There is a new cesarean study out in the British Medical Journal. Here are several news reports off the same report.
http://icwales.icnetwork.co.uk/news/wales-news/2007/10/31/caesarean-babies-70-more-likely-to-die-91466-20035743/
http://www.guardian.co.uk/uklatest/story/0,,-7037334,00.html
http://www.telegraph.co.uk/news/main.jhtml?view=BLOGDETAIL&grid=F11&blog=yourview&xml=/news/2007/10/31/view31.xml
Wednesday, October 31, 2007
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.
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?
By NATASHA SINGER
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, amommymakeover.com, 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:
http://www.nytimes.com/2007/10/04/fashion/04skin.html?pagewanted=print
October 4, 2007
Skin Deep
Is the ‘Mom Job’ Really Necessary?
By NATASHA SINGER
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, amommymakeover.com, 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:
http://www.nytimes.com/2007/10/04/fashion/04skin.html?pagewanted=print
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.
http://www.boston.com/yourlife/health/articles/2007/10/04/that_lively_pepper_may_help_dull_the_pain?mode=PF
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.
http://www.boston.com/yourlife/health/articles/2007/10/04/that_lively_pepper_may_help_dull_the_pain?mode=PF
Sunday, September 30, 2007
BOLD Play
Last night I saw Birth On Labor Day, a play based on real life birth stories collected by Karen Brody. The production, often called the "Vagina Monologues" of childbirth, looks at birth from many perspectives of very different archetypal experiences: The woman who wants an elective cesarean because she's afraid of having an episiotomy; the woman who drew inspiration for a natural birth from the ease with which household pets delivered their offspring; the woman who demanded an epidural, but then thought better of it in subsequent births; the woman that hospital staff had no patience for and told her if she didn't give birth soon, she'd have to have a cesarean, etc. The play was well done -- and I must say -- so evocative of the real thing that it was a very tense roller coaster ride to watch.
After the show, I participated in the talk-back segment. One question haunts me: How will our daughters give birth?
I'd love to hear your thoughts.
After the show, I participated in the talk-back segment. One question haunts me: How will our daughters give birth?
I'd love to hear your thoughts.
Wednesday, September 12, 2007
Stoic in Japan
An obstetric anesthesiologist flagged this New York Times story for me, noting that Japan's cultural values around pain relief may explain why the country has such a low epidural rate (single digits) compared with high rates here (80 percent in some hospitals).
September 10, 2007
Japanese Slowly Shedding Their Misgivings About the Use of Painkilling Drugs
By DONALD G. McNEIL Jr.
OKAYAMA, Japan — If any nation ought to lead the world in the consumption of painkillers, it is Japan. Its population is aging, and cancer is the leading cause of death. It has universal health insurance, and few restrictions on prescription narcotics. And it is a heavily medicated society; it consumes half the world’s Tamiflu, the anti-flu drug.
Yet, on charts detailing the per capita consumption of narcotic painkillers throughout the world — routinely topped by the world’s richest countries — Japan is down in the neighborhood of Bulgaria and South Africa. It consumes one-twelfth as much per capita as the United States.
The leading reason for that, said Dr. Fumikazu Takeda, a retired neurosurgeon who leads the fight for better pain control, is patients’ fear.
Until recently, morphine was used only in hospitals, and near the end.
“People hate morphine because they think, ‘As soon as the doctor injected morphine, my father died,’ ” Dr. Takeda said.
Also, until recently medical schools taught that narcotics should be used only briefly at low doses.
And some national sense of “gaman” — that suffering in silence is a virtue — persists even in hedonistic modern Japan.
“Long ago, a samurai who complained about pain was considered a very weak samurai,” he said. Young people have other ideas, but with life expectancies over 80, the typical cancer patient is from another generation.
....You can read the rest here: http://www.nytimes.com/2007/09/10/health/10painside.html?_r=1&oref=slogin
September 10, 2007
Japanese Slowly Shedding Their Misgivings About the Use of Painkilling Drugs
By DONALD G. McNEIL Jr.
OKAYAMA, Japan — If any nation ought to lead the world in the consumption of painkillers, it is Japan. Its population is aging, and cancer is the leading cause of death. It has universal health insurance, and few restrictions on prescription narcotics. And it is a heavily medicated society; it consumes half the world’s Tamiflu, the anti-flu drug.
Yet, on charts detailing the per capita consumption of narcotic painkillers throughout the world — routinely topped by the world’s richest countries — Japan is down in the neighborhood of Bulgaria and South Africa. It consumes one-twelfth as much per capita as the United States.
The leading reason for that, said Dr. Fumikazu Takeda, a retired neurosurgeon who leads the fight for better pain control, is patients’ fear.
Until recently, morphine was used only in hospitals, and near the end.
“People hate morphine because they think, ‘As soon as the doctor injected morphine, my father died,’ ” Dr. Takeda said.
Also, until recently medical schools taught that narcotics should be used only briefly at low doses.
And some national sense of “gaman” — that suffering in silence is a virtue — persists even in hedonistic modern Japan.
“Long ago, a samurai who complained about pain was considered a very weak samurai,” he said. Young people have other ideas, but with life expectancies over 80, the typical cancer patient is from another generation.
....You can read the rest here: http://www.nytimes.com/2007/09/10/health/10painside.html?_r=1&oref=slogin
Sunday, September 09, 2007
A bunch of boobs
Breastfeeding. You can try it at home, but you can't post it on Facebook. This also reminds me of a recent scuffle the queen of unassisted birth, Laura Kaplan Shanley, had with a YouTube posting of a woman giving birth alone.
http://www.blogher.org/everything-i-never-wanted-know-about-breasts-i-learned-facebook
http://laurashanley.blogspot.com/2007/08/censorship-on-youtube.html
http://www.blogher.org/everything-i-never-wanted-know-about-breasts-i-learned-facebook
http://laurashanley.blogspot.com/2007/08/censorship-on-youtube.html
Monday, September 03, 2007
Hopefully, the paperback version of my book will offer to even more people the historical context we need to judge modern maternity practices.
Friday, August 31, 2007
Midwife with a Knife: Forceps Are Your Friends
Forceps, as we know them in the west, were invented by men, specifically the Chamberlen family in England in the 16th century. For hundreds of years, only members of the all-male barber-surgeon trade could use the the tools, so midwives would have to call a barber to a birth gone awry. This post below, by a female OB -- and most OBs under 35 today in America are women -- caught my attention because its sentiment is so unexpected.
Midwife with a Knife: Forceps Are Your Friends
Midwife with a Knife: Forceps Are Your Friends
Tuesday, August 28, 2007
Maternal mortality
I know many people find America's maternal mortality statistics shocking -- particularly the fact that nearly two dozen countries have lower death rates attributable to pregnancy and birth than the US does -- but this report ratchets up the alarm.
Experts: U.S. Childbirth Deaths on Rise
By MIKE STOBBE
The Associated Press
Friday, August 24, 2007; 4:43 PM
ATLANTA -- U.S. women are dying from childbirth at the highest rate in decades, new government figures show. Though the risk of death is very small, experts believe increasing maternal obesity and a jump in Caesarean sections are partly to blame.
Some numbers crunchers note that a change in how such deaths are reported also may be a factor.
"Those of us who look at this a lot say it's probably a little bit of both," said Dr. Jeffrey King, an obstetrician who led a recent New York state review of maternal deaths.
The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to statistics released this week by the National Center for Health Statistics.
The rate was 12 per 100,000 live births in 2003 _ the first time the maternal death rate rose above 10 since 1977.
National Center for Health Statistics 2004 deaths report:
To read the full AP story go to:http://www.washingtonpost.com/wp-dyn/content/article/2007/08/24/AR2007082401321.html
To read the government report, see page 12 at:
http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf
Experts: U.S. Childbirth Deaths on Rise
By MIKE STOBBE
The Associated Press
Friday, August 24, 2007; 4:43 PM
ATLANTA -- U.S. women are dying from childbirth at the highest rate in decades, new government figures show. Though the risk of death is very small, experts believe increasing maternal obesity and a jump in Caesarean sections are partly to blame.
Some numbers crunchers note that a change in how such deaths are reported also may be a factor.
"Those of us who look at this a lot say it's probably a little bit of both," said Dr. Jeffrey King, an obstetrician who led a recent New York state review of maternal deaths.
The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to statistics released this week by the National Center for Health Statistics.
The rate was 12 per 100,000 live births in 2003 _ the first time the maternal death rate rose above 10 since 1977.
National Center for Health Statistics 2004 deaths report:
To read the full AP story go to:http://www.washingtonpost.com/wp-dyn/content/article/2007/08/24/AR2007082401321.html
To read the government report, see page 12 at:
http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf
Saturday, August 18, 2007
Summer reading
I have just finished reading two books. First was the thoroughly researched and thoroughly readable Pushed: The Painful Truth about Childbirth and Modern Maternity Care, by Jennifer Block, a former editor at Ms. Magazine and Our Bodies, Ourselves. The second was Animal, Vegetable, Miracle: A Year of Food Life, by Barbara Kingsolver, about her radical 12-month undertaking of eating only that which she grew herself or that grew nearby. What struck me about both of these books -- besides how well each was done -- is how much these seemingly disparate topics, how babies are born and how food gets to our table, overlap in modern life. In Pushed, Block writes how "there was a direct tie between the rise of the assembly line -- of mass production -- and the rise of standardized, mechanize birth." Pitocin, the labor inducing and augmenting drug that half of all American women receive in the hospital today during labor and delivery, "owed its commercial availability to the centralization of the meatpacking industry. One pound of dried extract became the profitable by-product of pituitary glands from twelve thousand young cattle."
Kingsolver, for her part, talks about how agribusiness has brought us the unlikely phenomenon of cheap bananas all year round in places where they don't grow, and farm subsidues that actually help companies like Monsanto put small-town farmers out of business. In the end, we are left with grocery stores full of foods that are less healthful and more damaging to the environment, given the fertilizers and pesticides involved, as well as the fuels used to transport the food.
The bottom line in Pushed is that the natural way of giving birth should be the default, not the exception today. And that we still don't fully understand how we are messing with our complex biological systems when we override them with drugs and tools and schedules in a room full of strangers.
Likewise, Kingsolver argues that we all need to be reeducated about the local seasonality of food, why it is important not just to eat organic but to buy local. She writes: "The drift away from our agricultural roots is a natural consequence of migration from the land to the factory...But we got ourselves uprooted entirely by a drastic reconfiguration of US farming, beginning just after World War II. Our munitions plants, challenged to beat their swords into plowshares, retooled to make amonium nitrate surpluses into chemical fertilizers instead of explosives. The next explosions were yields on midwestern corn and soybean fields." Which is why we are glugging down products sweetened with corn syrup and getting fat in the process. To say nothing of our 30-plus percent cesarean rate.
Kingsolver, for her part, talks about how agribusiness has brought us the unlikely phenomenon of cheap bananas all year round in places where they don't grow, and farm subsidues that actually help companies like Monsanto put small-town farmers out of business. In the end, we are left with grocery stores full of foods that are less healthful and more damaging to the environment, given the fertilizers and pesticides involved, as well as the fuels used to transport the food.
The bottom line in Pushed is that the natural way of giving birth should be the default, not the exception today. And that we still don't fully understand how we are messing with our complex biological systems when we override them with drugs and tools and schedules in a room full of strangers.
Likewise, Kingsolver argues that we all need to be reeducated about the local seasonality of food, why it is important not just to eat organic but to buy local. She writes: "The drift away from our agricultural roots is a natural consequence of migration from the land to the factory...But we got ourselves uprooted entirely by a drastic reconfiguration of US farming, beginning just after World War II. Our munitions plants, challenged to beat their swords into plowshares, retooled to make amonium nitrate surpluses into chemical fertilizers instead of explosives. The next explosions were yields on midwestern corn and soybean fields." Which is why we are glugging down products sweetened with corn syrup and getting fat in the process. To say nothing of our 30-plus percent cesarean rate.
Monday, August 13, 2007
Simpson's house
I am here in Edinburgh, a gorgeous cobbled, hilly city with a castle, plucky people and an overwhelming amount of artist events to see at one of its various festivals (The Fringe, The International Festival, and The Edinburgh International Book Festival, for which I am here). But the most interesting sight for me to see this morning was the home of James Young Simpson, the first person to use chloroform to alleviate the pain of childbirth. In 1847, Simpson, two medical assistants, and some other guests passed around a tumbler (preserved in the red wall-papered dining room) that was filled with the "curious liquid." After inhaling the chloroform, they all flopped to the floor, with the exception of Simpson's woozy niece who looked down on them as she cried out "I'm an angel! Oh I'm an angel." With that, Simpson knew he had found a cure for pain and administered the drug to his first obstetric patient shortly thereafter. The woman gave her baby girl the middle name "Anaesthesia." One other interesting note: Simpson's house, the place where a drug was invented, is now used as a drug treatment center.
Said in Scotland
I gave a talk today at the Edinburgh International Book Festival about my book, published in the UK as Birth: A History. In the front row of the event sat Gillian Smith, head of Scotland's Royal College of Midwives. At one point, the audience and I were lamenting the lack of one-on-care women often receive during labor in the hospital, and how this was feeding the trend, in western countries, of women hiring doulas. Ms. Smith, however, quickly pointed out that in Scotland -- unlike England where there is a severe midwifery shortage -- women DO receive continuous care from a midwife during labor and birth. "How?" I asked. "Is it a function of the modest size of Scotland's population or the government's understanding of the value of such care and its support of having enough midwives to service the population. (Don't forget, they have nationalized medicine here.) She credited the government's evidence-based view that continuous care leads to better labors and easier births.
Bonnie good!
Wednesday, August 08, 2007
It was only a matter of time...
When people talk about technology creeping into the delivery room, this is not usually what they have in mind. Check out this link to a piece on Salon.com.
http://machinist.salon.com/blog/2007/08/06/twitter_birth/index.html
http://machinist.salon.com/blog/2007/08/06/twitter_birth/index.html
Monday, August 06, 2007
An excellent op-ed
From today's Boston Globe:
The folly of 1 percent policy
By Eugene Declercq and Judy Norsigian | August 6, 2007
THE PHRASE that comes to mind when you hear Dick Cheney is probably not "reshaping American childbirth." Yet Vice President Cheney's "One Percent Doctrine" -- the title of Ron Suskind's 2006 book on post9/11 national security policy -- perfectly captures an approach to decision-making in American medicine that misallocates resources and undermines primary care. By focusing maximum resources on preventing an extremely rare but potentially disastrous outcome over necessary preventive care, this model has shaped healthcare decision-making in areas ranging from hysterectomies to coronary bypasses. One shift -- the rapidly rising caesarean rate -- exemplifies this problem.
Suskind reports that in debates over national security policy following 9/11, Cheney repeatedly invoked the principle that if there's even a 1 percent chance of a terrorist attack, we must prepare as if it were a certainty. This extreme position invariably gave Cheney the moral high ground in debates, where he could appear more willing to protect American interests than others with a broader focus. Of course, in winning the immediate argument, Cheney also ignored myriad longer-term complications involving problems not solved while the "emergency" is addressed.
In healthcare, caesarean sections represent the most recent example of this doctrine, as births are increasingly treated as potential emergencies requiring expensive, high-tech interventions. The caesarean rate in the United States has increased from 20 percent in 1996 to a record high of more than 30 percent in 2005, trailing only Italy (37 percent) and South Korea (35 percent) among industrialized countries. Obstetricians are more skilled at performing caesareans than ever before and caesareans are safer than ever. But they are not without negative consequences. When they are performed as elective surgery on mothers with little or no medical risk, these harms outweigh the benefits.
Yet caesareans are advocated as necessary to avert potential disasters that might occur. At a 2006 meeting sponsored by the National Institutes of Health, one doctor captured the 1 percent (or in this case 1/30th of 1 percent) doctrine when he described rare conditions and noted the benefits of a 100 percent caesarean rate (you read that right) in avoiding these outcomes in 3 in 10,000 cases.
Likewise, a 2006 position statement from the American College of Obstetricians and Gynecologists states that "Labor and delivery is a physiologic process that most women experience without complications," but then goes on to emphasize the 1 percent doctrine: ". . . serious intrapartum complications may arise with little or no warning, even in low risk pregnancies." The statement and the doctor's claim are true, of course -- anything can occur -- but does that mean that society benefits when every birth is handled as a disaster (or worse yet a lawsuit) waiting to happen?
No one wishes a health problem on any mother or child, but the "1 percent" advocates of higher caesarean section rates assert they care more about infant outcomes than those who oppose them. However, the consequences of universal caesarean sections on a largely healthy population are profound in both the short run (longer recovery, greater postpartum pain, higher maternal rehospitalization rates for surgical complications, higher costs) and long run (higher rates of subsequent stillbirths, greater risk of future uterine rupture, longer stays requiring more hospital space). The 1 percent doctrine cares little about such consequences since its focus is on winning the current argument.
Creating a crisis atmosphere is essential to the 1 percent doctrine and its ability to override all obstacles -- be they constitutional restrictions on national security measures or concerns about the United States ranking last among industrialized countries on infant mortality. Such an atmosphere encourages more centralized decision-making and stifles debate. The fact that most of these crises never occur and that countless resources are expended to prevent something that was unlikely to happen anyway is lost in the relief of the immediate positive outcome (a healthy baby or no terrorist attack). In the long run, however, we've wasted time and money, created new problems, and ignored systematically documented, if less emotional, evidence.
A version of the 1 percent doctrine has been invoked for decades in steering the US healthcare system away from an emphasis on preventive care for the whole population to an obsession with treating rare events. As a debating strategy, the 1 percent doctrine is extremely persuasive. As a policy guideline, it makes no sense in either politics or healthcare.
Eugene Declercq is a professor of maternal and child health at the Boston University School of Public Health. Judy Norsigian is executive director of Our Bodies Ourselves.
The folly of 1 percent policy
By Eugene Declercq and Judy Norsigian | August 6, 2007
THE PHRASE that comes to mind when you hear Dick Cheney is probably not "reshaping American childbirth." Yet Vice President Cheney's "One Percent Doctrine" -- the title of Ron Suskind's 2006 book on post9/11 national security policy -- perfectly captures an approach to decision-making in American medicine that misallocates resources and undermines primary care. By focusing maximum resources on preventing an extremely rare but potentially disastrous outcome over necessary preventive care, this model has shaped healthcare decision-making in areas ranging from hysterectomies to coronary bypasses. One shift -- the rapidly rising caesarean rate -- exemplifies this problem.
Suskind reports that in debates over national security policy following 9/11, Cheney repeatedly invoked the principle that if there's even a 1 percent chance of a terrorist attack, we must prepare as if it were a certainty. This extreme position invariably gave Cheney the moral high ground in debates, where he could appear more willing to protect American interests than others with a broader focus. Of course, in winning the immediate argument, Cheney also ignored myriad longer-term complications involving problems not solved while the "emergency" is addressed.
In healthcare, caesarean sections represent the most recent example of this doctrine, as births are increasingly treated as potential emergencies requiring expensive, high-tech interventions. The caesarean rate in the United States has increased from 20 percent in 1996 to a record high of more than 30 percent in 2005, trailing only Italy (37 percent) and South Korea (35 percent) among industrialized countries. Obstetricians are more skilled at performing caesareans than ever before and caesareans are safer than ever. But they are not without negative consequences. When they are performed as elective surgery on mothers with little or no medical risk, these harms outweigh the benefits.
Yet caesareans are advocated as necessary to avert potential disasters that might occur. At a 2006 meeting sponsored by the National Institutes of Health, one doctor captured the 1 percent (or in this case 1/30th of 1 percent) doctrine when he described rare conditions and noted the benefits of a 100 percent caesarean rate (you read that right) in avoiding these outcomes in 3 in 10,000 cases.
Likewise, a 2006 position statement from the American College of Obstetricians and Gynecologists states that "Labor and delivery is a physiologic process that most women experience without complications," but then goes on to emphasize the 1 percent doctrine: ". . . serious intrapartum complications may arise with little or no warning, even in low risk pregnancies." The statement and the doctor's claim are true, of course -- anything can occur -- but does that mean that society benefits when every birth is handled as a disaster (or worse yet a lawsuit) waiting to happen?
No one wishes a health problem on any mother or child, but the "1 percent" advocates of higher caesarean section rates assert they care more about infant outcomes than those who oppose them. However, the consequences of universal caesarean sections on a largely healthy population are profound in both the short run (longer recovery, greater postpartum pain, higher maternal rehospitalization rates for surgical complications, higher costs) and long run (higher rates of subsequent stillbirths, greater risk of future uterine rupture, longer stays requiring more hospital space). The 1 percent doctrine cares little about such consequences since its focus is on winning the current argument.
Creating a crisis atmosphere is essential to the 1 percent doctrine and its ability to override all obstacles -- be they constitutional restrictions on national security measures or concerns about the United States ranking last among industrialized countries on infant mortality. Such an atmosphere encourages more centralized decision-making and stifles debate. The fact that most of these crises never occur and that countless resources are expended to prevent something that was unlikely to happen anyway is lost in the relief of the immediate positive outcome (a healthy baby or no terrorist attack). In the long run, however, we've wasted time and money, created new problems, and ignored systematically documented, if less emotional, evidence.
A version of the 1 percent doctrine has been invoked for decades in steering the US healthcare system away from an emphasis on preventive care for the whole population to an obsession with treating rare events. As a debating strategy, the 1 percent doctrine is extremely persuasive. As a policy guideline, it makes no sense in either politics or healthcare.
Eugene Declercq is a professor of maternal and child health at the Boston University School of Public Health. Judy Norsigian is executive director of Our Bodies Ourselves.
Wednesday, August 01, 2007
Food for thought
Hospital told to return placenta to mom
The Associated Press
News Fuze
Article Launched:07/19/2007 09:33:19 AM PDT
LAS VEGAS—A woman has won a court fight to keep the placenta after her daughter's birth. She had planned to grind it up and ingest it as a way to fight postpartum depression, but now plans to bury it.
Clark County District Court Judge Susan Johnson granted a preliminary injunction Tuesday, ordering Sunrise Hospital and Medical Center in southern Nevada to return the placenta to Anne Swanson. Hospital officials said they will comply.
The hospital had refused to give the uterine lining to Swanson following the April 12 Caesarean birth of her daughter, with officials calling it contaminated biohazardous waste. The judge ordered the hospital not to destroy the placenta, which was frozen, and ordered that it be turned over to Swanson within two weeks.
Swanson, who was 30 when she gave birth, originally wanted to give her placenta to a friend to be dried, ground into a powder and packed into capsules. She said she now plans to dry, store and eventually bury the organ instead of eating it.
"I hope this brings about a better awareness about the benefits of placenta," she said, citing a theory that placental hormones can help control postpartum blues.
Amy Stevens, system vice president for Sunrise Health, which operates Sunrise Hospital, described the ruling as specific to Swanson. She said the hospital must comply with strict regulations in handling human biohazardous waste.
There is no Nevada law prohibiting hospitals from returning placentas to mothers. But several Las Vegas area hospitals told the Las Vegas Review-Journal the organ is usually destroyed unless a physician designates it for medical tests or a patient seeks it for specific religious or cultural reasons.
The Associated Press
News Fuze
Article Launched:07/19/2007 09:33:19 AM PDT
LAS VEGAS—A woman has won a court fight to keep the placenta after her daughter's birth. She had planned to grind it up and ingest it as a way to fight postpartum depression, but now plans to bury it.
Clark County District Court Judge Susan Johnson granted a preliminary injunction Tuesday, ordering Sunrise Hospital and Medical Center in southern Nevada to return the placenta to Anne Swanson. Hospital officials said they will comply.
The hospital had refused to give the uterine lining to Swanson following the April 12 Caesarean birth of her daughter, with officials calling it contaminated biohazardous waste. The judge ordered the hospital not to destroy the placenta, which was frozen, and ordered that it be turned over to Swanson within two weeks.
Swanson, who was 30 when she gave birth, originally wanted to give her placenta to a friend to be dried, ground into a powder and packed into capsules. She said she now plans to dry, store and eventually bury the organ instead of eating it.
"I hope this brings about a better awareness about the benefits of placenta," she said, citing a theory that placental hormones can help control postpartum blues.
Amy Stevens, system vice president for Sunrise Health, which operates Sunrise Hospital, described the ruling as specific to Swanson. She said the hospital must comply with strict regulations in handling human biohazardous waste.
There is no Nevada law prohibiting hospitals from returning placentas to mothers. But several Las Vegas area hospitals told the Las Vegas Review-Journal the organ is usually destroyed unless a physician designates it for medical tests or a patient seeks it for specific religious or cultural reasons.
Wednesday, July 25, 2007
Ricki Lake's birth documentary
Several people have asked about "The Business of Being Born," Ricki Lake's documentary about birth in the hospital and birth at home. The most recent update I have is that the film could have a limited theatrical release in the fall and perhaps an airing on Showtime before the DVD is released by the end of the year. It is an eye-opening film.
Monday, July 09, 2007
Gateway drug
From the LA Times....
http://www.latimes.com/news/nationworld/nation/la-sci-premature30jun30,0,7239244.story?coll=la-home-nation
Birth drug leaves some moms feeling worse
A drug commonly used for preterm labor has more serious side effects than alternatives and may even harm newborns, researchers say.
By Thomas H. Maugh II
Times Staff Writer
June 30, 2007
The drug most commonly used to delay preterm labor in women has more — and more serious — side effects than alternatives, without being any more effective, Stanford researchers reported Friday. The drug may even harm infants, they concluded.
Although labor generally cannot be stopped completely, physicians try to delay it for at least 48 hours to allow transfer of the mother to a specialized hospital and to maximize the effectiveness of steroids used to help the fetus' lungs mature.
The drug most commonly used is magnesium sulfate, but nifedipine and others are occasionally used.
"There is no free lunch with any of these drugs," collectively called tocolytic agents, said Dr. Deirdre Lyell of Stanford University's Lucille Packard Children's Hospital. "But magnesium sulfate has some particularly unpleasant side effects, including vomiting, lethargy and blurry vision. The alternative, nifedipine, often leaves women feeling better."
Despite obstetric advances, preterm delivery — births before 37 weeks' gestation — remains a major problem. In the U.S., 12.3% of births are preterm, for reasons largely unknown. Prematurity is the cause of 30% of infant deaths and of a variety of developmental problems.
Lyell, Dr. Yasser El-Sayed of Stanford and their colleagues studied 192 women in preterm labor at Packard Children's and Santa Clara Valley Medical Center. Half were randomly assigned to receive infusions of magnesium sulfate, and half oral nifedipine.
In the journal Obstetrics & Gynecology, the team reported that though magnesium sulfate quieted contractions more effectively than nifedipine, there were no differences in how long delivery was delayed, in the gestational age of the newborn or in the birth weight of the infants.
Meanwhile, two-thirds of the women who received magnesium sulfate experienced mild to severe side effects during treatment, including shortness of breath and fluid buildup in the lungs. Only a third of the women receiving nifedipine experienced side effects, such as headaches.
Infants born to the mothers who received magnesium sulfate, moreover, were more likely to be admitted to the neonatal intensive care unit and to stay there longer — a median of 8.8 days, compared with 4.2 days for the babies whose mothers received nifedipine.
Dr. Victoria Camerini, a neonatologist at Childrens Hospital Los Angeles who was not involved in the study, pointed out that magnesium can cause respiratory depression and bowel dysfunction in infants and that the mother's body has a mechanism to transport the drug across the placenta.
"If an obstetrician asked me which drug I would prefer," she said, "I would say nifedipine."
The researchers emphasized that magnesium sulfate was still an appropriate treatment for preterm labor. Many physicians continue to use it at the two hospitals where the study was conducted.
But perhaps it is time for physicians to give more weight to side effects when considering what to try first, Lyell said. "It has been my experience that women who have had magnesium sulfate remember it," she said. "They don't like it."
The findings are "probably a strong call to come up with more effective … agents with fewer side effects," said Dr. Michael C. Lu of UCLA's David Geffen School of Medicine, who was not involved in the research. "We also need to rethink our strategy in terms of preventing preterm births. Giving tocolytic therapy may be too little, too late."
--------------------------------------------------------------------------------
thomas.maugh@latimes.com
http://www.latimes.com/news/nationworld/nation/la-sci-premature30jun30,0,7239244.story?coll=la-home-nation
Birth drug leaves some moms feeling worse
A drug commonly used for preterm labor has more serious side effects than alternatives and may even harm newborns, researchers say.
By Thomas H. Maugh II
Times Staff Writer
June 30, 2007
The drug most commonly used to delay preterm labor in women has more — and more serious — side effects than alternatives, without being any more effective, Stanford researchers reported Friday. The drug may even harm infants, they concluded.
Although labor generally cannot be stopped completely, physicians try to delay it for at least 48 hours to allow transfer of the mother to a specialized hospital and to maximize the effectiveness of steroids used to help the fetus' lungs mature.
The drug most commonly used is magnesium sulfate, but nifedipine and others are occasionally used.
"There is no free lunch with any of these drugs," collectively called tocolytic agents, said Dr. Deirdre Lyell of Stanford University's Lucille Packard Children's Hospital. "But magnesium sulfate has some particularly unpleasant side effects, including vomiting, lethargy and blurry vision. The alternative, nifedipine, often leaves women feeling better."
Despite obstetric advances, preterm delivery — births before 37 weeks' gestation — remains a major problem. In the U.S., 12.3% of births are preterm, for reasons largely unknown. Prematurity is the cause of 30% of infant deaths and of a variety of developmental problems.
Lyell, Dr. Yasser El-Sayed of Stanford and their colleagues studied 192 women in preterm labor at Packard Children's and Santa Clara Valley Medical Center. Half were randomly assigned to receive infusions of magnesium sulfate, and half oral nifedipine.
In the journal Obstetrics & Gynecology, the team reported that though magnesium sulfate quieted contractions more effectively than nifedipine, there were no differences in how long delivery was delayed, in the gestational age of the newborn or in the birth weight of the infants.
Meanwhile, two-thirds of the women who received magnesium sulfate experienced mild to severe side effects during treatment, including shortness of breath and fluid buildup in the lungs. Only a third of the women receiving nifedipine experienced side effects, such as headaches.
Infants born to the mothers who received magnesium sulfate, moreover, were more likely to be admitted to the neonatal intensive care unit and to stay there longer — a median of 8.8 days, compared with 4.2 days for the babies whose mothers received nifedipine.
Dr. Victoria Camerini, a neonatologist at Childrens Hospital Los Angeles who was not involved in the study, pointed out that magnesium can cause respiratory depression and bowel dysfunction in infants and that the mother's body has a mechanism to transport the drug across the placenta.
"If an obstetrician asked me which drug I would prefer," she said, "I would say nifedipine."
The researchers emphasized that magnesium sulfate was still an appropriate treatment for preterm labor. Many physicians continue to use it at the two hospitals where the study was conducted.
But perhaps it is time for physicians to give more weight to side effects when considering what to try first, Lyell said. "It has been my experience that women who have had magnesium sulfate remember it," she said. "They don't like it."
The findings are "probably a strong call to come up with more effective … agents with fewer side effects," said Dr. Michael C. Lu of UCLA's David Geffen School of Medicine, who was not involved in the research. "We also need to rethink our strategy in terms of preventing preterm births. Giving tocolytic therapy may be too little, too late."
--------------------------------------------------------------------------------
thomas.maugh@latimes.com
Monday, July 02, 2007
New baby in the family
My brother's wife had a baby last Wednesday. Now, this would be a point of fascination for any aunt, but of course, Morgan's arrival was of particular interest to me. When I was finishing the manuscript for my book, Birth the Surprising History of How We Are Born, the final words I wrote were about my sister-in-law, Annmarie. She had just witnessed her own sister's delivery of a baby girl by cesarean (the baby was breech.) And Annmarie was transfixed by the idea of scheduling a date, waddling in to the OR, and having a newborn pulled from the zipper compartment. I wrote about her story in the context of the cesarean generation. (One out of every three babies in the US is born by c-section today, certainly not all out of necessity.)
Last fall, however, after Annmarie had read my book, she found out she was pregnant. Suddenly she seemed to have had a change of heart. She wanted a vaginal birth -- perhaps even with an element of surprise! So we were all excited when last week, she checked in to the hospital and contracted for several hours on her own. But her doctor thought her progress was slow compared with others on the maternity floor. Then came the Pitocin. Then the pain. Then the epidural. Then nothing...for three hours. No more dilation. So she had a c-section. The baby was in zero distress, by the way.
When the OB started cutting, Annmarie screamed. She could feel the scalpel scraping across her taut belly. They upped the juice and tried again. Again she screamed. They then put her under general anesthesia. When she woke up, she saw her gorgeous baby girl, with dark hair and big eyes, blinking at her.
Annmarie, like most new mothers I know, had little time or energy to question what had just happened. Fumbling with nursing, nursing a scar, she just valiantly got on with things, the many many things, involved with being a mother: loving her perfect baby, and being grateful for it. It's an anesthesia more powerful than the one they pumped into her in the OR.
Last fall, however, after Annmarie had read my book, she found out she was pregnant. Suddenly she seemed to have had a change of heart. She wanted a vaginal birth -- perhaps even with an element of surprise! So we were all excited when last week, she checked in to the hospital and contracted for several hours on her own. But her doctor thought her progress was slow compared with others on the maternity floor. Then came the Pitocin. Then the pain. Then the epidural. Then nothing...for three hours. No more dilation. So she had a c-section. The baby was in zero distress, by the way.
When the OB started cutting, Annmarie screamed. She could feel the scalpel scraping across her taut belly. They upped the juice and tried again. Again she screamed. They then put her under general anesthesia. When she woke up, she saw her gorgeous baby girl, with dark hair and big eyes, blinking at her.
Annmarie, like most new mothers I know, had little time or energy to question what had just happened. Fumbling with nursing, nursing a scar, she just valiantly got on with things, the many many things, involved with being a mother: loving her perfect baby, and being grateful for it. It's an anesthesia more powerful than the one they pumped into her in the OR.
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