More U.S. Women Delivering Babies at Home or Birth Centers

By Kathleen Doheny
HealthDay Reporter

WEDNESDAY, March 23, 2016 (HealthDay News) — More women in the United States are choosing to deliver their babies at home or in birth centers, a new study indicates.

In 2014, nearly 60,000 babies were born outside a hospital, the researchers said. While that is still a small minority of all births, the trend has been gathering steam in the last decade, the study authors added.

In 2004, less than 1 percent of U.S. births occurred out of hospitals, said report author Marian MacDorman. She is a research professor at the Maryland Population Research Center at the University of Maryland, in College Park.

By 2014, the number of out-of-hospital births had increased to 1.5 percent, the study found.

Women who opted for home or birth centers to deliver their babies tended to have low-risk pregnancies, MacDorman said.

The researchers looked at birth certificate data over the years from 47 states and the District of Columbia. MacDorman’s team found both geographic variation and other differences between mothers who went to the hospital and those who chose to give birth at home or in a birth center.

The Pacific Northwest had the highest rate of out-of-hospital births, while the deep South had the lowest. Mothers who gave birth at home were half as likely to be obese before getting pregnant, less likely to smoke and more likely to plan on breast-feeding. They were also more likely to be college graduates, the researchers said.

Nearly 79 percent of those who planned home births and over 92 percent who opted for birth centers had a midwife help deliver the babies. Only 8 percent of hospital births had midwives deliver the babies, the findings showed.

To make home births safer, MacDorman said women should be sure they are at low-risk, have a properly trained midwife, and be sure the midwife has relationships with doctors and hospitals so the mother and baby can be transferred if necessary.

A low-risk woman would have no high blood pressure, no diabetes or other chronic conditions, MacDorman said. “About 10 to 15 percent of women who labor at home end up having to go to the hospital,” she noted.

The study findings were published online this month in the journal Birth.

One expert pointed out that any birth outside a hospital can be risky.

“The bottom line is [that] any home delivery is a risk,” said Dr. David Mendez, neonatologist at Nicklaus Children’s Hospital in Miami.

In a hospital birth, he said, the risk of a baby dying is two in 1,000. “That number doubles with home delivery,” he said.

Mendez views birth centers as a good compromise for women who want a more natural experience, because they have medical personnel on hand if something goes wrong. “Birth centers are set up for a possible emergency, but the home birth experience isn’t,” he said.

One major concern, Mendez said, is the number of women in the study who chose home births but wanted a vaginal birth after a cesarean delivery, known as a VBAC.

“A lot of hospitals still don’t let women do a VBAC,” he said. Uterine rupture, an emergency situation, is a known risk for these women.

Despite the pros and cons, Mendez said he respects a woman’s right to decide where she wants to deliver her baby. Being aware of the risks, however, is crucial in making that decision, he added.

More information

To learn more about home births, visit the American Pregnancy Association.

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The Weird Thing That Can Happen to Your Teeth Before Your Period

Photo: Getty Images

Every few weeks, I get some uncomfortable sensations in my mouth. My teeth feel achy and loose. My gums are swollen and sensitive. And I have a desire to brush my teeth every couple of hours. These symptoms go away after a few days, but until then nothing seems to help.

The last time this happened, I finally consulted Dr. Google and came upon a condition called menstruation gingivitis—an inflammation of the gums that typically begins just before a woman’s period and goes away once her period starts.  

The symptoms matched mine, and after glancing at the calendar, I realized the timing made perfect sense. Mystery solved!

RELATED: Your Guide to Healthy, White Teeth

In search of more info, I called ob-gyn Mary Rosser, MD, PhD, at Montefiore Health System in New York City, who explained that women are more susceptible to gingivitis thanks to natural fluctuations in our hormone levels.

“A surge in the female hormones estrogen and progesterone causes an increase in blood flow to the gums, and a decrease in the way that we can fight off plaque and other toxins,” says Dr. Rosser. Plaque build-up irritates the gums, which become tender, swollen, and red, and some women see blood while they’re flossing or brushing their teeth. They may also develop sores on the insides of their cheeks. These symptoms tend to strike before menstruation and during pregnancy.

RELATED: 20 Things That Can Ruin Your Smile

There are a few other times in a woman’s life when she might develop periodontal problems due to changing hormones: during puberty, after menopause, and if she takes oral contraceptives (especially progesterone-only pills), says Dr. Rosser.

While the hormonal changes don’t cause gum disease, they can exacerbate any symptoms that you already have. That’s why Dr. Rosser stresses the importance of maintaining good dental hygiene year-round, and visiting your dentist every six months. Damage from gingivitis can be reversed if you’re diligent about those biannual appointments and the proper at-home cleaning routine—that means brushing, flossing, and rinsing with mouthwash twice a day.

RELATED: Best and Worst Food for Your Teeth

If your gums start to bleed when you floss before your period or during pregnancy, it may be tempting to quit this healthy habit. Don’t, Dr. Rosser cautions. Flossing will help lower your risk of developing more serious periodontal disease down the road.

Another tip: Consider cutting back on sugar and carbohydrates, she suggests. That may help ease the inflammation. But if at any point you notice that your symptoms are worse than usual, it’s worth scheduling a visit with your dentist to get checked out, says Dr. Rosser.

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Statewide Training on Cardiac Arrest Saves Lives in N. Carolina

WEDNESDAY, March 23, 2016 (HealthDay News) — A North Carolina program to increase bystander action in cases of cardiac arrest saved lives and reduced brain damage among survivors, a new study shows.

The statewide program trained family members and the general public to recognize the signs of sudden cardiac arrest and to perform CPR and use automated external defibrillators (AEDs).

“You can do something,” said study author Dr. Christopher Fordyce, of the Duke Clinical Research Institute in Durham, N.C. “You don’t have to just call 911 and stand while your loved one is on the floor. Start chest compressions immediately. Your actions actually make a difference.”

Cardiac arrest is the sudden loss of heart function in someone with or without known heart disease, according to the American Heart Association.

The North Carolina study found that the rate of bystander CPR for cardiac arrests that occurred in public places rose from 61 percent in 2010 to more than 70 percent in 2014. And, the rate of bystander CPR for cardiac arrests that occurred in homes rose from just over 28 percent to just over 41 percent.

In-home defibrillator use by bystanders rose from about 42 percent to more than 50 percent. There was no increase in AED use in public places, likely due to timely defibrillator use by emergency medical service personnel, according to the study authors.

The study is to be presented April 3 at an American College of Cardiology meeting in Chicago.

Meanwhile, rates of patients who survived until they left the hospital rose from about 11 percent to nearly 17 percent for public cardiac arrests, and from less than 6 percent to 8 percent for in-home cardiac arrests.

Gains in brain function were reported as well. Rates of patients who had minor or no loss of brain function rose from almost 5 percent to slightly more than 6 percent for in-home cardiac arrests, and from 9.5 percent to close to 15 percent for public cardiac arrests, the researchers said.

“The absolute rates are small, but the relative changes were pretty large. That’s only over five years, so if we continue to educate the public, we can continue to improve outcomes,” Fordyce said in a cardiology meeting news release.

“What’s interesting about this study is it’s the first time a statewide intervention has improved both public and residential cardiac arrest outcomes,” he noted.

Each year, more than 420,000 out-of-hospital cardiac arrests occur in the United States, the researchers said.

Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.

More information

The American Heart Association has more about cardiac arrest.

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Depression Tied to Worse Outcomes for Heart Patients

WEDNESDAY, March 23, 2016 (HealthDay News) — People who develop depression after being diagnosed with heart disease may be more likely to have a heart attack or die than those without depression, a new study finds.

The study included nearly 23,000 heart patients in the Canadian province of Ontario who were diagnosed with heart disease between late 2008 and late 2013.

During an average follow-up of three years, those with depression were 83 percent more likely die of any cause and 36 percent more likely to have a heart attack than those without depression.

Depression did not affect the chances of needing bypass surgery or heart artery stents.

However, the study did not prove that depression caused an increased risk for heart attack and death in these patients. It only found an association between those factors.

The study will be presented April 4 at an American College of Cardiology meeting in Chicago. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

“Patients who develop depression after being diagnosed with heart disease have a much worse prognosis,” said lead researcher Dr. Natalie Szpakowski, an internal medicine resident at the University of Toronto.

“Our findings suggest that these patients may need to be screened for mood disorders, whether it’s by their family doctor or cardiologist,” she said in an American College of Cardiology news release.

The researchers also found that patients with depression were more likely to be women and to have more severe chest pain. Other factors associated with depression included smoking, diabetes and having a higher number of other health problems.

“This is consistent with the literature in that women are more prone to depression, whether it’s due to sex hormones or social roles, we don’t fully know,” Szpakowski said. “Other studies have also found that more severe chest pain has been linked to depression, and we know people with more medical illnesses are more susceptible to being depressed.”

More information

The U.S. National Library of Medicine has more on heart disease and depression.

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Women, Men Share Similar Symptoms of Heart Disease

WEDNESDAY, March 23, 2016 (HealthDay News) — Tests used to confirm heart disease will probably pick up the same symptoms in women and men, a new study finds.

The two most prominent symptoms — chest pain (angina) and shortness of breath — are common to both sexes, concludes a study of more than 10,000 people in the United States and Canada.

“In most cases, symptoms of possible blockages in the heart’s arteries are the same [for women] as those seen in men,” study lead author Kshipra Hemal, of the Duke Clinical Research Institute in Durham, N.C., said in a news release from the American College of Cardiology (ACC).

However, the study also found that because standard evaluations don’t include certain heart disease risk factors more common to women than men, it may still be tougher for women to receive an accurate diagnosis.

The study will be presented April 3 at the ACC’s annual meeting in Chicago, and will also be published in the Journal of the American College of Cardiology: Cardiovascular Imaging.

For the research, Hemal’s team compared the test results of people with suspected heart disease. She noted that the research included “one of the largest cohorts of women ever evaluated in a heart disease study.”

The researchers found that chest pain was the main symptom for about 73 percent of women and 72 percent of men, followed by shortness of breath, which occurred in 15 percent of both women and men.

Women were more likely than men to have back, neck and jaw pain, or palpitations as their main symptom. But, the percentage of both sexes with these symptoms was extremely low: back pain, 1 percent of women, 0.6 percent of men; neck or jaw pain, 1.4 percent of women, 0.7 percent of men; palpitations, 2.7 percent of women, 2 percent of men.

Compared to men, women in the study: tended to be slightly older (62 versus 59); were more likely to be non-white; were less likely to smoke or be overweight; and were more likely to have high blood pressure, high cholesterol, a history of stroke, an inactive lifestyle, history of depression and a family history of early onset heart disease.

Women also scored lower than men when it came to assessing their risk for heart disease. According to Hemal’s team, that could be due to the fact that heart disease risk factors that are more common in women — depression, inactivity, and family history of early onset heart disease — are not included in most risk assessments.

“For health care providers, this study shows the importance of taking into account the differences between women and men throughout the entire diagnostic process for suspected heart disease,” Hemal said. “Providers also need to know that, in the vast majority of cases, women and men with suspected heart disease have the same symptoms.”

One expert stressed that while symptoms of heart disease may be similar for men and women, that’s not always the case for the signs of actual heart attack.

The new findings “run counter” to recent data “on differences between symptom presentation between men and women when it comes to heart attacks,” said Dr. Howard Levite, director of cardiology at Staten Island University in New York City.

For example, the American Heart Association notes that while men typically feel crushing chest pain when a heart attack hits, symptoms can be more subtle for women.

Women may feel chest pain — it is still the most common symptom for both sexes — but this pain can also be intermittent, the AHA said. Other symptoms tend to be more common in women than men, such as pain in one or both arms, the back, neck, jaw or stomach; shortness of breath with or without accompanying chest pain; cold sweats, nausea or lightheadedness, the AHA said.

In any case, if a person experiences any or all of these symptoms, they or a loved one should called 911 and receive hospital care as soon as possible, the AHA said.

The key to preventing heart attack is spotting and treating heart disease early. But Levite believes that current testing protocols may leave women at a disadvantage.

“Women are fighting an uphill battle when it comes to convincing doctors that they are having heart-related symptoms, because the standard scoring tests assign them to a lower risk category,” he said. “Factors more commonly found in women, such as anxiety and depression, are not in the current risk scores.”

Dr. David Friedman is chief of heart failure services at Northwell Health’s Franklin Hospital in Valley Stream, N.Y. He agreed that a thorough patient examination is key to good cardiac care.

“A high-quality clinical history of present illness — taking into account a good review of all patient complaints including symptom type, onset, duration, intensity, worsening and improving associated problems — can help us get a ‘back-to-basics’ approach, which can help further define patients’ potential cardiac risk profile,” Friedman said.

More information

For more on women and heart disease, head to the American Heart Association.

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Women May Not Be Aware of Heart Disease Risks

WEDNESDAY, March 23, 2016 (HealthDay News) — Many American women have heart disease risk factors, but few are properly informed of their risk by doctors, a new study finds.

Researchers conducted an online survey of 1,000 women nationwide and found that 74 percent had at least one heart disease risk factor, including high blood pressure, high cholesterol, diabetes, irregular menstrual cycle, early menopause or a family history of heart disease.

Women who were younger, lower-income or minority were the least likely to be aware of their heart disease risk factors. These same groups of women were also least likely to know that heart disease is the number one killer of both men and women, the researchers said.

Only 16 percent of those women were told by a doctor that they were at risk for heart disease. About one-third were advised to lose weight, the study revealed.

Nearly half of the women in the study said they had canceled or postponed a health appointment until they could lose weight, which suggests that a focus on women’s weight could interfere with proper health care, the researchers said.

They explained that anyone with a heart disease risk factor should receive regular blood pressure and cholesterol checks, along with counseling on smoking and heart-healthy living.

The study is to be presented April 4 at an American College of Cardiology meeting in Chicago. Findings presented at meetings are generally viewed as preliminary until they’ve been published in a peer-reviewed journal.

“Women’s heart awareness has stalled, despite almost three decades of campaigning by numerous women’s heart health advocacy groups,” study author Dr. C. Noel Bairey Merz, medical director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Heart Institute in Los Angeles, said in an American College of Cardiology news release.

Three-quarters of the women in the study said they rarely or never discuss heart health with family or friends, which is likely due to social stigma about body weight, the researchers said. Stereotypes about body weight and heart disease need to be countered with more evidence-based communication and preventive care, they added.

“Women feel stigmatized. They are most often told to lose weight rather than have their blood pressure and blood cholesterol checked,” Bairey Merz said.

“If women don’t think they’re going to get heart disease and they’re being told by society and their doctors that everything would be fine if they just lost weight, that explains the paradox of why women aren’t going in for the recommended heart checks,” Bairey Merz added. “Who wants to be told to lose weight?”

More information

The U.S. Office on Women’s Health has more on heart disease.

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How to Say ‘No’ to a Summer Vacation With the In-Laws

Photo: Getty Images

Q: My in-laws would like to join our big summer vacation. I consider our family trip precious alone time, just for us. Now what?

The first step is having a talk with your spouse to get on the same page. If you both agree on a parent-free vacation, then it’s best for him to delicately communicate that to his parents—you shouldn’t be the fall girl. He can propose alternative adventures they’ll love, such as a grandkid sleepover.

RELATED: 10 Signs You Really Need a Vacation

If he isn’t on the same page, however (perhaps he tries to avoid conflict with his folks), further explain your position: “It’s so important to me for us to create our own memories as a family unit with the kids!” And suggest compromises—for example, a long-weekend trip with all three generations.

Gail Saltz, MD, is a psychiatrist and television commentator in New York City who specializes in health, sex, and relationships.

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PTSD May Stiffen Veterans’ Arteries, Boosting Heart Risks

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, March 23, 2016 (HealthDay News) — Veterans suffering from post-traumatic stress disorder (PTSD) may have blood vessels that don’t expand normally, a new study suggests.

If vessels don’t widen as they should, the risk of heart attack and stroke goes up, the researchers noted.

The researchers also found that risk factors usually associated with blood vessel problems — such as high blood pressure, diabetes, high cholesterol and smoking — didn’t seem to account for why people with PTSD were more likely to have blood vessels that didn’t dilate properly.

The researchers suspect that stress may be to blame.

“We believe that we should try to gain a better understanding of the relationship between mental illness and cardiovascular health,” said lead researcher Dr. Marlene Grenon. She’s an associate professor of surgery at the University of California, San Francisco, and the Veterans Affairs Medical Center-Surgical Services.

Better strategies to manage stress could potentially have a positive impact on heart disease, she said.

“Stress management will be one of the main focuses of our program, along with other lifestyle factors such as diet and exercise,” Grenon said. “This could help not only people with PTSD but also people with all forms of chronic stress in their lives.”

While the study found a link between PTSD and blood vessel health, it wasn’t designed to prove a cause-and-effect relationship.

For the study, the researchers recruited 214 veterans, including 67 with PTSD. The researchers measured how well an artery in the arm of each study volunteer was able to relax and expand while a blood pressure cuff was inflated and deflated.

The researchers found that blood vessels of veterans with PTSD had a less healthy response. Their blood vessels expanded just under 6 percent, compared with 7.5 percent among the veterans without PTSD.

Other factors linked to a poorer response included increasing age, worse kidney function, high blood pressure and taking certain medications. However, after taking these factors into account, PTSD was still linked to blood vessels that were less able to dilate, the study found.

PTSD can also occur in non-veterans. It may develop as a reaction to a terrifying event, such as war, natural disasters, sexual assault and other physical violence or trauma.

People with the condition may have prolonged anxiety, flashbacks, nightmares and other life-altering symptoms.

“Post-traumatic stress disorder is estimated to impact close to 8 million men and women in the United States,” said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.

Prior studies have shown that PTSD is associated with a greater risk of heart disease and fatal heart attacks, he said. But, exactly how PTSD might increase these risks hasn’t been fully explained. The mechanism behind the association is probably very complex, he said.

More studies are needed to see whether impairment of blood vessel function is one of the contributing factors to the risk of heart disease in patients with PTSD, Fonarow said.

“Interventions that may effectively lower the risk of cardiovascular events need to be tested in this important patient population,” he said.

The new study findings were published online March 23 in the Journal of the American Heart Association.

More information

For more information on PTSD, visit the U.S. National Institute of Mental Health.

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Exercise May Keep Your Brain 10 Years Younger, Study Suggests

By Amy Norton
HealthDay Reporter

WEDNESDAY, March 23, 2016 (HealthDay News) — Older adults who exercise regularly could buy an extra decade of good brain functioning, a new study suggests.

The study found that seniors who got moderate to intense exercise retained more of their mental skills over the next five years, versus older adults who got light exercise or none at all.

On average, those less-active seniors showed an extra 10 years of “brain aging,” the researchers said.

The findings do not prove that exercise itself slows brain aging, cautioned senior researcher Dr. Clinton Wright, a neurologist at the University of Miami Miller School of Medicine.

It’s possible, he said, that there are other reasons why active older adults stayed mentally sharper.

The researchers accounted for some of those other explanations — including people’s education levels, smoking habits and health conditions such as high blood pressure and diabetes.

And exercise levels were still connected to the participants’ performance on tests of memory and “processing speed” — the ability to digest a bit of new information, then respond to it.

Plus, Wright said, it’s plausible that exercise would affect those mental skills. Other research has shown that physical activity boosts blood flow to the brain, and may enhance the connections among brain cells, for example.

Exercise can also help manage “vascular risk factors,” such as high blood pressure, unhealthy cholesterol levels and diabetes, Wright pointed out.

That’s important because many studies have suggested that some of the same risk factors for heart disease and stroke also boost the odds of dementia.

The new study findings were published March 23 in the journal Neurology.

Dr. Ezriel Kornel, a neurosurgeon who was not involved in the study, agreed that the findings don’t prove that exercise will keep you thinking clearly.

“It could simply be that people who are drawn to exercise are also at lower risk of cognitive decline,” said Kornel, a clinical assistant professor of neurological surgery at Weill Cornell Medical College, in New York City.

That said, he called the study “important,” because it at least suggests that exercise could have a big impact on people’s mental function as they age.

“We already know that exercise is highly valuable for cardiovascular health,” Kornel said.

The potential to add extra years of healthy brain function might motivate more people to get moving, he said.

The findings are based on nearly 900 older adults who took standard tests of memory, attention and other mental skills at an average age of 71. They repeated the tests five years later. At the time of the first test, they also underwent MRI scans of the brain, which allowed the researchers to look for changes associated with early mental impairment.

Overall, 10 percent of the group said they regularly got moderate to high-intensity exercise — which meant activities such as jogging, aerobics and calisthenics.

It turned out that those men and women showed substantially less mental decline over five years than the rest of the group — who were either sedentary or got light exercise, like walking.

When it came to tests of episodic memory — remembering words from a list — less-active and sedentary seniors showed the equivalent of 10 extra years of brain aging.

According to Wright, the results suggest that a casual walk around your neighborhood is not enough to preserve brain function as you age.

“It seems like we’re not going to get off easy,” he said. “There’s increasing evidence that it needs to be exercise that gets your heart rate up.”

However, Wright added, the necessary exercise regimen is far from clear. Seeking some answers, his team is running a trial testing the effects of exercise on stroke survivors’ brain function over time.

According to Kornel, exercise could theoretically benefit the brain in a range of ways. “Improved blood flow to the brain is one logical assumption,” he said.

But, he added, exercise can also keep people mentally engaged — by making them learn new things or concentrate, for example. And if you exercise with other people, Kornel noted, there’s a social aspect, too.

“If you’re out in the world, physically active, there are many things going on that are probably not happening when you’re just sitting on your sofa,” he said.

More information

The U.S. Centers for Disease Control and Prevention has advice on exercise for older adults.

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Getting Over a Cold? Try This Light and Energizing 15-Minute Workout

Whenever the weather changes, without fail, it seems a new round of bugs comes to town. Feeling draggy is never fun. But when it comes to your get-fit goals, there’s nothing more frustrating than finally getting into the swing of a great routine and then bam: you’re suddenly too pooped to hit the gym.

With a mild case of the sniffles, however, some gentle exercise could provide just the energy boost you need. Here’s a quick and light workout you can try at home. Perform 10-15 reps of each exercise, then repeat the series until about 15 minutes are up. Your focus should be on activating and stretching your muscles. So take care not to push your body too hard.  This circuit is designed to keep you moving without wrecking your recovery.

RELATED: 5 Legit Reasons to Skip a Workout, According to a Fitness Expert

Sun salutations

Photo: Jen Cohen

Start by standing with your arms by your sides, chest out, and shoulders back. From here, raise your arms up and over your head, reaching as high up as you can. Hold for a few seconds.

Lateral band walk

Photo: Jen Cohen

Place a light resistance band around your legs, just below your knees. Keep your feet shoulder-width apart, so the tension in the band stays tight. While maintaining this tension, squat down and take 5 steps to the left. Stay in your squat position and take 5 steps to the right. Repeat  you have completed 15 steps in each direction.

RELATED: Best and Worst Exercises to Do When You Have a Cold

Static lunge with floor touch

 

Photo: Jen Cohen

Get into a lunge position with your left leg behind you and right leg in front. Make sure your right leg is creating a 90-degree angle and that your knee is not going past your toes. From here, take your right hand and reach down to touch the outside of your right foot. Repeat this for 10 reps before switching sides.

Standing hip abduction

Photo: Jen Cohen

Place a light resistance band around your shins. Stand with your feet wide enough to create tension. Shift your weight into your right leg and lift your left leg off the ground. From here, extend your left leg out to the side as far as you can before bringing it back in. When you do this, be sure to keep your feet far enough apart to maintain constant tension in the band. Perform 10 reps before switching to your other leg.

RELATED: 11 Surprising Ways to Survive an Awful Allergy Season

Sumo squat to side reach

Photo: Jen Cohen

Take a wide stance with your toes slightly flared out. From here, squat down and place your hands behind your head. While maintaining your squat, tilt your torso to the right and tap your elbow to your leg. Come back to center and repeat on the left side. Continue alternating until you’ve completed 10 reps on each side.

Looking for more articles like this? Check out A 6-Move Circuit You Can Do Without Leaving Your Chair.

Jennifer Cohen is a leading fitness authority, TV personality, entrepreneur, and best-selling author of the new book, Strong is the New Skinny. With her signature, straight-talking approach to wellness, Jennifer was the featured trainer on The CW’s Shedding for the Wedding, mentoring the contestants to lose hundreds of pounds before their big day, and she appears regularly on NBC’s Today, Extra, The Doctors, and Good Morning America. Connect with Jennifer on Facebook, Twitter, G+, and Pinterest.

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