Health News

First womb-transplant baby born

A woman in Sweden has given birth to a baby boy using a transplanted womb, in a medical first, doctors report.

The 36-year-old mother, who was born without a uterus, received a donated womb from a friend in her 60s.

The British medical journal The Lancet says the baby was born prematurely in September weighing 1.8kg (3.9lb). The father said his son
was "amazing". Cancer treatment and birth defects are the main reasons women can be left without a functioning womb. If they want a
child of their own, their only option is surrogacy.

Medical marvel

The identity of the couple in Sweden has not been released, but it is known the mother still had functioning ovaries.

The couple went through IVF to produce 11 embryos, which were frozen. Doctors at the University of Gothenburg then performed the
womb transplant.

The donor was a 61-year-old family friend who had gone through the menopause seven years earlier.

Drugs to suppress the immune system were needed to prevent the womb being rejected.

A year after the transplant, doctors decided they were ready to implant one of the frozen embryos and a pregnancy ensued.

The baby was born prematurely, almost 32 weeks into the pregnancy, after the mother developed pre-eclampsia and the baby's heart rate
became abnormal.

Both baby and mum are now said to be doing well.

In an anonymous interview with the AP news agency, the father said: "It was a pretty tough journey over the years, but we now have the
most amazing baby.

"He's no different from any other child, but he will have a good story to tell.''
Media captionSurgeon Richard Smith on the prospects for British womb transplants

'Step change'

Two other medical teams have attempted womb transplants before.

In one case, the organ became diseased and had to be removed after three months. Another case resulted in miscarriages.

Prof Mats Brannstrom, who led the transplant team, described the birth in Sweden as a joyous moment.

"That was a fantastic happiness for me and the whole team, but it was an unreal sensation also because we really could not believe we had
reached this moment.

"Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of
treating many young females worldwide that suffer from uterine infertility."
Liza Johannesson, a gynaecological surgeon in the team, said: "It gives hope to those women and men that thought they would never have a
child, that thought they were out of hope."

However, there are still doubts about the safety and effectiveness of the invasive procedure.

Dr Brannstrom and his team are working with another eight couples with a similar need. The results of those pregnancy attempts will give a
better picture of whether this technique can be used more widely.

Dr Allan Pacey, the chairman of the British Fertility Society, told the BBC News website: "I think it is brilliant and revolutionary and opens
the door to many infertile women.

"The scale of it feels a bit like IVF. It feels like a step change. The question is can it be done repeatedly, reliably and safely."

The couple, fresh from celebrating the birth of their child, will soon have to decide if they want a second.

The drugs used to prevent the womb being rejected would be damaging in the long term - so the couple will either try again or have the
womb removed.

Midwives Journal at Operating Room

North Bay Midwives C-section rates

CYNTHIA SWEENEY
BUSINESS JOURNAL STAFF REPORTER | August 15, 2016

Despite the cost, and risk to mother and baby, the number of women giving birth by cesarean delivery, or C-section, increased
by 60 percent in the U.S. between 1996 and 2009, and by 2011 it was the nations most common operating room procedure.

With a resurgence of midwives, however, studies show that C-section rates at hospitals where they are employed are much
lower.

At 26 percent, California is below the national average of 32 percent, and at hospitals in the North Bay the rate is even lower.

Around the North Bay, most hospitals now engage midwives for their patients including Sutter Santa Rosa Regional Hospital,
Kaiser Permanente, NorthBay Healthcare, and Ukiah Valley Medical Center, which has the lowest C-section rate, at 16
percent.

As the only hospital in the county with a labor and delivery ward, Marin General Hospital handles an average of 1,400 births a
year. After adopting an expanded midwifery program in 2011, the hospital dropped its C-section rate by 10 percent in three
years.

That year, the hospital took over the county-run birth center, which had been providing midwives to its mostly publicly insured
patients. Hospital officials decided to continue offering the service to privately insured women as well.

Initially, 16 percent of those women opted for the midwife service, which includes around-the-clock nurse midwives.

Almost immediately, the C-section rate dropped from 32 percent to 27 percent. The rate continued to fall to where it now
fluctuates between 18 percent22 percent.

With a midwife, theres more leeway in decision-making, taking a wait and see approach versus making a decision on the fly,
said Sheri Matteo, a nurse midwife, and director of midwives at Prima Medical Group in Novato that serves the hospital with 13
midwives.
Marins program became the subject of a study at University of California San Francisco, which also examined rates for
successful vaginal birth after a C-section. The study found that with midwife assistance, the rate increased significantly from
13 percent to 22 percent.

Obstetrics is a team sport. It cant be done just by doctors or just by midwives. It works for us as an integrated team, Matteo
said. I think that the doctors have embraced the outcome of the study and see us as a positive influence on lowering the C-
section rate. Overall, we have been very accepted into the practice and the labor floor culture.

C-sections carry serious risks for both women and their babies. Women are at an increased risk for hemorrhage,
hysterectomy, infection, blood clots, longer recoveries, chronic pelvic pain, and difficulty with future pregnancies.

Problems for babies, can include breathing difficulties that need treatment in a newborn intensive care unit.

In the long-term, babies born by C-section are at increased risk of developing chronic childhood diseases like asthma and
diabetes.

The procedure is also more costly than a vaginal delivery. Statistics vary, but all cite the price tag of a C-section as $10,000 -
$20,000 more.

While there are clear cut indications when a C-section should be performed, such as when a baby is breach, or in the wrong
position, other factors are more subjective, such as fetal heart rate, and the amount of time the labor is taking are also
determining factors,

Matteo likened giving birth to running a marathon, where there is help and encouragement along the way.

Being in labor absolutely takes time and you need people to support you. Hospitals and medical institutions are not designed
to do that. C-sections can absolutely be a lifesaver, but not at a rate of over 30 percent, she said.

Midwives in California must complete three-years of study in an approved program before applying for a license. They are
trained for the full scope of womens health issues with a specialty in obstetrics, although mostly what they practice is pre-natal
care.

By being part of a midwife team, physicians can be available for labor and delivery, with no other competing demands on their
time, so theyre able to be more patient and await a vaginal delivery.

Ukiah Valley Medical Center (UVMC) has been employing midwives for more than 20 years. At nearly 16 percent, it also has
the lowest rate of C-section births in the North Bay area. Out of a total of 866 births last year, 61 percent were delivered with a
midwife.

At UVMC, midwives are on-call 24 hours a day, and assist with all stages of labor, while doctors are set up with remote-
viewing to check in on the patients heart rate and labor pattern. Out of bed positions are also available and women can walk
down the hall.

Women arent stuck in their room on a monitor, said Casey Ford, director of the Family Birth Center at UVMC. The majority
of women want a very natural child birth, and support and encouragement is a really big part of that.