Saturday, October 11, 2008

Midwives found to aid babies' survival

I am all in favour of midwives. I even married one once. So I am favourably disposed to the view that midwives do a good job. I have to point out again, however, that the causal chain is assumed rather than proven below. The finding probably tells us more about the sort of women (healthier women? Women who have previously given birth easily?) who choose midwife-assisted birth rather than anything else

WOMEN who are cared for by midwives rather than GPs or obstetricians are less likely to lose their babies within the first six months of their pregnancies, an international review of mat-ernity services has found. Researchers gave no reasons for the shock finding, taken from an analysis of 11 trials involving more than 12,200 women in four countries, but a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said women who were seen by the same midwife during pregnancy, labour and birth usually felt more supported and less anxious, leading to reduced risk of miscarriage.

That explanation has frustrated the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which says its members provide the same level of continuous care to their patients and could not be held accountable for miscarriages or stillbirths that occurred so early in pregnancy. "One third of women see private obstetricians and we all give continuity of care," the college's president, Christine Tippett, said yesterday. "I am on call 24 hours a day, seven days a week and I deliver about 90 per cent of my women. I think it is drawing a very long bow to link miscarriages before 24 weeks with continuity of care. Most miscarriages occur because of foetal or chromosomal abnormalities and there is no evidence to suggest the mode of care makes any difference."

The analysis, which is the largest undertaken in the world, also found that women in midwife-led models of care were less likely to be admitted to hospital during pregnancy, have instrumental deliveries, episiotomies or require analgesia and were more likely to have spontaneous vaginal births, feel in control during labour and better able to initiate breastfeeding.

Dr Dahlen said the analysis, published by the Cochrane collaboration, considered the gold standard of assessing medical evidence, proved that midwife-led models of care had no adverse outcomes and many benefits. "If this was a tablet, it would be mandatory that all women have it, but instead we have to deal with all this shroud waving by obstetricians. Now we know the evidence for their claims just isn't there," she said.

The Australian College of Midwives has long argued that better use of midwives would reduce the national caesarean rate, now at 31 per cent, cutting the number of people taking up operating theatres and beds in wards. However, the analysis showed there was no significant difference between the two groups when it came to caesareans, despite a recent Australian study which indicated surgery in midwife-led care occurred 4 per cent less often than under medical models. "Not many people realise that women having babies accounts for the largest single use of our hospitals every year, so if we want to … look after people on waiting lists, we should be looking at how we can provide good primary care to healthy pregnant women instead of channelling them into surgical theatres in their tens of thousands," the Australian College of Midwives vice president, Chris Cornwall, said.

The analysis also showed there was no significant difference between the two groups when it came to foetal deaths after six months gestation, length of labour, induction, intervention, premature births and admissions to neonatal intensive care units.


Marketers jump on superfoods fad

Experts say "superfoods", touted by marketers as miracle products, are about to hit Australian shelves in the race for our consumer dollars. In the UK, more items are added to a growing list of so-called superfoods with regular monotony - sometimes on the back of a small and dubious study. Cherry juice last month was hailed as the latest wonder drink after research found a 250ml glass offered the same health benefits as eating 23 portions of fruit and vegetables. The study also found it contained more anti-oxidants than five portions of peas, tomatoes, watermelon, carrots and banana.

Making it on to the "superfoods" list is a marketer's dream. UK sales of blueberries, for instance, have skyrocketed by 132 per cent since 2005, while salmon sales increased by 31 per cent in the same period. Spinach sales also have risen, likewise beetroot. Expensive exotic fruits and berries often are deemed to be in the same category as acai and noni fruit, boosting sales.

Adelaide-based physician and author of the best-selling CSIRO Total Wellbeing Diet, Dr Peter Clifton, has heard it all before and warns to be sceptical. "I think it will come here as well," he said. "But it's very difficult to describe any food as a superfood. They all have relatively weak physiological effects. Compared with a drug, food is a very, very weak thing, so be very cautious, rather than believe the marketers."

He and co-author Dr Manny Noakes, have just released another book, The CSIRO Healthy Heart Program. That lists superfood categories - fish and omega 3 fatty acids, low-fat dairy foods, nuts, whole grains, legumes, and oils and seeds - rather than singling out any one food. "I do think it is an overstatement to talk about superfoods and we do need to be careful about talking about food rather like snake oil," Dr Noakes said. She also singles out another buzz-word for scepticism. "There's no proven benefit of anti-oxidants in food at this point in time." she said. "There may be something in it but none of the studies has shown any proven benefit from increasing anti-oxidants in diet."

Both authors maintain the best way to health and happiness is a balanced diet including fruits and vegetables. Cancer Council nutrition spokesman Terry Slevin says, despite Australia's food regulations, marketers may be able to dub their product as a superfood provided there is some form of substantiation. "In terms of the current regulations, it might have to be tested in court but I'm pretty sure the term itself is not specifically banned," he said.


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