Low primary cesarean rate and high VBAC rate with good outcomes in an Amish birthing center.

PURPOSE: Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin. METHODS: We undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010. RESULTS: The cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000). CONCLUSIONS: Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates.

Culturally specific maternity care in Wisconsin.

There are significant health disparities in maternity care in the United States. One way to decrease these disparities may be to improve prenatal care among underserved minority women. This article reviews cultural and ethnic issues that may impact maternity care within 5 different groups of women commonly seen by maternity care providers in Wisconsin: African American, Latina, Hmong, Amish, and immigrant women. Understanding concerns that are specific to each group (such as higher rates of gestational diabetes in Latina women or desires to limit pelvic exams among Hmong women) may help clinicians provide more patient-centered maternity care.

Pediatric folk beliefs of inner-city black Chicagoans.

OBJECTIVES: To estimate the familiarity of black inner-city Chicagoans with pediatric folk beliefs identified by key informants. STUDY DESIGN: Five black staff members at an inner-city clinic identified 10 African American folk beliefs regarding pediatric care. A survey of 606 African American patients in Chicago assessed familiarity with these beliefs, and with medical recommendations regarding immunization and sleep position. RESULTS: The 2 medical recommendations were more familiar and more believed than any of the identified folk beliefs. The most widely known folk belief was that it is dangerous for a woman to go outdoors 4 to 6 weeks after she has a baby, which was familiar to 93% of respondents. The most believed cultural item was that it is bad to stand where an infant has to roll his eyes back to see you, which was familiar to 86% of respondents and thought true by 86% of those familiar with it. Respondents born in a southern state were significantly more likely to have heard of taping a coin over an umbilicus that sticks out (odds ratio [OR], 1.51; 95% confidence interval [Cl], 1.01-2.26; p = .045) and less likely to agree with infant back or side position for sleep (OR, 0.35; 95% CI, 0.14-0.85; p = .021). CONCLUSION: The widespread familiarity with specific folk beliefs in this population suggests that an understanding of these beliefs may be important for culturally competent providers of pediatric care in Chicago's inner city. Further research is needed to determine whether these findings are reproducible in other socioeconomic and geographic settings.

Pancreatitis in pregnancy.

OBJECTIVE: To estimate the incidence, cause, and complications of pancreatitis in pregnancy and to identify factors associated with adverse outcomes. METHODS: This study was a chart review of all pregnant patients diagnosed with pancreatitis from 1992-2001 at 15 participating hospitals. Information was collected on presentation, management, and outcome, along with the number of deliveries at each hospital. RESULTS: During the 10 years of the study, 101 cases of pancreatitis occurred among 305,101 deliveries, yielding an incidence of one in 3,021 (.03%). There were no maternal deaths; perinatal mortality was 3.6%. Eighty-nine women had acute pancreatitis, and 12 women had chronic pancreatitis. The majority (66%) of cases of acute pancreatitis were biliary in origin, and they were associated with better outcomes than nonbiliary causes. Cases of gallstone pancreatitis that received surgical or endoscopic intervention during pregnancy had lower rates of preterm delivery and recurrence than those that were conservatively managed, but this difference was not significant (P=.2). Alcohol was responsible for 12.3% of acute pancreatitis cases and 58% of chronic pancreatitis cases and was associated with increased rates of recurrence and preterm delivery. A calcium level, triglycerides, or both was not obtained in half of cases identified as idiopathic. CONCLUSION: Pancreatitis is a rare event in pregnancy, occurring in approximately 3 in 10,000 pregnancies. Although it is most often acute and related to gallstones, nonbiliary causes should be sought because they are associated with worse outcomes. LEVEL OF EVIDENCE: III.

Practical considerations of using topical honey for neuropathic diabetic foot ulcers: a review.

CONTEXT: It is increasingly important to identify and use low-cost effective dressings for treating diabetic foot ulcers as medical costs and rates of diabetes continue to rise. Honey is an inexpensive moist dressing with antibacterial and tissue-healing properties that has shown promise in the medical literature. Many clinicians are unfamiliar with its use, but patients with diabetic foot ulcers may wish to try honey therapy or discuss it with their physicians. The purpose of this review is to familiarize physicians with practical aspects of using honey to treat diabetic foot ulcers. EVIDENCE ACQUISITION: The authors have experience using topical honey and are currently conducting a randomized controlled trial of its effectiveness in treating diabetic foot ulcers. In this review, the authors summarize evidence of honey's effectiveness, its hypothesized mechanism of action, potential risks and benefits, the types of honey available, and the nature of its application. Critical aspects of ulcer care are also reviewed. CONCLUSION: Honey is a low-cost topical therapy with important potential for healing. Its use may be considered in diabetic foot ulcers after a discussion of risks and benefits and in conjunction with standard wound care principles.