Childbirth Options: What's Best?

Find the childbirth option that’s right for you.By Brenda Conaway
WebMD FeatureReviewed by Melinda Ratini, DO, MS

Your baby's kicks and stretches are a daily reminder that you'll soon get to see your little one's smile. The type of birth experience you want is a very personal decision. Do you want a natural childbirth in a home-like setting? Or would you feel more comfortable with all the conveniences of modern medicine close at hand?

While today's mom's-to-be have more options than ever before, you may be limited by certain factors that include:

Where your provider practicesWhat your insurance coversWhether you have a high-risk pregnancyWhere you live and what hospitals are close by

The vast majority of women in the U.S. give birth in a hospital. If you have a high-risk pregnancy or want to try having a vaginal birth after a cesarean delivery (VBAC), then a hospital is the safest -- and often the only -- place you can deliver your baby. Even if you have a low-risk pregnancy, you may want to give birth in a hospital where you have ready access to the latest in medical technology.

Fortunately, the old stereotype of delivering your baby in a cold hospital room with your feet up in stirrups is long gone. Now, many hospitals provide options that range from practical to plush in order to make the labor and delivery experience more comfortable.

Traditional hospital birth. In some hospitals, you may move from one room to another depending on what stage of labor you are in. For example, you may go through labor and delivery in one room, recover in another, and then move to a semiprivate room. Your baby may be brought to your room for feedings and visits but stay in the hospital nursery the rest of the time. Not all hospitals follow the same routine, so ask what you can expect during your stay.

Family-centered care. Many hospitals now offer private rooms where you can go through labor, delivery, and recovery all in the same room. Often your partner can stay with you. These rooms are often decorated with pictures on the walls, soothing colors, and cabinets that hide medical equipment when it's not in use. After birth, your baby stays in your room with you.

In-hospital birthing center. These centers are either within a hospital or next to a hospital. They offer natural childbirth in a home-like setting. If problems occur during labor, you are just steps away from expert staff and medical equipment to help you and your baby.

Many hospitals also offer:

Childbirth and parenting classes and lactation consultantsCertified nurse-midwives on staffThe ability to have an unmedicated, "natural" deliveryBirthing pools or tubs for water birthsBirthing stools, birthing balls, and other equipment to help you feel comfortable during laborThe option to wear your own clothes during labor and deliveryThe option to have friends and family attend the birth and to videotape your delivery

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Low Vitamin D More Common in Overweight Kids

By Rita Rubin
WebMD Health News

Dec. 24, 2012 -- Overweight and obese children and teens are more likely to have low vitamin D levels than kids with healthy weights, a new study suggests.

The study is published in Pediatrics.

Vitamin D is essential for bone health. Bone growth is high during childhood and adolescence. So it may be especially important to identify and treat vitamin D deficiency during that time, the researchers write.

Vitamin D deficiency is also linked to a variety of chronic conditions, such as:

High blood pressureType 1 diabetesMultiple sclerosis

 Previous research suggests that obesity may put you at risk for vitamin D deficiency.

Researchers in the study analyzed data from more than 12,000 U.S. children and teens aged 6 to 18. The children were enrolled in the 2003-2006 National Health and Nutrition Examination Survey.

About 21% of the healthy-weight youngsters were deficient in vitamin D. That was also true for 29% of those who were overweight, 34% of those who were obese, and 49% of those who were severely obese.

Even after accounting for such factors as vitamin D supplementation and intake of milk, which is typically fortified with vitamin D, the rates of vitamin D deficiency were higher in Latinos and African-Americans. Among the severely obese youngsters, 27% of whites, 52% of Latinos, and 87% of African-Americans were deficient in vitamin D.

"The particularly high prevalence in severely obese and minority children suggests that targeted screening and treatment guidance is needed," the researchers conclude.

Researcher Christy Turer, MD, a pediatrician at the University of Texas Southwestern Medical Center and Children's Medical Center in Dallas, says she and her colleagues already were routinely checking vitamin D levels in children at specialty clinics, such as weight management clinics. Those found to be deficient are prescribed high-dose vitamin D supplements, a pill taken weekly. After eight weeks of treatment, their levels are rechecked, and if they're near normal, she'll cut them back to monthly doses of vitamin D supplements.

Turer also recommends that vitamin-D-deficient patients drink low-fat milk. If they don't like to drink plain milk, she says they can add artificially sweetened flavors that add only 15 calories a serving.

"The reason that milk is important is it has not just vitamin D, but it has calcium," she says. Unsweetened soy milk and almond milk are also good sources of vitamin D and calcium, Turer says.

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2 Cups of Milk a Day Optimal for Most Preschoolers

Dec. 17, 2012 -- Milk is an important source of vitamin D and calcium in young children’s diets. But drinking more than two glasses a day may lower how much iron is stored in their bodies, raising the risk for anemia, a new study suggests.

When researchers looked at daily milk intake as it related to iron and vitamin D levels in about 1,300 preschoolers, they found that drinking 2 cups of milk a day seemed optimal for most children, says lead researcher and pediatrician Jonathon L. Maguire, MD, of St. Michael’s Hospital in Toronto.

Vitamin D and iron are important nutrients for growing children. Iron plays a critical role in brain development. Iron deficiency has been linked to problems in movement. Vitamin D is important for many reasons, including bone health.

Milk is one of the best sources of vitamin D and calcium, while iron-fortified cereals and meats are among the best sources of iron.

Drinking 3 cups or more of milk was associated with slightly lower ferritin levels in the blood, but the levels were still within the normal range for most children. Ferritin levels indicate how much iron is stored in the body.

The more milk the children drank, the lower their ferritin levels tended to be.

“Milk is an important source of nutrition for young children, but the message to parents is that too much of a good thing may come with a trade-off,” Maguire says.

Though parents of preschoolers often ask how much milk their young children should be drinking, Maguire says the answer is not that clear.

He points out that the American Academy of Pediatrics recommends limiting cow’s milk to about 2 cups a day for preschoolers, but the group’s committee on nutrition also calls for vitamin D supplements for children who drink less than about 4 cups a day (1,000 mL).

It isn’t clear if drinking milk directly blocks iron absorption or if its impact is less direct.

“Cow's milk doesn’t have much iron, and it may be that kids who drink a lot of it are not eating other foods that are rich sources of iron,” Maguire says. “We really don’t know.”

In the study, published in the journal Pediatrics, each 8-ounce cup of milk a child drank was associated with a 3.5% drop in ferritin levels.

“That may not sound like a lot, but it can add up, especially in children with other risk factors for iron deficiency,” Maguire says.

The researchers noted that vitamin D supplements may be important for darker-skinned children or for children who get little vitamin D from the sun. The body makes vitamin D when exposed to sunlight.

Pediatrician Steven Abrams, MD, a member of the AAP committee on nutrition, says parents shouldn’t stress too much about exactly how much of a certain food their child eats, as long as the child is eating a variety of healthy foods.

“Most of the children in this study who drank a lot of milk were not iron deficient,” he says. “The effect of milk on iron status was pretty small.”

In a statement addressing the study, the National Dairy Council pointed out that it is not clear if drinking milk has a direct impact on iron levels.

“This study supports the role and importance of milk in helping children meet their nutrient needs, specifically vitamin D, when following recommended guidelines for milk consumption,” the statement reads.

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About 100,000 Water-Expanding Toys Recalled

Dec. 18, 2012 -- Dunecraft Inc. is voluntarily recalling nearly 100,000 Water Balz, Growing Skulls, H2O Orbs “Despicable Me,” and Fabulous Flowers because of serious risks associated with swallowing these marble-sized toys.

The toys absorb water and can increase to more than 400 times their original size. If swallowed, they expand and can cause a blockage in the small intestines. This may cause discomfort, vomiting, dehydration, or death. They will not show up on an X-ray. Surgery is needed to remove the toys.

The Cleveland, Ohio-based manufacturer has received one report that an 8-month-old swallowed a Water Balz and needed surgery to have it removed.

The recalled toys are sold in packages of six in green, yellow, red, blue, and black. The company name, toy name, and model number appear on the toy's package.

These include:

Water Balz (Model Number BC-0338)Growing Skulls (Model Number BC-0320)H2O Orbs "Despicable Me" (Model Number DM-0447)Fabulous Flowers (Model Number BC-0440)

Water Balz and Growing Skulls were sold at Bed Bath & Beyond, Five Below, Hobby Lobby, Lakeshore Learning Materials, Microcenter, Urban Outfitters Direct, Wegmans, and other stores nationwide. They were also sold online at Amazon, Incredible Science, Keyport Hobbies, American Toy Stores, and other web sites from September 2010 through November 2012 for about $3 per package.

The H2O Orbs "Despicable Me" were sold exclusively at Universal Studios stores during June 2012 for about $3 per package. Fabulous Flowers were sold exclusively at Milaeger's in Racine, Wis., from June 2012 through November 2012 for about $3 per package.

Parents should immediately keep the toys away from children and contact the company for a free replacement toy at 800-306-4168, from 8 a.m. to 5 p.m. ET Monday through Friday, or online at Dunecraft's web site and click on the recall tab for more information.

Report any issues with the recalled toys to the U.S. Consumer Product Safety Commission at SaferProducts.gov.

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Thousands of Mistakes Made in Surgery Every Year

Dec. 26, 2012 -- More than 4,000 preventable mistakes occur in surgery every year at a cost of more than $1.3 billion in medical malpractice payouts, according a new study.

How preventable? Well, researchers call them "never events" because they are the kind of surgical mistakes that should never happen, like performing the wrong procedure or leaving a sponge inside a patient's body after surgery.

But researchers found that paid malpractice settlements and judgments for these types of never events occurred about 10,000 times in the U.S. between 1990 and 2010. Their analysis estimates that each week surgeons:

Leave a foreign object like a sponge or towel inside a patient's body after an operation 39 timesPerform the wrong procedure on a patient 20 timesOperate on the wrong body site 20 times

"I continue to find the frequency of these events alarming and disturbing," says Donald Fry, MD, executive vice president at Michael Pine and Associates, a health care think tank in Chicago. "I think it's a difficult thing for clinicians to talk about, but it is something that must be improved."

In the study, researchers looked at malpractice claim information for surgical never events from the National Practitioner Data Bank from 1990 to 2010. The results are published in Surgery.

Malpractice settlements and judgments relating to leaving a sponge or other object inside a patient, performing the wrong operation, operating on the wrong site or on the wrong person were included in their analysis.

The results showed a total of 9,744 paid malpractice judgments and claims for these types of never events were reported over the 20-year period, totaling $1.3 billion.

Based on these results, researchers estimate that 4,044 surgical never events occur each year in the U.S.

Researchers say the actual number of these surgical mistakes is likely even higher.

"What we report is the low end of the range because many never events go unreported," says researcher Marty Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine.

Makary says by law, hospitals are required to report never events that result in a settlement or judgment.

But not all items left behind after surgery are discovered. They are typically only reported when a patient experiences a complication after surgery, and doctors try to find out why.

"We believe the events we describe are real," says Makary. "I cannot imagine a hospital paying out a settlement for a false claim of a retained sponge."

The consequences of surgical mistakes ranged from temporary injury in 59% of the cases to death in 6.6% of the cases and permanent injury in 33% of people affected.

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Social Media, Tweens, and Teens: Pointers for Parents

By Rebecca Felsenthal Stewart
WebMD Feature

Whether or not you're tweeting or sharing your daily thoughts on Facebook, you have to acknowledge it: Interacting with friends online is a fact of life for your children.

"These connections are really integral to the social lives of today's kids," says Caroline Knorr, parenting editor for Common Sense Media, a nonprofit organization that helps families navigate the world of media and technology.

Besides the benefits, there are also risks. That's where you come in.

"It's a parent's responsibility to parent around the technology", says Shawn Marie Edgington, author of The Parent's Guide to Texting, Facebook and Social Media.

Facebook, Instagram, and Twitter all require children to be at least 13 years old to join. That's because of the "Children's Online Privacy Protection Act," which limits companies from collecting personal information about kids under 13. "

Some kids younger than 13 dodge those age limits by faking their birth date and setting up an account, whether their parents know it or not. 

"Parents need to ask their children on a regular basis, ‘Do you have a Facebook account? Do your friends?'" Edgington says. She recommends that when you buy your child a cell phone, one of the conditions is that she can't get a Facebook, Twitter, or Instagram account until age 13 and you approve it.

If you’re tempted to make an exception for them, you might want to consider the message you're sending if you allow them to break the rules by lying, about whether they're mature enough to behave safely and responsibly, and about what you will do to monitor their activity (such as "friending" them).

Once your child is of age and has your permission, sit down together to set up the account. Use all the privacy restrictions available and don't give unnecessary information like cell phone numbers, Knorr says.

This is also a good time to talk about what not to post, such as your home address, your child's location, and any inappropriate pictures (including those that have "geotagging" that gives away the child's location.)

Instruct her never to "friend" anyone she doesn't know, and never to share her password, Edgington says. Tell her that she can come to you if anything happens online that makes her uncomfortable.

Write a contract for your child about how they behave on social media. Outline consequences: "If you take away a 16-year-old's cell phone, it's worse than taking away his car," Edgington says.

Remind your child that social rules apply online, Knorr says.

Explain that it comes down to how she wants to portray herself to the world, and that once something is online, it's hard to make it go away. "Everything your child posts is about his image and brand because it's going to be there forever," Edgington says. Colleges and employers check social networking sites and do Google searches on applicants. 

Though the concept of long-term consequences may not click with your child right away, keep reinforcing it.

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New Procedure May Aid Stubborn High Blood Pressure

Dec. 18, 2012 -- People who can’t get their high blood pressure down with drugs may be helped by a new procedure that deactivates overactive nerves in the kidneys, a small study shows.

The procedure is already available in Europe and other countries. It’s being tested in the U.S.

It’s meant to treat people with a severe type of high blood pressure that’s difficult to control, even with multiple medications. People who develop this condition, which is called resistant hypertension, are at higher than average risks for strokes, heart attacks, kidney disease, and heart failure. Resistant hypertension affects about 1 in 11 people who have high blood pressure.

“We all have these patients. They’re very thin. They exercise. They eat right. They’re on four medications and it’s still very difficult to control their blood pressure,” says Varinder Singh, MD, chairman of cardiology at Lenox Hill Hospital in New York City.

“In those patients, you’re looking for another treatment method,” says Singh, who was not involved in the research. “I look forward to having this.”

The procedure is done under local anesthesia. Doctors make a small incision in an artery near the groin and use it to thread a catheter up to the kidneys. A machine then fires short bursts of radio waves to deaden the sympathetic nerves.

“The sympathetic nerves are the stimulant nerves of the kidneys. They are commonly activated in [high blood pressure],” says researcher Murray Esler, MD, PhD, professor and senior director of the Baker IDI Heart and Diabetes Institute in Melbourne, Australia.

When the nerves are overactive, they cause the body to retain too much sodium. Too much sodium drives up blood pressure, Esler says.

The new study is a continuation of a trial that assigned 106 patients to receive either the new procedure or usual care.

People were enrolled in the study if they were on at least three medications for high blood pressure and had a baseline systolic blood pressure, the top number, over 160, or over 150 if they had diabetes. Most continued to struggle with high blood pressure, despite taking an average of five different medications. 

At the end of six months, people who got the new procedure, which is called renal denervation, saw their blood pressure drop from an average of 178/97 to 143/85, while people who continued getting usual care actually saw their high blood pressure climb slightly.

For the second phase of the study, researchers asked members of the comparison group if they wanted to try the new procedure. Most did. 

Their results were similar to those of patients in the first treatment group. The majority of patients saw their blood pressure drop by at least 10 points. Average reductions for the group were even bigger, about 20 to 30 points for systolic blood pressure, the top number. Diastolic blood pressure, the bottom number, was also lowered significantly.

But most people didn’t see their blood pressures return to normal levels. Normal blood pressure is considered to be less than120/80.

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Kids With Food Allergies Targets for Bullies

Dec. 24, 2012 -- Colorado Springs high school junior Morgan Smith can’t remember a time when he didn’t have life-threatening food allergies.

The 16-year-old had his first reaction to peanut butter at 9 months of age when he broke out in hives after touching his sister’s PBJ sandwich.

He had his first run-in with a peanut butter bully in first grade.

The classmate chased him around the playground during recess with a pack of peanut butter crackers saying he was going to kill him with them.

Morgan says he wasn’t exactly terrified, but he didn’t find the incident funny either because he knew even casual contact with the crackers could make him sick.

His food allergies made him a target of another bully soon after that and again in middle school.

Now a new study from Mount Sinai Medical Center confirms that Morgan’s experience is far from unique.

Nearly 1 in 3 children who took part in a survey at the Center’s Jaffee Food Allergy Institute reported having been bullied, but nearly half of parents said they were not aware of the bullying. They also found that about a third of the children reported bullying especially because of their food allergies.

The survey also found that bullying was a bigger contributor to stress and reduced quality of life than food allergies themselves.  

Food allergies are on the rise among children, up almost 20% in the U.S. in just over a decade, with 5% of children allergic to foods such as peanuts, tree nuts, milk, eggs, and shellfish, according to the National Institute of Allergy and Infectious Diseases.

“We found that when parents knew about the bullying the children’s quality of life tended to be better, but about half the time parents didn’t know,” says researcher and pediatric psychiatrist Eyal Shemesh, MD. “And they often didn’t know about the most serious incidents.”

The Mount Sinai researchers surveyed 251 children and their parents recruited from the Center’s food allergy center.

The parents and children were surveyed separately to discern whether the children had been bullied about food allergies or for other causes.

In all, 45% of the children and 36% of the parents reported that bullying had occurred, and 31% of children and 25% of parents reported that the bullying had included threats with food.

Close to 1 in 3 bullied children had been taunted with the food they were allergic to, 12% had been forced to touch it, and 10% had had it thrown at them. More than half of the incidents occurred at school.

The study was published online today in the journal Pediatrics.

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