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Thursday, December 31, 2009

Maple Grove's Opening Act? A C-Section

The first hospital to be built in the metro area in 10 years opened it's doors to business today. It's first act? A scheduled cesarean.

WCCO reports:

Melissa Bistodeau, had a scheduled C-Section in the afternoon. She, along with her husband Joe Bistodeau, and son Cole, got the royal treatment.

Nurses and doctors gave them a standing ovation as they made their way to their room.

The hospital is opening in stages, due at least in part to the current recession. It's current focus in on labor and delivery, and it's marketing campaign to attract patients appears to be working. The hospital website heralds its facility as the "region's premier birth center" and boasts of labor and delivery suites that help you feel "at home."

According to the Star Tribune (emphasis added):

On Saturday, nearly 6,000 visitors showed up for an open house at the new facility. People milled around the lobby clutching gift bags and chatting with Cochrane as the Maple Grove High School jazz band played. Kids got their faces painted. Outside, families posed for photos in front of a North Memorial helicopter.

Todd and Christine Nelson of Ramsey were in a long line waiting to tour the birth center and surgical area. Christine is expecting her first baby in April. She says she changed obstetricians so she could deliver at Maple Grove.

Hmmmm. The birth center AND surgical area? Since when do these two things go together? I guess the state's 26% cesarean rate might tell us something about that.

While Maple Grove Hospital may be selling itself as the best maternity care around, evidence from scientific research suggests other standards. The Milbank Report on Evidence-Based Maternity Care: What it is and What it Can Achieve, based on a rigorous analysis of the best scientific studies of childbirth available, states (emphasis added):

Although most childbearing women and newborns in the United States are healthy and at low risk for complications, national surveys reveal that essentially all women who give birth in U.S. hospitals experience high rates of interventions with risks of adverse effects. Optimal care avoids when possible interventions with increased risk for harm. This can be accomplished by supporting physiologic childbirth and the innate, hormonally driven processes that developed through human evolution to facilitate the period from the onset of labor through birth of the baby, the establishment of breastfeeding, and the development of attachment. With appropriate support and protection from interference, for example, laboring women can experience high levels of the endogenous pain-relieving opiate beta-endorphin and of endogenous oxytocin, which facilitates labor progress, initiates a pushing reflex, inhibits postpartum hemorrhage, and confers loving feelings. Large national prospective studies report that women receiving this type of care are much less likely to rely on pain medications, labor augmentation, forceps/vacuum extraction, episiotomy, cesarean section, and other interventions than similar women receiving usual care. Such physiologic care is also much less costly and thus provides outstanding value for those who pay for it. Burgeoning research on the developmental origins of health and disease clarifies that some early environmental and medical exposures are associated with adverse effects in childhood and in adulthood. Recognition of known harms and the possibility that many harms have not yet been clarified further underscores the importance of fostering optimal physiologic effects and limiting use of interventions whenever possible.

Unless the care providers at Maple Grove Hospital (or any birth place, for that matter) support this kind of evidence-based care, expectant mothers and families in the Twin Cities might want to think twice before signing up for this "premier" birth center.

Tuesday, December 15, 2009

Dads get post partum depression, too

The great discussion at last night's support meeting ("Healing From Traumatic Birth") reminded me of this recent article from the New York Times on fathers and post partum depression.

According to the article:

Up to 80 percent of women experience minor sadness — the so-called baby blues — after giving birth, and about 10 percent plummet into severe postpartum depression. But it turns out that men can also have postpartum depression, and its effects can be every bit as disruptive — not just on the father but on mother and child.

We don’t know the exact prevalence of male postpartum depression; studies have used different methods and diagnostic criteria. Dr. Paul G. Ramchandani, a psychiatrist at the University of Oxford in England who did a study based on 26,000 parents, reported in The Lancet in 2005 that 4 percent of fathers had clinically significant depressive symptoms within eight weeks of the birth of their children. But one thing is clear: It isn’t something most people, including physicians, have ever heard of.

 I guess it really shouldn't be surprising. Childbirth certainly transforms life for a woman who becomes a mother, but men go through a significant change as well, often bringing up new worries about the health and well-being of their partners and children, as well as increased financial and other strain. In the case of men whose partners have had traumatic birth experiences, the rate of post partum depression might be even higher.

So, why don't we know more about this? Again, from the article:

Unlike women, men are not generally brought up to express their emotions or ask for help. This can be especially problematic for new fathers, since the prospect of parenthood carries all kinds of insecurities: What kind of father will I be? Can I support my family? Is this the end of my freedom?

And there is probably more to male postpartum depression than just social or psychological stress; like motherhood, fatherhood has its own biology, and it may actually change the brain.

A 2006 study on marmoset monkeys, published in the journal Nature Neuroscience, reported that new fathers experienced a rapid increase in receptors for the hormone vasopressin in the brain’s prefrontal cortex. Along with other hormones, vasopressin is involved in parental behavior in animals, and it is known that the same brain area in humans is activated when parents are shown pictures of their children.

There is also some evidence that testosterone levels tend to drop in men during their partner’s pregnancy, perhaps to make expectant fathers less aggressive and more likely to bond with their newborns. Given the known association between depression and low testosterone in middle-aged men, it is possible that this might also put some men at risk of postpartum depression.

Well, duh. I guess we could have guess at the whole men-don't-express-their-emotions well. But the biological links are not something that I had ever thought about.

So, what can we women, their wives and partners, do about it? One thing is to get help for our own depression. The reason is this:

By far the strongest predictor of paternal postpartum depression is having a depressed partner. In one study, fathers whose partners were also depressed were at nearly two and a half times the normal risk for depression. That was a critical finding, for clinicians tend to assume that men can easily step up to the plate and help fill in for a depressed mother. In fact, they too may be stressed and vulnerable to depression.

There are lots of resources in the Twin Cities community for support in healing from depression and other difficult emotions after birth. Whether you had a traumatic experience or the most wonderful birth imaginable, post partum depression can be a serious, but not insurmountable, issue - not only for moms, but for dads too.

Click here for a list of local resources.