CAPPA Fall Savings!

Save on CAPPA Certification Processing Fee
The leaves are falling and so are CAPPA prices

Processing Fee Savings
Ready to turn in your CAPPA certification packets
or pre-pay your processing fee?
Then enjoy our $25.00 discount through October 10th 2008! Use CAPPA's
online store to pre-pay for your processing fee or recertification fee
and receive a $25.00 discount instantly!

Regular Price: $75.00 Sale Price: $50 Offer ends 10-10-08
This offer is good on Exam processing fees and on Re-certification fees.
SAVE NOW, visit www.cappa.net and enter the CAPPA Shop

Childbirth Educator Training Workshop

CAPPA Approved Childbirth Educator Training
November 6-7, 2008
Colorado Springs, CO

Experience the CAPPA Difference!

CAPPA trained and certified instructors teach in hospitals, birth centers, community-based programs, pregnancy centers and independently. You can add this valuable service to your current offerings.

You will receive a solid evidence-based foundation to teach a variety of Childbirth Education Courses with curriculum you develop. Skill sets for teaching will be gained through many types of teaching strategies and learning style approaches.

What the training includes:
Roles of Childbirth Educator
History of Childbirth Education
Cultural influences of Childbirth Educator
Stages and Phases of Normal Labor
Comfort Measures
Postpartum and Breastfeeding
Medical Interventions
Cesareans and VBAC's
Proper use of media in classroom
Adult principles of learning
Evidence based teaching practices (overview of reviewing and understanding research)
Curriculum development
Marketing

This is the first step toward your CAPPA certification. If you are a registered nurse, licensed or registered midwife, certified doula, or certified childbirth educator - you may qualify to fast track through the CAPPA program. Details on CAPPA, certification requirements and more! www.cappa.net

Instructor: Desirre Andrews CCCE, LCCE, CLD, CLE
Cost: $350 (cash, check or paypal)
For additional information or to register: www.birthingtouch.com , desirre@birthingtouch.com or 719-331-1292.

Please forward to others who may be interested.

CAPPA Training and Certification

I have listed three trainings coming up with CAPPA. These include Lactation Educator, Childbirth Educator and Labor Doula. For a complete list of trainings visit www.cappa.net.

Please read the past three blog entries for details and registration information regarding these trainings.

CAPPA's Mission
CAPPA certified professionals aim to empower, connect and advocate for families in the childbearing year. CAPPA seeks to forge positive and productive relationships between organizations that support healthy, informed family choices. The organization consists of a leadership board, regional representatives, trainers, mentors, advisors and its membership. CAPPA is the most comprehensive pregnancy, childbirth and postpartum organization available.

CAPPA Lactation Educator Training

This training fulfills one step for certification as a CAPPA Certified
Lactation Educator (CLE)

Dates: October 6-7, 2008
Location: Columbia, Tennessee

Instructor: Micky Jones, BS, CLE, CLD, HCHI
CAPPA Lactation Educator Faculty

Registration
Call or email Micky Jones: 1-877-365-6262 ext 1
micky@ninemonthsandbeyond.com

Fee: $350.00
$250 for WIC Peer Counselors/empoyees
Fee includes the required CAPPA Lactation Educator Manual.

CAPPA membership and CLE Certification Packets will be available for
purchase at the training or contact Micky in advance.

***NOTE: The pre-workshop study guide can be accessed FOR FREE at
http://cappa.net/CLE_STUDY.asp Completion of study guide is required
prior to the workshop; and it is necessary to bring the guide to the
training.

Please contact Micky for a Registration form and payment information.

See www.ninemonthsandbeyond.com and www.cappa.net for more information.

Hosted by the Regional Breastfeeding Promotions Coordinator, South
Central Regional Health Office of Tennessee. Contact: Nancy Rice,
M.S., LDN, CLC at 931-490-8374 for more information.

Childbirth Educator Training Workshop

Interested in becoming a CAPPA Certified Childbirth Educator?

CAPPA Childbirth Educator Training
November 15 and 16, 2008
Bedford, MA 01730

Trainer: Julie Brill, CCCE

This workshop equals 16 contact hours of continuing education.

To register visit www.wellpregnancy.com or call 781-275-6564
Space is limited!

*Why wait--get certified!*

- Teach parents proven pain-coping practices
- Learn to meet the needs of various types of learners
- Demonstrate simple ways to improve prenatal nutrition
- Describe the fundamentals of labor and birth
- Identify ways to prepare birth partners
- Use the risk/benefit model to teach interventions and pain meds
- Prepare Parents for Postpartum and Possible Unexpected Outcomes
- Market your services

CAPPA's Mission
CAPPA certified professionals aim to empower, connect and advocate for families in the childbearing year. CAPPA seeks to forge positive and productive relationships between organizations that support healthy, informed family choices. The organization consists of a leadership board, regional representatives, trainers, mentors, advisors and its membership. CAPPA is the most comprehensive pregnancy, childbirth and postpartum organization available.

Labor Doula Training

ONLY 2 WEEKS LEFT!!!!!! RESERVE YOUR SPACE !!!

Largo, Florida(Tampa Bay Area)

Faculty- Janice Banther,CCCE,CLD,CD(DONA)

Dates: Oct.9, Oct.10, Oct.11

Fee: $275

To find out more-please go to website
www.birthingwithlove.com
There will be a link on the front page to take
you to the brochure for the training and will give you
the information you need and answer many of your questions.

You will learn:

- Labor Support for unmedicated and medicated mothers

- Scope of practice

- Understanding interventions and hospital procedures

- Prenatal and postpartums

- Effective advocacy and communication skills

- Getting started as a new doula and marketing your doula business

- Much,much more!

If you need to reach Janice for more information,
please call 727-934-1267.

Janice K. Banther,CCCE,CLD,CD(DONA)
FOR THE LOVE OF BIRTH,INC.
Executive Director
www.birthingwithlove.com
The Premier Childbirth Education
and Doula Organization in the
Tampa Bay Florida Area

Birth by C-Section May Raise Allergy Risk in Some Kids

Thu, Sep 18, 2008 (Reuters Health) — Among children who have a parent with allergies or asthma, delivery by cesarean section appears to increase the odds that they will develop allergic rhinitis and atopy — but not asthma — US researchers report.

The investigators note that to the best of our knowledge, this is the first study to look at the "relationship between birth by cesarean section and atopy and allergic diseases at school age among children at high risk for atopy," Dr. Juan C. Celedon, from Harvard Medical School in Boston, and colleagues note in the Journal of Allergy and Clinical Immunology.

The study involved 432 children who were followed from birth to 9 years of age. One or both parents had a history of allergies or asthma. Physician-diagnosed asthma and allergic rhinitis in the children was assessed using caregiver interviews conducted at least twice a year. Allergy skin testing was performed in 271 children at an average age of 7.4 years.

Children born by cesarean section were 2.1-times more likely to develop atopy than their peers born by vaginal delivery, the report indicates.

Similarly, the authors found that cesarean section increased the risk of allergic rhinitis 1.8-fold. As noted, however, cesarean section did not increase the risk of asthma or wheeze.

Allergic rhinitis, sometimes called "hay fever", refers to a group of symptoms that mimic a common cold such as nasal congestion, sneezing, itching and tearing eyes. Atopy is the innate tendency to develop the classic allergic diseases, such as allergic rhinitis and asthma. It involves the overstimulation of the immune system in response to common environmental proteins such as house dust mite, grass pollen, and food allergens.

Considering that other studies have identified cesarean section as a risk factor for asthma, the authors believe that the lack of association between cesarean section and asthma may simply be due to limited statistical power of the study to detect it. However, they point out that their study was adequately powered to look for an association with wheeze, a major asthma symptom.

Celedon and colleagues speculate that the lack of exposure to maternal vaginal and fecal flora during cesarean section and the absence of labor could both have indirect immunologic effects that promote atopy.


-- Reuters

Knowledge can help beat the odds of a Caesarean

Women can reduce their chances of having a Caesarean, area maternity care providers say
BY ANNIE ADDINGTON - aaddington@ledger-enquirer.com --

--------------------------------------------------------------------------------

Certified labor doula and childbirth educator Val Staples knows firsthand the value of a Caesarean.

Her now 16-year-old son, Joshua, was born prematurely and presented in breech (or bottom-down) position, and Staples' doctor decided that a Caesarean was in order. Although Staples, who lives in Opelika, Ala., regrets not going into that first pregnancy more fully informed about her options, she believes her doctor made the safest choice.

But she also believes deeply in the value of a natural vaginal birth when conditions permit it. That's why, after plenty of research and preparation, Staples went on to have a successful natural VBAC (vaginal birth after Caesarean) a year later, when her second son was born in 1993 -- and then four more natural VBACs after that.

Without that first Caesarean, it is possible Staples might never have had children to begin with. Without the opportunity for VBAC, Staples likely wouldn't be matriarch in a family of eight. The American College of Obstetricians and Gynecologists says that women who have more than one or two children via Caesarean face increasing risks for serious complications.

Staples, who now serves as director of doula programs for the Childbirth and Postpartum Professional Association in Atlanta, is grateful that her childbearing years hit before the era of concerns about safety and professional liability made it nearly impossible to get a VBAC in many communities. But she is also a realist, and she says that her mission now as a doula -- a nonmedical assistant in childbirth -- and as a childbirth educator, is to help women prevent that first Caesarean if possible.

Staples said she believes it is possible for women to work proactively to defy the national statistics -- which suggest that American women now have a 31 percent chance of having a Caesarean. A hearty dose of research, preparation and healthy living during pregnancy can significantly decrease your chances of needing a Caesarean, Staples said.

"My big thing now is getting those first-time moms and preventing those first Caesareans," said Staples. "If they start out with an induction when they're not necessarily ready to be in labor, they're increasing their chances of a C-section, and next time around they're probably going to have to have a Caesarean again."

Avoiding interventions

Staples said every intervention -- whether it be rupturing membranes, inducing or accelerating labor with Pitocin, or giving an epidural before a woman is in active labor -- increases the odds of complicating the labor, throwing the body out of synch with its natural rhythm and potentially making a Caesarean necessary.

Melissa Terry Flynn, a certified nurse-midwife with Obstetric and Gynecologic Associates of Columbus, agrees that women have power to reduce the likelihood of needing a Caesarean.

"Choosing not to have interventions decreases your risk of complications and C-sections," she said. "Choosing to allow labor to start on its own, choosing to allow labor to progress on its own without intervention -- without any kind of medication or any kind of anesthesia would reduce your chances."

CAPPA Labor Doula Training

Where: Largo Florida (Tampa Bay Area)

Trainer: CAPPA Faculty- Janice Banther, CCCE, CLD, CD(DONA)

Dates: Oct.9, Oct.10, Oct.11

Fee: $275.00

For more information please visit www.birthingwithlove.com. Or, call Janice Banther at 727-934-1267.

*Remember to read the labor doula training brochure found on the home page of the website.

You will learn:

- Labor Support for unmedicated and medicated mothers

- Scope of practice

- Understanding interventions and hospital procedures

- Prenatals and Postpartums

- Effective advocacy and communication skills

- Getting started as a new doula and marketing your doula business

- Much, much more!


Janice K. Banther, CCCE, CLD, CD(DONA)
FOR THE LOVE OF BIRTH,INC.
Executive Director
www.birthingwithlove.com
The Premier Childbirth Education and Doula Organization in the Tampa
Bay Florida Area

Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new paradigm in patient safety

Steven L. Clark, MD, Michael A. Belfort, MD, PhD, Spencer L. Byrum, LCDR (ret.) USCG, Janet A. Meyers, RN, Jonathan B. Perlin, MD, PhD


Received 16 October 2007; received in revised form 26 November 2007; accepted 14 February 2008. published online 12 May 2008.

In a health care delivery system with an annual delivery rate of approximately 220,000, a comprehensive redesign of patient safety process was undertaken based on the following principles: (1) uniform processes and procedure result in an improved quality; (2) every member of the obstetric team should be required to halt any process that is deemed to be dangerous; (3) cesarean delivery is best viewed as a process alternative, not an outcome or quality endpoint; (4) malpractice loss is best avoided by reduction in adverse outcomes and the development of unambiguous practice guidelines; and (5) effective peer review is essential to quality medical practice yet may be impossible to achieve at a local level in some departments. Since the inception of this program, we have seen improvements in patient outcomes, a dramatic decline in litigation claims, and a reduction in the primary cesarean delivery rate.

10 First Aid Mistakes

Sometimes, the first aid measures taken on the scene before a patient arrives at the hospital can make all the difference. Here are the 10 most common first aid mistakes -- and what you should do instead.

1. Cut off finger part

Don't try to preserve the loose part by placing it directly on ice.

Do wrap the severed part in damp gauze (saline would be ideal for wetting the cloth), place it in a watertight bag and place the bag on ice. Then be sure to bring the bag and ice to the emergency room. As for the wound on the hand or body, apply ice to reduce swelling and cover it with a clean, dry cloth.

2. Knocked-out tooth

Don't scrub the tooth hard even if it's dirty (a gentle rinse is OK)

Do put the tooth in milk and go straight to the ER; there's a chance the tooth could be reimplanted.

3. Burns

Don't apply ice or butter or any other type of grease to burns. Also, don't cover a burn with a towel or blanket, because loose fibers might stick to the skin. When dealing with a serious burn, be careful not to break any blisters or pull off clothing stuck to the skin.

Do wash and apply antibiotic ointment to mild burns. Head to the hospital for any burns to the eyes, mouth, or genital areas, even if mild; any burn that covers an area larger than your hand; and any burn that causes blisters or is followed by a fever.

4. Electrical burns

Don't fail to get medical attention for a jolt of electricity, even if no damage is evident. An electrical burn can cause invisible (and serious) injury deeper inside the body.

Do go to the ER immediately.

5. Sprained ankle

Don't use a heating pad.

Do treat a sprain with ice. Go to the ER if it is very painful to bear weight; you might have a fracture.

6. Nosebleed

Don't lean back. And after the bleeding has stopped, don't blow your nose or bend over.

Do sit upright and lean forward and pinch your nose steadily (just below the nasal bone) for five to 10 minutes. If the bleeding persists for 15 minutes (or if you think you are swallowing a lot of blood) go to the ER.

7. Bleeding

Don't use tourniquets! You could cause permanent tissue damage.

Do apply steady pressure to the wound with a clean towel or gauze pack and wrap the wound securely. Go to the ER if the bleeding doesn't stop, or if the wound is gaping or caused by an animal bite. To help prevent shock, keep the victim warm.

8. Ingestion of poison

Don't induce vomiting or use Ipecac syrup (unless instructed to do so by emergency personnel).

Do call poison control, and bring the ingested substance with its container to the ER.

9. Being impaled

Don't remove the object; you could cause further damage or increase the risk of bleeding.

Do stabilize the object, if possible, and go to the ER.

10. Seizures

Don't put anything in the victim's mouth.

Do lay the victim on the ground if possible in an open space and roll the victim onto his or her side. Call 911.

You should also call 911 whenever you see or experience chest pain, fainting, confusion, uncontrollable bleeding or shortness of breath.

Sources:
Newsweek April 14, 2008

Visit www.mercola.com to read further suggestions from Dr. Mercola's

GIGANTIC CHILDREN'S WEAR RESALE

SATURDAY, SEPTEMBER 20, 2008
8am - 12 noon

Infant to Teen Clothing, Toys,
Equipment, Maternity Wear, Furniture,
Books, Videos and more


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Newark, DE 19713
(Route 4, off Rte. 273 and next to
Delaware School for the Deaf)


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Sponsored by:
FIRST STATE MOTHERS OF MULTIPLES


For more info call (302) 368-9691 or visit our
website: www.fsmom.org

First State Mothers of Multiples is a not for profit
organization offering support and encouragement for
mothers, parents and guardians raising multiples.

Major Confusion on How to Do Breast Checks

(from www.mercola.com)

Is there a right way to check your breasts for early signs of cancer? Many women remain confused as experts now say there is no evidence that rigorous monthly "self-examination" -- widely recommended in the United States -- reduces breast cancer deaths. Plus, it can lead to unnecessary biopsies.

Two large studies looking at a total of more than 388,000 women found that death rates from breast cancer were the same among women who rigorously self-examined as those who did not, while there were almost twice the number of biopsy operations in the self-examination group.

According to some experts, the best way for a woman to check her breasts is not to follow a strict examination routine, but to get to know what is normal, and feel them regularly for signs of any changes.

Sources:
BBC News July 15, 2008
Cochrane Database of Systematic Reviews July 2008, Issue 3

Dr. Mercola's Comments:

Breast self-exams have long been recommended as a simple way for women to keep track of anything unusual in their breasts. Now, after studies have found that such exams do not reduce breast cancer death rates, and actually increase the rate of unnecessary biopsies, many experts are recommending a more relaxed approach known as “breast awareness.”

Breast awareness is really self-explanatory. It means women should regularly check their breasts for changes, but can do so in a way that feels natural for them. In other words, you don’t have to do it on the same day each month, or using any particular pattern.

Simply be aware of what’s normal for you so you can recognize anything out of the ordinary. What should you keep an eye out for?

A new lump or hard knot found in your breast or armpit
Dimpling, puckering or indention in your breast or nipple
Change in the size, shape or symmetry of your breast
Swelling or thickening of the breast
Redness or scaliness of the nipple or breast skin
Nipple discharge, especially any that is bloody, clear and sticky, dark or occurs without squeezing your nipple
Changes in your nipple such as tenderness, pain, turning or drawing inward, or pointing in a new direction
Any suspicious changes in your breasts
Are Mammograms a Good Idea?

Aside from breast self-exams, the other mainstay in the U.S. medical system is the mammogram. The U.S. Preventive Services Task Force recommends women get a mammogram every year or two after age 40.

But I strongly disagree.

The benefits of mammograms are highly controversial, while the risks are well established. Back in 2001, around the time that U.S. health officials widened the use of mammograms to included women over 40 (previously it was only women over 50), a Danish study published in The Lancet revealed some startling data.

The study concluded that previous research showing a benefit was flawed and that widespread mammogram screening is unjustified.

Specifically, the Danish researchers argued that earlier studies in Europe and North America were improperly randomized and that they used a faulty definition of breast cancer survival.

Meanwhile, the technology carries a first-time false positive rate of up to 6 percent. False positives can lead to expensive repeat screenings and can sometimes result in unnecessary invasive procedures including biopsies and surgeries.

Just thinking you may have breast cancer, when you really do not, focuses your mind on fear and disease, and is actually enough to trigger an illness in your body. So a false positive on a mammogram, or an unnecessary biopsy, can really be damaging.

Not to mention that women have unnecessarily undergone mastectomies, radiation and chemotherapy after receiving false positives on a mammogram.

An Amazing Deception

That mammograms are still recommended at all speaks volumes about the state of modern medicine.

Decades ago in 1974, the National Cancer Institute (NCI) was warned by professor Malcolm C. Pike at the University of Southern California School of Medicine that a number of specialists had concluded "giving a women under age 50 a mammogram on a routine basis is close to unethical."

Why?

Well for starters mammograms expose your body to radiation that can be 1,000 times greater than that from a chest x-ray, which poses risks of cancer. Mammography also compresses your breasts tightly, and often painfully, which could lead to a lethal spread of cancerous cells, should they exist.

“The premenopausal breast is highly sensitive to radiation, each 1 rad exposure increasing breast cancer risk by about 1 percent, with a cumulative 10 percent increased risk for each breast over a decade's screening,” points out Dr. Samuel Epstein, one of the top cancer experts.

Dr. Epstein, M.D., professor emeritus of Environmental and Occupational Medicine at the University of Illinois School of Public Health, and chairman of the Cancer Prevention Coalition, has been speaking out about the risks of mammography since at least 1992. As for how these misguided mammography guidelines came about, Epstein says:


“They were conscious, chosen, politically expedient acts by a small group of people for the sake of their own power, prestige and financial gain, resulting in suffering and death for millions of women. They fit the classification of "crimes against humanity."”


Not surprisingly, as often happens when anyone dares speak out against those in power, both the American Cancer Society and NCI called Dr. Epstein’s findings “unethical and invalid.”

But this didn’t stop others from speaking out as well.

In July 1995, The Lancet again wrote about mammograms, saying "The benefit is marginal, the harm caused is substantial, and the costs incurred are enormous ..."
Dr. Charles B. Simone, a former clinical associate in immunology and pharmacology at the National Cancer Institute, said, "Mammograms increase the risk for developing breast cancer and raise the risk of spreading or metastasizing an existing growth.”
"The high sensitivity of the breast, especially in young women, to radiation-induced cancer was known by 1970. Nevertheless, the establishment then screened some 300,000 women with Xray dosages so high as to increase breast cancer risk by up to 20 percent in women aged 40 to 50 who were mammogramed annually,” wrote Dr. Epstein.
Safe Screening Methods do Exist: The Benefits of Thermography

But you’re not likely to hear about them from your general practitioner.

“ … The establishment ignores safe and effective alternatives to mammography, particularly trans illumination with infrared scanning,” Dr. Epstein points out.

Most physicians continue to recommend mammograms for fear of being sued by a woman who develops breast cancer after which he did not advise her to get one. But I encourage you to think for yourself and consider safer, more effective alternatives to mammograms.

The option for breast screening that I most highly recommend is called thermography.

Thermographic breast screening is brilliantly simple. It measures the radiation of infrared heat from your body and translates this information into anatomical images. Your normal blood circulation is under the control of your autonomic nervous system, which governs your body functions.

Thermography uses no mechanical pressure or ionizing radiation, and can detect signs of breast cancer years earlier than either mammography or a physical exam.

Mammography cannot detect a tumor until after it has been growing for years and reaches a certain size. Thermography is able to detect the possibility of breast cancer much earlier, because it can image the early stages of angiogenesis (the formation of a direct supply of blood to cancer cells, which is a necessary step before they can grow into tumors of size).

Visit www.mercola.com for links and related articles:

*A state by state list of thermagraphy centers

Articles:
*New Federal Guidelines Ignore Dangers of Mammography.
*When Will the Insanity of Mammogram Recommendation End?
*Can Professional Breast Exams Replace Mammography?

Free Vaccine Talk in Philadelphi

Childhood Vaccination: Questions All Parents Should Ask

DATE: Tuesday Sept 9, at 7pm.
Speaker: Dr George Rhodes

Call 215.546.1977, or email ekatebr@earthlink. net, for more information
2409 Waverly St (nr Fitler Square)Phila PA 19146

Married Couples Who Play Together Stay Together

(from www.mercola.com)

For married couples, finding moments to be together free of financial, family or other stresses is not an indulgence, according to new research from the University of Denver.

"The more you invest in fun and friendship and being there for your partner, the happier the relationship will get over time," says Howard Markman, a psychologist who co-directs the university's Center for Marital and Family Studies.

“The correlation between fun and marital happiness is high, and significant.”

Other studies, too, have found that having fun together -- especially while doing “new and exciting activities” -- is the secret to a happy marriage.

Having a joyful marriage is unfortunately the exception rather than the rule in the United States. This is tragic as your happiness and ability to be optimally productive in your life is severely limited when you are not in a happy relationship with your spouse.

Taking some free time to really engage yourselves in something fun (without the kids and without any worries) is something we all can do more of, but there are other ways to support your relationship as well.

Four Tips to a Happy Marriage

Research shows that happily married couples live longer and heal faster than those in unhappy relationships. With that in mind, here are some practical ways to increase the happiness in your relationship:


1. Fight fair. “The way you interact during marital arguments is as important a heart risk factor as whether you smoke or have high cholesterol,” says Timothy W. Smith, a psychology professor at the University of Utah. Verbal aggression, such as yelling at or insulting your partner, leads to decreased intimacy and “self-silencing” -- keeping quiet during a fight -- has been linked to depression, eating disorders and heart disease in women.

2. Keep positive feelings alive. Couples most likely to be married for the long-term are those who maintain their positive feelings for their spouse for at least the first two years. The Emotional Freedom Technique (EFT) can help you to clear any emotional blocks that may be sabotaging your relationship.

3. Read the book Fighting for Your Marriage. I generally give this book to all the couples I know who are planning to get married. It is a valuable source of information for positively handling disagreements between you and your spouse, which will increase the success of your relationship.

4. Support your partner’s goals and dreams. People feel happiest in relationships where they feel the other person helps them achieve their own personal goals.

Sources:
ABC News July 26, 2008

http://www.orgyn.com/en/webzine/2008/Issue_15/Traffic-light_system.asp?C=29686396898540046296

Traffic-light system for cesareans shows benefits
Issue 15: 11 Aug 2008
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology 2008;in press

A trial of a novel "traffic-light" color-coding system for specifying the urgency of cesarean sections has been shown to significantly shorten the time from decision to delivery.

Specialists at centers in Pierre-Benite and Lyon, France, developed and tested the communication tool, which is intended for on-call obstetricians to use in order to convey the degree of urgency for cesarean section to the rest of the perinatal team.

In the three-color system, it was suggested that red should be used to indicate very urgent cases corresponding to life-threatening situations (to the mother or fetus) and warranting an ideal decision-to-delivery time (the time interval from the decision being made to perform a cesarean section, to the birth of the infant) of 15 minutes.

This covers seven situations: hemorrhage from placenta previa, placental abruption, umbilical cord prolapse, suspected uterine rupture, failure of operative vaginal delivery performed for abnormal fetal heart rhythm, acute fetal bradycardia without recovery, and maternal seizure related to eclampsia.

The orange code would refer to urgent cases, warranting an ideal decision-to-delivery interval of 30 minutes. It was suggested that this would include cases of operative vaginal delivery failure, and cases of persistent abnormal fetal heart rhythm.

The green code would be used for non-urgent cases, with an ideal decision-to-delivery interval of 60 minutes. This would include cesarean section performed due to failure to progress or due to abnormal presentation.

The developers intend that the on-call obstetrician would inform the perinatal team of the code (red, orange, or green) as soon as a cesarean is deemed necessary.

In a new paper due to be published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, the researchers (Dupuis et al) report the findings of their trial of the system. They compared decision-to-delivery intervals in two 6-month periods: before and after introduction of the system. Relevant hospital staff were informed fully about the new scheme before it was introduced.

The study was confined to all emergency cesarean sections in the study periods: 96 cases in the first period (15 deemed very urgent, or red; and 81 deemed urgent, or orange) and 78 cases in the second period (14 deemed very urgent, or red; and 64 deemed urgent, or orange).

The overall mean decision-to-delivery interval before introduction of the code was found to be 39.6 minutes. After introduction of the code this had been reduced significantly, to a mean of 31.7 minutes.

The mean decision-to-delivery interval for the very urgent (red) cases was reduced from 21.3 minutes to 19.1 minutes, while the mean decision-to-delivery interval for the urgent (orange) cases was reduced from 42.5 minutes to 34.4 minutes

Reductions were seen in the time from decision to operating theater, and in the time from incision to delivery. The period of preparation in-between, from the arrival of the patient in theater to the first incision, was the same before and after introduction of the code.

The researchers conclude that the study indicates that "use of the three-color code could significantly shorten the decision-to-delivery interval in emergency cesarean sections" by clearly communicating the degree of urgency within the perinatal team. Prospective studies are needed to investigate use of the system further, they add.