Preventive Labor Induction‐AMOR‐IPAT: Much Promise,Not Yet Realized

ABSTRACT: “Preventive Labor Induction‐AMOR‐IPAT” is a method designed to time induction before the fetus becomes too large or the placenta dysfunctional. In two retrospective cohort studies and one randomized trial, the developers claim to have reduced cesarean section rates and improved newborn outcomes. These claims have yet to be substantiated in an adequately powered trial, but having decided on the need for an induction, the investigators do manage inductions in a woman‐centered and intimate style that has merit. (BIRTH 36:1 March 2009)     

Breastfeeding,Bed‐Sharing,and Infant Sleep

Abstract: Background: Expectations for infant sleep development and for the appropriate degree of parental proximity for infant sleep are culturally weighted and historically shifting aspects of parenting behavior, and are known to affect breastfeeding prevalence and duration. This paper examined how new parents managed night‐time feeding in the first 4 months, with a particular focus on the relationship between breastfeeding, infant sleep location, and sleep bout duration. Methods: Sleep logs and semistructured interviews were used with a sample of 253 families in North Tees, United Kingdom, to explore how parents responded to their infant's sleep patterns, how breastfeeding parents managed night‐time feeding, and whether bed‐sharing was a common strategy. Results: A clear relationship between breastfeeding and parent‐infant bed‐sharing was demonstrated. Some evidence indicated that bed‐sharing may promote breastfeeding. Conclusions: An understanding of the role of infant feeding practice on infant sleep and parental caregiving at night is a crucial element in breastfeeding promotion and enhancement of infant health. Health professionals should discuss safe bed‐sharing practices with all parents. (BIRTH 30:3 September 2003)     

Gamma‐aminobutyric acidA receptor agonist,muscimol, increases KiSS‐1 gene expression in hypothalamic cell models

Purpose

Accumulating evidence indicates that hypothalamic kisspeptin plays a pivotal role in the regulation of the hypothalamic–pituitary–gonadal (HPG) axis. In this study, the direct action of the gamma‐aminobutyric acid (GABA)_A receptor agonist on kisspeptin‐expressing neuronal cells was examined.

Methods

A hypothalamic cell model of rat hypothalamic cell line R8 (rHypoE8) cells and primary cultures of neuronal cells from fetal rat brains were stimulated with a potent and selective GABA_A receptor agonist, muscimol, to determine the expression of the KiSS‐1 gene.

Results

Stimulation of the rHypoE8 cells with muscimol significantly increased the level of KiSS‐1 messenger (m)RNA expression. The ability of muscimol to increase the level of KiSS‐1 mRNA also was observed in the primary cultures of the neuronal cells from the fetal rat brains. The muscimol‐induced increase in KiSS‐1 mRNA expression was completely inhibited in the presence of the GABA_A receptor antagonist. Although muscimol increased the expression of KiSS‐1, the natural compound, GABA, failed to induce the expression of KiSS‐1 in the rHypoE8 cells. Muscimol did not modulate gonadotropin‐releasing hormone expression in either the rHypoE8 cells or the primary cultures of the fetal rat brains.

Conclusions

This study's observations suggest that the activation of the GABA_A receptor modulates the HPG axis by increasing kisspeptin expression in the hypothalamic neurons.     

Outcomes of Free‐Standing,Midwife‐Led Birth Centers: A Structured Review

Abstract: Background : Over the last two decades, childbirth worldwide has been increasingly concentrated in large centralized hospitals, with a parallel trend toward more birth interventions. At the same time in several countries, interest in midwife‐led care and free‐standing birth centers has steadily increased. The objective of this review is to establish the current evidence base for free‐standing, midwife‐led birth centers. Methods : A structured review, based on Cochrane guidelines, was conducted that included nonrandomized studies. The comparative outcomes measured were rates of normal vaginal birth; cesarean section; intact perineum; episiotomy; transfers; and babies remaining with their mothers. Results : Of the 5 controlled studies that met the review criteria, all except one was a single site study. Since no study was randomized, meta‐analysis was not performed. The included studies all raised quality concerns, and significant heterogeneity was observed among them. For the outcomes measured, every study reported a benefit for women intending to give birth in the free‐standing, midwife‐led unit. Conclusions : The benefits shown for women recruited into the included studies who intended to give birth in a free‐standing, midwife‐led unit suggest a question about the efficacy of consultant unit care for low‐risk women. However, the findings cannot be generalized beyond the individual studies. Good quality controlled studies are needed to investigate these issues in the future.     

Trends in Midwife‐Attended Births in the United States, 1989‐2009

Introduction: Data on attendance at birth by midwives in the United States have been available on the national level since 1989. Rates of certified nurse‐midwife (CNM)–attended births more than doubled between 1989 (3.3% of all births) and 2002 (7.7%) and have remained steady since. This article examines trends in midwife‐attended births from 1989 to 2009. Methods: The data in this report are based on records gathered as part of the US National Standard Certificate of Live Birth from a public use Web site, Vital Stats ( http://www.cdc.gov/nchs/VitalStats.htm ), that allows users to create and download specialized tables. Results: Between 2007 and 2009, the proportion of all births attended by CNMs increased by 4% from 7.3% of all births to 7.6% and a total of 313,516. This represents a decline in total births attended by CNMs from 2008 but a higher proportion of all births because total US births dropped at a faster rate. The proportion of vaginal births attended by CNMs reached an all‐time high of 11.4% in 2009. There were strong regional patterns to the distribution of CNM‐attended births. Births attended by “other midwives” rose to 21,787 or 0.5% of all US births, and the total proportion of all births attended by midwives reached an all‐time high of 8.1%. The race/ethnicity of mothers attended by CNMs has shifted over the years. In 1990, CNMs attended a disproportionately high number of births to non‐white mothers, whereas in 2009, the profile of CNM births mirrors the national distribution in race/ethnicity. Discussion: Midwife‐attended births in the United States are increasing. The geographic patterns in the distribution of midwife‐attended births warrant further study.