Reaction and consideration.
The findings of this large study are significant, interesting and require consideration. However as with all research it requires scrutiny and with much research further study and investigation to clarify the findings implications.

Some considerations.
Autism has had an association with Pre-term birth, and LSCS (Lower Segment Caesarean Section) is associated more commonly with pre-term birth to avoid physical complication or stresses upon the baby.
This is one factor that can compounded by uncorrected over view studies.
The 63 papers that contribute the body of evidence of which this association has been drawn has little reference to whether adjusted corrections have been made or considered in reference to the conclusion results. That is not to underplay the findings, they are significant and of interest but dictate clarification and further assessment.

Assoc. Prof. Jason Howitt of Swinburne University identifies concerns that some of the studies had high rates of autism not consistent with the general population and suggests heavy bias as it is " not consistent with worldwide rates of autism of between 1-3% of all birth." In some studies included in this research the rates were between 10-70%.

Professor Jeffrey Keelan acknowledges the significance of the study but that the researchers have been unable to adequately adjust for many factors that may link outcome with birthing method. He reiterates that further evaluation and research is need to clarify the findings.

Dr Alex Polyakov is a Senior Lecturer in the Department of Obstetrics and Gynaecology at The University of Melbourne and a Consultant Obstetrician, Gynaecologist and Fertility Specialist
"It is a meta-analysis which combined data from 61 studies that included more than 20 million deliveries. The authors reported a statistically significant association between caesarean delivery and autism spectrum disorders as well as ADHD. Other psychiatric disorders did not demonstrate a statistically significant association with the mode of delivery. The methods employed in meta-analysis have been criticised recently. This criticism is usually centred on the fact that a number of unrelated studies, which employed a variety of methodologies, populations and statistical analysis techniques are combined to produce a point estimate of risk. The legitimacy of such data manipulation must be questioned and its results are usually of doubtful exactitude. This can easily be demonstrated if one was to examine two largest individual studies included in the autism spectrum disorders (ADH) and ADHC meta-analysis.
 
ADH
A study by Curran et al was conducted in Sweden between 1982 and 2011 and used ICD-9 and ICD-10 to define ADH and examined 2,697314 deliveries, 28,290 children were diagnosed with ADH. This translates to a prevalence of ADH of 1.05% in this population. This is the largest study in this meta-analysis. The second-largest study was by Yip et al and was conducted in Norway and Finland between 1984 and 2004. It used ICD-8, 9 and 10 to define ADH and included 1,052,397 deliveries with 1,303 children being diagnosed with ADH. In this study, which is the second-largest included in this meta-analysis, the prevalence of ADH was 0.12%, approximately 10 times less than reported by Curran et al. This demonstrates the pitfalls of combining radically different studies to try to arrive at a meaningful conclusion.
 
ADHD
The above exercise can be repeated with the ADHD portion of the article. If the two largest studies included are examined, the prevalence of ADHD in one was 2.77%, while in the second-largest sample it was 0.2%, again a tenfold difference.
 
What can be concluded from these discrepancies in the prevalence of the two diagnoses? Firstly, even if the final results are accepted, it is almost impossible to assess their clinical significance. A 20% increase in risk has radically different meanings, depending on the prevalence of a particular outcome. For example, a 20% jump from a baseline of 3%, will translate into 3.6%, probably a clinically significant increase, that would warrant an intervention to prevent it. On the other hand, the same 20% increase, if applied to the baseline rate of 0.2%, will result in 0.24% prevalence, which may not be as clinically troublesome and may not warrant an intervention.
 
Secondly, one must question the wisdom of combining such divergent studies and expecting an accurate and unbiased estimation of risk. The old saying from computer science: 'garbage in, garbage out' seems to apply, as poor quality input will invariably produce sub-optimal output.
 
Overall, it must be stated that both caesarean section and vaginal delivery have risks for mothers and babies. These risks are not the same and there is no consensus as to which mode of delivery is better overall. The study adds another possible risk to indiscriminate utilisation of caesarean section as the preferred mode of delivery, but it must be balanced against recognised risks of alternative delivery strategies."

Emeritus Professor Alastair MacLennan AO (head of Australian Collaborative Cerebral Palsy Research group and University of Adelaide) also identifies a cautionary overview.
"Although an interesting and controversial topic the many methodological weaknesses of this study make any conclusion very unreliable.

Firstly no realistic physiological mechanism for the weak association of autism and ADHD with mode of delivery is offered.

The studies analysed were very different (heterogeneous) and all were observational studies that do not allow for a wide variety of potential biases.

As a general rule for outcomes in observational studies to be plausibly significant the Odds Ratio (times difference) should be more than 2 and the confidence intervals should not cross one. In this study, the ASD odds ratio was only 1.33 and ADHD was only 1.17.
For all the other outcomes examined the confidence intervals crossed one meaning that there was no statistical significance."

In summary, it is a large study with an interesting and well-performed metaanalysis of neurodevelopment outcomes on an impressively large number of deliveries (over 20 million) from over 60 studies performed across 19 different countries. The central findings are that caesarean section deliveries are associated with a 33% increase in risk of autism spectrum disorder (ASD) and a 17% increase in attention-deficit/hyperactivity disorder (ADHD).
​The issue is: can a casual connection and link be drawn based on the evidence? Further research is required.

Is it ok to masturbate during pregnancy?

It is generally perceived that masturbating during pregnancy is safe, in some instances it can provide health benefits, such as lowering stress and promoting blood flow.Women experience different effects on their libido whilst pregnant, their hormones have a large effect on this.
Women often wonder whether masturbating while pregnant is safe or if there are any risks. The good news is that, in most cases, it is totally safe. Dr Petrina Duncan welcomes consultation in regard to your own personal contextual consideration in this regard.

Masturbation is safe during low-risk pregnancies.In most low-risk pregnancies, masturbation is a perfectly safe way to relieve stress and manage an elevated libido. Consultation with Dr Petrina or your chosen health professional is advised.  Sex toys can be utilised as long as hygeine is maintained and all toys are clean. 
Wash all toys with soap and water to prevent bacteria from entering the vagina. Hands should also be clean and nails trimmed to prevent any risk of cuts or lacerations.


Are there benefits?
Masturbation, including during pregnancy, can be good for the body. Some women even report stronger or more intense orgasms while pregnant.
Some benefits of masturbation during pregnancy include:

• lowering stress levels
• improving sleep
• easing pregnancy-related discomfort and pain
• increasing the release of endorphins

In addition, masturbation is the safest form of sexual activity. There is no risk of sexually transmitted infections (STIs) unless a person is sharing a sex toy with someone else.
Are there side effects?Later on in pregnancy, a woman may notice increased Braxton-Hicks contractions following an orgasm. These contractions, though sometimes uncomfortable, are nothing to worry about. There are other cramping sensations that can be associated with the post orgasmic state but these should remain mild. If they raise any concern, you should always consider contacting Dr. Petrina or your chosen health provider


Are there any risks?
There are no risks associated with masturbation for a woman having a low-risk pregnancy who has no complications or other medical issues.
When preterm labor is a risk, however, vaginal penetration — or even having an orgasm — can trigger labor. In these cases, the doctor may recommend avoiding intercourse or orgasms to lower the chances of premature delivery.
As identified above without appropriate consideration there are potential risks of infection from grazes and cuts caused by long nails. 


When to avoid masturbating during pregnancy

• placenta previa, in which the placenta covers the cervix
• a weakened cervix
• premature rupture of membranes
• a history of premature labor
• vaginal bleeding
• uterine infections
• intrauterine growth restrictions

It is extremely important to contact Dr Petrina or your own chosen health professional in relation to your own unique circumstances and/ or recommendations.
This advise may be that a woman avoids having orgasms altogether or only refrain from vaginal penetration, for example.
The Uterine muscle contracts during orgasm. In some situations, this can trigger early labor, premature delivery, or other serious complications.
If vaginal penetration is to be avoided, masturbation or mutual masturbation with a partner can be a good alternative. However if an orgasm is contra-indicated and has been advised against then one should avoid masturbation and all other sexual activity.
If the water has broken or if there is any vaginal bleeding, refrain from masturbation and other sexual activity. Always consult your chosen health professional.


Some sexual activity is not safe during pregnancy and as with most things, whilst pregnant consultation with your chosen health professional is advised. 
All content is strictly informational and should not be considered medical advice.