely to develop childhood cancer than are those who are exposed to the same amount of radiation after birth. (International Journal of Cancer 46:362-365, 1990) The risks of diagnostic tests during pregnancy should be carefully considered. Copyright Phylis Austin

WEIGHT GAIN DURING PREGNANCY
 Pregnant women have been advised not to gain more than 25 pounds over the course of their pregnancy. A study carried out in California compared the pregnancy outcome of those who gained various amounts of weight during pregnancy. It did not seem to matter much how much she gained. There were few differences in those who gained less weight, and those who gained more than the recommended 25 pounds. (Obstetrics and Gynecology 76:1-7, 1990) Our current recommendations for weight gain during pregnancy need to be reevaluated. However, this is not reason for women to abandon appetite control during pregnancy. More weight gain generally indicates larger infants; larger infants are more difficult to deliver. Copyright Phylis Austin

DIABETES/PREGNANCY
 While pregnancy-induced diabetes mellitus is more common in women over 35-years-of-age, it does not carry a greater risk to either the mother or infant than in younger mothers. (American Journal of Obstetrics and Gynecology 164(1 Pt 2)394, January 1991) Copyright Phylis Austin

PROLONGED PREGNANCY/CHILD DEVELOPMENT
 Children born of so-called prolonged pregnancies were followed over several years. These children developed normally. (American Journal of Obstetrics and Gynecology 164(1 Pt 2)151, January, 1991) Recent studies have shown that the estimated date of confinement (date given the mother for the anticipated birth of her infant) has been based on incorrect information, and human pregnancy actually lasts longer than thought a few years ago. Mothers who are slightly overdue should not be rushed into labor induction. Copyright Phylis Austin

PRENATAL CIGARETTE SMOKE EXPOSURE/CHILDHOOD CANCER
 Children whose mothers smoke during the pregnancy are at increased risk of later development of childhood cancer according to a recent study. If the child's father (but not mother) smoked the child was at increased risk of brain cancer. (American Journal of Epidemiology 133(2)123-132, 1991) Copyright Phylis Austin

HYDROTHERAPY/PAIN RELIEF DURING LABOR AND POSTPARTUM
 Whirlpool baths were shown to be very helpful in relieving childbirth-associated pain according to a study from Denver. The maternity unit at AMI Presbyterian/St. Luke's Hospital in Denver, Colorado, found that women placed in whirlpool tubs during labor experienced relaxation and decreased pain, and progressed rapidly with dilation. The women had decreased fluid retention and lower blood pressures in the whirlpool. They also noted that postpartum pain was decreased by the use of whirlpool baths.
Postpartum treatments may be given for 10 to 15 minutes at a time, two or three times a day.
The whirlpool is cleaned with bleach after each use. One cup of Chlorox is added to the filled tub, the water is circulated through the jets, and the tub drained and cleaned with a cleanser. The tub is then thoroughly rinsed. (MCN: Maternal Child Nursing 16:97-99, March-April 1991) Copyright Phylis Austin

VAGINAL DOUCHING/CERVICAL CANCER
 Douching may increase the risk of cervical cancer by changing the normal vaginal chemical environment. Women who douche more than once a week are at increased risk of developing cervical cancer. (American Journal of Epidemiology 133(4)368-375, 1991) Copyright Phylis Austin

MATERNAL STRESS/FETAL GENITAL SYSTEM
 The male offspring of rats exposed to stress during pregnancy were observed to have abnormalities of the genital system. The stress was felt to suppress the gonadal secretions, which interfered with sexual differentiation. (Physiology and Behavior 20: 193-195, 1978) Copyright Phylis Austin

POSITION IN CHILDBIRTH
 Many studies have shown that hospital labor and delivery routines are not in the best interest of mother or infant, but for the convenience of the staff. Pregnant women should look for a health care provider who will accommodate their wishes for delivery. A review of the advantages of giving birth in the upright position include (1) a more favorable angle of the pelvic bones (2) the mother has better control of her abdominal muscles (3) gravity aids in delivery (4) oxygen and blood flow to the uterine muscles is increased (5) contractions are shorter and stronger, leading to shorter labors (6) labor is less painful, and (7) the risk of perineal tear is decreased (8) The mother is comfortable and familiar with the muscular coordination in this position from a lifetime of bowel movements. (Mothering, Fall, 1986, p. 59-63) Copyright Phylis Austin

LABOR COMPLICATIONS/EPIDURAL ANESTHESIA
 A study comparing the effects of social support during pregnancy with the use of epidural anesthesia revealed that epidural anesthesia administered during the first stage of labor was associated with later labor complications and interventions. Other studies have shown an association between the use of epidural anesthesia and back pain, fever in the mother, depression of the newborn infant and increased cesarean section rates. (Pediatric Research 29(4 Pt 2)220A, April 1991) Copyright Phylis Austin

SMOKING DURING PREGNANCY/SLOWER INFANTS
 Infants born to smoking mothers have been shown to have slower mental development than infants born to non-smoking mothers. A three year follow-up of children revealed that those born to smoking mothers were about half an inch shorter, had a five point lower IQ rating, and had more language problems than children born to non-smoking parents. (International Journal of Epidemiology 19(1)66-77, 1990) Copyright Phylis Austin

MATERNAL CIGARETTE SMOKING/TUBAL PREGNANCY
 Women who smoke are at greater risk of tubal pregnancy (the development of a fetus at a location other than in the womb). Many of these infants die during the first few months of pregnancy; those that do mature are generally delivered by cesarean section. (American Journal of Epidemiology 133(4) 332-337, 1991) Copyright Phylis Austin

MATERNAL HEMATOCRIT/PREGNANCY OUTCOME
 Women with high hematocrits during pregnancy may be at increased risk of preterm delivery of their infants. High hematocrits were also associated with fetal growth retardation. (Obstetrics and Gynecology 77(2)190-194, February 1991) Copyright Phylis Austin

PRENATAL CLINICS/WEIGHT RECORDS
 The routine recording of weight in pregnant women may produce anxiety, and may not be really helpful in the evaluation of infant growth. (British Journal of Obstetrics and Gynecology 98:189-94, February 1991) Copyright Phylis Austin

HANDS AND KNEES POSITION/ROTATION OF FETUS
 Women whose infants are in breech position (infants positioned so that the hips rather than the head are born first) may change the position of their infants so they will be born head first by assuming a hands and knees position. Two women in this small study group (four women) had a rotation in the position of their infant while in the hands and knees position during the second stage of labor. Other women in the group who did not utilize this position, but went through most of their labor in the recumbent position had prolonged labor, increased pain, and had operative delivery. The women whose infants rotated had short second stages of labor, and no complications during the delivery. The authors observe that infants which are going to rotate during this maneuver will do so during the first hour after the mother assumes the position, although some infants have rotated only halfway by the conclusion of the first hour, and the mother must maintain the position longer to allow the infant to complete the full rotation. Some women find the hands and knees position so comfortable for labor that they prefer it.
While the researchers point out that this is a small study group and further studies need to be carried out, it warrants our consideration. (Birth 18(1)40-47, March 1991) Copyright Phylis Austin

PASSIVE SMOKE EXPOSURE DURING PREGNANCY/CHILDHOOD DEVELOPMENT
Infants who are exposed to passive smoke while in the womb develop more slowly than those not exposed to smoke. Pregnant women should avoid exposure to other people's cigarette smoke. (Neurotoxicology and Toxicology 13(1):5-12, 1991) Copyright Phylis Austin

LIMB ABNORMALITIES/CHORIONIC VILLUS SAMPLING
 A recent report suggests that chorionic villus sampling, a test often done on pregnant women to evaluate fetal development, may cause limb abnormalities. (The Lancet 337:762-763, March 30, 1991) Copyright Phylis Austin

SMOKING DURING PREGNANCY/CONGENITAL ABNORMALITIES
 Smoking during pregnancy may cause congenital abnormalities, particularly in women over 35 years of age. (American Journal of Obstetrics and Gynecology 164(1 Pt 2)353, January 1991) Copyright Phylis Austin

RADIATION DURING PREGNANCY/LEUKEMIA IN CHILDHOOD
 A recent review of causes of childhood cancer reports that about five percent of all cases are attributed to radiation exposure during the pregnancy. Some cases are due to chemotherapy. Other causes are not known. Half of all cases of childhood leukemia die during the first five years after onset of the disease. (Archives of Disease in Childhood 66:179-80, 1991) Pregnant women should evaluate very carefully any radiologic procedure recommended during pregnancy--or even if she is likely to become pregnant. Copyright Phylis Austin

WARM WATER BATH/LABOR AND CHILDBIRTH
 Many birth institutions are now beginning to provide facilities for warm water immersion for women during labor and birth. This practice is much more common in European hospitals.
Dr. Michael Odent of France has done the preliminary research on this method of pain relief during labor and delivery.
In his book, Birth Reborn, Dr. Odent comments that "the history of obstetrics is largely the history of the exclusion of mothers from their central role in the birth process." Odent feels that birth is a natural process, not an illness and proposes that health care providers serve merely as an assistant in the birth process, and not attempt to carry out the process for the woman.
Some studies have suggested that immersion in warm water may be helpful for pregnant women suffering from toxemia of pregnancy. Women laboring in tubs of warm water are in an upright position which increases the ability of the uterus to perform its work, and decreases pain. Lying down during labor increases the need for pain medication and often slows labor, and often leads to the use of oxytocin to stimulate labor.
The Birth Center reports no infections or aspiration pneumonia in babies delivered in the tubs. Infants removed from the water too quickly may sever the cord, leading to blood loss. If any bleeding is noted the assistants at the Birth Center clamp the cord immediately. (The Female Patient 16:35-47, August 1991) Copyright Phylis Austin

CROHN'S DISEASE/DIETARY YEAST
 A study from Dundee, Scotland, reports that the elimination of dietary yeast from the dietary of Crohn's disease patients resulted in improvement of symptoms. (Clinical Nutrition 10(Suppl 2)45, 1991) Copyright Phylis Austin

MASTITIS/BREAST STRIPPING
 It has been estimated that from one to nine percent of nursing women develop mastitis, an inflammation of the breast. Abscesses may form in the breast, causing the mother a great deal of pain. The mother may develop fever and her breast may become red, hot, and painful. There may be an abnormal hardening felt in the breast.
Physicians at the University of Victoria in British Columbia taught mothers to strip their own breasts to remove inflammation products and prevent the development of abscesses. They recommended that before the stripping is carried out the infant be allowed to nurse. After examination to find the firm nodules in the breast they lubricated the breast with gel, and with the thumb, pressed firmly up above the indurated area, stroking down toward the nipple to push the inflammation products out. They mashed the induration against the rib cage, moving slowly but firmly toward the nipple. When the fingers reached the areola (the brown area around the nipple) the index finger was placed opposite the thumb, and the nipple squeezed between the two digits. The entire procedure was repeated at least three times, or until only milk was forced out of the breast. (Inflammation products appeared curd- like, gelatinous, or mucus-like and did not flow when forced out of the nipple). The procedure was sometimes painful to the mother, but gentle, slow pressure with firm movement pushed out the inflammation products, and often brought great and immediate relief to the mothers. From 15 minutes to one hour were required for the entire treatment. The stripping procedure should be repeated after every feeding, or about every two to four hours. (Canadian Medical Association Journal 145(4)299-306, August 15, 1991) Copyright Phylis Austin

EPISIOTOMY/LACERATION
 A study from the Department of Obstetrics and Gynecology at Mount Sinai Hospital in Toronto, Ontario, Canada reveals that while episiotomy is associated with a lower rate of perineal laceration, there is an overall increase in the rate of perineal trauma. Furthermore, the trauma tends to be greater than if no episiotomy is done. Previous studies have shown no reduction in perinatal morbidity, decrease in perineal laceration, or decreased rates of genital prolapse associated with episiotomy. (Obstetrics and Gynecology 77:668-671, May 1991) Copyright Phylis Austin

TWINS/CAESAREAN SECTIONS
 Physicians delivering twins often perform a caesarean section to deliver the second infant, even if the first is born vaginally. A recent study from the Georgetown University Hospital School of Medicine indicates that in many cases the second twin may be born vaginally after the physician delivers the first infant, then rotates the second into the proper position for birth. The maneuver, called external cephalic version, was successful in 16 of 18 infants in the breech (hips first position) and 11 of 12 infants in the transverse position. (Obstetrics and Gynecology 79:421-3, 1992) Copyright Phylis Austin

EDEMA (FLUID RETENTION)/PREGNANCY
 Almost every woman experiences swelling of her legs during pregnancy. Such measures as resting with the legs elevated are helpful. A study from the Department of Obstetrics and Gynecology of the University of North Carolina School of Medicine revealed that immersion in water is both safe and effective in the relief of edema of pregnancy.
Pregnant women were divided into three groups: one group was placed on lateral supine bed rest, the second group was put into a bathtub with water up to their waist, and the third group placed in a tub with water at shoulder level for one hour. The women in both water groups showed the most marked improvement in their symptoms; the deeper the water the better the response. Fluid loss after water immersion was more than twice fluid loss after bed rest. (Obstetrics and Gynecology 75:147-151, February 1990) Copyright Phylis Austin

MEDICAL PROCEDURES DURING BIRTH
 A study from the College of Nursing at the University of New Mexico suggests that as the available medical technology increases so does its utilization during childbirth in low-risk women. Women giving birth in centers without excessive technology equipment were not subjected to these procedures, but demonstrated equally good outcomes. (Journal of Nurse-Midwifery 36(6)327-333, November- December 1991) Copyright Phylis Austin

LABOR PAIN DURING CHILDBIRTH
 Women who labor in the upright position (sitting or standing) have less front and back pain than those who labor in the horizontal (lying down) position. (Journal of Pain and Symptom Management 6:476-480, November 1991) Copyright Phylis Austin

INDUCING LABOR
 Many obstetricians make it a practice to induce labor in women who do not go into labor when the physician calculates they are due. A study reported at the District VI Annual Meeting of the American College of Obstetricians and Gynecologists indicated that unless there was some complicating factor, mothers and infants did best if induction was not performed before 42 weeks of gestation.
Mothers who had labor induced before 42 weeks with an unfavorable cervix (less than 2 cm dilated and less than 80 percent effaced) had longer first stage labors, longer times between membrane rupture and delivery, and greater risk of undergoing cesarean section. (Obstetrics and Gynecology News 27(1)2, 27, January 1, 1992) Copyright Phylis Austin

CESAREAN SECTION/NEUROLOGICAL DEVELOPMENT
 Infants born by cesarean section are apparently deprived of the catecholamine surge induced by vaginal birth. A study of 30 infants demonstrated less optimal neurological responses in those delivered by cesarean section. The authors feel that high catecholamine levels may be important in the infant's neurological development in the first few days after birth. (Early Human Development 26:51-60, 1991) Copyright Phylis Austin

SEASONS/PRE-ECLAMPSIA
 A study from Israel reports that pre-eclampsia and pregnancy- induced high blood pressure are more common during the winter months. (Obstetrics and Gynecology Investigations 32:88-90, 1991) Copyright Phylis Austin

EXTERNAL CEPHALIC VERSION/BREECH
 After a study of 1038 women with breech infants the Department of Obstetrics and Gynecology at Hvidore Hospital at the University of Copenhagen, Denmark, recommends that women without contraindications be offered external cephalic version to attempt to change the infant's position to vertex. (European Journal of Obstetrics and Gynecology and Reproductive Biology 42:23-27, 1991) Copyright Phylis Austin

CHORIONIC VILLUS SAMPLING/FETAL DEFECTS
 Chorionic villus sampling done as a prenatal test may cause injury to the fetus according to a recent report from the University Illinois College of Medicine in Chicago. A review of infants subjected to this test revealed that about one percent of infants tested had limb malformations.
Earlier studies from England showed an increased incidence of limb, facial and tongue defects in infants whose mothers had undergone this diagnostic procedure during pregnancy. (The Journal of NIH Research 4:61-62, July 1992) Copyright Phylis Austin

CERVICAL CANCER/VAGINAL CANCER/PESSARY USE
 Long-term use of a vaginal pessary for vaginal prolapse may cause irritation, which in turn, may lead to cancer. A study of 68 patients in France revealed that the mean interval between pessary insertion and the development of cancer was about 18 years. (Cancer 69:2505-2509, 1992) Copyright Phylis Austin

MORNING SICKNESS
 Pregnant women who participate in a regular exercise program decrease their risk of morning sickness, without endangering their fetus, according to a study of almost 400 women. Women who exercised had lower rates of bloating and nausea than did non- exercisers. (Medical Tribune 33(12) June 25, 1992) Copyright Phylis Austin

CAFFEINE/PREGNANCY
 Caffeine takes longer to be metabolized during pregnancy, which may lead to a build-up in the body. The fetal heart has been shown to be sensitive to the effects of caffeine as early as the first trimester. (Journal of Perinatal Medicine 19(Suppl 2)135, 1991) We feel that no one should use coffee, and certainly not pregnant women! Copyright Phylis Austin

TWIN BIRTHS
 Physicians have felt that the second infant in a set of twins should be born as quickly as possible after the birth of the first, and for this reason many of these infants are born by cesarean section. A study from Berlin suggests that in many cases these infants may safely be delivered without haste. (Gynecologic and Obstetric Investigation 33:19-20, 1992) Copyright Phylis Austin

IRON SUPPLEMENTS DURING PREGNANCY
 Pregnant women are routinely given iron supplements during pregnancy by many obstetricians. Several recent studies have called into question the wisdom of this practice. High levels of hemoglobin and hematocrit decrease oxygen availability, hindering infant growth. (Journal of the American Dietetic Association 92(4)484-486, April 1992) Copyright Phylis Austin

DELIVERY POSITION
 Women in labor often have pain relief by a change in position. Women who give birth in a hospital setting may be placed flat on the back, in a position comfortable for the physician, but uncomfortable for the woman. A study on position during labor and delivery revealed a lower incidence of episiotomy in women who deliver in the standing, squatting, or hands and knees position. Some have suggested that this lower incidence occurred because it was less convenient for the health care provider to perform the episiotomy, so it was not done.
A study done by a Vermont midwife suggests that the hands and knees position may be of great benefit to the laboring woman. Jane M. Gannon, CNM, MSN, reviewed the cases of 21 of their patients who had delivered in the hands and knees positions and observed that none of them had undergone episiotomies. While some of the women did suffer lacerations the incidence of lacerations was no greater than the rate of episiotomy in a comparison group.
Mrs. Gannon suggests that delivery in the hands and knees position may decrease perineal injury and may increase space between the fetus and the vaginal walls making descent of the infant easier. Furthermore, the hands and knees position may take pressure off the vena cava, improving blood flow to the umbilicus and placenta. Shoulder delivery may also be easier with the woman in a hands and knees position, and some obstetricians routinely use this maneuver to assist in the rotation of a fetus in the posterior position.
Mrs. Gannon reports that the woman should assume the hands and knees position when the head begins to remain visible at the introitus. Pelvic expansion and relaxation is increased by having the knees slightly more than shoulder width apart. The woman should be given something to rest her upper body against for support. (Journal of Nurse Midwifery 37(1)48-52, January-February 1992) Copyright Phylis Austin

EPISIOTOMY
 A study from the Jewish General Hospital and McGill University in Montreal, Canada, again indicates that episiotomies often do not benefit women. In addition to recovering from the birth women often endure discomfort or pain from their episiotomy. An episiotomy, an incision to enlarge the vagina, is often performed during the second stage of labor. It is done in approximately 70-80 percent of births in North America, and is one of the most common surgical procedures in the Western world. (Online Journal of Current Clinical Trials 1(1)January 1992) Copyright Phylis Austin

LABOR/ARTIFICIAL RUPTURE OF MEMBRANES
 In many hospitals if a woman in labor does not have ruptured membranes, the membranes will be artificially ruptured in the belief that it will hasten delivery. A midwife reports that the rupture of the membranes may dramatically increase contraction strength, making it necessary for the woman to take pain medication. She compared two groups of patients, one undergoing artificial rupture and other progressing in labor until the membranes broke spontaneously. She observed that artificial rupture was routinely done when the woman was 3.5 cm dilated, but spontaneous rupture did not occur until the woman progressed to about 8.7 cm. However, there was no significant difference in the length of labor in the two groups! Complication rates, type of delivery, Apgar scores of the infants, and problems in the early postpartum period were about the same in both groups. (Midwives Chronicle & Nursing Notes 105(1251)76-78, April 1992) The lesson from this study is don't interfere with nature in labor unless you have to. Copyright Phylis Austin

DELAYED FEEDING OF INFANTS OF DIABETIC MOTHER/PROLONGED NEONATAL UNIT STAY
Twenty-six infants of diabetic mothers were studied in a Belfast, North Ireland hospital. They concluded that delayed feeding was a major factor in prolonged hospital stay. (Journal of Perinatal Medicine 20(Suppl 1)214, 1992) Copyright Phylis Austin

EPISIOTOMY
 A study from the Jewish General Hospital and McGill University in Montreal, Canada, again indicates that episiotomies often do not benefit women. In addition to recovering from the birth women often endure discomfort or pain from their episiotomy.
An episiotomy, an incision to enlarge the vagina, is often performed during the second stage of labor. It is done in approximately 70-80 percent of births in North America, and is one of the most common surgical procedures in the Western world. (Online Journal of Current Clinical Trials 1(1)January 1992) Copyright Phylis Austin

LABOR/ARTIFICIAL RUPTURE OF MEMBRANES
 In many hospitals if a woman in labor does not have ruptured membranes, the membranes will be artificially ruptured in the belief that it will hasten delivery.
A midwife reports that the rupture of the membranes may dramatically increase contraction strength, making it necessary for the woman to take pain medication.
She compared two groups of patients, one undergoing artificial rupture and other progressing in labor until the membranes broke spontaneously. She observed that artificial rupture was routinely done when the woman was 3.5 cm dilated, but spontaneous rupture did not occur until the woman progressed to about 8.7 cm. However, there was no significant difference in the length of labor in the two groups! Complication rates, type of delivery, Apgar scores of the infants, and problems in the early postpartum period were about the same in both groups. (Midwives Chronicle & Nursing Notes 105(1251)76-78, April 1992) The lesson from this study is don't interfere with nature in labor unless you have to. Copyright Phylis Austin

DELAYED FEEDING OF INFANTS OF DIABETIC MOTHER/PROLONGED NEONATAL UNIT STAY
Twenty-six infants of diabetic mothers were studied in a Belfast, North Ireland hospital. They concluded that delayed feeding was a major factor in prolonged hospital stay. (Journal of Perinatal Medicine 20(Suppl 1)214, 1992) Copyright Phylis Austin

VITAMIN K INJECTIONS IN LABOR/CHILDHOOD CANCER
 Infants of mothers given vitamin K injections during labor to prevent possible hemorrhage are at increased risk of developing childhood cancer. This is the second study demonstrating this relationship. (British Medical Journal 305:341-346, August 8, 1992) More evidence accumulates to show that supernutrition in any form carries some risk to the health. Copyright Phylis Austin

EATING/LABOR
 Eating during labor may shorten labor and benefit the infant, according to a study from Ireland. Mothers who ate lightly during early labor required less pain medication and their infants had better muscle tone and stronger heartbeats. (Nutrition Health Reviews 64:16, 1992) Copyright Phylis Austin

DIABETIC MOTHERS/PREECLAMPSIA
 Diabetic mothers who have protein in their urine early in their pregnancy are at greater risk of developing preeclampsia. Diabetic mothers are known to have higher rates of preeclampsia. (American Journal of Obstetrics and Gynecology 168(1 Pt. 2)315, January, 1993) Copyright Phylis Austin

SMOKING/PREGNANCY
 Women who smoke during pregnancy are known to have smaller infants than non-smokers. A recent study from the University of Alabama at Birmingham reveals that they are also more likely to have preterm delivery, birth defects, and spontaneous abortion. The smokers in the study group also had higher rates of pyelonephritis (inflammation of the kidney and its pelvis) (American Journal of Obstetrics and Gynecology 168(1 Pt 2)316, January 1993) Copyright Phylis Austin

CESAREAN SECTION RECOVERY
 Women who have undergone cesarean section recover faster if they spend an hour a day rocking in a rocking chair with their infants. The rockers reported less gas pain, and were able to leave the hospital sooner than non-rockers. The rocking mothers also seemed to bond with their infants during the rocking time. (Bottom Line Personal, September 30, 1992, p. 9) Copyright Phylis Austin

CAFFEINE INTAKE DURING PREGNANCY/INFANT BEHAVIOR
 Infants of mothers who consumed high levels of caffeine during pregnancy spend more time in rapid eye movement sleep than those of low caffeine consumption. They were also more likely to have lower birth weight. Studies of laboratory animals suggest that caffeine intake during pregnancy causes abnormalities in brain development, and changes in the body's method of handling cholesterol and zinc. Caffeine is known to cross the placental barrier. (American Journal of Obstetrics and Gynecology 168(4)1105-1102, April 1993) Copyright Phylis Austin

ASTHMA/PRETERM LABOR AND DELIVERY
 Women who suffer asthma and utilize asthma medications during pregnancy are at increased risk of preterm labor. (Epidemiology 4(2)143-150, March 1993) Copyright Phylis Austin

PRETERM RUPTURE OF THE MEMBRANES
 Preterm rupture of the membranes places the infant at risk of prematurity. Many physicians put these mothers in the hospital where they are placed at bed rest, and carefully monitored to allow the infant to mature before birth. These periods may extend for weeks or months, resulting in a very long hospital stay for the mother. A study from the Department of Obstetrics and Gynecology at the University of South Florida College of Medicine in Tampa, Florida, suggests that carefully selected mothers may be managed at home without increasing risk of complications. (Obstetrics and Gynecology 81:61-64, 1993) Copyright Phylis Austin

MISCARRIAGE/SHIFT WORK
 Pregnant women who work a shift beginning at 3 to 4 p.m. are at higher risk of miscarriage than are women who work a day shift. (Bottom Line Personal 14(6)8, March 30, 1993) Copyright Phylis Austin

NIGHT WORK/PREGNANCY LOSS
 Women whose regular work schedule involve the evening hours or the night shift are more likely to suffer pregnancy loss than are women who work day hours. Evening workers were about four times as likely as daytime workers to lose the pregnancy. (Epidemiology 4:73-75, 1993) Copyright Phylis Austin

PRENATAL SMOKE EXPOSURE/MENTAL ABILITY
 Infants whose mothers smoke or who are exposed to the smoke of others may suffer a decrease in their spatial information processing abilities. (Teratology 47(5)462-463, May 1993) Copyright Phylis Austin

NUTRITIONAL SUPPLEMENTATION/BIRTHWEIGHT
 Health officials in many countries are campaigning to provide nutritional supplementation to pregnant women, in an attempt to increase the birthweight of their infants. Researchers have recently questioned the value of this policy, and raise the question of whether or not these attempts may actually be detrimental to the mother and/or infant. They point out that birthweight is not an indication of health or lack of it. Illness in small infants is not attributable to low birth weight, but to the disease process which caused the low birth weight. Furthermore, there is no evidence that increasing birth weight reduces sickness or death in newborns.
Efforts to increase infant birthweight also increase the risk of complications during labor. A larger infant is at greater risk of being delivered surgically because of cephalopelvic disproportion.
No one would question the importance of adequate and good nutrition throughout pregnancy, but attempts to supplement a balanced diet should be carefully considered. (The Lancet 340:1021-1023, October 24, 1992) Copyright Phylis Austin

MISCARRIAGES
 It is estimated that 50 to 60 percent of all first pregnancies in America end in miscarriage. Pregnant women may decrease their risk of miscarriage by proper prenatal care, good nutrition, and stress avoidance.
Women over 35 years-of-age, women with previous gynecological surgeries, those who use tobacco or alcohol, or who are exposed to environmental toxins are at increased risk of miscarriage. (Bottom Line Personal 14(18)12-13, September 30, 1993) Copyright Phylis Austin

CHORIONIC VILLUS SAMPLING/BIRTH DEFECTS
 Infants of mothers who undergo chorionic villous sampling (CVS) early in pregnancy are at increased risk of certain types of birth defects. (Teratology 48:93-95, 1993) Copyright Phylis Austin

EXERCISE/PREGNANCY
 Women who are physically fit when they become pregnant and who have normal pregnancies may continue a modified exercise program throughout their pregnancy. A study from Columbia University School of Public Health in New York, indicates that fetal growth patterns are improved in exercising mothers. (American Journal of Epidemiology 137:1105-1114, 1993) Copyright Phylis Austin

FOOD AND FLUID INTAKE DURING LABOR
 Laboring women are typically denied food and fluid during active labor. They are typically given fluids by I.V. A recent literature review disclosed no clear scientific reason for restricting food or fluid. On the other hand, allowing the laboring mother to eat and drink as she wishes assists in the prevention of fatigue and dehydration, and permits her to feel more in control of her labor. (Journal of Nurse Midwifery 38(4)199-207, July-August 1993) Copyright Phylis Austin

PREGNANT ADOLESCENTS/SUGAR INTAKE
 Adolescents who become pregnant are at increased risk of certain types of pregnancy complications. Many of these young women are accustomed to a diet high in sugar, with large intakes of soda pop, sweetened breakfast cereals, ice cream, and pancakes with syrup. A comparison study reveals that adolescent mothers who take a high sugar diet are at increased risk of having an infant which is small for its gestational age. (Pediatric Research 33(4 Pt 2)7A, April 1993) Copyright Phylis Austin

"PUSHING" DURING LABOR
 Women in labor are often urged to "push" during the second stage of labor. A study done in Manchester, England, suggests that allowing the woman to push when she feels the urge, rather than when the doctor instructs her to is just as effective. (Journal of Advanced Nursing 18:171-1177, 1993) Still more evidence supporting the fact that the mother's body is designed to deliver the infant with a minimum of intervention. Copyright Phylis Austin

PASSIVE SMOKE/PREGNANCY/LOW BIRTH WEIGHT
 The infants of women who are exposed to passive smoke are at increased risk of low birth weight. (American Journal of Public Health 83(2)207-210, February 1993) We advise pregnant women (and everyone else) to stay away from smokers. Copyright Phylis Austin

CROHN'S DISEASE/BAKER'S YEAST
 A reaction to bakers yeast may cause or contribute to symptoms of Crohn's disease. Earlier studies have shown that Crohn's disease patients have a higher incidence of allergic reaction to baker's yeast than non-Crohn's sufferers. The elimination of baker's yeast may be helpful to Crohn's sufferers. (Gastroenterology 104(4 Pt 2)A806, April 1993) Copyright Phylis Austin

LABOR INDUCTION/AUGMENTATION
 Sixty percent of births worldwide in the early 1980s involved either clinically induced or clinically augmented labors, despite the fact that labor induction involves considerable risk and cost, and is often disliked by laboring mothers. Labor induction (beginning labor by artificial means) has been considered good medical practice for such conditions as prolonged pregnancy, severe high blood pressure, Rh incompatibility, diabetes, preeclampsia, and prolonged rupture of the membranes. Less than 10 percent of pregnancies fall into this category.
Stimulating labor which has begun naturally is more common than inducing labor, but justification for its use seems even less specific. The American College of Obstetricians and Gynecologists (ACOG) reminds us that "Slow progress may not constitute abnormal progress." (American College of Obstetricians and Gynecologists. Dystocia: Etiology, Diagnosis and Management Guidelines. Committee Statement, Washington D.C., ACOG, 1983, p. 3)
Stripping of membranes, amniotomy (artificial rupture of the membranes), and substances taken by injection, infusion, or ingestion to strengthen and/or stimulate uterine contractions are the most common of the procedures.
Even such stimulants as herbs, which are considered "natural," can make the mother feel that her body is not performing its function well, and must be helped. This is the premise that underlies drug administration, and implies that other people understand better than the mother's body what the pace should be. (Mothering (657)76- 79, Summer 1993) Copyright Phylis Austin

UTEROVAGINAL PROLAPSE/URINARY STRESS INCONTINENCE/CONSTIPATION
Women who have a history of constipation during young adulthood are at increased risk of uterovaginal prolapse, and perhaps urinary stress incontinence in later life. Childbirth-associated trauma has also been identified as a risk factor, but these researchers feel that constipation may be a more important factor. (British Journal of Obstetrics and Gynecology 101:147-152, February, 1994) Copyright Phylis Austin

EXERCISE/PREGNANCY
 The American College of Obstetricians and Gynecologists established a set of guidelines for safe exercise during pregnancy. A recent study of 174 pregnant women revealed that those who were physically fit before they became pregnant could safely exercise in excess of the ACOG guidelines without harm to their infants or themselves. Pregnant women who participate in long-duration and moderate intensity exercise actually had a lower cesarean section rate than other mothers in the study. (Journal of Gynecology and Neonatal Nursing 22(4)329-335, July-August 1993) Copyright Phylis Austin

SMOKING/PREGNANCY
 There have been numerous reports in the lay press of the dangers of cocaine use during pregnancy. Now researchers from Duke University School of Medicine report that cigarettes may be more harmful to the developing fetus than cocaine. Exposure to cigarettes produced a reduction in some brain nerve cells. (Journal of the American Medical Association 271(8)576-578, February 23, 1994) Copyright Phylis Austin

OVERWEIGHT MOTHERS/BIRTH DEFECTS
 Overweight mothers are at increased risk of having infants with neural tube defects or other malformations. (American Journal of Obstetrics and Gynecology 170:541-548, February 1994) Copyright Phylis Austin

WARM BATH/LABOR
 A study comparing 89 women who took a warm bath following spontaneous rupture of the membranes with 89 women who did not revealed no significant differences in asphyxia (suffocation) or other respiratory problems, infections, or maternal amnionitis in the two groups. They did report lower five minute apgar scores in the bathing group. (Birth 19:57-63, June 1992) Warm baths have several beneficial effects on the mother, including reduced discomfort during the last weeks of pregnancy and during labor. Copyright Phylis Austin

CAFFEINE/PREGNANCY
 The use of caffeine before and during pregnancy increases the risk of fetal loss. (Journal of the American Medical Association 270(24)2940-2943, December 22-29, 1993) We have yet to find any good reason for anyone to use caffeine. Copyright Phylis Austin

EPIDURAL ANAESTHESIA/BACKACHE AFTER DELIVERY
 Many women suffer backache after having epidural anesthesia during childbirth. This backache may persist for over a year. This study suggests that 8 out of every 100 women who have epidural anesthesia develop backache, which may become chronic. (British Medical Journal 301:9-12, July 7, 1990) Copyright Phylis Austin

ANTICONVULSANTS/PREECLAMPSIA
 Pregnant women sometimes develop preeclampsia, a disease which may be associated with high blood pressure, weight gain and swelling of extremities due to fluid retention, protein in the urine, headache, visual disturbance, or convulsions. Obstetricians have routinely prescribed anticonvulsants in these women in the hope of preventing convulsions. During a study designed to determine the most effective medication researchers discovered a most interesting fact--these women may often be treated without the administration of any anticonvulsant! The incidence of seizure in the women not given anticonvulsants was similar to the incidence in women treated with either of the two most frequently used medications. (The Lancet 337:250-251, January 26, 1991) It is know that anticonvulsants may have adverse effects on mental development of infants, so their use should be avoided if at all possible. Copyright Phylis Austin

BODY SIZE, BLOOD PRESSURE AND HEMATOCRIT/PREECLAMPSIA
 A study of over 4,000 pregnant women revealed that as body size, blood pressure, and hematocrit increased, so did the risk of developing preeclampsia during the pregnancy. (American Journal of Obstetrics and Gynecology 164(1 Pt 2)393, January 1991) Copyright Phylis Austin

BREECH PRESENTATION/TRIAL OF LABOR
 Many physicians consider a breech presentation (infant presenting its hips rather than its head at the birth outlet) a reason for cesarean section. A study from the University of New Mexico Medical Center suggests that otherwise healthy women with infants in breech presentation may be given a trial of labor before intervention is considered. (American Journal of Obstetrics and Gynecology 164(1 Pt 2)403, January 1991) Copyright Phylis Austin

BIRTH COMPANIONS
 A study from Finland reveals that mothers in labor who have a support person with them continuously during labor have shorter hospital stays before delivery, and were less likely to have their contractions stop, delaying the birth. (Journal of Psychosomatic Obstetrics and Gynecology 11:239-250, 1990) Midwives should be aware of the value of the mother's companion ("significant other"). Copyright Phylis Austin

CAFFEINE USE IN PREGNANCY/FETAL GROWTH
 Caffeine use during pregnancy may cause fetal growth retardation. Infants of these mothers may be low birth weight infants. (American Journal of Public Health 81(4)458-461, April 1991) Copyright Phylis Austin

LENGTH OF PREGNANCY
 The estimated date of delivery has been based on Naegele's rule, which was to add 7 days and 9 months to the date of the last menstrual period. Recent reports have shown that most pregnancies go beyond this point. Some now feel that this rule causes both mothers and obstetricians unnecessary concern, and should be abandoned. They suggest instead, that a time range of 38-42 weeks be given to the pregnant woman. (The Lancet 337:600-601, March 9, 1991) Copyright Phylis Austin

IRON SUPPLEMENTS DURING PREGNANCY/PROLONGED PREGNANCY
 Iron supplementation is routine in many obstetric practices in the United States. A study from the Department of Public Health at the University of Helsinki compared women who were routinely given iron supplements with a group given iron supplements only as iron deficiency became apparent. The final outcome for mothers and infants was basically the same, with the exception that the routinely supplemented group were more likely to have prolonged pregnancies. The study group calls for further study of the need for routine iron supplementation, and point out that pregnancy produces hemodilution, which may provide a better blood supply to the placenta. (Journal of the American College of Nutrition 10(1)3- 10, 1991) An editorial accompanying the article comments that routine supplementation may do more harm than good. (Journal of the American College of Nutrition 10(1)1-2, 1991) Copyright Phylis Austin

YEAST INFECTIONS
 A douche may be made by soaking a large handful of juniper berries (Juniper communis) overnight in half a gallon of water. The next morning bring the water to a boil and simmer for 30 to 40 minutes. Cool, then use as a douche once daily for ten days. If the vulva is sore the same mixture may be used for a sitz bath. Sugar, alcohol, refined foods, and citrus should be eliminated during the treatment period. (Mothering, Fall, 1986, p. 13, 14) Copyright Phylis Austin

FORCEPS DELIVERY/BRUXISM/TMJ PAIN
 Children who are delivered with the use of forceps have greater incidences of bruxism (teeth grinding) and temporomandibular joint discomfort than do children delivered without the use of forceps. (Pediatric Dentistry 11(3)193, September 1989) Copyright Phylis Austin

LIMB DEFECTS/SMOKING MOTHERS
 Infants of mothers who smoke are more likely to suffer limb deficiencies than are the infants of non-smoking mothers. (British Medical Journal 308:1473-6, 1994) Copyright Phylis Austin

ULTRASOUND IN PREGNANCY/SPEECH DELAYS IN INFANTS
 Infants exposed to ultrasound while still in utero are about twice as likely to suffer delayed speech than are non-exposed infants. (Canadian Medical Association Journal 149:1435-1440, 1993) Copyright Phylis Austin

ELECTIVE REPEAT CESAREAN DELIVERY
 Vaginal birth after cesarean section (VBAC) has a success rate of about 75 percent. Women who successfully deliver vaginally have shorter hospital stays, require fewer postpartum transfusions, and suffer fewer postpartum fevers than women who undergo repeat cesarean section. (Obstetrics and Gynecology 83:927-932, 1994) Copyright Phylis Austin

EPIDURAL ANALGESIA/CESAREAN SECTION
 Researchers from California report that the administration of epidural analgesia during childbirth increases the risk of cesarean section. (Obstetrics and Gynecology 83(6)1045-1052, June 1994) Copyright Phylis Austin

SMOKING IN PREGNANCY/CHILDHOOD INTELLIGENCE
 Infants of mothers who smoke during pregnancy may suffer neurodevelopmental impairment. When children of smoking mothers were compared with those of non-smoking mothers they showed lower I.Q. scores, changes in auditory responsiveness, hypertonicity (increased muscle tone), increased tremors, and other central nervous system symptoms. It is possible that tobacco may reduce the oxygen and nutrient supply, producing fetal hypoxia (lack of oxygen). (Pediatrics 93(2)221-227, February, 1994) Copyright Phylis Austin

CAFFEINE EXPOSURE DURING PREGNANCY/SECOND GENERATION EFFECTS
The second generation of mice exposed to caffeine before becoming pregnant and during pregnancy showed behavioral changes in the second generation of the offspring, even though they were not given caffeine. (Neurotoxicology and Teratology 11:357-362, 1989) Copyright Phylis Austin

BEAUTICIANS/SPONTANEOUS ABORTIONS
 Pregnant women who are exposed to chemicals used by cosmetologists are at increased risk of spontaneous abortions. As hours of exposure increase so does risk of abortion. (Epidemiology 5:147- 155, 1994) Copyright Phylis Austin

OBSTETRIC TECHNOLOGY
 A report from Nigeria indicates that healthy women given simple prenatal care and delivered without the use of extensive obstetric technology have as favorable pregnancy outcomes as women given the high-tech obstetric care given in such countries as the United States. (The Lancet 337:553, March 2, 1991) Copyright Phylis Austin

FETAL HEART RATES/CESAREAN SECTIONS
 When fetal heart rates increase or decrease during labor it may produce great anxiety on the part of obstetricians, and in some cases could even lead to caesarean section, believing that the infant is in distress.
Jan G. Nijhuis, M.D., professor of perinatology at University Hospital in Nijegon, the Netherlands, told the First World Congress on Labor and Delivery that proper evaluation of fetal behavior could effectively reduce the C-section rate.
He has observed three types of irregular fetal heartbeats: a "wavy" heartbeat may suggest that the fetus is sucking his thumb; a quickened beat may indicate an exercising fetus; and an almost undetectable beat may suggest a sleeping fetus. Dr. Nijhuis has observed that sleeping heart patterns may persist for about 90 minutes, even during labor.
Dr. Nijhuis points out that after birth if we see an infant sleeping quietly we don't awaken it to see if it is sleeping or in a coma. He sees no point in doing it before birth either. (Medical Tribune 35(15)8, August 11, 1994) Copyright Phylis Austin

SMOKING DURING PREGNANCY/LUNG CHANGES IN INFANTS
 Laboratory animals exposed to nicotine in utero showed emphysema-like changes in their lung tissue. Elastic tissue and alveoli formation were decreased. The authors conclude that maternal smoking may predispose the child to later emphysema. (South African Medical Journal 83:195- 199, 1993) Copyright Phylis Austin

FISH CONSUMPTION DURING PREGNANCY/FETAL LUNG DEVELOPMENT
 Fish in many areas of the United States are known to be contaminated with mercury. Mercury is a known toxin which is capable of crossing the placental barrier. A study from Canada revealed that infants whose mothers consume mercury-containing fish during pregnancy are at risk of delayed lung development. (Pediatric Pulmonology 17:11-21, 1994) Copyright Phylis Austin

BIRTH CUSHION/LABOR
 The use of a birthing cushion designed to place laboring women in a squatting position decreased the need for forceps delivery compared to a group who gave birth in the traditional lying down position. The second stage of labor was significantly shorter in those in the squatting position, and women who used the birth cushion reported that they liked it. (The Lancet 2(74-77, July 8, 1989) Copyright Phylis Austin

BRAIN INJURY/AMNIOCENTESIS
 Four cases of brain injury due to amniocentesis done when the fetus was 16 to 19 weeks of age suggest that brain damage as a result of amniocentesis may not be rare. Brain injury is often attributed to birth events, but many now feel that it is more often the result of events before birth. Amniocentesis-induced injuries may be far more frequent than has been previously recognized. (Annals of Neurology 36(3)516, September 1994) Copyright Phylis Austin

LABOR IN CHILDBIRTH/CHILD'S IMMUNE SYSTEM
 The process of labor may strengthen an infant's immune system according to a study from London, United Kingdom. Immune system function of infants born by cesarean section was compared with infants born vaginally. Infants born vaginally had higher values for several immune system indicators. The researchers conclude that labor may benefit the child's immune system. (American Journal of Obstetrics and Gynecology 171:1271-2, 1994) Copyright Phylis Austin

ULTRASOUND IN PREGNANCY
 Pregnant women are eager to know the status of their developing fetus, and many obstetricians have provided their patients with "keepsake" ultrasound scans of the infant. The Food and Drug Administration cautions that ultrasound is not without risk, and that the fetus should not be exposed to ultrasound energy without the expectation of medical benefit. The Food and Drug Administration warns that they may take action against physicians who do ultrasounds for non-medical purposes.
The Texas State Department of Health recently took action against facilities who provided "keepsake" ultrasounds. (Radiology Today 11(11)3, November 1994) Copyright Phylis Austin

PROTEIN/PREGNANCY
 Many counsel pregnant women to take in large amounts of protein. One study suggests the daily intake of 100 to 120 grams of protein. A study of pregnant women at The Farm who consumed between 50 and 65 grams of protein per day had no low birth weight or premature infants. There were no cases of preeclampsia except for one borderline case, but this women had a history of small placentas and small-for-date infants in each of her three previous pregnancies. (Birth Gazette 10(4)42, 43, Fall, 1994)
Most of the women at The Farm are vegetarian; some are strict vegan. Copyright Phylis Austin

PREECLAMPSIA/MILK
 Preeclampsia of pregnancy (high blood pressure, protein in urine, and edema) is increased in women who drink three or more glasses of milk a day, according to a report from the University of California. Researchers followed over 9,000 pregnant women who recorded their daily milk consumption. Like earlier studies, this showed increased rates in women who consumed less than one glass per day.
Calcium has been shown to reduce blood pressure in pregnant women so researchers were quite surprised at the increased incidence of preeclampsia in the high milk intake group. (American Journal of Epidemiology 141:667-73, 1995)
Greens are excellent sources of calcium, and may be consumed daily. Copyright Phylis Austin

IRON/PRETERM DELIVERY
 Pregnant women with high serum ferritin concentrations are at increased risk of early preterm spontaneous delivery, according to a report from the Departments of Nutrition Sciences and Obstetrics and Gynecology at the University of Alabama at Birmingham. They concluded that serum ferritin levels can be used to predict early preterm delivery. (American Journal of Clinical Nutrition 61(4)911, April 1995) Copyright Phylis Austin

EPIDURAL ANALGESIA/UTERINE FUNCTION
 The ability of the uterus to contract is significantly reduced after epidural analgesia. A study from the Departments of Obstetrics and Gynecology and Anesthesia at the University of Texas Health Science Center at San Antonio, revealed that epidural analgesia led to longer second stages. Earlier reports have shown that epidural analgesia is associated with more operative deliveries.
Epidural analgesia may paralyze the pelvic floor muscles, hindering descent and head rotation of the infant.
Even with oxytocin therapy cervical dilation was significantly slower in women who had epidural analgesia. (Obstetrics and Gynecology 85(5)749-755, May 1995) Copyright Phylis Austin

MATERNAL SMOKING/PREGNANCY COMPLICATIONS/SUDDEN INFANT DEATH SYNDROME
Smoking during pregnancy leads to increased abortion rates, low birthweight, and higher rates of perinatal disorders. Sudden infant death syndrome is also more frequent in infants of smoking mothers. (Journal of Family Practice 40(4)385-394, April 1995) Copyright Phylis Austin

WEIGHT GAIN DURING PREGNANCY
 Women who gain excessive weight during pregnancy tend to retain the weight after childbirth. (American Journal of Clinical Nutrition 61(4)893, April 1995) Copyright Phylis Austin

IRON SUPPLEMENTS DURING PREGNANCY
 Iron and vitamin supplements are often routinely given to a pregnant woman. Unfortunately, this practice is based on studies of women who were either not pregnant or on pregnant women who were taking iron supplements, so it is difficult to accurately evaluate the need for iron supplements during pregnancy.
A recent study from the United Kingdom revealed that as the pregnancy progressed and iron requirements increased, iron absorption from foods also increased. Some feel that this increased absorption will provide adequate iron without supplementation.
Iron supplementation is not entirely without risk. Iron may cause abnormally large red blood cells, cause diarrhea or constipation, and suppress zinc absorption. Zinc is an important nutrient during pregnancy.
Pregnant women should be counseled regarding the use of iron rich foods, the intake of foods high in Vitamin C which encourage iron absorption, and counseled against the use of such items as tea and coffee which interfere with iron absorption. (Obstetrical and Gynecological Survey 50(2)85-97, February 1995; British Medical Journal 309:79-82, 1994) Copyright Phylis Austin

SMOKING DURING PREGNANCY/CHILDREN
 Daughters born to women who smoked during pregnancy are at greater risk of suffering miscarriage when they become pregnant. Animal studies have shown ovarian atrophy in the female offspring of smoking mothers. These women are also at increased risk of undergoing some type of gynecological surgery in adulthood.
Males born to smoking mothers are more likely to have undescended testes at age 11.
Animal studies suggest that some adverse effects may be carried down to grandchildren of smoking mothers.
Women who smoke during pregnancy are themselves at increased risk of bleeding during the first trimester, of miscarriage, are more likely to suffer nausea, vomiting, thrush infections, headaches and backaches. (Medical Tribune for the Family Physician 35(4), February 24, 1994; Nursing Times 90(6)7, February 9, 1994) Copyright Phylis Austin

TOBACCO/CAFFEINE/MISCARRIAGE/SPONTANEOUS ABORTION
 A study from Madrid, Spain indicates that the use of tobacco and caffeine increase the risk of spontaneous abortion or miscarriage. (European Journal of Epidemiology 10:665-668, 1994) Copyright Phylis Austin

HOT FOOT BATHS/LABOR
 An Oregon midwife who uses hot foot baths to relieve headaches observed that labor contractions increased when the laboring woman's feet were placed in the hot water to relieve her headache. (Midwifery Today (36)10, Winter 1995 Copyright Phylis Austin

OVERWEIGHT/PREGNANCY COMPLICATIONS
 Women who are overweight when they become pregnant are at greater risk of developing such complications as gestational diabetes, hypertension, and having a caesarean delivery. They are also at greater risk of incision infection after caesarean section. Infants born to overweight mothers were also at greater risk of requiring intensive care after birth. (Obstetrics and Gynecology 87:389-394, 1996) Copyright Phylis Austin

PREECLAMPSIA OF PREGNANCY/CALCIUM/VITAMIN D-3
 Calcium and vitamin D-3 supplements during pregnancy decrease the percentage of pregnant women who develop preeclampsia according to a report from Japan. Over 900 women were followed throughout pregnancy; 16.9% of those not treated developed preeclampsia, but only 10.9% of those given the supplements did. The supplements may be beneficial to women at high risk of preeclampsia. (International Journal of Obstetrics and Gynecology 47:115-120, 1994) Copyright Phylis Austin

CAFFEINE/FETUS
 Theobromine, theophylline and paraxanthine accumulate in the fetal brain after the mother consumes caffeine. While the adult brain has the ability to exclude these substances the fetal brain does not. Earlier reports have demonstrated the accumulation on these toxic substances in the amniotic fluid. (Developmental Brain Research 75:193-199, 1993) Copyright Phylis Austin

BACK PAIN/PREGNANCY
 About half of pregnant women report back pain. Dr. Julie Colliton, a physiatrist, divides back pain of pregnancy into three types: lumbar, sacroiliac, and night backache.
Backache of pregnancy sometimes begins before the 12th week of pregnancy and may persist for six months after delivery. Women who have had previous pregnancies, who had pre-pregnancy back pain, and who are not physically fit at the time they become pregnant are at increased risk.
Lumbar backache may radiate down one or both legs. This type of backache is probably due to the hormonal and postural changes which occur during pregnancy. It is provoked by being seated for long periods or by weightbearing.
Sacroiliac pain is centered near the posterior superior iliac spine, and may radiate down the leg. This type of backache occurs four times as often as lumbar pain, and may persist for several months after delivery. It may occur concurrently with lumbar backache.
Night pain backache is located in the lower back, and appears only at night. It may occur at the same time as lumbar and sacroiliac backache. The pain may be described as a cramping or menstrual- type pain, which may interfere with sleep. Changing position does not cause pain.
Massage, including ice massage, heat, and proper posture, pelvic tilts, leg lifts, and arm and leg extension exercises help to strengthen muscles. (Physician and SportsMedicine 24(7)89-95, July 1996) Copyright Phylis Austin

MATERNAL DIET/HYPERTENSION IN OFFSPRING
 The adult blood pressure of individuals whose mothers consumed more than 50 g. of animal protein per day during the pregnancy tends to be higher than a control group whose mothers consumed less animal protein.
The babies of women who consumed a high proportion of their calories as protein, particularly animal protein, also had lower birthweight. Earlier studies have shown that low birthweight infants are more likely to have high blood pressure in adulthood. (British Journal of Obstetrics and Gynecology 103:273-280, March 1996) Copyright Phylis Austin

BETA-CAROTENE/PREECLAMPSIA OF PREGNANCY
 A preliminary report from the recent annual meeting of the Society of Gynecologic Investigation suggests that a high beta-carotene intake (as from yellow, orange and green foods) may prevent the development of preeclampsia of pregnancy. (Obstetric and Gynecologic News 31(12)22, June 15, 1996) Copyright Phylis Austin

EXERCISE DURING PREGNANCY/PREGNANCY OUTCOME
 Women who were active prior to becoming pregnant and who continue their exercise program throughout pregnancy report fewer episodes of leg cramps, shortness of breath, fatigue, and swelling than do inactive women. The active women also reported less discomfort with vaginal discharge. Most of the 101 pregnant women preferred brisk walking as their exercise.
Earlier studies have shown that reasonable exercise routines do not adversely impact either mother or fetus. Exercising women also report increased self-esteem, less depression, decreased mood swings, and many of them have shorter labors. Some studies have shown higher Apgar scores in the infants of women who exercised regularly during pregnancy.
Others have reported fewer problems with backache, headache, hot flashes, and shortness of breath in exercising women. (JOGNN 25(1)49-54, January 1996) Copyright Phylis Austin

MATERNAL DIET/DIVERTICULOSIS IN OFFSPRING
 Babies born to mothers who consume a low fiber diet during pregnancy appear to be at increased risk of developing diverticulosis in adult life. (Gut 39:423-429, 1996). Diverticulosis is a pouchlike protrusion or bulge of the large intestine. These pouches may become inflamed. Copyright Phylis Austin

MORNING SICKNESS/"TOXIC" FOODS
 A recent popular book proclaimed that nausea and vomiting of pregnancy was nature's way of keeping the mother from consuming "toxic" foods which could injure the baby. While this study was readily received by the lay press, and even some scientific journals, it was not based on any scientific foundation. Judith E. Brown, Ph.D., professor of nutrition at the University of Minnesota in Minneapolis, studied over 500 women, and observed that those women who consumed the "toxic" foods were no more likely to have a poor pregnancy outcome or infants with birth defects. (American Journal of Obstetrics and Gynecology 176:179-181, 1997) Copyright Phylis Austin

C-SECTION/LARGE INFANTS
 Pregnant women with large infants are often subjected to C- section in the belief that this decreases the risk of injury to the infant during the birth process. A review done at the University of California at San Francisco and at Boston, Mass, reveal that this practice is poor medical and fiscal practice. They observed that to prevent one case of brachial plexus injury during birth between 19 and 162 cesarean sections would have to be performed.
Diabetic women tend to have larger babies. Between 5 and 48 caesareans would be required in this group. (Obstetrics and Gynecology 89:643-647, 1997) Copyright Phylis Austin

X-RAY EXPOSURE/MEN/BIRTH OUTCOME
 Men who are exposed to x-rays in the year prior to conception may contribute to slowed development and growth of their offspring according to the Avon Longitudinal Study of Pregnancy and Childhood. Infants of radiation exposed males had lower birth weights and slowed intrauterine growth. (American Journal of Epidemiology 145:546-551, 1997) Copyright Phylis Austin

EPIDURAL ANESTHESIA/LABOR COMPLICATIONS
 The use of epidural anesthesia during labor decreases the spontaneous delivery rate, increases the rate of forceps delivery, vacuum extraction rate, fever higher than 38 degrees C. during and following labor, and the risk of postpartum hemorrhage. (Gynecology and Obstetric Investigation 49:24-27, 1995) Copyright Phylis Austin

NSAID EXPOSURE IN UTERO/RENAL FAILURE
 In-utero exposure to NSAIDs (non-steroidal anti-inflammatory agents) may cause renal failure in the newborn infant. NSAID use during pregnancy may contribute to oligohydramnios (reduced amount of amniotic fluid), bleeding disorder, perforation of the small bowel and premature closure of the ductus, a structure vital to heart function in the unborn child. (Pediatric Nephrology 8:700- 704, 1994) Copyright Phylis Austin

STUFFY NOSE/PREGNANCY
 Many pregnant women complain of stuffy nose as hormone- associated changes may cause swelling of the nasal membranes, often most pronounced at night. It may disrupt sleep, and if severe, may be very troublesome. The use of medication may bring unwanted risks to the fetus. The women in this study group who were given nasal dilators reported significant relief their difficulties. (Journal of Reproductive Medicine 41:897-902, 1996) Copyright Phylis Austin

VULVOVAGINAL CANDIDIASIS/UNIVERSITY STUDENTS
 Approximately two-thirds of all women suffer at least one episode of vulvovaginal candidiasis during their lifetime. Symptoms include itching, burning, soreness and vaginal discharge.
A study of university students indicated that the risk of developing vulvovaginal candidiasis was increased in those who had participated in receptive oral sex twice or more in the previous two weeks, used contraceptives or spermicides, had suffered an episode of candidiasis during the previous year, or were of other than the Caucasian race. (Epidemiology 7:182-187, 1996) Copyright Phylis Austin

SMOKING DURING PREGNANCY/ATTENTION DEFICIT DISORDER
 The children of mothers who smoke during their pregnancy are at increased risk of attention deficit hyperactivity disorder (ADHD), according to a report from Harvard Medical School in Boston. Twenty-two percent of boys with ADHD had mothers who smoked during their pregnancy while only eight percent of males of non-smoking pregnancy had ADHD. Infants of smoking mothers also had significantly lower IQs. (American Journal of Psychiatry 153:1128- 1142, 1996) Copyright Phylis Austin

FOLIC ACID/PRENATAL VITAMINS
 Folic acid in prenatal vitamin preparations may be unavailable for utilization. The six prescription prenatal vitamin preparations investigated did not release folic acid sufficiently to meet the United States Pharmacopoeial Convention standards. The researchers felt that other preparations not tested performed similarly. (Journal of the American Pharmaceutical Association NS37:397-400, 1997) ED- Many are advocating the use of folic acid supplements during pregnancy to reduce birth defects. A vegetarian diet, however, provides a higher blood level of folic acid than most supplements, insuring the most favorable nutrient balance for pregnancy. Copyright Phylis Austin

HEAT/HUMIDITY/PRETERM LABOR
 High environmental temperatures and humidity may increase rates of preterm labor in pregnant women. It is known that heat stress may trigger labor in laboratory animals. It is possible that these factors may produce dehydration, which stimulates the release of hormones which stimulate uterine contractions.
The authors of this study caution that further studies are needed to confirm these findings. (American Journal of Public Health 87(7)1205-1207, July 1997). ED- Encouraging pregnant women to stay well hydrated with good quantities of pure water may prevent preterm labor. Copyright Phylis Austin

WALKING DURING LABOR/SURGICAL DELIVERY
 Still another study shows that women who are allowed to walk during labor are less likely to undergo surgical delivery of their infants. Women in this study group who walked had half the surgical delivery rate of those who did not walk freely. (Journal of Nurse-Midwifery 42(1)4-8, January/February 1997) Copyright Phylis Austin

EXERCISE/PREGNANCY
 Some have felt that healthy, physically-fit women should discontinue exercise during their pregnancy. Dr. James Clapp III, of Case Western Reserve University in Cleveland, Ohio, followed 20 exercising women and 20 women who discontinued their exercise routine during pregnancy.
At birth the infants of the exercising women were slightly smaller and weighed less than the infants of the non-exercising women, but were still in the middle of the anticipated height and weight range for their gestational age.
A follow-up evaluation of the infants at five years of age found that the children of non-exercising women were slightly overweight. Furthermore, children in the exercise group had higher scores on oral language and general intelligence tests. (Journal of Pediatrics 129:856-863, 1996) Exercise during pregnancy benefits both mother and baby, with long-term benefits. Copyright Phylis Austin

TUB BATH DURING LABOR
 A warm bath may be very helpful in reducing pain during labor, but some have been reluctant to allow them because of the risk of infection. A study from Sweden reports no increased risk of infection in mother or infant, even if the woman has premature rupture of the membranes.
Earlier studies have cautioned that bathing increased the risk of infection, but in this study group no digital examinations were done until the women actually went into labor. Digital exams are known to increase the risk of infection, and may have been the source of the infections reported in the earlier study. (Acta Obstetrics and Gynecology Scandinavia 75:642-644, 1996) Copyright Phylis Austin

MATERNAL SMOKING/BEHAVIOR DISORDERS IN CHILDREN
 Women who smoke during pregnancy are more likely to have offspring with behavior disorders according to a recent study from The Netherlands. These changes were more pronounced in males than in females. (Archives of Environmental Health 52(4)317-321, July 1997) Copyright Phylis Austin

WEIGHT GAIN IN MULTIPLE PREGNANCY
 The incidence of multiple births has increased over the past 20 years, and currently about 2 percent of pregnant women carry twin gestations. The amount of weight these women should gain remains an unanswered question. The National Academy of Sciences suggested in 1990 that women carrying twin gestations should gain between 35 and 45 pounds during the pregnancy. Over 900 women were interviewed over a four-year period. Those with the most favorable pregnancy outcomes did not smoke, and gained 40 to 45 pounds. The researchers concluded that women carrying twins should gain at least one pound a week, with an overall weight gain of 35 pounds or more. (Journal of the American Dietetic Association 96(2)178-181, February 1996) Copyright Phylis Austin

LABOR INDUCTION/PROLONGED PREGNANCY
 Prolonged pregnancy is the most common single reason for labor induction. A study of nearly 25,000 pregnancies indicates that many women considered to be past their due date actually were not. The date of the last menstrual period is often used as a basis to calculate due dates, but we are coming to understand that this system often gives incorrect dates. Evaluation by ultrasound revealed that most of the women considered to be post term actually were not. (British Journal of Obstetrics and Gynecology 104:792- 797, July 1997) Copyright Phylis Austin

BAKER'S YEAST/CANDIDA ALBICANS YEAST INFECTION
 Women who do not wash their hands thoroughly after baking bread or using baker's yeast for any purpose may transfer the yeast to their vaginal area, where it may cause a yeast infection. (Medical Tribune: Obstetrician and Gynecologist Edition 4(6) 1997) Copyright Phylis Austin

EPIDURAL ANESTHESIA/FETAL AND MATERIAL COMPLICATIONS
 The use of an epidural anesthesia during childbirth may produce a fever in both the mother and child, which may lead to unnecessary suffering, testing and anxiety. About 14 percent of women who had an epidural anesthesia had fevers over 100.4 degrees F. and the newborns in this study were four times as likely to be subjected to testing and/or given antibiotics. (Pediatrics 99:415-419, 1997) Copyright Phylis Austin