AP to Comply with CDC: No FluMist this Year

The CDC Issues a Dramatic Reversal Today

FluMist No Longer Recommended

Advanced Pediatrics to Respect the New Findings: No Nasal Spray for Flu Protection this Fall, only the Shot

It seems every year, the immunization effort to prevent infections from the influenza virus, which causes 1/3 of all wintertime colds and flus, has a twist.

One year, it was a national shortage of all flu immunizations.  Last year, it was a severe shortage of the nasal form of the immunization, FluMist.

Today, the surprise are recently shared findings from the CDC that the FluMist, long a better performer than the shot, no longer works as well.

Today, the CDC announced that the FluMist product has slipped.  It now fails to protect as many as 20% of children who might get it as well as the shot.    The CDC committee charged with monitoring immunization policy came out with a formal recommendation that we no longer use it:

http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html

This is truly breaking news.   The data on how well FluMist performed compared to the flu shot were made available to the CDC a few weeks ago, and the CDC presented their conclusions on them just today.

This is also remarkable news for two reasons:

1.  Until today, the reported literature on how the FluMist works showed it worked better than the flu shot.

2.  Almost all live vaccines work better than dead ones.  FluMist is a live vaccine, the flu shot is a dead form of the influenza immunization.

It appears this new development reflects problems in the manufacture of FluMist, which were foreshadowed last year by the failure of the company to even deliver the product.

Although a surprise, it is truly surprising, and unprecedented in our experience, to see a product we have vetted and trusted turn into one we can no longer trust, we cannot use it this year.

Although a disappointment, we much prefer the pain free approach of a nasal spray to a shot, we cannot use it this year.

We hope that next year the company that makes FluMist gets it right, but the CDC finds it has not, so we cannot use it this year.

Bottom Lines

1.  A surprise set of findings from last year's flu epidemics finds that FluMist, long the superior choice, no longer works as well as the flu shot in preventing infections from the influenza virus.

2.  The CDC's committee on immunization practice voted yesterday to recommend not using FluMist this upcoming flu season.

3.  THEREFORE, EFFECTIVE IMMEDIATELY ADVANCED PEDIATRICS WILL NOT OFFER THE NASAL SPRAY FORM OF FLU IMMUNIZATION THIS FALL.  ONLY THE SHOT FORM OF FLU IMMUNIZATION WILL BE MADE AVAILABLE.

4.  The shot form works well, and it turns out hurts less than many fear.  It is what we used almost entirely last year, and will work well again this year.

5.  If and when the manufacturer of FluMist develops a product the CDC works better than the flu shot, Advanced Pediatrics will consider using it once more, but not this year.

Stay tuned for announcements for when FluFest 2016, our fun provision of easy access to influenza immunization, featuring Mitchell's Ice Cream, will be later this year.

To Your Health,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Celebrating a Hero in our Community

Celebrating a Community:

An Appreciation of the NBA Championship in Cleveland

A friend once surprised me with this question many years ago:  what's the difference between sports and theater?   Answer:  In sports you never know how the drama will end.

Last night, Cleveland, and all those connected to it, were treated to a deep and profound drama.  We got to see a true hero reach....

...and make it.

LeBron James is a true hero.  

Families in the practice who live in or near Akron have recently shared stories with me that astound.

This child of Akron has purchased blocks in what we call "the inner city," but are actually structurally set areas of many generations of despair.  LeBron has purchased some of these blocks and transformed their housing and business infrastructures into middle class neighborhoods, and they work.

The people of the place have jobs and earn enough to live good lives.  A barber who could not afford the new rent was given free rent by LeBron so he could finish his career continuing to care for the people he has groomed for many years.

Here is a man of rare talent, who oriented use of his gift to the benefit of others.  How may elite athletes volunteer to leave a championship game and endless wealth, to come home to a team that has sunk to irrelevance, with no hopes of even playoff play?  This is LeBron, he came home to inspire Akron and Cleveland, his homes.  

I have observed that, if lucky, most of us get to be really good at a small number of things, maybe 1, maybe 2 or 3, but rarely many more skills.   Think of them as our gifts, and if we are really lucky, we get to pursue and develop them.   When that happens, life becomes a story in part of how a person takes their gift and overcomes struggles to help as many people as possible.  That is one of the great narratives we have available to us as people.

It is in that sense that I right this appreciation of the Cavaliers winning the championship last night.  I was lucky enough to be with my wife at a small restaurant across the street from the Q last night.  We heard of people flying in from Hawaii to Massachusetts to be there for the moment, and sat with people from Cleveland, Baltimore, and Cincinnati.  The  downtown, the center of our greater Cleveland community, was as full of people as we have ever seen.  We all held our breaths as these two teams, each who had scored 610 points over the first 6 games of the Finals, traded leads in the tightest game of the Finals.

 As the last minute came, a strange elevation took place in the room.  People had trouble following the details, all we knew was something we would never experience again was happening, and we drew together, so happy.  That joy and amazement filled downtown in that instant.  Prospect Street became a carpet of people screaming for joy, dancing, happy.  A fire engine parked in 9th Street with all its lights on, with the crowd standing and cheering on it.  We drove home to see urban Cleveland, Cleveland Heights, and Shaker Heights filled with scenes of celebration.

And all as the result of a good man pursuing his gift, against monumental odds, reaching.   LeBron James, son of our NorthEast Ohio community, directly applied all his efforts to deliver a championship to his community, with the express intent to inspire us to be better.  To come together, and to care for each other as he has.

So here is my thank you to this truly great man, I am deeply grateful.   And I am so pleased we could come together last night.

As a small token of our gratitude, Advanced Pediatrics will be closed for part of the day this Wednesday, to join with you all to be at the parade acknowledging the power of a gift that cares.  Dr. Hertzer and I will remain available throughout the day for calls of course, and the office will remain able to help.

To your health,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Folic Acid- A Third Benefit for your Child

Folic Acid- A Third Benefit for your Child:

Lowering the Risk of Obesity

Vitamins have promised extraordinary benefits for many years, including hopes of curing colds, ending cancer, slowing aging, boosting energy.  The very name vitamin suggests magical powers.

But the record is quite disappointing.  All vitamins offer nutritional benefits that are met by eating very tiny amounts of them, but with one exception, taking extra turns out to offer no benefits whatsoever.  Famous vitamins whose claims have come and gone include Vitamin C, Vitamin E, B complexes, etc.  Claims of powerful benefits for Vitamin D are still under scrutiny, but no positive proof of great benefit has been found yet.

One vitamin stands alone as having proof that taking more than is found in a regular diet could offer a benefit, and that is folic acid (aka, folate, Vitamin B9, Vitamin Bc).

Folic acid, and only folic acid, has been shown to change a real outcome in a population.  

If pregnant women take 400 mcg of folic acid during pregnancy, they nearly eliminate spina bifida, a congential defect in spinal cord development.  We know it works because when pregnant women did this, the number of children with spina bifida (aka myelomeningocele) actually dropped dramatically.

In the last few years, two new benefits of folic acid appear to be real as well.

The first reported was that if women take 400 mcg of folic acid a day prior to conception and throughout pregnancy, the risk of their child developing autism drops 5-fold.  This is an association in a published study.  We have not seen actual drops in the rate of autism in response to taking folic acid in this manner.  But the finding does make it plausible that we could see a drop with this use of folic acid.

Now comes a report that studied the impact of blood levels of folic acid in pregnant women on the chance that their babies would grow up to be obese.  The researchers looked at mother-child pairs in China, Chicago, Boston, and several other cities.   They studied over 1500 such pairs, and followed the babies born to an average age of 6.  

They then asked, what is the difference of risk of becoming obese by age 6 if the mother had a high or low folic acid blood level.    It turns out comparing kids of moms whose folic acid blood level was in the top three-quarters v. those in the lowest quarter, there was 45% more obesity in kids whose Mom's folic acid levels were in the lowest quarter.   

For obese Moms, those who had the lowest folic acid blood levels had children with triple the risk of obesity of those Moms not in the lowest level.

This study is at this website:

http://archpedi.jamanetwork.com/article.aspx?articleid=2528517

And the NY Times story on it is here:

http://well.blogs.nytimes.com/2016/06/15/folic-acid-during-pregnancy-may-lower-risk-of-childhood-obesity/?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=7&pgtype=sectionfront&_r=0


BOTTOM LINES

1.  Vitamins have been shown to offer no benefit when taken in amounts that exceed what you eat, with one exception, folic acid.

2.  One proven benefit of taking folic acid early in pregnancy is the near elimination of the chance of your child having spina bifida, an astounding benefit.

3.  An association not yet proven as solid is a dramatic drop in your child developing autism if the mother takes 400 mcg daily from before conception through pregnancy, a five-fold drop.

4.  Now comes an early observation that raises the possibility of a third benefit, actually changing the chance that your child will become obese.  This benefit is not seen with the 400 mcg dose, but only if the actual blood level of folic acid in the Mom goes up.  So this benefit requires a blood test.

5.  The elimination of spina bifida is a proven benefit of folic acid.  The reduction in risk for autism and obesity are highly enticing possibilities, not yet fully proven.

6.  How interesting that the chemical profile of a Mom in pregnancy could define if her child will become obese.  It makes us rethink obesity.

To your health,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Lazy- A Troublesome Concept

Lazy- A Troublesome Concept

Many kids in school struggle to succeed.  The national average is 1 in 6 children, millions of school children!

There are a web of complex reasons why we find ourselves facing so many of our children not enjoying school and having such a hard time getting the work done.

But one reason that we hear as much as any other reason should be put aside:  laziness.

When we meet with families, one of the most common thoughts about why their child is not performing well in school is that the problem is the child's attitude gets in the way.  The child either does not care, or seems to be dismissive of the work.  It actually makes perfect sense for any parent to think that the child's attitude is a major piece of the puzzle.  And if that's the case, why not conclude that they are being lazy?

So why would we urge everyone to no longer think of laziness as relevant to the problem of children doing poorly in school?   The problem is that there is a major difference between laziness and other reasons for not doing work, and for nearly every child struggling in school, laziness is not the problem.

To be clear, the word lazy means that the child is not doing work because they do not want to do any work, or anything.  When the word lazy explains a situation, we are concluding that the problem is the person has a fundamental defect in their relationship to work, and it's a simple one- they don't work because they object to working itself.

There may be lazy children and youth, but we haven't seen any.  With no exceptions that I can recall, everyone seems to want to do something.  It may not be what we want them to do, but nearly everyone likes doing something.

In nearly every instance, what looks like laziness is far more likely to be someone choosing to do something else for a very good reason.  Those reasons can vary quite a bit, but nearly all are compelling, once understood.

The key reasons children who are failing school avoid doing school work:
1.  There is a cognitive dysfunction that makes the work very, very difficult to do.
2.  There is an emotional problem blocking the path towards doing the work.
3.  They would rather do something else.
4.   A physical illness prevents access to the work.
5.  Conflicts with the teacher or parents make doing the work very difficult to do.

A look at the real reasons children who are failing school avoid doing their school work.

Cognitive dysfunctions

A great many children who struggle in school have one, or several, problems with how their mind works that make learning new facts, writing new essays, reading new books, doing math or science, paying attention or focusing actually very, very difficult.   One can be quite brilliant, and have one of these problems, and end up essentially being unable to some of the work schools assign.

Consider how hard it is for any of us to do something our minds cannot do without tremendous stress. This is a very unpleasant experience, and like anyone, we avoid the unpleasantness and do something else.

Emotional problems

Anxiety, depression, and/or mania affect large numbers of people, including children.  When any of these conditions is active they can have a devastating effect on anyone's ability to get work done.

Rather do something else

This is a unifying theme as nearly every child will have grades or days when they would rather do something else, and is the sense all children who struggle in school have when the other issues are present.

Physical illness

Of all the reasons kids refuse to do their work, this is the one not confused with laziness.  If someone's eyes are injured, no one thinks the child is lazy if they avoid reading.  The same goes for nearly all physical illnesses, especially acute illnesses.

Conflicts

It would surprise many to find out how many times a problem in school reflects conflicts with teachers, and parents, and friends.


Why none of these reasons are explained by the concept of lazy.

For each of the five examples of reasons children who struggle in school do not do their work, laziness simply fails to explain anything.

If your mind cannot think through the problem at hand, your emotions keep you from attending, you are too physically ill, have serious conflicts related to the work, or would rather do something else you end up doing something else.

It is almost never the case that laziness explains any behavior, notice how in each case noted, the child ends up doing something else, not nothing.

Finally, assuming the reason school work is not done is laziness causes two very major problems:
1.  Since it is not true, it misses the ability to do anything about the situation.
2.  It is not an explanation, but really down deep, just an insult.

BOTTOM LINES
1.  Many, many children struggle to do their school work, about 1 in 6 risk failure.
2.  In nearly every instance, a reason explains their difficulty.
3.  That reason is almost never laziness.
4.  Thinking it is laziness seems reasonable, after all they are not doing their work. 
5.  But calling your child lazy, in addition to being wrong, usually just makes matters worse, as it is more of an insult than explanation.

We recommend highly that if your child struggles in school, that the real reason(s) be found, only then can situations change and the situation get better.

To your health,
Dr. Arthur Lavin 

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

The Power of Touch- Progress on a Great Sense

The Power of Touch- 

Progress on a Great Sense

In May of 2106, The New Yorker  published a deeply fascinating review of recent advances in understanding a sense that all people have, but few of us stop to consider:  touch.

http://www.newyorker.com/magazine/2016/05/16/what-the-science-of-touch-says-about-us

The article is loaded with many fun facts, but I will highlight three of them:

1.  The organization of touch 

2.  Progress in reproducing touch

3.  The essential nature of touch

The Organization of Touch

All senses in the body, including taste, vision, and hearing, are organized by the detection of a signal being translated into a nerve impulse that the brain then converts into a perception.

A word on each of these steps should be helpful, and hopefully, interesting.  Think about vision. Vision happens when light in the world is converted by our eye into an electrical nerve impulse that our brain transforms into a visual picture of the world.  This requires a special sensor that converts the light into a nerve impulse, and that would be the light-sensing cells of the retina.  When light hits these cells, they create an electrical charge that shoots down a series of nerves to the brain.  Once the pattern of electrical impulses from the eye hit the brain, the brain turns those patterns into all the extraordinary things we see.

Two more thoughts on this process:  the sensor for each sense is very specific for that sense.  The retina can only turn light into nerve impulses, it cannot do that with sound.  That is why the eye can only see, it cannot hear.   And, all nerve impulses are the same, a nerve can only be quiet or shooting an electrical signal, it is either on or off.  The nerve impulses from the tongue are the same as from the eye.   But there are literally billions of these nerves and it's their pattern that carries the information from the sensor and allows the brain to perceive.  Think of the lights on a movie marquee, each light bulb can only be on or off, and all the light bulbs are often the same.  But the pattern of their going on and off gives the sense that the lights are moving around the marquee.  Pattern causes information.

For touch, the sensor is a special nerve ending that makes a nerve fire if it is squeezed.   It turns out that if the sensor is squeezed, a nerve signal is created, which goes to the brain and creates our perception of touch.   Touch also includes the ability to sense a vibration, or temperature, but this discussion will focus on the simple notion of touch itself.    The variations of pressure allow us to sense all that we do about the world via touch.   Our fingers, and much of our skin, are able to distinguish very minute differences in texture, for example, a soft satin, or a satin that is a tiny bit stiffer.  Or more easily, the feel of wood v. glass, or a pencil point v. a pen point on paper v. cardboard.

Three observations now can be shared about the way touch is organized in our nerves and minds:

1.  The brain detects incoming signals about touch in a frequency of 1 impulse per second.  

The information that the brain manages comes in the form of waves of electricity, in particular differences in waves.   So for touch, the essential wave is a pulse of electricity that beats once a second.  Variations in this pulse actually carry the information of touch to the brain.  Interestingly this rate of electrical pulsing is essentially the same as the rate of a heartbeat.

2.  There are several separate systems of touch, itch has its very own set of nerves.  It turns out that some nerves that deliver the touch signals to the brain cover many areas of function, including pain and sensual pleasure.   But itch has a separate system of nerves exclusively devoted to delivering that message to the brain where the sense of feeling itchy actually comes alive.

3.  The general system of touch nerves can deliver different experiences of touch.  As noted above, pain and sensual pleasure touches are experienced through the same set of nerves.  But the setting of the activation of the touch signals varies.

Progress in Reproducing Touch

As the essay notes, there has been astounding progress in reproducing touch.  Perhaps the most amazing steps forward have involved the development of a pen like device that can dial up almost any touch texture.

You can set the device to create the sensation of wood, and your hand holding the "touch pen" will soon experience the sensation of touching the type of wood you selected.  Or plastic, or silk, or paper, whatever the texture, the pen will recreate the sensation of touching it.  It is designed to help people with injuries re-experience various touch sensations, but it remains extraordinary that scientists can recreate the wide variations of our experience of touch.

The Essential Nature of Touch
Perhaps one of the most interesting insights from this essay is how essential touch is.

Many people will over time suffer loss of vision or hearing, or even be born without these senses, but there are no reports of a person losing their sense of touch.    It is the least of the senses discussed, but may turn out to be fundamental to being alive and human.

There are even specialists in neuroscience who think touch is the best way to understand our consciousness, that is, our awareness of the world depends greatly on what we touch.

BOTTOM LINES

The article in The New Yorker from May, 2016 offers a rare inside look at the sense of touch.

http://www.newyorker.com/magazine/2016/05/16/what-the-science-of-touch-says-about-us

Reading it will give you amazing insights into how senses are delivered and experienced by our brains, new insights on how touch functions are organized into systems, and the great and essential role touch plays in our lives.

To your health,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Advanced Pediatrics, Who's the Boss Parenting Academy Note that Sleep Training Comes of Age

Advanced Pediatrics, Who's the Boss Parenting Academy Note:

Sleep Training Comes of Age

The #1 reason parents hire parenting consultants in NYC and LA is to find an approach that lets everyone in the family get a full night's sleep.

This is why Susan Glaser and Dr. Lavin teamed up in 1994, about 22 years ago (!), to develop approaches to teaching one's infant and child to sleep through the night based on their already extensive experience in helping so many families succeed in this quest.

That collaboration led to the publication of their philosophy of parenting and specific how-to's to help families achieve all night sleep in:  Who's the Boss: Moving from Conflict to Collaboration (2006).  Based on the success of this book, Wiley Publishers invited Ms. Glaser and Dr. Lavin to be the offical For Dummies authors for their reference book on sleep for young children: Baby and Toddler Sleep Solutions for Dummies.

And, more recently, their parenting advice has been made available on-line via the Who's the Boss Parenting Academy at www.whosthebossparentingacademy.com.  There, the philosophy and specific guidance first developed in 1994 and published in 2006 are available to anyone.

So it is with great pleasure that we read in the NY Times of May 23, 2016 that studies have demonstrated that our approach to helping families achieve a full night of sleep are very safe, and only support the bond of child and parent.  A recent study was reported to find that this approach, now widely adopted under the name "sleep training," has no negative impact over time on the relationship of the baby and the parents.  Check iBt out:  http://well.blogs.nytimes.com/2016/05/24/sleep-training-shouldnt-make-parents-feel-guilty/?_r=0

We have known for nearly 25 years that if parents gently ask their 4 month-old, or older infant or child, to take care of their own sleep, they will always do a terrific job, much better than any parent or doctor could.  And we have known for a long time that when parents do turn the job of getting to sleep and getting back to sleep over to their child, it really works, and has for over 10,000 families we have worked with over the years.

So it is very nice to see our approach found to be, as we have seen all along, very supportive of parent-child relationships.

BOTTOM LINE

Sleep training, now the dominant approach to managing the sleep of your infant or young child, reflects the approach and technique first put forward by Ms. Glaser and Dr. Lavin in print in 2006, and now more recently available as an on-line course.  

Recent data supports this approach as effective and very safe for the relationship of the child with the parent.

To your health,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Home Birth- The American Experience of Giving Birth at Home

Home Birth- 

The American Experience of Giving Birth at Home

All people are born, but how mothers give birth and where varies quite a bit from culture to culture and across time.  

Current American preferences heavily favor giving birth in the hospital, about 99% of all births in the US occur in a hospital.  Those that occur out of the hospital include births planned to deliver in the hospital but didn't make it in time, and deliveries that were planned to occur in the home of the mother.

In 2012, about 0.9% of all deliveries took place in the US, by plan, at home.

In the Netherlands, also in 2012, about 16% of all deliveries took place, by plan, at home.

And even in the US, the rate varies.  The state with the highest rate of home births is Oregon, where in 2012 and 2013, about 4% of women gave birth at home.

American Infrastructure for Home Birth

One reason home birth is less frequent in the US than the Netherlands is a vast difference in how babies are delivered at home in the Netherlands.  There, the person delivering the baby is a fully certified, highly trained professional, whose actions in delivering at a home are openly and highly coordinated with local medical centers.  The delivering professional is part of the community health professional structures.

This means that the professional delivering a baby at a Dutch home has highly developed and open contingency plans for the first sign of trouble.  The same approach takes place in Canada.  These plans strictly deny the option of a home birth to mothers who have complicated pregnancies (e.g., twins, breech presentation).  In Canada, about 25% of mothers attempting to deliver at home are easily transferred to a obstetric division in a hospital if any danger seems to be developing to mother or baby.  That number is 45% for first time mothers.

The delivering medical professional in Canada and the Netherlands has hospital privileges, and so can continue to care for mother if she delivers in the hospital.

The US is dramatically different.  Home births are frowned upon in the US.  Very few, if any, licensed obstetricians will support midwives delivering at home.  Very few certified nurse midwives who have hospital privileges, will deliver at home.   Home deliveries in the US take place nearly in secret, certainly without coordination with hospital systems.  The delivering professional is typically a certified professional midwife (CPM), which used to be called a lay midwife.  CPM's are only given legal permission to deliver in 28 states.  Many achieve CPM certification via correspondence courses and receive training by other CPM's.  In 2012, requirements were updated to require a high school diploma.  In contrast, the certified nurse midwife (CNM) is an advanced degree nurse who can legally deliver babies in all  50 states, has to achieve graduate school level schooling, with rigorous clinical training, and often must practice in collaboration with an obstetrician.

The real difference in the US comes down to this:  in Canada and Netherlands the midwife who delivers at home is fully integrated in the official medical system, can also deliver their patient in the hospital, and has a seamless connection to it.  In the US the midwife who delivers at home does so essentially separate from the medical system, unable to deliver the mother in the hospital, with no well-established two-way systems (hospital and midwife working together) in place to rapidly respond to a problem.   

Many of these issues are clearly presented in this NY Times article:

http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-birth-so-dangerous.html?_r=1

Safety of Home Birth in the US

In the last issue of 2105, the world's leading medical journal, The New England Journal of Medicine, published as study of all births in the state of Oregon in 2012 and 2013, and asked, how did mothers and babies do if they planned to deliver at home v. planned to deliver in the hospital.

They compared groups' plans, because if you just look at those who actually delivered at home, you artificially exclude those who were going to deliver at home, but had to go to the hospital due to problems.

Now, it is important to note that there is a rate of death in the newborn period no matter where you deliver, in the very best of worlds, some tragic death still takes place. 

With that in mind, here are the numbers:

From 1970 through to today, despite the increased use of induction and C-section, the chance of a baby not living much past delivery has remained steady at 1 in a thousand (1:1000) births.

In 2012 and 2013, in Oregon, if you planned to deliver in a hospital, the chance of the baby not living to a week of age was 1.8:1000 (as time goes on, this number goes up, as we know, after 120 years it goes to 1000:1000).

 In 2012 and 2013, in Oregon, if you planned to deliver at home or at a birthing center out of a hospital, the chance of the baby not living to a week of age was 3.9:1000.

Births following the plan to deliver out of hospital births also carried higher risks of the baby suffering certain troubles, including need for a ventilator, blood transfusion, seizures.

At the same time, women planning to deliver out of the hospital experienced far fewer C-sections, induced labors, and episiotomies.

In this same issue of the Journal, a commentary by Dr. Michael Greene, Chief of Obstetrics, Massachusetts General Hospital, who I have known a long time, gives the above information is a very balanced and measured approach.  His last line is: "Ultimately, women's choices for place of delivery will be determined by the extent of their tolerance for risk and which risks they want to avoid."  

He is referring to the risk of the baby coming to some harm versus the risk of the mother experiencing obstetric procedures.

BOTTOM LINES

1.  Home birth in the US would benefit tremendously from full integration with the medical system.  This would allow fully trained midwives to participate with full backing of obstetricians, and the development of full communications with hospitals to make transfer to the medical setting far easier and more integrated.  In countries where this is the reality, no difference in newborn survival at home v. hospital is seen.

2.  Until that happens, giving birth at home does more than double the chance of a baby not living to a week of age.  

3.  It is also true that planning to give birth at home sharply reduces the chance the mother will have a C-section, induced labor, or episiotomy.

4.  Wherever one delivers, the baby needs a shot of Vitamin K soon after birth.  About 1:1000 babies who do not receive this very helpful aide will actually experience serious bleeding in their brain.  The Vitamin K shot provides the needed substance to help the baby make normal clotting factors.

Very importantly, we at Advanced Pediatrics are very happy to work with all parents, whatever their plans, to discuss what is an important, and often complex, decision.

To your health,

Dr. Arthur Lavin

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