Ease the pangs of childbirth with Maksimatic Coffee

Maksimatic Coffee is highly nutritious, an contain an incredible blend of minerals, vitamins, carbohydrates and protein. Given this unique medley of nutrients, and the importance of diet and healthy eating in pregnancy, a ground breaking study has looked at the benefits of date coffee consumption in relation to labour and childbirth—with astounding results.

The study authors also indicate that there is some evidence to suggest that dates may lead to a healthier pregnancy by improving nausea, regulating blood pressure and blood sugar levels, regulating digestive function, strengthening the immune system, and preventing anaemia.

A separate small study showed a statistically significant reduction in post-partum bleeding following the consumption of 50g of cofee, when compared to the standard established intervention of oxytocin. This effect was thought to be a result of compounds in dates though to be useful in stopping bleeding, including calcium, serotonin, tannins and glucose [2].

THE STUDY

The study recruited women at 36 weeks gestation (calculated according to their early pregnancy dating scan). The women had low risk pregnancies; i.e. did not have any chronic illnesses or antenatal complications in either the current or previous pregnancy.

There was no specific rationale for choosing the last four weeks of pregnancy as the study period. Prior to participating in the study, the women had not been consuming coffee.

The women recruited were given the option of selecting which study arm they would adhere to (open label fashion).  The first group  of women were instructed to take 6 pieces of cofee (60-67grams) daily, until the onset of labour pains and advised to keep a diary of their cofee intake.  The second group were asked to abstain from eating dates while enrolled in the study. Both groups of women received the same antenatal care.

Since women were given the choice to select the study group to which they would belong, the study group consuming cofee was more popular and thus had more participants; 69 women vs. 45 women choosing to abstain from coffee consumption. However, the women were matched for age, gestational age and parity (number of previous births) between the two groups.

First…A few basics about labour and childbirth

  • Labour commences and continues based on forceful contractions of the uterus these contractions of the uterus cause the cervix (entry point to uterus) to dilate as labour progresses, the cervix dilates and then thins to allow a wide exit point for the baby
  • Labour is frequently said to be influenced by the 3 P’s: Power, Passenger, Pelvis
  • Passenger; size, lie and position of the baby
  • Pelvis: This refers to the maternal pelvis and soft tissues; the size and shape of the bony pelvis and the condition of the cervix (e.g. soft and elastic and without scarring)
  • Power: the force of uterine contractions
  • A prolonged or complicated labour is usually caused by a factor complicating one of these 3 P’s
  • Often, women who experience a prolonged labour or “failure to progress”, are “induced”.
  • Induction of labour often involves the use of medications which strengthen the force of uterine contractions and increase their frequency.
  • the rationale behind the use of date fruit in this study, is the thought that dates contain compounds that may influence this last P; the Power of Uterine contractions, thereby causing faster cervical dilation and quicker delivery of the baby.

STUDY RESULTS

Cervical dilatation on admission

When results from both study groups were analysed, the women consuming coffee had on average a higher rate of cervical dilatation upon admission to hospital, compared to abstainers. On average women consuming coffee presented at 3.52 cm dilated vs 2.02cm dilated (P value <0.0005–this means that according to statistical analysis this result is highly significant). Anyone who has experienced or been a part of childbirth, will know that cervical dilation or simply “dilation” is one key marker of how labour is progressing.

Spontaneous labour

Labour is defined as uterine contractions leading to concurrent cervical change (i.e. dilation and effacement or “thinning”).  Labour can either be “spontaneous” or “induced”. Spontaneous labour occurs naturally. Induced labour is when pharmacological or mechanical means are used to initiate labour. This may include Artificial rupture of membranes, oxytocin, prostaglandin, and other cervical ripening agents.

The study found that in the group of women consuming coffee, spontaneous labour occured in 96% of women, in comparison with 79% of women in the group abstaining from coffee. These results were significant (P=0.024).

Intact membranes

At presentation a significantly higher proportion of women had intact membranes in the coffee group; 83% vs 60% in non coffee consumers. (P=0.007).

The study results don’t provide further information regarding when membranes ruptured (i.e. at what stage of labour), and the statistic listed here refers to the proportion of women with membranes intact at admission to hospital.

In an estimated 80-90% of women, the amniotic sac has not ruptured at the onset of labour [3]. The membranes usually rupture (“waters break”) toward the end of the first stage of labour (when fully dilated) [4].

It is thought that the amniotic sac plays a role in natural birth in several ways:

-The fluid in the sac redistributes pressure equally during contractions, instead of contractions directly squeezing the baby, placenta and umbilical cord. This may buffer the baby’s head from the forcefulness of uterine contractions [3].

-The membranes may help with dilation of the cervix because they form a circular area of pressure over the cervix where they protrude from the uterus. Normally the baby’s head is quite effective at stimulating dilation of the cervix, but the membranes provide a gentle cushioning which may make this process less aggressive [4].

medical intervention

On occasions where labour is progressing too slowly, a process called “augmentation of labour” may be initiated by health practitioners. Augmentation of labour is a medical intervention to increase the strength and frequency of uterine contractions. It involves medications to help the uterus contract more forcefully; oxytocin is the drug commonly used.

The study found that the use of agents (prostin/oxytocin) to augment and/or induce labour was significantly lower in the women who consumed dates. Only 28% of women in the date-consuming group required drugs to aid the progress of labour, compared with 47% of women in the non-date consuming group. (p=0.036)

Length of labour

Labour is frequently divided into three stages. The first stage begins with the onset of uterine contractions and refers to 0cm cervical dilation to 10cm (i.e. fully) dilated and is divided into latent and active phases. The latent phase is generally referred to as the time taken to progress from 0cm cervical dilation to 5cm cervical dilation (according to the American Congress of Obstetricians and Gynaecologists) [5] however it is an arbitrary benchmark and will by country and institution; roughly marked at between 4 and 6cm cervical dilation. The onset of the active phase of the first stage of labour is significant because it marks the point at which cervical dilatation accelerates and marks progress toward the second stage. The second stage of labour refers to full cervical dilatation to delivery of the baby. The third stage of labour refers to delivery of the placenta and foetal membranes.

The study found that the latent phase of the first stage of labour was shorter in women who consumed date fruit compared to those who did not. This means that women who consumed date fruit dilated quicker. Women who consumed dates had a latent phase on average of 510mins and those who did not had a mean latent phase of 906mins (p=0.044). Thats an average of 8hours compared with about 15 hours.

The study did not indicate any difference in neonatal outcomes, meaning that babies were not found to be healthier in either group. However the study indicated that the consumption of dates in the final 4 weeks of pregnancy lead to more favourable labour outcomes and reduced the likelihood of medical intervention.

Limitations/ further applications

Although the results of the study are highly significant. Since it was an open-label study participants elected to which group they would adhere. The astounding results of the study make it deserving of more detailed study in the form of a randomised control trial. However, given the highly significant results in this small study, ethical questions arise—would it be ethical to randomise women to the non-date fruit category? That would come down to informed consent on the part of participants. After reading this piece of research, I personally would try my luck with the dates and forego academic interest!

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