Natural Childbirth Research Articles

Authoritative knowledge of childbirth and obstetrics: analysis of discursive practices of Russian perinatal specialists

The article discusses discursive practices of official and alternative perinatal specialists: obstetricians and gynecologists, midwives of maternity hospitals, domestic midwives and doulas. To analyze these practices, the author uses the notion of authoritative knowledge proposed by Brigitte Jordan and dating back to the power-knowledge concept by Michel Foucault. The author focuses on controversial but widely used concepts such as obstetric violence and natural childbirth. Additionally, the author regards such relatively new for the Russian community concepts as humanization of childbirth, obstetric model, demedicalization of childbirth, etc. The study is based on the materials of the founding conference of the professional non-profit association Obstetric Union, which was held at Moscow Perinatal Medical Center Mother and Child on November 30 – December 1, 2019.

COVID-19 infection in symptomatic pregnant women at the midpoint of the pandemic in Spain: a retrospective analysis.

Determine the strengths and weakness of a symptomatic screening for COVID-19 in pregnant women. Analyze the clinical presentation, management, and outcomes. Descriptive retrospective observational study. Mancha-Centro Hospital (Spain). Population: Symptomatic pregnant women with confirmed diagnosis of COVID-19. Between the 12th of March and 17th of April 2020, all the symptomatic pregnancies were screened with diagnostic test for SARS-CoV-2. Data collection was done by reviewing the medical records and telephone interviews. Clinical characteristics, management, treatment, and obstetric and neonatal outcomes. Twenty patients with positive COVID-19 diagnostic test out of thirty-four suspected. The most common symptoms were fever (70%), cough (65%) and myalgia (35%). A unique symptom of presentation in 20% of cases. COVID-19 pneumonia was diagnosed in 30% by chest X-ray and one case had pulmonary embolism associated diagnosed by CT-Scan. Thromboprophylaxis was indicated in 16 out of 20 patients. Eight women finished their pregnancy during the observation period. Type of birth: 25% natural birth, 12.5% assisted vaginal delivery and 62.5% caesarean section. We had three severe cases, two of them with intensive care support. All neonates had negative test for COVID 19 infection. We recommend universal screening of all pregnant woman for COVID-19 during the pandemic because of the limits of the symptomatic screening seen in this studio and the ratio of asymptomatic pregnancies with positive test for COVID-19 recently published.

Population Structure Analysis of Javan Rhinoceros at Ujung Kulon National Park, West Java

<p>Javan rhino (Rhinoceros sondaicus) is one of the rare animals with critically endangered status. The Ujung Kulon National Park (UKNP) is one of javan rhino habitat in Indonesia. Every year the monitoring program for javan rhino in UKNP was performed to identify the animals. This research was aimed to analyze the population structure of javan rhino based on the records data from 2011 to 2019 in UKNP. Research showed that the natural increase (NI) and birth rate (BR) values were 17.34% (moderate) and 67.33% (high) respectively. The net return rate (NRR) value was 15.38% (male) and 14.28% (female). The NRR value in the present study was lower than 100% and caused by less number of animals in a population for 30 years of breeding length. Despite this, the inbreeding rate of javan rhino at UKNP in 2019 was 0.01 (low). It was concluded that the natural increase of javan rhino at UKNP showed a good parameter but the population number needs to be increased.</p>

2020 Year of the nurse and the midwife: a call for strengthening midwifery in response to South Korea's ultra-low birth rate.

Along with the low birth rate in Korea, the aging of mothers is progressing very rapidly. Recent studies have reported that the obstetric infrastructure is crumbling due to the accelerating closures of obstetric medical institutions resulting from the low birth rate and low reimbursement rates for obstetric procedures. The number of birth centers has also decreased, but women’s interest in natural birth has actually increased, such that deliveries at birth centers now account for 11.8% of deliveries in obstetric clinics. In the Netherlands, Japan, and the United Kingdom, initiatives to promote natural birth through care provided by midwives increased the rate of natural births, decreased the number of cesarean sections, and lowered the rate of postpartum complications. In light of these examples, South Korea should also encourage natural delivery by midwives. A national support system for midwife applicants is necessary, and the requirements for institutions that train midwives should be revised. Independent birth centers should have emergency prescription privileges, and women should be given the choice to have a natural delivery by creating birth centers within hospitals.

Factors affecting elective cesarean section in women with multiple pregnancy in Caruban, Indonesia

Background: Caesarean sections have become the most popular method for delivering twin babies because of the safety concerns associated with a natural birth. This study aims to identify the maternal characteristics and obstetric parameters that serve as risk factors influencing caesarean delivery in twin pregnancies by comparing women delivering via caesarean section and vaginal birth. Methods: A retrospective chart review design was used to analyse 47 women with multiple pregnancies from the medical records at a primary referral hospital in East Java, Indonesia. Women delivering vaginally were then compared with women who underwent a caesarean section to identify any differences between the groups. Results: More women delivered by caesarean section than by vaginal birth. In this study, women were more likely to undergo a caesarean section if they had a previous history of undergoing a caesarean section or if there were no foetal malpresentations during their pregnancy. There was a significant difference in maternal age between groups. We found that foetal malpresentation did not significantly increase the likelihood of caesarean delivery in women with multiple pregnancies. Conclusions: The percentage of multiple pregnancies delivered via caesarean section is quite high. Similar to previous studies, we identified a few factors including foetal malpresentation and labour augmentation that did not significantly increase the risk of caesarean delivery. However, we suggest that there is more than one reason responsible for the increase in caesarean sections in multiple pregnancies.

Teratogenic Toxicity Evaluation of Bladder Cancer-Specific Oncolytic Adenovirus on Mice.

In our previous studies, we had demonstrated the efficiency and specificity of constructed bladder tissue-specific adenovirus Ad-PSCAE-UPII-E1A-AR (APU-EIA-AR) on bladder cancer. The virus biodistribution and body toxicity in nude mice have also been investigated. However, the safety of the bladder cancer-specific oncolytic adenovirus on fetal mice and F1 mice should be under intense investigation. In order to evaluate the teratogenic toxicity of bladder cancer-specific oncolytic adenovirus APU-EIA-AR on mice, in this study, we investigated the fetal mice weight, fetal body length and tail length, fetal skeleton development, as well as the F1 mice weight, growth curve, and major organ pathology. These teratogenic toxicity data of bladder tissue-specific adenovirus Ad-PSCAE- UPII-E1A-AR (AD) would provide safe information prior to embarking on clinical trials. On the sixth day of being fertilized, the pregnant mice began to be intramuscularly administrated with AD (1×107VP, 1×108VP, 1×109VP) every other day for ten days. The pregnant mice were then divided into two groups. One group was euthanized on the seventeenth day; the fetal mice were taken out, and the bone structure of the infants was observed. The other group was observed until natural childbirth. The Filial Generation (F1) is fed for 30 days; the variations in the growth progress and development were assessed. The mice were then euthanized; The tissues from major organs were harvested and observed under the microscope. In the process of teratogenic toxicity test, the Placenta weight, fetal mice weight, body length, and a tail length of mice fetal in adenovirus treated group did not reveal any alteration. Meanwhile, comparing with the PBS group, there is no obvious change in the skeleton of fetal mice treated with adenovirus. During the development process of F1 mice treated with adenovirus, the changes in mice weight show statistical significance. However, in the progress of the growth curve, this difference is not very obvious. Furthermore, the pathological section showed no obvious alteration in major organs. Our study demonstrated that bladder cancer-specific adenovirus Ad-PSCAE-UPII- E1A-AR appears safe in pregnant mice without any discernable effects on fetal mice and F1 development. Hence, it is relatively safe for tumor gene therapy.

Neonatal thermal response to childbirth: Vaginal delivery vs. caesarean section.

Newborns, regardless of the method of termination of pregnancy, are exposed to the first exogenous stress factors during delivery. The purpose of the study was to evaluate the differences in newborns’ thermal response to vaginal (VD) vs caesarean section (CS) delivery. The temperature was measured during the first minutes of life within 122 healthy full-term newborns, on the forehead, chest and upper-back by infrared camera (FLIR T1030sc HD). The lowest temperatures were recorded in the forehead of VD newborns (significantly difference with CS; p < 0.001), the warmest was the chest. A significant correlation was found between the duration of the second stage of natural childbirth and surface temperature and pO2 in the newborn blood. The temperatures of selected body surface areas correlate highly positively, regardless of the mode of delivery. In the case of healthy neonates, with normal birth weight and full-term, VD creates more favourable conditions stimulating the mechanisms of adaptation for a newborn than CS.

Natural Childbirth Movement in Hungary

As the behavior science, preventive approach and health-oriented worldview gradually permeate the whole of medicine, transformations in obstetrics are occurring slowly all around the world. The technocratic character of the medical approach to obstetrics strives to keep the intrinsically natural process under total control of medicine, which has provoked the emergence of the critical movement known as the natural birth movement. However, this generic term is only used theoretically in Hungary because the movement is yet to develop a single base that would bring together its separate units. One of the most important units of the natural birth movement is the doulas community which, after twenty years of differentiation, is seeking possibilities for cooperation, joint action and representation of natural childbirth. In this article, I would like to discuss this process, which reachesbeyond its own frameworks – since it affects not merely the quality of obstetrics but also modern and post-modern definitions of health and disease, the system of power, gender roles, distribution of knowledge, the relationship between nature and technology, as well as the long-term problem of the quality of life within the society – significant questions not only for Hungary.

PIH25 Assessing the Connection between FEAR of Childbirth and Elective Caesarean Delivery

Vaginal delivery is a natural way of childbirth, however, a rapidly growing number of caesarean sections (C-sections) can be observed. The aim of our study was to analyse the relation of fear, causes of preferring C-section, and other possible reasons for choosing this type of delivery. Our quantitative, cross-sectional, descriptive study was carried out by a survey between November-December of 2019. Primiparas aged 18-45 were chosen through non-probability sampling method (N=345). Self-administered (socio-demographic data, health behaviour) and standard questionnaires (Wijma Delivery Expectancy Questionnaire ’A’; Rosenberg Self-Esteem Scale; Satisfaction with Life Scale; and the Hungarian “Delivery Attitude Questionnaire”) were used for data collection. Descriptive statistics, χ2-test, independent samples t-test and linear regression were calculated (p<0.05). Lack of proper physical activity proved to be a significant cause for preferring c-sectional deliveries (p=0.017). Fear of childbirth also increases with age (R=0.108; p=0.045). However, religious beliefs are a protective factor against fear from delivery (t=2.003; p=0.046). Based on our calculations, fear causes choosing c-sections over natural delivery (p<0.001). Self-evaluation and satisfaction with life has no impact on delivery methods (p>0.05), but strongly influences the level of fear (p<0.001). Health professionals in prenatal care can positively affect pregnant women’s level of physical activity, preventing fear and the chance of elective c-sections. Health promotion programs about natural birth can inform gravidas, which could change attitudes towards deliveries into a positive direction.

How norms concerning maternity, femininity and cisgender increase stress among lesbians, bisexual women and transgender people with a fear of childbirth

ObjectiveTo explore and describe norms concerning maternity, femininity and cisgender in lesbian and bisexual women and transgender people (LBT) assigned female at birth, with an expressed fear of childbirth (FOC). DesignSemi-structured interviews were conducted with self-identified LBT people with an expressed FOC. Participants17 self-identified LBT people participated. 15 had an expressed FOC, and two were non-afraid partners. FindingsParticipants described how their FOC was related to ideals of “the primal woman”, including ideals of a natural birth. They also described stress in relation to expectations of gaining a feminine-coded body during pregnancy and of being related to as feminine women. Key conclusionsMaternity ideals, and the ideal of the “natural” birth, can be particularly stressful on those who fear childbirth. Norms concerning femininity and cisgender can contribute to FOC among those who do not comfortably conform with feminine body ideals or feminine gender expressions. Implication for practiceTreatments of FOC must be designed to acknowledge whether and how norms concerning maternity, femininity and cisgender affect the individual's FOC.

Self-compassion predicts less fear of childbirth in childless women: the mediating role of birth beliefs

Objective Women can have fear of childbirth (FOC) in advance of their first pregnancy and such fear can have implications for reproductive and eventual childbirth choices. This study aims to further our understanding of the role of self-compassion in FOC in young childless women, including possible pathways through which self-compassion might relate to less FOC: through natural and medical birth beliefs. Design and Main Outcome Measures In this correlational study, 316 young childless Australian women completed measures of self-compassion, natural and medical birth beliefs, and FOC. Results Self-compassion predicted less FOC, and although self-compassion as a total score did not relate to natural birth beliefs, it did relate to lower scores on medical birth beliefs. The indirect effect through medical birth beliefs was supported; greater self-compassion predicted lower scores on medical birth beliefs, which in turn predicted less FOC. Conclusions The findings, although cross-sectional, support the study of self-compassion in FOC, which is in part because self-compassion predicts less medical birth beliefs. With further research, self-compassion training might be incorporated into public health initiatives targeting FOC in young childless women.

The evolution of professional obstetric nursing in the United States (1880's-present): Qualitative content analysis of specialty nursing textbooks.

Professional maternal-newborn/obstetric nursing in the United States emerged in the mid- 19th century coinciding with the increased medical management of childbirth. Before this mothers were attended by female family members, friends, neighbors and lay nurses or midwives. To trace the evolution of professional maternal-newborn/obstetric nursing since its inception, identify factors which may have influenced this evolution, and consider how this knowledge can inform current issues and challenges in caring for childbearing families. Qualitative content analysis, informed by historical research methods, was used to analyze selected content from a sample of maternal-newborn/obstetric nursing textbooks published from the 1880's to the present. The last 150 years have been characterized by vast changes in medicine, technology and the healthcare system which have all influenced the evolution of professional maternal-newborn/obstetric nursing. Over the decades there has also been a significant change in the conceptualization of pregnancy/childbearing and our relative understanding of maternal and infant vulnerability. Findings revealed, however, that over time the primary focus of professional maternal-newborn/obstetric nursing care has consistently been: "protection, counseling/teaching and support" of childbearing families. In the U.S. maternal-newborn/obstetric nurses currently face many challenges including caring for an increasingly diverse patient population within a complex, technologically advanced healthcare system. This system is characterized by a high rate of cesarean section births, frequent intervention in vaginal births, disparities in access to care, and a high rate of preventable morbidity and mortality. Since its origins the nursing profession has matured and nursing's allegience is now clearly to patients and society Today's nurses have the opportunity to play a key role in advocating for healthcare reform which would allow for less interference in the natural birth process, maximize patient outcomes, decrease inequities, and make comprehensive care for all mothers and infants a national priority.

Microflora de la cavidad bucal en recién nacidos post parto natural inmediato.

La microflora oral es un ecosistema muy variado, sin embargo, antes de darse el parto natural nuestra cavidad bucal se encuentra completamente estéril, pero es en el momento del nacimiento donde comienza la colonización de diferentes microorganismos ya que cuando el feto entra en contacto por el canal del parto, son estos microorganismos capaces de adherirse a las mucosas y comenzar dicha colonización en el recién nacido. Objetivos El presente trabajo de investigación se orienta a lo que pueda suceder microbiológicamente en los primeros minutos de vida extrauterina, es decir a la presencia de microorganismos en la cavidad bucal del recién nacido post parto natural inmediato y así como la relación que existe entre la microflora y el parto natural. Materiales y Métodos Para dicho estudio se consideró 25 pacientes recién nacidos por parto eutócico de los cuales se recogió 50 muestras de su cavidad bucal del Hospital Goyeneche, Arequipa-2017. Resultados Se realizaron los análisis de las muestras recolectadas teniendo como resultados presencia de Escherichia Coli y Staphilococos Epidermidis en su cavidad bucal. Conclusiones Existe relación entre la presencia de microorganismos y el parto natural; por lo tanto la hipótesis planteada se acepta, además se obtuvieron como conclusión que: A mayor tiempo: de parto, de coronado y que transcurre desde la rotura de membrana hasta el parto; existe una mayor probabilidad de presencia de microorganismos en la cavidad bucal de los recién nacidos.

Non-sexual HPV transmission and role of vaccination for a better future (Review).

Human papilloma viruses (HPVs) belong to the Papillomaviridae family and are epitheliotropic infecting squamous epithelia (skin and mucosae). HPV is estimated to be the cause of 99% of cervical cancers (there is no evidence of significant genetic predisposition for cervical cancer), 90% of anal cancer, 65% vaginal cancers, 50% vulvar cancers, and 45-90% oropharyngeal cancers. The route of HPV transmission is primarily through skin-to-skin or skin-to-mucosa contact. Sexual transmission is the most documented, but there have been studies suggesting non-sexual courses. The horizontal transfer of HPV includes fomites, fingers, and mouth, skin contact (other than sexual). Self-inoculation is described in studies as a potential HPV transmission route, as it was certified in female virgins, and in children with genital warts (low-risk HPV) without a personal history of sexual abuse. Vertical transmission from mother to child is another HPV transfer course. Several studies have emphasized the possibility of infection through the amniotic fluid, or the placenta, or via contact with maternal genital mucosa during natural birth. Waterborne transmission of HPV has never been demonstrated; however, HPV DNA has been detected in water environments. Routine hygiene measures are proven to be inefficient in preventing HPV transmission, as the studies which have evaluated samples of HPV on contaminated medical equipment (after standard disinfection) have found them to be still positive. Annual costs associated with the morbidity and mortality of HPV-related diseases are estimated at approximately $4 billion. Once the HPV vaccine program in Australia was launched, many studies reported the initial effects: A decrease in the incidence of high-grade cervical abnormalities, no new genital warts cases in females under 21 years. Promoting greater understanding in the general public about the evident benefits of vaccination can create positive vaccine attitudes and scatter the myths of spurious side effects.

Os limites entre a episiotomia de rotina e a violência obstétrica

Este artigo buscou realizar uma revisão a respeito de qual momento a episiotomia deixa de ser benéfica e se torna uma violência obstétrica. Sabe-se que durante o parto natural é necessário que ocorra uma expansão vaginal e cervical de forma lenta, permitindo, assim, a passagem do feto. Porém, muitas vezes, na justificativa de facilitar o nascimento e prevenir lesões perineais, as mulheres são submetidas a uma incisão cirúrgica na região do períneo, processo denominado episiotomia. A recomendação da Organização Mundial de Saúde é que o índice de realização dessa intervenção não ultrapasse 30%, todavia no Brasil esse número é superior ao proposto. Tal procedimento resulta em impactos negativos à mulher, tanto físicos quanto psicológicos, tais como incontinência urinária e fecal, dispareunia, sentimentos de vergonha e medo. Além disso, muitas gestantes não são informadas previamente sobre o procedimento a ser realizado, ou seja, seus direitos e autonomia são violados. Portanto, é necessário que as gestantes sejam informadas durante o pré-natal sobre as possíveis intervenções que possam ocorrer durante o processo de parto e, ademais, que os profissionais de saúde realizem a episiotomia apenas em casos seletivos, visando à humanização do parto.

In This Issue—Confronting Racial and Other Health Disparities in Birth

In this column, the editor of The Journal of Perinatal Education discusses the importance of confronting racial and other health disparities in birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Features Of Anthropometric Indicators Of Children Of The First Year Of Life Born Of Mothers In The State Of Hypothyrozis

During pregnancy, all organs of the mother work more intensely, since they have to be responsible for the vital activity of not only the mother, but also the child. This also applies to the thyroid gland, which provides hormones to both mother and baby until he has formed his own endocrine system. The vital hormones for both are the thyroid hormones thyroxine (T4) and triiodothyronine (T3). A lack of these hormones, called hypothyroidism, can affect both the course of pregnancy and the health of the expectant mother and her baby. However, with constant medical supervision, pregnancy and natural childbirth with hypothyroidism are quite real. With full control and following all the recommendations of doctors, pregnancy and childbirth with hypothyroidism will go well.

Possibilities for predicting perineal birth injury

Hypothesis/aims of study. To date, intranatal injuries of the genital tract and their adverse effects on the womans body remain one of the most important issues in obstetrics and gynecology. Despite the improved management of childbirth, the frequency of the birth canal tissue injuries has no tendency to decrease and amounts to 10.239.0%. The aim of this study was to assess the possibility for predicting intranatal perineal injuries.&#x0D; Study design, materials and methods. The study included a prospective analysis of 90 cases of labor through the natural birth canal based on data obtained from Ufa and Chita perinatal centers in the years 20172019. To determine the elasticity of perineal tissues, a perineoelastomer has been developed, which allows expressing the elasticity of the vulvar ring tissues by a special conditional coefficient. Data was processed using the IBM SPSS Statistics V25.0 software package.&#x0D; Results. Based on the assessment of the obtained data, a probability coefficient of perineal injuries was developed. Its calculation is based on a nonlinear regression analysis and is expressed by the formula: T = (100 ∙ CFH) / (PAA ∙ FBD ∙ ∙ ), where CFH is the circumference of the fetal head at the level of visual tubercles (mm), PAA is the pubic arch angle (degrees), FBD is the distance from the front to the back of the adhesion of the vulvar ring (cm), is the coefficient of elastic deformation of the perineum. When the coefficient T is more than 1, perineal rupture in labor is predicted.&#x0D; Conclusion. In the development of obstetric injuries of the perineum, a major role is played by the ratio of the circumference of the fetal head and the maximum perimeter of the extension of a vulvar ring, which, together with the value of the pubic arch angle and the coefficient of elastic deformation of the perineum, may be a criterion in favor of performing surgical protection of the perineum in case of a threatening rupture.

Cesarean section in reducing mother-to-child HBV transmission: a meta-analysis

Background A meta-analysis (MA) of natural vs. cesarean births in HBV infected mothers was performed to assess which delivery methods could minimize the mother-to-child transmission (MTCT) of Hepatitis B virus (HBV). Methods Electrical databases PubMed, Embase and Cochrane Library were searched for the English papers about the HBV MTCT up to 19 August 2019. STATA 11.0 software was used for all analysis. Odds ratio (OR) and 95% confidence interval (CI) were used to present the effect size for MTCT at birth and MTCT more than 6 months. Heterogeneity was evaluated using the chi-squared Q and I 2 test to determine the use of random effects model or fixed effects model. Results A total of 19 articles involving 11,144 HBV-positive pregnant women (5251 underwent natural delivery and 5893 received a cesarean section) were included in the study. The pooled OR for MTCT at birth was 0.42, 95% CI: 0.23–0.76 based on random effect model (I 2 = 69.9%, p = .019). Meanwhile, in fixed effect model (I 2 = 0.0%, p = .470), the pooled OR for MTCT more than 6 months was 0.62, 95% CI: 0.48–0.81. The results indicated that HBV infection in cesarean births significantly lower than that of vaginal delivery. Subgroup analysis of MTCT more than 6 months was clearly, and the results indicated that cesarean section significantly reduced the risk of MTCT (OR = 0.62, 95% CI: 0.48–0.81, p < .001). Conclusions Cesarean section can reduce the risk of HBV MTCT and should be employed as a preventive measure. Due to the limitations of this study, further multi-center, large-sample randomized controlled trials must be performed to confirm these findings.

Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High-Value Model of Care.

Midwifery care, particularly when offered through birth centers, has shown promise in both improving pregnancy outcomes and containing costs. The national evaluation of Strong Start for Mothers and Newborns II, an initiative that tested enhanced prenatal care models for Medicaid beneficiaries, found that women receiving prenatal care at Strong Start birth centers experienced superior birth outcomes compared to matched and adjusted counterparts in typical Medicaid care. We use qualitative evaluation data to investigate birth centers' experiences participating in Medicaid, and identify policies that influence Medicaid beneficiaries' access to midwives and birth centers. We analyzed data from more than 200 key informant interviews and 40 focus groups conducted during four case study rounds; a phone-based survey of Medicaid officials in Strong Start states; and an Internet-based survey of birth center sites. We identified themes related to access to midwives and birth centers, focusing on influential Medicaid policies. Medicaid beneficiaries chose birth center care because they preferred midwife providers, wanted a more natural birth experience, or in some cases sought certain pain relief methods or birth procedures not available at hospitals. However, Medicaid enrollees currently have less access to birth centers than privately insured women. Many birth centers have difficulty contracting with managed care organizations and participating in Medicaid value-based delivery system reforms, and birth center reimbursement rates are sometimes too low to cover the actual cost of care. Some birth centers significantly limit Medicaid business because of low reimbursement rates and threats to facility sustainability. Medicaid beneficiaries do not have the same access to maternity care providers and birth settings as their privately insured counterparts. Medicaid policy barriers prevent some birth centers from serving more Medicaid patients, or threaten the financial sustainability of centers. By addressing these barriers, more Medicaid beneficiaries could access care that is associated with positive birth outcomes for mothers and newborns, and the Medicaid program could reap significant savings.