Wednesday, October 31, 2007

New c-section study

There is a new cesarean study out in the British Medical Journal. Here are several news reports off the same report.,,-7037334,00.html

Friday, October 12, 2007

A bone to pick...

I’ve been reading with interest about the controversy surrounding whether Lucy’s 3.2 million-year-old fragile remains should be put at risk as she is publicly displayed, for the first time outside of Ethiopia, at the Houston Museum of Natural Science between now and next April.
In my mind, however, it is Lucy’s legacy that has put us at risk.
When you see her - and you should -- peer at her frame and ponder one of the more profound questions of our time: Is that why the cesarean rate is so high?
The first time I laid eyes on Lucy’s likeness, it was a mocha-colored cast of her 47 fossilized bones, encased in glass and hung on the wall in the American Museum of Natural History in New York.
At the time, about a year after my son was born, I was trying to understand why human birth is both a natural physiological process that has successfully (over)populated the earth, as well as a painful experience that leaves little room for error.
That day, in New York, I stared at Lucy’s replicated half-remaining pelvis, which was originally dug out of the ground in Ethiopia in 1974, and sighed as my son squirmed in his stroller beneath her.
“So small!” I shrieked to no one in particular.
Granted, Lucy, living on a diet of nuts and berries and the occasional carcass leftovers, probably stood only about 3.5 feet tall, and weighed about 60 pounds. (Males of her type would have been taller.) But indeed, Lucy’s legacy – as the museum’s slick marketing materials state – is profound in that her fossil shows us how humans evolved from knuckle-dragging ape-like creatures, with roomy pelvises, to upright creatures that became more intelligent.
And therein lays the problem. Lucy’s pelvis was narrower than those of earlier primates. Her pelvis had to be smaller to support efficient walking on two feet. If she continued to walk with the aid of arms on the ground, her stance would have been wider and, when bipedal, she would have rocked from side to side, like chimps do when upright. Meanwhile, our ancestors became increasingly intelligent – meaning their crania enlarged.
Ah, Lucy’s legacy. Big head, small pelvis: The modern consequence of such bad anatomical math plays out every day in hospital labor and delivery units around the world. In America, we can understand Lucy’s legacy in the popular cry for epidurals. We can feel Lucy’s legacy in the rush for the scalpel, with nearly one out of every three births in the U.S. now by cesarean section. And we can ponder Lucy’s legacy as babies are born larger and larger with every passing year. For the record, our pelvises are not getting bigger.
As I sit here, pregnant again, wondering how my own obstetrical drama will play out (the first time ended in a c-section, of course but I am not worried this time), can someone in Houston do me a favor?
Tell Lucy I have a bone to pick with her.

Thursday, October 04, 2007

The mommy job

Stringing the words Mommy and Job together seems oxymoronic. Afterall, isn't all of motherhood work? Most of it good work? Apparently, not when breastfeeding makes your chest sag and carrying a baby to term gives you a pouch that would make a kangaroo envious. Surgeons to the rescue, according to the below story in the New York Times! I will not pass judgment on those women who are so self-conscious of their post-baby bodies that they will go under the knife. But having a breast lift, tummy tuck and lipo done all at once would certainly put one out of commission for a while. Who has time when you have kids?

October 4, 2007
Skin Deep
Is the ‘Mom Job’ Really Necessary?
DR. DAVID A. STOKER, a plastic surgeon in Marina Del Rey, Calif., has a surgical cure for the ravages of motherhood. He, like many plastic surgeons nationwide, calls it a “mommy makeover.”

Aimed at mothers, it usually involves a trifecta: a breast lift with or without breast implants, a tummy tuck and some liposuction. The procedures are intended to hoist slackened skin as well as reduce stretch marks and pregnancy fat.

“The severe physical trauma of pregnancy, childbirth and breast-feeding can have profound negative effects that cause women to lose their hourglass figures,” he said. His practice, Marina Plastic Surgery Associates, maintains a Web site,, which describes the surgeries required to overhaul a postpregnancy body.

“Twenty years ago, a woman did not think she could do something about it and she covered up with discreet clothing,” Dr. Stoker said. “But now women don’t have to go on feeling self-conscious or resentful about their appearance.”

In 1970, “Our Bodies, Ourselves,” the seminal guide to women’s health, described the cosmetic changes that can happen during and after pregnancy simply as phenomena. But now narrowing beauty norms are recasting the transformations of motherhood as stigma.

These unforgiving standards are the offspring of pop culture and technology, a union that treats biological changes as if they were as optional as hair color. Gossip magazines excoriate celebrity moms who don’t immediately lose their “baby weight.” Even Cookie, a luxury parenting magazine, recently ran an article that described postpregnancy breasts as “the ultimate indignity” and promoted implant surgery; a photo of droopy water-filled balloons accompanied the article.

Many women struggle with the impact of aging and pregnancy on their bodies. But the marketing of the “mommy makeover” seeks to pathologize the postpartum body, characterizing pregnancy and childbirth as maladies with disfiguring aftereffects that can be repaired with the help of scalpels and cannulae.

“The message is that, after having children, women’s bodies change for the worse,” said Diana Zuckerman, the president of the National Research Center for Women and Families, a nonprofit group in Washington. If marketing could turn the postpregnancy body “into a socially unacceptable thing, think of how big your audience would be and how many surgeries you could sell them,” she said.

Pregnancy affects each woman differently, with age and genetics playing a role in how the body recovers. While many plastic surgeons argue that pregnancy both “deforms” breasts and redistributes fat so that it becomes difficult to exercise away, some obstetricians disagree.

“Some women have stretch marks from pregnancy or weight gain,” said Dr. Erin E. Tracy, an assistant professor in obstetrics, gynecology and reproductive biology at the Harvard Medical School. “But there is no intrinsic abnormality to the breasts or the abdomen.”

Mommy surgery appeals both as a quick fix for stubborn postpregnancy weight and as a way to control aging itself. Dozens of doctors devote parts of their Web sites to the mom job, including Dr. Lloyd M. Krieger, a plastic surgeon in Beverly Hills, Calif., who offers the Rodeo Drive Mommy Makeover for women who want “their tummies and breasts back the way they looked before pregnancy.”

Mommy surgery came to public attention earlier this year after the American Society of Plastic Surgeons reported a rise in cosmetic surgery among women of child-bearing age (not all of whom are necessarily mothers). Last year, doctors nationwide performed more than 325,000 “mommy makeover procedures” on women ages 20 to 39, up 11 percent from 2005, the group said. And last Sunday, the ABC drama “Brothers and Sisters” included a playground scene in which one mother asked, “Do you think I should get a mommy job?”

Read more here:

I thought chili peppers CAUSED pain...

Regarding the apparent scientific breakthrough below, being able to move through labor without pain would be a major improvement over the current epidural, which relegates women to bed. Still, I wonder what the side effects might be. There's always something.

That lively pepper may help dull the pain
Ingredient is central to new anesthetic
By Colin Nickerson, Globe Staff | October 4, 2007

The world's hottest work in anesthesiology is being done at Harvard, where researchers are deploying pepper against pain.

Scientists at Harvard Medical School and Massachusetts General Hospital yesterday described a new targeted approach to anesthesia that uses the active ingredient in chili peppers as part of an ingenious recipe for blocking sensation only from pain neurons. That's a significant departure from current anesthetics, which suppress signals from other types of nerve cells as well.

Most critically, the technique - as shown in experiments on rats - doesn't cause the numbness or partial paralysis that is the unwelcome side effect of local anesthesia, used for surgery performed on conscious patients.

If approved for use in humans, the method could dramatically ease the trial of giving birth by sparing women pain while allowing them to more fully participate in labor. It could also diminish the trauma of many kinds of surgery or the discomfort of dental work. Not only would there be no "ouch," there would be none of the sickening wooziness or loss of motor control that often comes from standard forms of local anesthesia.