General Anesthesia During Childbirth May be Risk Factor for Depression

New research suggests having general anesthesia in a cesarean delivery is linked with significantly increased odds of a variety of mental health concerns.
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Emergency caesareans put new mothers at higher risk of developing postnatal depression

A major study provides new evidence that emergency C-sections put new mothers at greater risk of experiencing mental health problems after giving birth.  Click here to read further.

NIHR Signal Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births

Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.

From the NIHR Dissemination Centre

NIHR Signal Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births

Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.

This UK trial looked at how position in labour affects the type of birth in first-time mothers after a low-dose epidural.

From the NIHR Dissemination Centre

NIHR Signal Caesarean section is better for extremely premature breech babies but not necessarily for their mothers

Delivering extremely preterm breech babies (23 to 27 weeks) by caesarean reduced the risk of infant death or brain bleeds by around 40% compared with vaginal delivery.

Choice of delivery is a balance of risks for mother and baby. There are immediate risks to the mother associated with anaesthesia and surgery but also risks in subsequent pregnancies following surgery on the immature uterus. In this review, there was limited information on outcomes for the mothers.

From the NIHR Dissemination Centre

The investigation of stillbirth

This House of Commons briefing discusses the way that stillbirth is investigated at present and the government announcement about independent investigations in future.

A rapid resolution and redress scheme for severe avoidable birth injury: government summary consultation response

This consultation response document summarises the views received through the 12-week Consultation on rapid resolution and redress scheme for severe birth injury, launched in March 2017.

Over 200 unique responses were received, from a range of stakeholders, including: family members with personal experience of birth injury; the organisations that support them; and frontline clinical and legal professionals.

Stillbirth risk is doubled if pregnant women sleep on their backs in third trimester

New research published in BJOG: An International Journal of Obstetrics and Gynaecology suggests that the risk of stillbirth is doubled if pregnant women sleep on their backs during the third trimester.

The Midlands and North of England Stillbirth Study (MiNESS) is the largest study of maternal sleep position and risk of stillbirth. It looked at 291 pregnancies that ended in stillbirth and 735 women who had a live birth.

The findings suggest women who go to sleep on their back - known as the supine position - have a 2.3 fold increase in risk of late stillbirth (after 28 weeks of gestation) compared with women who sleep on their side.

RCOG position on PLOS Medicine study: Inducing first-time mothers aged 35 and over earlier could reduce stillbirths and neonatal deaths

A study published in PLOS Medicine has found that inducing first-time mothers aged 35 and over at 40 weeks could reduce the risk of stillbirth and neonatal death (the death of a baby 7 days after birth), when compared to current guidelines which recommend induction of labour between 41 and 42 weeks for all women regardless of age.

Commenting on the study, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:
“This large study supports emerging research which suggests that moving forward the offer of induction to 40 weeks may play a role in reducing the proportion of stillbirths and neonatal deaths, but it should be emphasised that this study is the first to focus on a specific patient group – first time mothers aged 35 and over...

WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage

Postpartum haemorrhage (PPH) is a major cause of mortality, morbidity and long term disability related to pregnancy and childbirth. Effective interventions to prevent and treat PPH exist and can largely reduce the burden of this life-threatening condition.

Given the availability of new scientific evidence related to the use of tranexamic acid in the prevention and treatment of PPH, this document updates previous WHO recommendations.

NIHR Signal Vaginal cleansing before caesarean delivery reduces risk of infections

Cleaning the vagina with an antiseptic solution before a caesarean delivery halves the risk of subsequent womb infection. This evidence applies mainly to women who are having a caesarean delivery when already in labour or if their waters have broken.

Womb infections can occur up to six weeks after giving birth and are more common after caesarean delivery. Symptoms include fever, pain and increased vaginal discharge.

This review included 4,837 women who had a planned or unplanned caesarean delivery. It provides evidence of the benefits of this simple, low-cost procedure. Though it is not yet recommended in UK guidance, in theory it could prevent serious illness and future fertility problems secondary to infection.

From the NIHR Dissemination Centre

Tissue pathway for histopathological examination of the placenta

This tissue pathway from the Royal College of Pathologists aims to provide guidance on the range of indications for referral of aplacenta for histopathological examination and minimum standards for pathologists undertaking placental examinations. Variations to the standard pathway for singleton placentas, relating to pregnancies from multiple gestations, are also included. Please note that products of conception (1st trimester) have been included in the tissue pathways for gynaecological pathology.

Each Baby Counts full 2015 report

The Royal College of Obstetricians and Gynecologists (RCOG) has published the first full Each Baby Counts report into all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015.

Swings in dad's testosterone affects the family -- for better or worse -- after baby arrives

Testosterone levels are a key factor in a family's health and happiness after a newborn arrives. Researchers have found that a drop can signal postpartum depression in dad, and a spike may be a sign of aggression. Click here for further details.

Drug reduces deaths from bleeding after childbirth

Tranexamic acid, given to women who bleed heavily after giving birth, reduced the risk of death by 31% when given within three hours.

This trial included 20,060 women with postpartum haemorrhage who were randomly assigned to receive tranexamic acid or placebo. This is the first large study to indicate that it is safe and implies it should be considered as an early drug option for postpartum haemorrhage. In keeping with other recent research, there was no increase in risk of blood clots.

From the NIHR Dissemination Centre

Maternity care must not become further polarised

Bill Kirkup on the storm that has erupted following the royal college decision to withdraw its guidance on promoting normal birth Maternity care must not become further polarised

Last week, the Royal College of Midwives removed its guidance on promoting “normal” birth. That has been followed by an exchange of claims and counter claims in the press and in social media.

Teamwork in maternity units key to reducing baby deaths and brain injuries during childbirth

A detailed analysis of all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015 has identified key clinical actions needed to improve the quality of care and prevent future cases, reveals a summary report from the Royal College of Obstetricians and Gynaecologists’ (RCOG) Each Baby Counts initiative.

Mindfulness-focused childbirth education leads to less depression

A new study shows mindfulness training that addresses fear and pain during childbirth can improve women's childbirth experiences and reduce their depression symptoms during pregnancy and the early postpartum period.

RCOG statement on drug treatment for excessive blood loss after childbirth

A major trial published in The Lancet shows that a cheap and widely available medication can reduce deaths from severe bleeding after childbirth, the leading cause of maternal mortality worldwide. The study of 20,000 women from 21 countries shows that maternal deaths were reduced by 31%, and urgent surgery to stop life-threatening bleeding was decreased by 36%, if the tranexamic acid was given within three hours of delivery.

Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:

"The results of this important trial are very welcome and show that early administration of a cheap, widely available and heat-stable drug can reduce the number of maternal deaths from excessive bleeding after childbirth, also known as postpartum haemorrhage (PPH). The medication can also reduce the need for urgent surgery to stop life-threatening bleeding. "

Skin-to-skin contact improves breastfeeding of healthy babies

Early skin-to-skin contact improves breastfeeding of healthy full-term babies. Skin-to-skin contact is the direct contact between a naked baby and the mother’s bare chest. It can occur before or after the baby is cleaned following birth.

From the NIHR Dissemination Centre.