103 W. State Street Boise, Idaho (208) 342-7642 www.idahoperinatal.org 1

Idaho Perinatal

Project News

Lending Library: What’ s New

Tool Kit: Postpartum Depression Screening Book: Breaking the Silence: Depression Around Childbirth Please visit www.idahoperinatal.org to see a complete list of holdings.

Fall 2005

Mark Your Calendars The Idaho Perinatal Project Winter Conference is scheduled for February 2 & 3, 2006. The new streamlined conference schedule has been modified from three to two days. Thursday, February 2, 2006, will focus on Obstetrical issues. Friday, February 3, 2006, will consist of parallel tracks which focus on Gynecological and Newborn/Pediatric issues.

Inside This Issue 2. Increased Incidence of Fraternal Twins 3. Flu Season is Approaching 4. Calendar of Events

Lay Midwives and Their Role in Idaho by Clarence W. Blea, MD Maternal Fetal Medicine Specialist Chairman, Idaho Perinatal Project The Idaho Perinatal Project’s mission, as described on our Home page, is consistent with our current goal to address the increasing role of lay practitioners in the practice of obstetrics in our community. We feel this is important, as there is a perception in the medical community disparate from that of the lay community regarding the role of midwives. In addition to providing education for the lay and medical community, we are opening avenues of discussion between lay care providers, lay midwives, and certified midwives in Idaho. Continued on page 2

103 W. State Street Boise, Idaho (208) 342-7642 www.idahoperinatal.org 2

Continued from page 1

The assertion from rural hospitals and their medical providers is that quality-of-care issues have come to light when patients of lay practitioners delay medical intervention and present at the emergency room in crisis.

Traditionally, Idaho has had no specific practice guidelines that apply to lay practitioners in relation to obstetrics. Conversely, there have been somewhat stringent regulatory patterns when licensed nurse midwives practice in a medical setting. There also appear to be midwives that have had some level of training, yet have chosen to not operate within the confines of the medical institution, choosing instead to practice at either a birthing center or other non-hospital facility.

It is our intent to open a dialogue with Idaho midwives, and to increase channels of communication and awareness, in an attempt to improve quality of care. We intend to offer a means whereby either certification, standardization, or educational opportunities are provided to all practitioners, regardless of level of training so as to enhance the quality of obstetrical care provided by lay providers. Our goal is timely presentation to medical care facilities when needed, in an attempt to improve maternal/child outcomes – or perhaps eventually have health care providers that will agree to participate in a formalized fashion with lay midwives.

It may be also useful to consider collection of demographic data (such as outcomes) for patient populations utilizing lay midwives, and communicate these findings to the lay public, medical community, and legislators in order to stimulate legislation for the regulation of these lay providers. It is not necessarily the Idaho Perinatal Project’s intent to limit the practice of these lay providers, but simply – as we are not necessarily affiliated with any medical care providers per se – to enhance obstetrical and pediatric outcomes. We are currently making headway toward this goal, as our initial attempts at dialogue and data collection have already sparked attention and communication from the medical and midwife communities. We invite you to join in this discussion. Please contact Sherry Iverson, Idaho Perinatal Project director, at iversons@slrmc.org or call (208) 342-7642.

Increased Incidence of Fraternal Twins Among Obese and Tall Women IVillage Childbirth Education Connection Newsletter July 2005 It used to be that the chance of having twins, especially identical ones, was a random event with less than one occurrence every 100 births. Not so anymore. According to a study in the March issue of Obstetrics & Gynecology, the US incidence of fraternal twins increased by 65% between 1980 and 2002 (from 18.9 to 31.1 per 1,000 live births). Aside from the obvious trends of increased maternal age at birth and the increased use of fertility drugs and assisted reproductive technologies, the study finds that women with a pre-pregnancy body mass index (BMI) of 30 or more are significantly more likely to have fraternal twins. Women in the top 25th percentile of height had significantly increased odds ratio for fraternal-twin pregnancies, although this association was not as strong as that for BMI. With the proportion of US women ages 20-39 with a BMI of 30 or more increasing from 9.3% in the early 1960’s to 29.1% in 1999-2002, the rate of twin births is likely to increase as the percentage of obese women in the US continues to rise. For a full view of this article, visit www.idahoperinatal.org, News, then OB Update.

March of Dimes Idaho Chapter Community Grant Program

To obtain an application, contact:

Callie Kidd March of Dimes – Idaho Chapter

3222 W. Overland Rd Boise, ID 83705

1-800-336-5421 or (208) 336-5438 ckidd@marchofdimes.com

The Idaho Department of Health & Welfare, Bureau of Health Policy and Vital Statistics has provided the Idaho Perinatal Project with the new Prematurity Fact Sheet and statistics regarding dental care during pregnancy. To access this information, visit www.idahoperinatal.org, News, and click on the links.

103 W. State Street Boise, Idaho (208) 342-7642 www.idahoperinatal.org 3

Counseling and Treating Obese Patients During Pregnancy ACOG Today September 2005 The increase of obesity in the US in recent years means ob-gyns are seeing more patients who are obese and pregnant or planning to become pregnant. A new ACOG Committee Opinion addresses the increased health risks obese women face in pregnancy and encourages ob-gyns to provide preconceptional counseling and education to patients about possible complications. In additions, ob-gyns should encourage obese patients to undergo a weight-loss program before attempting pregnancy, according to Obesity in Pregnancy, which was published in the September issue of the Green Journal. Studies of obese pregnant women have shown increased risks of gestation hypertension, preeclampsia, gestational diabetes, fetal macrosomia, and cesarean delivery. Operative and postoperative complications include increased rates of excessive blood loss, operative time greater than two hours, wound infections, and endometritis, according to the document. The document says ob-gyns should consider screening for gestational diabetes during the first trimester and repeat testing later in pregnancy if the initial screening is negative. Ob-gyns are also encouraged to conduct an anesthesiology consultation antepartum because obese pregnant women have an increased risk for emergent cesarean delivery and anesthetic complications such as difficult epidural and spinal placement and intraoperative respiratory events from failed or difficult intubation. For the remainder of this article, visit www.idahoperinatal.org, News, OB Update.

Flu Season is Approaching: Are You Immunizing Your Pregnant Patients? ACOG Today September 2005 Ralph W. Hale, MD, FACOG Executive Vice President In November last year, the Committee on Obstetric Practice issued a Committee Opinion called Influenza Vaccination and Treatment During Pregnancy. I hope everyone who cares for pregnant women has read this important document. As the Committee Opinion states, “Influenza vaccination is an essential element of prenatal care.” The Committee Opinion supports the expanded recommendations issued by the Centers for Disease Control and Prevention last year that state that an intramuscular, inactivated vaccine may be used in all three trimesters. The ideal time to vaccinate pregnant women is October and November. However, any time throughout the influenza season is appropriate—the flu season runs from October 1 through mid-May. At a recent conference sponsored by ACOG, a number of the country’s experts discussed maternal immunizations. On several occasions, the experts pointed out the immunizing the mother offers some immunity to her infant as well. Because there is no influenza vaccine or antiviral therapy approved for infants younger than six months, immunization of the mother offers a two-for-one advantage. Flu shots should be routine prenatal care. In obstetrics we utilize many preventative measures to protect the mother and help her child. Immunization for influenza should also be part of every ob-gyn’s routine prenatal care. As influenza season nears, please familiarize yourself with the symptoms and offer your patients an immunization. I would also encourage you to reread the Committee on Obstetric Practice’s Committee Opinion Influenza Vaccination and Treatment During Pregnancy (#305, November 2004). You may find the document in the 2005 Compendium or on the ACOG website, www.acog.org, under “Publications” and “Committee Opinions”.

Obstetricians! Please consider joining your colleagues for the

American College of Obstetricians and Gynecologists Idaho Section Annual Meeting. The dinner meeting will be from 7:00 to 9:00 p.m. and include dinner, a brief lecture, an

update about section activities, and a chance to share ideas with your colleagues from around the state. Please RSVP to Sarah Jacobson at

381-4174 or Lee Parsons, MD, at 888-0909. ACOG members can attend for free, while

guests will be charged $20.00 payable by check to ACOG or at the dinner.

103 W. State Street Boise, Idaho (208) 342-7642 www.idahoperinatal.org 4

IDAHO PERINATAL PROJECT ADVISORY BOARD MEMBERS

Penny Beach, MD Terry Reilly Health Services Clarence Blea, MD St. Luke’s RMC Susan Bradford, MD Pediatrician Jonathan Cree, MD ISU Family Residence Program Shoni Davis RN, DNSc Boise State University Janel Galbraith Idaho Hospital Association Melanie Harker, MD St. Luke’s Wood River MC Andrew Jones, DO St. Mary’s Hospital Judy Jones, RN, MSN St. Luke’s RMC

Cheryl Juntunen, MS, RN South Central District Health Lynn Kammermeyer Idaho Chapter, March of Dimes Martin Ladwig, MD, FACOG Gate City Women’s Health Diane Markus, RNC St. Alphonsus RMC Darla Miller, RNC Eastern Idaho, RMC Lu Ann Nielsen, RN Franklin County Med. Ctr. Don Smith, MD Magic Valley RMC Teneale Chapton Dept. of Vital Statistics Pawel Zieba, MD St. Luke’s RMC

STAFF: (208) 342-7642

Sherry Iverson, RN, Coordinator Sarah Jacobson, Project Assistant

Cooling May Protect Some Newborn’s Brains Chilling a newborn’s entire body can help prevent or reduce brain damage caused by lack of oxygen during difficult births, research suggests. However, experts say the results are too preliminary and in conflict with previous research for the treatment to be used outside of medical studies. “Widespread application of brain cooling would be premature,” Dr. Lu-Ann Papile, a neonatologist at the University of New Mexico Health Sciences Center, wrote in an editorial accompanying the study in today’s New England Journal of Medicine. She had no role in the study. Between 60,000 and 80,000 of the 4 million babies born in the United States each year are at high risk of death or disability because of birth problems that deprive them of oxygen. The Idaho Statesman, October 2005

Perinatal Hotline Helps Physicians Treat Pregnant HIV-Infected Women ACOG Today September 2005 A Perinatal Hotline is now providing free 24-hour consultation about management of HIV in pregnant women, HIV testing in pregnancy, and care of HIV-exposed infants. The Perinatal Hotline is staffed by HIV experts who can also refer callers to local clinicians for co-management or transfer of care. Early identification of HIV-infected pregnant women and advances in anti-retroviral therapies have led to a decrease in mother-to-child transmissions to a 1-in-12 chance. “Since the hotline started in December 2004, we have helped hundreds of clinicians offer the most up-to-date therapies to their patients,” said Jessica Fogler, MD, assistant director of the Perinatal Hotline. “Perinatal HIV transmission remains a tragic yet largely preventable problem. Although the number of transmissions has dropped, each transmission has enormous personal, family, public health, and economic consequences.” Based at UCSF/San Francisco General Hospital, the hotline is part of the National HIV/AIDS Clinicians’ Consultation Center of the Health Resources and Services Administration, in partnership with the Centers for Disease Control and Prevention. Perinatal Hotline 888-448-8765 www.ucsf.edu/hivcntr/hotlines/perintal.html

Statistics The Idaho Department of Health & Welfare, Bureau of Health Policy and Vital Statistics has provided the Idaho Perinatal Project with the new Prematurity Fact Sheet and statistics regarding dental care during pregnancy. To access this information, visit www.idahoperinatal.org, News, and click on the links.

103 W. State Street Boise, Idaho (208) 342-7642 www.idahoperinatal.org 5

Idaho Perinatal Project 103 W. State St. Boise, ID 83702

Non-Profit Organization U.S. Postage

PAID Permit No. 194

Boise, Idaho

CALENDAR OF EVENTS Event OB ACLS Preconference Date January 31 – February 1, 2006 ~ Boise, Idaho Sponsor: St. Luke’s RMC 208-381-1501 Event Idaho Perinatal Project Winter Conference Date February 2-3, 2006 ~ Boise, Idaho Sponsor Idaho Perinatal Project ~ 208-342-7642

Event 16th Annual Rocky Mountain Childbirth Conference

Date September 28-29, 2006 ~ Billings, Montana Sponsor: Elizabeth Seton Prenatal Clinic ~ 406-237-3620