Are tocolytics safe & effective?

A new study questions the safety of drugs used for pre-term labor, saying some are linked to complications and not always effective:

In an accompanying editorial, the researchers said their study is a reminder that the decision to use tocolysis shouldn't be taken lightly.

"After 30 years of research, we still do not know whether tocolysis benefits the fetus, so the choice of which drug to use remains a secondary question. The real dilemma is whether or not we should treat at all," they wrote. The long-held belief that "keeping the baby inside longer must be a good thing" needs to be reevaluated, they said.

Early Caesareans Pose Risks to Newborns

Research is catching up to what we knew all along: babies born by elective c-section prior to 39 weeks are at a significantly higher risk of medical problems. Even just a week can mean a huge difference for a baby's health. Complications of being born too early include respiratory distress, infections, and hypoglycemia. This is in addition to the normal risk of being born by c-section, as the New York Times article points out,

Doctors noted that even when babies born by Caesarean are delivered at the same week of pregnancy as babies delivered vaginally, they are at higher risk of respiratory difficulties because the process of labor and delivery primes the fetal lungs for breathing air.

Although the increasing prematurity rate in the US is often blamed on women with little to no prenatal care and poor nutrition, a large chunk of the problem is inductions or c-sections scheduled too early - perhaps in combination with incorrect due dates. Read between the lines of this quotation:

But Dr. Alan Fleischman, medical director of the March of Dimes, said the findings should reinforce the message that "every week counts" in a pregnancy. The women who were more likely to deliver early were white women with private health insurance, and the medical centers were all top-notch hospitals, he noted.

"These are not preterm babies, and these are pregnancies that should have good outcomes," he said.

Keep in mind that the research deals with "elective" cesareans, meaning there was no medical indication for the surgery. The National Partnership for Women and Families' article on the same study reports:

John Thorp, professor of obstetrics and gynecology at the University of North Carolina-Chapel Hill, said that there are differences between infants delivered at 37 weeks vaginally and those delivered via elective c-section. He said, "We would not worry about a 37-and-a-half week baby born vaginally with the onset of labor" because in that situation, "there is some signal from a baby to his mother that says 'I'm ready'"

More discussion and links are available at the Citizens for Midwifery blog. And check out a related press release from Lamaze International, Best Practices in Maternity Care Not Widely Used in the United States.

And as for my opinion, God (or Mother Nature, if you prefer) knew what He was doing. If a 37 or 38 week baby was ready to be born, he would have been born already. Anytime you force a baby to come early, whether through drugs or surgery, you have got to expect a baby that is not completely ready to face life "on the outside".

News Items

A couple items in the news caught my eye, regarding recent research studies:

Contaminants in human milk - not breastfeeding an infant typically poses more of a threat to the baby's health than does exposure to any of the chemicals which can be detected in breastmilk.

Depressed pregnant women have twice the risk of preterm delivery - A recent study found that pregnant women with symptoms of depression have an increased risk of preterm delivery, and that the risk grows with the severity of the depressive symptoms. Most of the women in the study were not taking medication for depression.

Caffeine intake during pregnancy - Any amount of caffeine intake by pregnant women increases the risk of low birth weight in their babies:

In light of this evidence, the UK Government's Food Standards Agency are altering their guidance on the recommended daily limit of caffeine consumption and reducing it from 300mg to 200mg.