Science & Sensibility

A neat new blog from Lamaze International, Science & Sensibility, a "research blog about healthy pregnancy, birth & beyond". Looks wonderful already.

Thanks to Molly of Citizens for Midwifery for pointing it out.

The "Swine Flu" and Pregnant/Breastfeeding Women

The CDC yesterday issued some guidance for healthcare providers in treating pregnant and breastfeeding women who have or may have the swine influenza A (H1N1) virus. The CDC notes that the flu can be more severe in pregnant women, with a higher risk of complications for the baby, especially if the mom develops pneumonia.

On the subject of breastfeeding, the CDC's advice - which is applicable for pretty much any illness, not just the flu - is as follows:

Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness. Women who deliver should be encouraged to initiate breastfeeding early and feed frequently. Ideally, babies should receive most of their nutrition from breast milk. Eliminate unnecessary formula supplementation, so the infant can receive as much maternal antibodies as possible.

If a woman is ill, she should continue breastfeeding and increase feeding frequency. If maternal illness prevents safe feeding at the breast, but she can still pump, encourage her to do so. The risk for swine influenza transmission through breast milk is unknown. However, reports of viremia with seasonal influenza infection are rare.

It is important to note that by the time a woman shows symptoms of an illness, her baby has already been exposed, so she should never stop breastfeeding or be separated from the baby when sick. There are only a couple notable exceptions to this rule - tuberculosis and HIV come to mind. But for almost all diseases, a sick mother should breastfeed more, not less.

More "news" we already knew: Don't lie on your back when you are in labor

Remaining active and mobile during labor can shorten the first stage and results in less discomfort for moms:

Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour, according to a new Cochrane evidence review.

Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found.

This is not only for physiological reasons, such as widening the pelvis and optimizing fetal position, but "[o]ther research has found that feeling in control and able to make choices reduces pain and psychological distress in general." If fact, lying on your back during labor can be dangerous:

[l]ying flat on one's back during labor can put a great deal of pressure on the blood vessels in the abdomen. "There is widely accepted physiological evidence that the supine position may be harmful in late pregnancy and labor," [lead review author Annemarie] Lawrence said.

According to the reviewers, the supine position puts the entire weight of the pregnant uterus on the blood vessels that supply oxygen to both mother and child, which could potentially lead to problems with heart functioning in the mother and reduced oxygen to the baby. These outcomes could be serious in extreme cases. Lying on one's side has no link with such problems, however.

So why do so many women labor in bed?

[Teri] Stone-Godena[, director of midwifery at the Yale School of Nursing,] said that despite all the attention given to empowering women to have the type of birth experience they prefer, medical professionals still pressure women into lying in bed during labor, because it is more convenient this way for nurses and doctors - and makes fetal monitoring easier.

"I think this research is very vindicating of women being allowed to assume positions of comfort," she said. "Listening to their bodies is what they need to do. Most of time when we limit people's activity, it isn't for reasons that are soundly based on evidence."

She added, "This clearly shows that there are no advantages in staying in bed unless that's where you want to be."

Generally speaking, if a particular labor position causes you increased pain or discomfort, it's not a good one to be in - for you or the baby. Pain is your body's way of letting you know you need to change what you are doing.

Link to article.

Baby News - the Joy and the Sorrow

Hello everyone!

When I started this blog, it's purpose was two-fold; first, to be my pregnancy journal for my third pregnancy (now a very busy three-year-old). I posted pretty much every week during the second & third trimesters, and a couple times while in labor. Second, the blog was to be a place to post interesting and helpful links about pregnancy, childbirth, breastfeeding, and infant care. I do a lot of research & reading and I just needed to share it. Isn't that why anyone has a blog? To share their stuff with the world?

This summer I became pregnant with Baby #4. If you were paying attention, you would have noticed that in July I noted that I would be taking a break from blogging, and did not post again until October 15th, National Pregnancy and Infant Loss Remembrance Day. In mid-August, at 11 weeks, I began bleeding heavily and a sonogram revealed an embryo that had stopped growing about three weeks prior and had no heartbeat. Needless to say, we were sad and also a bit surprised, since I had already produced three children without incident. The actual miscarriage process went as smoothly as could be expected and so we were blessed in that. Baby #4's due date was March 7, just a month ago.

In November we discovered that we were expecting Baby #5. We were neither "trying" nor not trying, but rather were monitoring closely (BTW, if you are a woman of childbearing age and haven't yet read Toni Weschler's Taking Charge of Your Fertility, do so now, and thank me later. I'd also like to give a shout out to fertilityfriend.com). We kept the pregnancy a secret for 11 weeks, through Christmas and the New Year, a feat made possible due only to the fact that this was my first non-HG pregnancy (still plenty of nausea & vomiting, though). So far so good! I've passed the 20-week mark, which means there is zero chance of miscarriage (only because after 20 weeks, a fetal death is considered a stillbirth); and in another couple weeks I will have passed the viability point. Not milestones I had ever felt the need to mark with my previous pregnancies. I do not feel that I am particularly anxious or fearful with this pregnancy, only more cautious with my hopes and feelings.

So what's the plan for The Baby Blawg? I will start up regular updates, probably every couple weeks and then weekly towards the end. And expect more regular posting on birth stuff and, hopefully, a lot of book reviews. Please join me!

Shopping for Breast Pumps

Shopping for a breast pump? The US Food & Drug Administration has a whole website devoted to choosing a pump. This might be a good place to start, but the FDA does not make any recommendations as to specific brands. For even more information, check out Kellymom's list of
milk expression tips & pump information.

Are tocolytics safe & effective?

A new study questions the safety of drugs used for pre-term labor, saying some are linked to complications and not always effective:

In an accompanying editorial, the researchers said their study is a reminder that the decision to use tocolysis shouldn't be taken lightly.

"After 30 years of research, we still do not know whether tocolysis benefits the fetus, so the choice of which drug to use remains a secondary question. The real dilemma is whether or not we should treat at all," they wrote. The long-held belief that "keeping the baby inside longer must be a good thing" needs to be reevaluated, they said.

Early Caesareans Pose Risks to Newborns

Research is catching up to what we knew all along: babies born by elective c-section prior to 39 weeks are at a significantly higher risk of medical problems. Even just a week can mean a huge difference for a baby's health. Complications of being born too early include respiratory distress, infections, and hypoglycemia. This is in addition to the normal risk of being born by c-section, as the New York Times article points out,

Doctors noted that even when babies born by Caesarean are delivered at the same week of pregnancy as babies delivered vaginally, they are at higher risk of respiratory difficulties because the process of labor and delivery primes the fetal lungs for breathing air.

Although the increasing prematurity rate in the US is often blamed on women with little to no prenatal care and poor nutrition, a large chunk of the problem is inductions or c-sections scheduled too early - perhaps in combination with incorrect due dates. Read between the lines of this quotation:

But Dr. Alan Fleischman, medical director of the March of Dimes, said the findings should reinforce the message that "every week counts" in a pregnancy. The women who were more likely to deliver early were white women with private health insurance, and the medical centers were all top-notch hospitals, he noted.

"These are not preterm babies, and these are pregnancies that should have good outcomes," he said.

Keep in mind that the research deals with "elective" cesareans, meaning there was no medical indication for the surgery. The National Partnership for Women and Families' article on the same study reports:

John Thorp, professor of obstetrics and gynecology at the University of North Carolina-Chapel Hill, said that there are differences between infants delivered at 37 weeks vaginally and those delivered via elective c-section. He said, "We would not worry about a 37-and-a-half week baby born vaginally with the onset of labor" because in that situation, "there is some signal from a baby to his mother that says 'I'm ready'"

More discussion and links are available at the Citizens for Midwifery blog. And check out a related press release from Lamaze International, Best Practices in Maternity Care Not Widely Used in the United States.

And as for my opinion, God (or Mother Nature, if you prefer) knew what He was doing. If a 37 or 38 week baby was ready to be born, he would have been born already. Anytime you force a baby to come early, whether through drugs or surgery, you have got to expect a baby that is not completely ready to face life "on the outside".

NaBloPoMo

Melamine found in US formula

FDA defends safety of U.S. infant formula:

FDA tests found "very low levels" of the industrial chemical melamine in Nestle's Good Start Supreme with Iron formula, said Stephen Sundlof, director of the FDA's Center for Food Safety and Applied Nutrition.

It also found low levels of cyanuric acid in Mead Johnson's Enfamil Lipil with Iron, Sundlof said. Mead Johnson is a unit of Bristol-Myers Squibb.

Those findings "do not raise public health concerns," Sundlof told a conference call. "The domestic supply of infant formula is safe."

Representatives for Nestle and Bristol-Myers could not immediately be reached for comment.

The FDA earlier this week said it had found one brand of formula containing melamine, a chemical used widely in the production of plastics and fertilizer, but declined to name the company to Reuters.

The article goes on to say that the FDA is not yet finished testing samples.

Water Aerobics

Water Aerobics during pregnancy reduces the need for analgesia (pain meds) in labor. Seriously.

It's not rocket science

I've had this bookmarked for the longest time (3 1/2 years, to be exact), but since it's NaBloPoMo and I'm looking for things to blog about quickly, thought I'd share. It's an excellent post from katiekind about mothers, babies, and attachment:

You could take it as an insult, but God does not credit us with being rocket scientists when it comes to taking care of the next generation. Instead he pre-programs caregiving behavior on the part of mothers AND he pre-programs babies to elicit caregiving from their mothers. An obvious example is how a nursing mother's breasts gush milk in response to hungry-baby sounds. Just in case she can't figure it out from the way her baby is frantically mouthing anything that gets near...her breasts start to tingle and next thing she knows, the front of her shirt is milky. It is not the most subtle of hints. But considering how tiny and vulnerable babies are, it's a hint to heed. This milk-ejection reflex subsides after the first few months of nursing. By that time a nursing mother and her baby have sync'ed up well and the mother knows her baby's subtlest signs of need for nursing.

But it doesn't stop there.

Read more.

Free book of childbirth stories

Sheri Menelli is offering downloadable copies of her book Journey into Motherhood: Inspirational Stories of Natural Birth for free. Get your copy here.

News Items

A couple items in the news caught my eye, regarding recent research studies:

Contaminants in human milk - not breastfeeding an infant typically poses more of a threat to the baby's health than does exposure to any of the chemicals which can be detected in breastmilk.

Depressed pregnant women have twice the risk of preterm delivery - A recent study found that pregnant women with symptoms of depression have an increased risk of preterm delivery, and that the risk grows with the severity of the depressive symptoms. Most of the women in the study were not taking medication for depression.

Caffeine intake during pregnancy - Any amount of caffeine intake by pregnant women increases the risk of low birth weight in their babies:

In light of this evidence, the UK Government's Food Standards Agency are altering their guidance on the recommended daily limit of caffeine consumption and reducing it from 300mg to 200mg.

When doing nothing is the best course of action

Many C-Sections Can Be Avoided By Waiting Out Stalled Labor for an extra two hours, according to a new study:

"One third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year," said [study author Dr. Aaron] Caughey, who is affiliated with the UCSF National Center of Excellence in Women's Health. "In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach."

The cesarean delivery rate reached an all-time high in 2006 of 31.1 percent of all deliveries, according to the UCSF study. Arrest in the active phase of labor has been previously shown to raise the risk of cesarean delivery between four- and six-fold.

"Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection," Caughey said. "After a cesarean, women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture."

The study also notes that ACOG already recommends waiting at least two hours before proceeding with a cesarean when adequate contractions in active labor produce no progress , but "it is routine practice in many clinical settings to proceed with a cesarean for 'lack of progress' before those ACOG criteria have been met", according to Caughey.

HT: Unnecessarian

But what if the test is wrong?

Kathy at Woman to Woman Childbirth Education has posted several great articles recently, including What does natural birth sound like and C-sections and Mastectomies. But I really wanted to focus on "But what if the test is wrong?" which reminds women to get a second opinion,

One question to keep in mind with this sort of thing is always, “What’s the false positive rate?” Because if a recommendation is made to you to induce or perform a C-section or have some other intervention based on one thing alone, and that “thing” is wrong almost half the time, then how confident can you — and the doctor, for that matter — be in the diagnosis and subsequent intervention. If, however, there is a low false-positive rate, then you can be more confident that your diagnosis is indeed accurate.

and to be wise in evaluating the risks of their options:

It’s one thing for doctors to say that having some medical condition or refusing some intervention “doubles your risk” — which sounds very bad — but it’s another to find out that the “risk” is still only 1 in 50,000 (which is double the risk of 1/100,000). Sure, nobody wants to be that one, but that means that 99,999 mothers and babies are subjected to an intervention which also carries risk. It’s about perspective — a balance — a trade-off between two different courses of action. Nothing in life is guaranteed (except death and taxes); and there are risks and benefits for every course of action. It’s up to you to choose which risks are acceptable for the proposed benefit.

I could not have said it better myself.

Recommended Reading

The Tatum Family blogger reviews several great books on pregnancy and childbirth.

Breast-Fed Babies Better Behaved

Breastfeeding has an effect on behavior during childhood, according to a recent study reported by the Washington Post and HealthDay News:

Parents of youngsters who were breast-fed as infants were less likely to report that their child had a behavior problem or psychiatric illness during the first five years of life, a new study found.

And the likelihood of mental health issues decreased in proportion to the duration of breast-feeding, meaning that a child who had been breast-fed for a year was less likely to have behavior problems than a child who had been breast-fed for just two months.

Oxytocin, anyone?

The Unnecessarian

Check out this relatively new blog dedicated to avoiding an unnecessary cesarean - the Unnecesarean.

National Pregnancy and Infant Loss Remembrance Day

October 15th has been designated by Congress as National Pregnancy and Infant Loss Remembrance Day, in order to remember the approximately 1 million pregnancies each year in the US which end in miscarriage, stillbirth, or neonatal death.

Pregnancyloss.info has, hands down, the best collection of information on miscarriage.

Do you wonder if miscarriages are ever misdiagnosed? Visit The Misdiagnosed Miscarriage for information and support. Primarily for early loss.

Now I Lay Me Down To Sleep is a network of professional photographers who provide services to families experiencing infant loss, at no cost.

The New York Times did a piece a while back on perinatal hospice, A Place to Turn When a Newborn Is Fated to Die.

"He that goeth forth and weepeth, bearing precious seed, shall doubtless come again with rejoicing, bringing his sheaves with him". - Ps. 126:6

Taking a break

Hello faithful readers,

I'm going to take a bit of a blogging break. Not surprising, since I haven't posted to this blog for over a month. But I'm still here. Expect me back in 4-6 weeks; I may pop in a bit sooner if I feel up to it.

Three Years Old

Today is The Baby Blawg's third anniversary. The blog is 3 and my Andrew is almost 2 1/2.

Sleeping through the night

Anthropologist Kathy Dettwyler has a neat commentary on her website on the subject of Sleeping Through the Night:

No doubt about it, the gap between what our culture teaches us to expect of the sleep patterns of a young child (read them a story, tuck them in, turn out the light, and not see them again for 8 hours) and the reality of how children actually sleep if healthy and normal, yawns widely.

But the first steps to dealing with the fact that your young child doesn't sleep through the night, or doesn't want to sleep without you is to realize that:

• (1) Not sleeping through the night until they are 3 or 4 years of age is normal and healthy behavior for human infants.
• (2) Your children are not being difficult or manipulative, they are being normal and healthy, and behaving in ways that are appropriate for our species.

Once you understand these simple truths, it becomes much easier to deal with parenting your child at night. Once you give up the idea that you must have 8 hours of uninterrupted sleep at night, and view these nighttime interactions with your child as precious and fleeting, you get used to them very quickly.

Too much water raises seizure risk in babies

With summer and the hot weather coming on, it's a good time to remind parents that babies who are not eating solids should not drink water, and too much can cause seizures.

Timing Contractions

This looks handy: Contraction Master. For those of you who like to live-blog labor.

The Culprit

or, "how we spent our afternoon".

Can you identify this object? (not the Penny, the white thing) If you look closely, the slight yellow at the top is actually ear wax, which it acquired while spending several hours in my two-year-old's ear. This small piece of plastic caused no physical damage, just a blow of $50 to our bank account. With only the small end visible, it was impossible to identify the object, and thus to determine how far into the ear canal it actually went. Not that far, as it turns out. In fact, we might not have even known had my unusually verbal son not said, "Mommy, take off ear!".

In the News

Some interesting items in the news this week about pregnancy, breastfeeding, and child care:

The rates of pregnant women with diabetes is soaring.

While the news that More Mothers Breast-Feed, in First Months at Least is exciting (especially the increase among African-American moms), the number of babies still breastfed at six months remain unchanged. And there are other questions about the collection of data:

The most recent C.D.C. survey did not report breast-feeding rates at 6 months because of a lack of data.

and further:

Dr. Barbara L. Philipp, associate professor of pediatrics at Boston University, said the C.D.C. survey had not asked mothers whether they breast-fed exclusively. “One sip was positive, so they set the bar very low,” Dr. Philipp said.

and hospitals have still not banned the bags:

Dr. Philipp said that while doctors and nurses were doing a better job of emphasizing the benefits of breast-feeding to patients, most continue to offer new mothers free diaper bags containing infant formula when mothers go home with their newborns.

“That’s a problem because at least five studies have shown that when a doctor or nurse hands the family that bag, even if they take the formula out, that mother will have less success with breast-feeding,” Dr. Philipp said.

Breast cancer risk cut by breast feeding (not if you live in Tanzania, though) although a Brittish poll found that 75% of moms are not aware of that benefit.

And while it isn't exactly "news", more studies confirm that Breastfeeding will improve children's IQ scores.

Just in case you needed something else to worry about, extra iron for infants who don't need it might delay development, arsenic in baby rice puts children at risk, children are more vulnerable to harmful effects of lead at age 6 than as toddlers, and nearly one-third of U.S. parents don't know what to expect of infants.

Dark Chocolate Reduces Preeclampsia Risk

At last, the study we have all been waiting for: Chocolate May be Boon to Pregnant Women; Dark chocolate is good for pregnant women: study.

By biting into rich, dark chocolate, there is a 69 percent less chance of contracting preeclampsia, a major pregnancy complication with cardiovascular manifestations such as hypertension that affects up to eight percent of pregnancies, said Dr. Elizabeth Triche.

The associate director at the Yale Center for Perinatal, Pediatric & Environmental Epidemiology, at Yale University, co-authored the 1996-2000 study of 2,291 women published in the May issue of Epidemiology.

The study method measured the density of theobromine -- a chemical in chocolate -- in the arterial cord blood extracted from the umbilical cord at delivery.

The primary effects of theobromine include diuresis, myocardial stimulation and vasodilatation. Other chemicals in chocolate include magnesium, which lowers hypertension, and flavanoids, which are potent antioxidants, the study said.

"Quantifying self-reported chocolate and cocoa consumption is extremely difficult due to considerable variation in the cocoa content of chocolate products," Triche said.

"The darker (the chocolate) is, the better it is. The more highly processed, the more fat and sweet it is, the less it contains theobromine," she said, adding that theobromine concentrations in chocolate vary from 0.15 percent to 0.46 percent.

"In this prospective cohort of pregnant women, we observed that chocolate consumption, as measured by cord serum levels of the biomarker theobromine, was associated with lower risk of preeclampsia," the study concluded.

Baby Blog Turns Three

Today is the first of two anniversaries celebrated at The Baby Blawg; today is the day I actually created the blog. Later comes the anniversary of the day I commenced posting.

I wish I could think of something brilliant or witty to say about it.

Supporting Your Partner in Labor

The Talk Birth blog links to Transition to Parenthood's helpful handouts, including Ideas for Supporting Your Partner in Labor.

Trans Fats in Pregnancy

Surprised this hasn't gotten more press:

A study on rats found that babies had a higher chance of being fat if their mother ate trans fats in pregnancy or while feeding their young.

The experts at Sao Paulo university in Brazil also found they were also more likely to suffer insulin resistance, which often leads to diabetes.

Luciana Pisani, who led the study, said: "This has important implications."