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WASHINGTON (AP) -- Sitting in a tub of warm water can relieve a mom-to-be's pain during the early stages of labor, but actually giving birth under water has no proven benefit and may be risky, say recommendations for the nation's obstetricians.

There's no count of how many babies in the U.S. are delivered in water, but it is increasingly common for hospitals to offer birthing pools or tubs to help pregnant women relax during labor.

In a report released Thursday, a distinction is made between the two uses, saying that early on immersion may be helpful, as long as some basic precautions are taken.

But there has been little scientific study of underwater delivery, along with a handful of reports over the past decade or so of near-drownings and other risks to the infant, said the joint opinion from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.

Although complications appear to be rare, the report urges that underwater deliveries be performed only in research studies to settle the questions.

"Laboring in water is not the same as delivering under water," said co-author Dr. Jeffrey Ecker of Harvard University, adding that he's cared for numerous women comforted by immersion during labor.

As for delivery, "We want people to do more research," added ACOG committee member Dr. Aaron Caughey of Oregon Health & Science University.

In fact, midwives at Caughey's hospital perform several dozen underwater deliveries a year and are collecting data on how mothers and babies fare, said Cathy Emeis, a certified nurse-midwife at the Oregon university. She cautioned that the numbers are small but so far don't show increased risks.

Pregnant women interested in a water birth at the Oregon facility are required to take a special class and sign a consent form, Emeis said.

"We always acknowledge to our patients that there is not a lot of high-quality evidence that shows there's a benefit to birthing under water," she said.

Thursday's recommendations aren't binding. Birthing in warm water, which proponents say simulates the uterine environment, has been an option for several decades, although more women use it for early labor than delivery, said Tina Johnson of the American College of Nurse-Midwives.

"I don't know that this statement will necessarily change women's desire for that option," said Johnson, whose organization is drafting its own guidelines.

The report recommends that hospitals or birth centers choose low-risk candidates for immersion during labor, keep tubs clean, monitor women appropriately and be able to move them out of the water quickly if a problem occurs.

It says potential risks of underwater delivery include infection, difficulty regulating the baby's body temperature and respiratory distress if the baby inhales water.

© 2014 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.

 
 

 

HALF OF US ADULTS 40 TO 75 ELIGIBLE FOR STATINS

Thursday, 20 March 2014 06:10 Published in Health & Fitness

Almost half of Americans ages 40 to 75 and nearly all men over 60 qualify to consider cholesterol-lowering statin drugs under new heart disease prevention guidelines, an analysis concludes.

It's the first independent look at the impact of the guidelines issued in November and shows how dramatically they shift more people toward treatment. Supporters say they reveal the true scope of heart risks in America. Critics have said the guidelines overreach by suggesting medications such as Zocor and Lipitor for such a broad swath of the population.

"We wanted to be really objective and just quantify what the guidelines do, and not get into a discussion about whether they are correct," said Michael Pencina, the Duke University biostatistician who led the analysis. It was published online Wednesday by the New England Journal of Medicine.

Under the new guidelines, 56 million Americans ages 40 to 75 are eligible to consider a statin; 43 million were under the old advice. Both numbers include 25 million people taking statins now.

"That is striking ... eye-opening," Dr. Daniel Rader of the University of Pennsylvania said of the new estimate.

But since too few people use statins now, the advice "has the potential to do much more good than harm," said Rader, a cardiologist who had no role in writing the guidelines.

Nearly half a million additional heart attacks and strokes could be prevented over 10 years if statin use was expanded as the guidelines recommend, the study estimates.

The guidelines, developed by the American Heart Association and American College of Cardiology at the request of the federal government, were a big change. They give a new formula for estimating risk that includes blood pressure, smoking status and many factors besides the level of LDL or "bad" cholesterol, the main focus in the past.

For the first time, the guidelines are personalized for men and women and blacks and whites, and they take aim at strokes, not just heart attacks. Partly because of that, they set a lower threshold for using statins to reduce risk.

The guidelines say statins do the most good for people who already have heart disease, those with very high LDL of 190 or more, and people over 40 with Type 2 diabetes.

They also recommend considering statins for anyone 40 to 75 who has an estimated 10-year risk of heart disease of 7.5 percent or higher, based on the new formula. (This means that for every 100 people with a similar risk profile, seven or eight would have a heart attack or stroke within 10 years.)

Under this more nuanced approach, many people who previously would not have qualified for a statin based on LDL alone now would, while others with a somewhat high LDL but no other heart risk factors would not.

The Duke researchers gauged the impact of these changes by using cholesterol, weight and other measurements from health surveys by the Centers for Disease Control and Prevention. They looked at how nearly 4,000 people in these surveys would have been classified under the new and old guidelines, and projected the results to the whole country.

The biggest effect was on people 60 and older, researchers found. Under the new guidelines, 87 percent of such men not already taking a statin are eligible to consider one; only 30 percent were under the old guidelines. For women, the numbers are 54 percent and 21 percent, respectively.

Dr. Paul Ridker and Nancy Cook of Brigham and Women's Hospital in Boston have criticized the risk formula in the guidelines. Ridker declined to be interviewed, but in a statement, he and Cook noted that most people newly suggested for statins do not have high cholesterol but smoke or have high blood pressure. Those problems and lifestyle changes should be addressed before trying medications - which the guidelines recommend - they write.

Dr. Neil Stone, the Northwestern University doctor who helped lead the guidelines work, stressed that the guidelines just say who should consider a statin, and they recommend people discuss that carefully with a doctor.

"We think we're focusing the attention for statins on those who would benefit the most," Stone said.

Dr. Harlan Krumholz, a Yale University cardiologist who has long advocated this approach, agreed.

"The guidelines provide a recommendation, not a mandate" for statin use, he said.

Pencina, the leader of the Duke study, said his own situation motivated him to look at the guidelines more closely. His LDL was nearing a threshold to consider a statin under the old guidelines, but under the new formula for gauging risk, "I'm fine," he said.

---

Online:

Cholesterol info: HTTP://TINYURL.COM/2DTC5VY

Risk formula: HTTP://MY.AMERICANHEART.ORG/CVRISKCALCULATOR

Heart facts: HTTP://CIRC.AHAJOURNALS.ORG/CONTENT/127/1/E6

---

Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP

© 2014 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.

Martinez, Gibson sharp in starts

Wednesday, 19 March 2014 23:15 Published in Sports
 
JUPITER, Fla. (AP) -- St. Louis' Carlos Martinez and Minnesota's Kyle Gibson each enhanced their chances of earning a spot in their team's rotation with solid outings, and the Cardinals beat the Twins 3-1 on Wednesday.
 
Martinez cruised into the fifth, holding the Twins to one hit, but Jason Bartlett had an RBI single to right-center in the sixth that ended the right-hander's scoreless string at 14 innings.
 
For Bartlett, the hit was his first of the spring in 27 at-bats.
 
The 22-year-old righty struck out four but kept his pitch count low by inducing two inning-ending double plays.
 
"He's starting to learn his stuff but he's also trusting a pretty good catcher behind the plate to help him understand which ones he needs to focus on and what pitches are most likely to get him out of a jam," St. Louis manager Mike Matheny said.
 
Making his fourth appearance - second start - Gibson limited the Cardinals to Matt Adams' second homer of spring training in 4 1-3 innings. Gibson allowed four hits.
 
"He's pitching really well," Minnesota manager Ron Gardenhire said. "We really like him. He's doing what he's supposed to do. That's good stuff."
 
Peter Bourjos doubled and scored the go-ahead run on a wild pitch by Samuel Deduno in the eighth inning.
 
STARTING TIME
 
Minnesota: Deduno is also a candidate for the fifth spot in the Twins' rotation. Deduno had allowed one earned run in 9 2-3 innings. He piggybacked Gibson against the Cardinals, allowing two runs in 2 2-3 innings.
 
St. Louis: As good as Martinez was in short relief last season, one reason the Cardinals believe he will eventually be a starter is that in minor league starts his fastball didn't lose much of its velocity over the course of multiple innings.
 
"There are some guys who can come out and just really light up the (radar) gun for an inning or so. There's other guys that can hold it. He's been one that's been able to hold it," Matheny said.
 
TRAINER'S ROOM
 
Twins: shortstop Pedro Florimon made his Grapefruit League debut on Tuesday night and was back in the lineup again on Wednesday. After missing much of the spring because of an appendectomy, Florimon should be a fixture in Minnesota's lineup over the final week-and-a-half.
 
"He needs at-bats," Gardenhire said. "He needs to play because he sat out the whole spring and then we'll see where we are in a week and go from there, but I'm going to try to get him out there pretty much every day."
 
Cardinals: Second baseman Mark Ellis' sore knee continues to keep him out of action. Matheny said Ellis could play were it the regular season, but the veteran will likely get at least a couple more days off.
 
NESHEK BACK
 
Pat Neshek pitched in a major league game for the first time since leaving Cardinals camp last week to be with his wife for the birth of their child. A non-roster invitee, Neshek struck out two and earned the save on Wednesday.
 
SUPER UTILITY
 
Barlett received his first spring start at third base for the Twins. Defense hasn't been the non-roster invitee's problem. He entered Wednesday's game 0 for 24 at the plate.
 
"He's actually having quality at-bats," Gardenhire said. "The numbers in spring training never affect me if you are having quality at-bats."
 
ROSTER MOVES
 
After the game, Matheny said St. Louis sent pitcher Tyler Lyons to the minors. Early in the spring, Lyons was thought to be an option for the fifth starting spot. He worked exclusively out of the bullpen once games began, allowing 13 runs in eight innings.
 

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