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The Birth of a Mother
A sweet sweet photo collection of a family’s journey to natural childbirth. I love the years the births span and especially the pictures of how dad is with mom, supporting her throughout her journey.
Continue reading »Born in the Caul, in the Water
What this video shows is a birth center water birth with the baby born in the caul, meaning the bag of waters are still intact. You’ll see a large white bubble-looking bag being born and inside is the baby. Unfortunately, the midwife breaks the bag of waters, which is totally unnecessary. The force of the contraction and the baby moving would have achieved that on its own.
Continue reading »Married to the Midwife
This article from Mothering Magazine can be found here: http://mothering.com/pregnancy-birth/married-to-the-midwife
By Tom Smith
Web Exclusive
Sharon’s alarm buzzes, and I wait for her to turn it off. Finally I roll over, mumbling that it’s her alarm, and would she please turn it off-only to find myself talking to an empty bed. I groan, remembering the 2 a.m. phone call and thinking of the harried morning ahead.
When they call, she goes. It doesn’t matter what time it is, it doesn’t matter where in the movie you are or who’s over for dinner. Out the door she goes, and woe to the man who tries to stop her. I did, once. We were having a fight and she got the phone call. It wasn’t fair, I said. I stamped my foot. I cried. She just got madder and madder. She asked me if I wanted to call the woman and tell her to go ahead and have the baby herself. For a moment I hated the woman having the baby, but I also began to realize that for Sharon, a laboring mother always takes first priority.
I’ve heard midwives say, sometimes jokingly, sometimes with fierceness, that there is no profession quite like it. I agree, and would add that there is nothing quite like being married to a midwife. I hate what she does and I love what she does. I find it annoying and I find it exciting. Someone once told me that the divorce rate is high among homebirth midwives. I thought, “Are you kidding? What with the low pay and the bad hours and throw in the risk of prosecution in our state, what man wouldn’t want a midwife for a spouse?”
Am I angry? Sometimes. Do I want her to do something else? No way. How can I, when she comes home at 4 a.m. with tears in her eyes and tells me the story of a mother who was so afraid because her last baby had died in utero at 6 months, and how the grief and pain and joy combined as the 9 lb. baby burst into the world? She loves her work and she loves her women. She makes so many hard choices. I don’t want to make her choose between her work and me. Besides, I’d probably lose.
When our daughter, Hannah, whines and asks why her mother has to go out again tomorrow, Sharon says simply, “It’s my work, it’s what I do.” That’s true, but it is also her calling and her passion. It’s what she does to make a difference in the world. She is a lioness when she says, “Women need to have a choice about where they have their babies.” I admire her greatly at that moment–and then the phone rings. I listen as she explains about the importance of eating to feed the baby. She waves her hand as she talks, cutting to shreds the myth of minimal weight gain during pregnancy. She says, “For God’s sake, if you’re hungry, eat! Eat lots of protein. Sure, four eggs with hot sauce is fine. We want fat, happy babies.” She hangs up, and the phone rings again.
One day Hannah answered the phone, and then called Sharon, who retreated into the bedroom. I asked my daughter who it was. She said she didn’t know, but it sounded like a midwife. I thought, “Oh yes, I know what you mean. The friendly but businesslike tone, the willingness to talk to children and the sound of sisterhood coming over the lines, ‘I need to talk to your mother about something.’” As Sharon shuts the door to the bedroom I hear her say, “We use comfrey and rosemary in our sitz bath for postpartum moms and find…”
The homebirth midwives I know soak up knowledge like hungry sponges. I envy Sharon’s single-minded drive for information, whether found in a medical bulletin or in the herbal lore that is passed around orally. She eagerly collects birth stories and medical texts, experiential knowledge and book knowledge. These women have to know their stuff, because they walk a pretty narrow line–especially in Indiana. Homebirth midwifery is not exactly illegal here, but neither is it licensed.
Sometimes I feel like I’m living with an emotional roller coaster. Most of the births are uneventful, and Sharon returns home exhausted and satisfied. But sometimes when she gets home her face is filled with pain and she begins, “We had to transport…” A story of loss begins, and I go down with her into the anguish. Often the stories are not easy to listen to: the agonizing decision as it becomes increasingly clear that this birth is not going to happen in the home, the cold sterility of the ER room, the gruffness and sometimes outright hostility of the doctors who don’t have much contact with midwives. And through it all, the grief, because often, though not always, a transport means a cesarean. The midwife goes along, assisting the woman’s partner, suggesting options at the hospital. The cord of sisterhood remains intact even in this environment, so different from the quiet security and warmth of a home.
I confess that Sharon’s profession frightens me at times. She works so close to the window between life and death. She assists in the pouring forth of life into the world, and sometimes it’s a dangerous place to stand.
I talk about it as if I’m actually there, but I’m just a small part of the supporting cast. I’m a listener. I wonder at the beauty and the pain, at the toughness and vulnerability of women, and yet I stand outside. I learn the names of the birthing women and hear their birth stories, but never meet most of them.
I often think that I’m married to someone on the Wise Woman path. But Sharon is not an archetype; she’s a real woman who deals in blood and pain and bulging bellies and the epiphany of new life. She is a guardian of the birth time, and when that times comes, there nothing to do but let her go. The phone rings and she’s gone.
Tom Smith divides his time between writing, homeschooling his two children, Ben and Hannah, and working at the local library. He lives in Lafayette, Indiana, where he is still married to the midwife after 14 years.
Continue reading »Proper Care of an Intact Penis
A great article about how to care for an uncircumcised penis: http://www.doctorsopposingcircumcision.org/DOC/faq.html
Introduction:
More and more North American boys are being allowed to keep their normal, natural penis the way nature designed it, and circumcision rates are dropping steadily. In the Western US the number of intact (not circumcised) boys is over 70% now and rising, with around 90% of boys kept intact in neighboring Western Canada. But because circumcision was once so widespread, both N. American physicians and parents have lost the ancient ‘folklore’ about how to care for a normal, natural, intact boy. This is especially true in the USA, the last country to impose routine infant circumcision on a majority of its children. One recent medical textbook on care of the newborn freely admits:
“Because circumcision is so common in the United States, the natural history of the preputial development has been lost, and one must depend on observations made in countries in which circumcision is usually not practiced.” (Avery’s Neonatology: Pathophysiology and Management of the Newborn, by Mhairi G. Macdonald, Mary M. Seshia, and Martha D. Mullett (Lippincott Williams & Wilkins–2005, at page 1088).
The myth that boys need special penile hygiene, including forced retraction of the foreskin to clean the glans, was started by 19th century physicians who suggested that the child’s penis produced itchy substances which encouraged masturbation. As they believed masturbation caused insanity, blindness, tuberculosis, and a litany of other diseases (for which they could offer no other cure), these early physicians urged parents to employ aggressive, even cruel, hygiene. Those pre-germ myths became imbedded in English language culture and linger even today. They can even be heard in locker room jokes. As a result, our DOC physicians get regular complaints from parents of sons about antique advice given by well-intentioned but ill-informed medical professionals or older relatives. One medical historian points out how odd it is that boys alone were affected by this mythology:
“To appreciate the scale of the error, consider its equivalent in women: it would be as if doctors had decided that the intact hymen in infant girls was a congenital defect known as ‘imperforate hymen’ arising from ‘arrested development’ and hence needed to be artificially broken in order to allow the interior of the vagina to be washed out regularly to ensure hygiene.” (Dr. Robert L. Darby, “A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain” Univ. of Chicago Press 2005:235)
Thus in English-language countries, both medical providers and parents need updating in the proper way to care for the intact boy the way Europeans have understood it for centuries. Luckily this is amazingly easy—mostly, there is nothing to do –but do nothing.
We provide below some answers to common questions curious or concerned parents ask our DOC physicians all the time. We hope these provide some comfort and reassurance. Of course each child is unique. For highly unusual cases and special circumstances, we are able to recommend ‘foreskin-friendly’ medical providers in many parts of North America. Please email us in confidence and privacy if the discussion below does not assist you with your son’s situation, or you need the face-to face help of a medical provider in your region. Feel free to print out this text or portions of it, to present to your medical providers if you feel that is appropriate. We encourage you to do so.
Check out the remainder of this article to find answers to the below questions:
Was I foolhardy to leave my son intact?
* Does my intact (not circumcised) son require any special hygiene?
* Is it necessary to pull a boy’s foreskin back to clean it?
* Is it true my son’s foreskin should have been retractable by age 5?
* Should I retract my son’s foreskin just a little bit more each day?
* Does my son really need a circumcision to treat a foreskin infection?
* What if my son gets a urinary tract infection?
* Why does my son’s foreskin puff-out when he pees?
* Do the white bumps under my son’s foreskin indicate infection?
* Does my son’s overhanging foreskin need a ‘trim’?
* How do I stop my toddler from ‘fiddling’ with his penis in front of our guests?
* What should I tell my son to say if he is teased for being intact?
The Prepuce: Something Every Penis Needs
A very medical movie made by Doctors Opposing Circumcison. Watch it to learn more, watch it if you aren’t sure where you stand on this issue:
http://www.doctorsopposingcircumcision.org/video/prepuce.html
Continue reading »CoSleeping
This original article can be found right here: http://neuroanthropology.net/2008/12/21/cosleeping-and-biological-imperatives-why-human-babies-do-not-and-should-not-sleep-alone
By James J. McKenna Ph.D.
Edmund P. Joyce C.S.C. Chair in Anthropology
Where a baby sleeps is not as simple as current medical discourse and recommendations against cosleeping in some western societies want it to be. And there is good reason why. I write here to explain why the pediatric recommendations on forms of cosleeping such as bedsharing will and should remain mixed. I will also address why the majority of new parents practice intermittent bedsharing despite governmental and medical warnings against it.
Definitions are important here. The term cosleeping refers to any situation in which a committed adult caregiver, usually the mother, sleeps within close enough proximity to her infant so that each, the mother and infant, can respond to each other’s sensory signals and cues. Room sharing is a form of cosleeping, always considered safe and always considered protective. But it is not the room itself that it is protective. It is what goes on between the mother (or father) and the infant that is. Medical authorities seem to forget this fact. This form of cosleeping is not controversial and is recommended by all.
Unfortunately, the terms cosleeping, bedsharing and a well-known dangerous form of cosleeping, couch or sofa cosleeping, are mostly used interchangeably by medical authorities, even though these terms need to be kept separate. It is absolutely wrong to say, for example, that “cosleeping is dangerous” when roomsharing is a form of cosleeping and this form of cosleeping (as at least three epidemiological studies show) reduce an infant’s chances of dying by one half.
Bedsharing is another form of cosleeping which can be made either safe or unsafe, but it is not intrinsically one nor the other. Couch or sofa cosleeping is, however, intrinsically dangerous as babies can and do all too easily get pushed against the back of the couch by the adult, or flipped face down in the pillows, to suffocate.
Often news stories talk about “another baby dying while cosleeping” but they fail to distinguish between what type of cosleeping was involved and, worse, what specific dangerous factor might have actually been responsible for the baby dying. A specific example is whether the infant was sleeping prone next to their parent, which is an independent risk factor for death regardless of where the infant was sleeping. Such reports inappropriately suggest that all types of cosleeping are the same, dangerous, and all the practices around cosleeping carry the same high risks, and that no cosleeping environment can be made safe.
Nothing can be further from the truth. This is akin to suggesting that because some parents drive drunk with their infants in their cars, unstrapped into car seats, and because some of these babies die in car accidents that nobody can drive with babies in their cars because obviously car transportation for infants is fatal. You see the point.
One of the most important reasons why bedsharing occurs, and the reason why simple declarations against it will not eradicate it, is because sleeping next to one’s baby is biologically appropriate, unlike placing infants prone to sleep or putting an infant in a room to sleep by itself. This is particularly so when bedsharing is associated with breast feeding.
When done safely, mother-infant cosleeping saves infants lives and contributes to infant and maternal health and well being. Merely having an infant sleeping in a room with a committed adult caregiver (cosleeping) reduces the chances of an infant dying from SIDS or from an accident by one half!
Research
In Japan where co-sleeping and breastfeeding (in the absence of maternal smoking) is the cultural norm, rates of the sudden infant death syndrome are the lowest in the world. For breastfeeding mothers, bedsharing makes breastfeeding much easier to manage and practically doubles the amount of breastfeeding sessions while permitting both mothers and infants to spend more time asleep. The increased exposure to mother’s antibodies which comes with more frequent nighttime breastfeeding can potentially, per any given infant, reduce infant illness. And because co-sleeping in the form of bedsharing makes breastfeeding easier for mothers, it encourages them to breastfeed for a greater number of months, according to Dr. Helen Ball’s studies at the University of Durham, therein potentially reducing the mothers chances of breast cancer. Indeed, the benefits of cosleeping helps explain why simply telling parents never to sleep with baby is like suggesting that nobody should eat fats and sugars since excessive fats and sugars lead to obesity and/or death from heart disease, diabetes or cancer. Obviously, there’s a whole lot more to the story.
As regards bedsharing, an expanded version of its function and effects on the infant’s biology helps us to understand not only why the bedsharing debate refuses to go away, but why the overwhelming majority of parents in the United States (over 50% according to the most recent national survey) now sleep in bed for part or all of the night with their babies.
That the highest rates of bedsharing worldwide occur alongside the lowest rates of infant mortality, including Sudden Infant Death Syndrome (SIDS) rates, is a point worth returning to. It is an important beginning point for understanding the complexities involved in explaining why outcomes related to bedsharing (recall, one of many types of cosleeping) vary between being protective for some populations and dangerous for others. It suggests that whether or not babies should bedshare and what the outcome will be may depend on who is involved, under what condition it occurs, how it is practiced, and the quality of the relationship brought to the bed to share. This is not the answer some medical authorities are looking for, but it certainly resonates with parents, and it is substantiated by scores of studies.
Understanding Recommendations
Recently, the American Academy of Pediatrics (AAP) SIDS Sub-Committee for whom I served (ad hoc) as an expert panel member recommended that babies should sleep close to their mothers in the same room but not in the same bed. While I celebrated this historic roomsharing recommendation, I disagreed with and worry about the ramifications of the unqualified recommendation against any and all bedsharing. Further, I worry about the message being given unfairly (if not immorally) to mothers; that is, no matter who you are, or what you do, your sleeping body is no more than an inert potential lethal weapon against which neither you nor your infant has any control. If this were true, none of us humans would be here today to have this discussion because the only reason why we survived is because our ancestral mothers slept alongside us and breastfed us through the night!
I am not alone in thinking this way. The Academy of Breast Feeding Medicine, the USA Breast Feeding Committee, the Breast Feeding section of the American Academy of Pediatrics, La Leche League International, UNICEF and WHO are all prestigious organizations who support bedsharing and which use the best and latest scientific information on what makes mothers and babies safe and healthy. Clearly, there is no scientific consensus.
What we do agree on, however, is what specific “factors” increase the chances of SIDS in a bedsharing environment, and what kinds of circumstances increase the chances of suffocation either from someone in the bed or from the bed furniture itself. For example, adults should not bedshare if inebriated or if desensitized by drugs, or overly exhausted, and other toddlers or children should never be in a bed with an infant. Moreover, since having smoked during a pregnancy diminishes the capacities of infants to arouse to protect their breathing, smoking mothers should have their infants sleep alongside them on a different surface but not in the same bed.
My own physiological studies suggest that breastfeeding mother-infant pairs exhibit increased sensitivities and responses to each other while sleeping, and those sensitivities offers the infant protection from overlay. However, if bottle feeding, infants should lie alongside the mother in a crib or bassinet, but not in the same bed. Prone or stomach sleeping especially on soft mattresses is always dangerous for infants and so is covering their heads with blankets, or laying them near or on top of pillows. Light blanketing is always best as is attention to any spaces or gaps in bed furniture which needs to be fixed as babies can slip into these spaces and quickly to become wedged and asphyxiate. My recommendation is, if routinely bedsharing, to strip the bed apart from its frame, pulling the mattress and box springs to the center of the room, therein avoiding dangerous spaces or gaps into which babies can slip to be injured or die.
But, again, disagreement remains over how best to use this information. Certain medical groups, including some members of the American Academy of Pediatrics (though not necessarily the majority), argue that bedsharing should be eliminated altogether. Others, myself included, prefer to support the practice when it can be done safely amongst breastfeeding mothers. Some professionals believe that it can never be made safe but there is no evidence that this is true.
More importantly, parents just don’t believe it! Making sure that parents are in a position to make informed choices therein reflecting their own infant’s needs, family goals, and nurturing and infant care preferences seems to me to be fundamental.
Our Biological Imperatives
My support of bedsharing when practiced safely stems from my research knowledge of how and why it occurs, what it means to mothers, and how it functions biologically. Like human taste buds which reward us for eating what’s overwhelmingly critical for survival i.e. fats and sugars, a consideration of human infant and parental biology and psychology reveal the existence of powerful physiological and social factors that promote maternal motivations to cosleep and explain parental needs to touch and sleep close to baby.
The low calorie composition of human breast milk (exquisitely adjusted for the human infants’ undeveloped gut) requires frequent nighttime feeds, and, hence, helps explain how and why a cultural shift toward increased cosleeping behavior is underway. Approximately 73% of US mothers leave the hospital breast feeding and even amongst mothers who never intended to bedshare soon discover how much easier breast feeding is and how much more satisfied they feel with baby sleeping alongside often in their bed.
But it’s not just breastfeeding that promotes bedsharing. Infants usually have something to say about it too! And for some reason they remain unimpressed with declarations as to how dangerous sleeping next to mother can be. Instead, irrepressible (ancient) neurologically-based infant responses to maternal smells, movements and touch altogether reduce infant crying while positively regulating infant breathing, body temperature, absorption of calories, stress hormone levels, immune status, and oxygenation. In short, and as mentioned above, cosleeping (whether on the same surface or not) facilitates positive clinical changes including more infant sleep and seems to make, well, babies happy. In other words, unless practiced dangerously, sleeping next to mother is good for infants. The reason why it occurs is because… it is supposed to.
Recall that despite dramatic cultural and technological changes in the industrialized west, human infants are still born the most neurologically immature primate of all, with only 25% of their brain volume. This represents a uniquely human characteristic that could only develop biologically (indeed, is only possible) alongside mother’s continuous contact and proximity—as mothers body proves still to be the only environment to which the infant is truly adapted, for which even modern western technology has yet to produce a substitute.
Even here in whatever-city-USA, nothing a baby can or cannot do makes sense except in light of the mother’s body, a biological reality apparently dismissed by those that argue against any and all bedsharing and what they call cosleeping, but which likely explains why most crib-using parents at some point feel the need to bring their babies to bed with them —findings that our mother-baby sleep laboratory here at Notre Dame has helped document scientifically. Given a choice, it seems human babies strongly prefer their mother’s body to solitary contact with inert cotton-lined mattresses. In turn, mothers seem to notice and succumb to their infant’s preferences.
There is no doubt that bedsharing should be avoided in particular circumstances and can be practiced dangerously. While each single bedsharing death is tragic, such deaths are no more indictments about any and all bedsharing than are the three hundred thousand plus deaths or more of babies in cribs an indictment that crib sleeping is deadly and should be eliminated. Just as unsafe cribs and unsafe ways to use cribs can be eliminated so, too, can parents be educated to minimize bedsharing risks.
Moving Beyond Judgments to Understanding
We still do not know what causes SIDS. But fortunately the primary factors that increase risk are now widely known i.e. placing an infant prone (face down) for sleep, using soft mattresses, maternal smoking, overwrapping babies or blocking air movement around their faces. In combination with bedsharing, where more vital normal defensive infant responses and may be more important to an infant (like the ability to arouse to bat a blanket which momentarily falls to cover the infants face when its parent moves or turns) these risks become exaggerated especially amongst unhealthy infants. When infants die in these obviously unsafe conditions, it is here where social biases and the sheer levels of ignorance associated with actually explaining the death become apparent. A death itself in a bedsharing environment does not automatically suggest, as many legal and medical authorities assert, that it was the bedsharing, or worse, suffocation that killed the infant. Infants in bedsharirng environments, like babies in cribs, can still die of SIDS.
It is a shame and certainly inappropriate that, for example, the head pathologists of the state of Indiana recommends that other pathologists assume SIDS as a likely cause of death when babies die in cribs but to assume asphyxiation if a baby dies in an adult bed or has a history of “cosleeping”. By assuming before any facts are known from the pathologist’s death scene and toxicological report that any bedsharing baby was a victim of an accidental suffocation rather than from some congenital or natural cause, including SIDS unrelated to bedsharing, medical authorities not only commit a form of scientific fraud but they victimize the doomed infant’s parents for a third time. The first occurs when their baby dies, the second occurs when health professionals interviewed for news stories (which commonly occurs) imply that when a baby dies in a bed with an adult it must be due to suffocation (or a SIDS induced by bedsharing). The third time the parents are victimized is when still without any evidence medical or police authorities suggest that their baby’s death was “preventable,” that their baby would still be alive if only the parents had not bedshared. This conclusion is based not on the facts of the tragedy but on unfair and fallacious stereotypes about bedsharing.
Indeed, no legitimate SIDS researcher nor forensic pathologist should render a judgment that a baby was suffocated without an extensive toxiological report and death scene investigation including information from the mother concerning what her thoughts are on what might or could have happened.
Whether involving cribs or adult beds, risky sleep practices leading to infant deaths are more likely to occur when parents lack access to safety information, or if they are judged to be irresponsible should they choose to follow their own and their infants’ biological predilections to bedshare, or if public health messages are held back on brochures and replaced by simplistic and inappropriate warnings saying “just never do it.” Such recommendations misrepresent the true function and biological significance of the behaviors, and the critical extent to which dangerous practices can be modified, and they dismiss the valid reasons why people engage in the behavior in the first place.
For More Information:
A Popular Parenting Book
Sleeping With Your Baby: A Parent’s Guide To Cosleeping by James J.McKenna (2007). Platypus Press.
The Scientific Perspective
McKenna, J., Ball H., Gettler L., Mother-infant Cosleeping, Breastfeeding and SIDS: What Biological Anthropologists Have Learned About Normal Infant Sleep and Pediatric Sleep Medicine. Yearbook of Physical Anthropology 50:133-161 (2007)
McKenna, J., McDade, T., Why Babies Should Never Sleep Alone: A Review of the Co-Sleeping Controversy in Relation to SIDS, Bedsharing and Breastfeeding (pdf). Paediatric Respiratory Reviews 6:134-152 (2005)
Care After a Miscarriage
Take care of your immune system. If there is something you normally do, like eating a clove of garlic everyday or taking Echinacea, do it. You can drink Miso soup daily or make chicken and veggie stock. Besides the eating nutritious foods and drinking lots of water, get sleep. Rest and nap daily and be sure to honor your healing time by sleeping. You’ve just been through a lot.
Try making Vitality Stock. Along with the below herbs, throw in some marrow bones and veggies and let simmer:
Dong Gui – 2-3 slices
Astragalus – 3 slices
Codonopsis – 1 root
Da Zao – 2-3 dates
Ginger – 2-3 slices
Make a medicinal strentgh quart of Nettle tea every night to drink the next day. Do this for a month. The Nettle will help rebuild chi, liver and blood. There is also lots of assimilated iron in Nettle.
And of course, be kind to yourself. You’ve just been through a death, lost a dream and now must heal. Grief isn’t something that is straight-forward and it doesn’t end in a set amount of time.
Continue reading »First Hour After Birth – Don’t Wake the Mother!
Because Michel Odent has done such great work in the world of baby catching, I wanted to share this article from Midwifery Today….
This article can be found at Midwifery Today: http://www.midwiferytoday.com/articles/firsthour.asp
by Michel Odent
© 2002 Midwifery Today, Inc. All rights reserved.
The hour following birth is undoubtedly one of the most critical phases in the life of human beings. It is not by chance that all human groups have routinely disturbed the physiological processes in this short period of time, via beliefs and rituals. Our cultural milieus are to a great extent shaped at the very beginning of the mother-newborn interaction.
The first hour following birth may be looked at from a multitude of complementary perspectives. My objective is to catalogue 12 such perspectives to demonstrate the real dimension of this enormous subject.
Perspective 1: The sudden need to breathe
We do not need to develop this widely documented perspective. It is well understood that during the first hour following birth the baby must suddenly use its lungs. This implies, in particular, that the heart must urgently pump blood to the pulmonary circulation. The prerequisite is that the pulmonary and systemic circulations separate by closure of the connections between them (ductus arteriosus and foramen ovale).
Perspective 2: The behavioral effects of hormones
This perspective needs to be developed, so recent are the available data.
Today we are in a position to explain that all the different hormones released by mother and fetus during the first and second stages of labor are not yet eliminated during the hour following birth. All of them have a specific role to play in the mother-newborn interaction. Until recently the behavioral effects of these hormones had not even been suspected.
The key hormone involved in birth physiology is undoubtedly oxytocin. Its mechanical effects have been well known for a long time (effects on uterine contractions for the birth of the baby and the delivery of the placenta; effects on the contractions of the myo-epithelial cells of the breast for the milk ejection reflex). Prange and Pedersen demonstrated the behavioral effects of oxytocin for the first time in 1979 via experimentation with rats: An injection of oxytocin directly into the brain of virgin rats induced a maternal behavior. This experiment laid the foundation for a new generation of studies. The results of hundreds of such studies can be summarized in one or two sentences: Oxytocin is the typical altruistic hormone; it is involved whatever the facet of love one considers.
These data appear important when one knows that, according to Swedish studies, it is after the birth of the baby and before the delivery of the placenta that women have the capacity to reach the highest possible peak of oxytocin. As in any other circumstances (for example sexual intercourse or lactation) the release of oxytocin is highly dependent on environmental factors. It is easier if the place is very warm (so that the level of hormones of the adrenaline family is as low as possible). It is also easier if the mother has nothing else to do but look at the baby’s eyes and feel contact with the baby’s skin, without any distraction. The way oxytocin is released is a new avenue for research. To be effective, this release must be pulsatile: The higher the frequency of pulses, the more effective this hormone is.
Oxytocin is never released in isolation. It is always part of a complex hormonal balance. That is why love has so many facets. In the particular case of the hour following birth, in physiological conditions, the high peak of oxytocin is associated with a high level of prolactin, which is also known as the “motherhood hormone.” This is the most typical situation for inducing love of babies. Oxytocin and prolactin complement each other. Furthermore, estrogens activate the oxytocin and prolactin receptors. We must always think in terms of hormonal balance.
It was also in 1979 that the maternal release of morphine-like hormones during labor and delivery was demonstrated. The release of these endorphins is now well documented. In the early 1980s we learned that the baby also releases its own endorphins in the birth process, and today there is no doubt that, for a certain time following birth, both mother and baby are impregnated with opiates. The property of opiates to induce states of dependency is well known, so it is easy to anticipate how the beginning of a “dependency”—or attachment—will likely develop.
Even hormones of the adrenaline family (often seen as hormones of aggression) have an obvious role to play in the interaction between mother and baby immediately after birth. During the very last contractions before birth the level of these hormones in the mother peaks. That is why, in physiological conditions, as soon as the “fetus ejection reflex” starts, women tend to be upright, full of energy, with a sudden need to grasp something or someone. They often need to drink a glass of water, just as a speaker may do in front of a large audience. One of the effects of such adrenaline release is that the mother is alert when the baby is born. Think of mammals in the wild, and we can more clearly understand how advantageous it is for the mother to have enough energy—and aggressiveness—to protect her newborn baby if need be. Aggressiveness is an aspect of maternal love. It is also well known that the baby has its own survival mechanisms during the last strong expulsive contractions and releases its own hormones of the adrenaline family. A rush of noradrenaline enables the fetus to adapt to the physiological oxygen deprivation specific to this stage of delivery. The visible effect of this hormonal release is that the baby is alert at birth, with eyes wide open and dilated pupils. Human mothers are fascinated and delighted by the gaze of their newborn babies. It is as if the baby was giving a signal, and it certainly seems that this human eye-to-eye contact is an important feature of the beginning of the mother and baby relationship among humans.
The highly complex role of hormones of the adrenaline-noradrenaline family in the interaction between mother and baby has not been studied for a long time. A small number of animal experiments open the way to further research. Mice that lack a gene responsible for the production of noradrenaline leave their pups scattered, unclean and unfed, unless they are injected with a noradrenaline-producing drug when giving birth.
From the hormonal perspective it appears clearly that sexuality comes full circle. In all the different episodes of our sexual life the same hormones are released and similar scenarios are reproduced. For example, during sexual intercourse, both partners—male and female—release oxytocin and endorphins. It is the beginning of an attachment that is following the same model as the mother-baby attachment during the hour following birth.
Our current knowledge of the behavioral effects of different hormones involved in the birth process helps us to interpret the concept of a sensitive period introduced by ethologists. It is clear that all the different hormones released by the mother and by the baby during labor and delivery are not eliminated immediately. It is also clear that all of them have a specific role to play in the later interactions between mother and baby.
Perspective 3: The perspective of ethologists
Ethologists observe the behaviors of animals and human beings. They often study one particular behavior in a number of unrelated species. They were the first scientists who claimed that, in terms of mother-newborn attachment among birds and mammals, there is a short yet crucial period immediately after birth that will never be repeated. Harlow studied in particular the process of attachment among primates.
The importance of the ethological approach is gradually emerging after the recent discovery of the behavioral effects of hormones involved in the birth process.
An ethological study of the first hour following birth among humans is difficult because the physiological processes are routinely disturbed. However, it is possible in unusual circumstances. Imagine a woman who gave birth in her own bathroom while her husband was shopping. She is in a very warm and quite dark place. She does not feel observed at all. However, from the crack of the door you can catch a glimpse of the scene now and then. By combining what you learned from different stories like that, you’ll be in a position to describe a stereotyped behavior. First, the mother looks at her newborn baby between her legs. After a while she dares to touch her with her fingertips. Then she becomes more and more audacious and wants to hold her baby in her arms. At that time most women are as if fascinated by the baby’s eyes.
Perspective 4: The first hour as the beginning of lactation
There was a time, not so long ago, when we wouldn’t have considered the first hour following birth as the time when lactation is supposed to start. Imagine a baby born at home a century ago. The cord was cut right away. Then the baby was washed, dressed and shown to the mother before being put in a crib. An anecdote can help us realize how recent this perspective is. In 1977, in Rome, at the Congress of Psychosomatic, Gynaecology and Obstetrics, I presented a paper about the early expression of the rooting reflex. I was simply describing the ideal conditions that allow the baby to find the breast during the first hour following birth. None of the obstetricians and pediatricians present at that session could believe that a human baby would be able to find the breast during the hour following birth.
Today most midwives know that the human baby is naturally programmed to find the breast during the hour following birth. Moreover, one can understand that, in physiological conditions, when the newborn baby is ready to find the breast, the mother is still in a particular hormonal balance. She is still “on another planet.” She is still very instinctive. She knows how to hold her baby. Among humans, breastfeeding is potentially instinctive—during the hour following birth. After that there is room for education, imitation and even technique.
Perspective 5: First hour and metabolic adaptation
As long as the baby is in the womb the nutrients, particularly the vital fuel glucose, are provided in a continuous mode via the cord. Immediately after birth the baby must adapt to a discontinuous supply. The remarkable ability of the neonate to respond to significantly low glucose value has been studied in depth by M. Cornblath in the United States, and by Jane Hawdon, Laura Derooy and Suzanne Colson (see Suzanne’s article “Womb to World,” Midwifery Today Issue 61, page 12) in the United Kingdom.
Perspective 6: The bacteriological point of view
At birth, a baby is germ-free. An hour later there are millions of germs covering her mucous membranes. To be born is to enter the world of microbes. The question is, which germs will be the first to colonize the baby’s body? Bacteriologists know that the winners of the race will be the rulers of the territory. The germ environment of the mother is already familiar and friendly from the perspective of the newborn because mother and baby share the same antibodies (IgG). In other words, from a bacteriological point of view, the newborn human baby urgently needs to be in contact with only one person—her mother. If we add that early consumption of colostrum will help establish an ideal gut flora, there is no doubt that, from a bacteriological point of view, the hour following birth is a critical period with lifelong consequences. Our gut flora can be presented as an aspect of our personality that cannot be easily modified later on in life.
Perspective 7: Starting up the process of thermoregulation
While in the womb the baby never had any opportunity to experience differences in temperature (apart from possible episodes of maternal fever). Once more, the first minutes following birth appear as an interruption of continuity. As the mechanisms of thermoregulation are not yet mature at birth there are theoretical reasons to be worried about the cases of maternal hyperthermia during labor that are induced by an epidural anesthesia or a too hot bath. Such situations might challenge in a dangerous way the thermoregulation of the baby by exaggerating the differences of temperature between the intra- and the extra-uterine environments.
Perspective 8: Adaptation to gravity
During the first hour a new relationship to gravity is established. Suddenly the vestibular nerve, which serves equilibrium, is carrying to the brain an unprecedented flood of impulses from the semicircular canals, utricles and saccules.
Perspective 9: The ethnological approach
Ethnology has established itself as a science by publishing databases. Today its material on pregnancy, childbirth and the first days following birth is easily accessed.
Most cultures disturb the first contact between mother and baby during the hour following birth. The most universal and intriguing way is simply to promote a belief, such as the belief that colostrum is tainted or harmful to the baby, even a substance to be expressed and discarded. Such a belief necessitates that, immediately after birth, the baby must not be in her mother’s arms. This implies rituals such as the ritual of cutting the cord immediately. The first contact between mother and baby can be disturbed through many other rituals: bathing, rubbing, tight swaddling, foot binding, “smoking” the baby, piercing the ears of the little girls, opening the doors in cold countries, etc.
It would take volumes to present a comprehensive study of the characteristics of a great number of cultures in relation to how they challenge the maternal protective instinct during the sensitive period following birth. However a simple conclusion can be drawn from a rapid overview of the data we have at our disposal: The greater the social need for aggression and an ability to destroy life, the more intrusive the rituals and beliefs are in the period surrounding birth.
If disturbing the first contact between mother and baby and promulgating such excuses as the belief that colostrum is bad are so universal, it means that these behaviors have carried evolutionary advantages.
After taking into account and combining all the perspectives that indicate the importance of the hour following birth, and after referring to perinatal rituals and beliefs, we are in a position to claim that the cultural milieus are to a great extent shaped during the hour following birth. Now we can consider the hour following birth in the context of our modern societies.
Perspective 10: The obstetrical approach
All these considerations were necessary before looking at the hour following birth in the context of our modern societies. In our societies the cultural control of childbirth is mostly a medical control.
From medical literature and textbooks it appears that, in obstetrical circles, the question is: “How do you manage the so-called third stage?” Medical journals periodically publish prospective randomized, controlled studies comparing different ways to “manage” the third stage. The only objective is to evaluate the risks of postpartum hemorrhage. These studies are conducted in the context of large obstetrical units. All research protocols use a negative definition of “expectant management” (e.g., no use of uterotonic drugs and no clamping of the cord). The factors that can positively facilitate the release of oxytocin are not included in the protocols. The results of such trials have led to the practice of routinely injecting oxytocic substances into all mothers at the very time of the birth of the baby. Such substances block the release of the natural hormone; furthermore they have no behavioral effects. The effects of these obstetrical routines must be considered in terms of civilization.
Perspective 11: The midwifery approach
Certain midwives can still practice authentic midwifery. This means they are not prisoners of strict guidelines and protocols. They can play their role of protectors of the physiological processes. Immediately after the birth of the baby the main preoccupation of such midwives is the release by the mother of a high peak of oxytocin because it is necessary for safe delivery of the placenta and is the hormone of love.
They first make sure the room is warm enough. During the third stage women never complain that it is too hot. If they are shivering, it means the place is not warm enough. In the case of a homebirth, the only important tool to prepare is a transportable heater that can be plugged in any place and at any time and can be used to warm blankets or towels. Their other goal is to make sure the mother is not distracted at all while looking at the baby’s eyes and feeling contact with the baby’s skin. There are countless avoidable ways of distracting mother and baby at that stage. The mother can be distracted because she feels observed or guided, because somebody is talking, because the birth attendant wants to cut the cord before the delivery of the placenta, because the telephone rings, or because a light is suddenly switched on, etc. At that stage, after a birth in physiological conditions, the mother is still in a particular state of consciousness, as if “on another planet.” Her neocortex is still more or less at rest. The watchword should be, “Don’t wake up the mother!”
Perspective 12: A Political Note
It makes sense that studying the third stage of labor from a non-medical perspective makes many people—particularly doctors—feel uncomfortable. Any approval that might lead us to reconsider our attitudes during this short period of time is shaking the very foundations of our cultures. Research can be politically incorrect. Politically incorrect research includes certain aspects of “primal health research,” particularly studies exploring the long-term consequences of how we are born. The medical community and the media shun the findings of these important studies—on such topical issues as juvenile criminality, teenager suicide, drug addiction, anorexia nervosa, autism, etc.—despite their publication in authoritative medical or scientific journals.
Michel Odent, MD founded the Primal Health Research Centre in London and developed the maternity unit in Pithiviers, France, where birthing pools are used. He is the author of ten books published in twenty languages. Two of them—Birth Reborn and The Nature of Birth and Breastfeeding—were published originally in the United States. His most recent book is The Farmer and the Obstetrician.
Continue reading »Preparing for an Unassisted Homebirth – Guest Blog
Olivia, from Write About Birth, wrote the below article about Unassisted Homebirth. She is the monther of two children, both born at home, the second being unassisted. Enjoy!
Unassisted childbirth is a birth which is not managed by a medical professional, but by the laboring woman herself. Women who have had an unassisted homebirth or are planning one believe that birth is a normal bodily function, and not an illness or a medical emergency. This more gentle, peaceful birth appeals to more and more women, though giving birth without the attendance of a birth professional is still a rare choice.
Unassisted birthers feel that an environment in which they are comfortable and undisturbed by medical interventions makes birth safer. In addition, many strongly feel that today’s medicalized birth climate often leads to complications that would not have arisen in an undisturbed birth.
As an unassisted birther, I am by no means anti-hospital. A hospital is the best place to be in for any person who finds themselves in a true medical emergency, whether it is a heart attack or a cord-prolapse during birth. However, for healthy pregnant women, I feel hospitals are more likely to create medical emergencies than to prevent them.
Women whose labors were induced are statistically more likely to end up with a c-section, for example, because of a variety of risks pitocin poses to both mother and baby. Limitations placed on women in hospital births, such as rules against eating and drinking, and fetal monitors that prevent women from changing positions and walking around in labor, also slow it down. And feeling stressed and scared certainly has the power to stall or stop labor. Families who opt for unassisted homebirths avoid this slippery slope of medical interventions.
But unassisted birth is about more than avoiding a series of unwanted possibilities that comes with attended births, and hospital births in particular. Personally, I decided to opt for a freebirth after first having a midwife-attended homebirth which was less than ideal, but not in any way traumatic. I knew my body was designed to birth babies, just as it was designed to safely gestate them. From a physical standpoint, I see birth as a normal bodily function. From a spiritual standpoint, I see the birth of a baby as a sacred time that should be spent with immediate family, undisturbed by third parties.
Preparing for an unassisted homebirth is a highly individual process – one that is not the same for any two mothers, or even any two pregnancies. For me, informing and educating myself about what is normal through literature, studies and other sources, as well as what is not, was key, as well as listening to my own body and intuition. Here are some pointers for those planning an unassisted birth.This is by no means a complete guide, but some things to think about! You can also find a list of UC birth supplies on my blog.
During pregnancy
• Ensuring a balanced and healthy diet and being physically active promotes both maternal and fetal health.
• Knowing what position the baby is in before a woman goes into labor helps be prepared for birth. Some women are happy to birth a breech baby at home, while others would seek medical assistance. Fetal position can be assessed in a number of ways.
• Determining the location of the placenta is something that can likewise be achieved in a number of different manners. It is important to know that the placenta is not low-lying or covering the cervix, as the baby will not be able to pass through the birth canal. Placenta Previa is one of the few complications that truly requires a c-section. I opted for an ultrasound, but placental position can be determined with a Doppler too. Placenta Previa also causes bleeding in late pregnancy.
• An ultrasound can also provide information about the location of the umbilical cord, and show whether the fetus is wrapped in its cord in any way. True knots are something else that can sometimes be picked up through ultrasound.
During birth
• Rupture of membranes can increase the risk of infection, so after a woman’s waters break it is important to avoid inserting anything into the vagina.
• Observing the timing of contractions, and other bodily sensations, provides plenty of information on how a labor is progressing. Therefore, I did not carry out any cervical checks in labor.
• Recognizing any possible complications in time to either deal with yourself or seek medical attention immediately is key. True medical emergencies can include prolapse and shoulder dystocia (in some cases), but intuition telling you something is off, and you need to seek medical attention, is quite enough information to act on!
• Pushing or bearing down only when your body tells you to (which is when you have difficulty stopping it!) , or letting your body do its own pushing, minimizes the chances of rupturing.
• Choose the labor position that feels most comfortable.
Post-partum
• Skin to skin contact after birth helps both mother and baby adjust, and nursing immediately after birth causes the uterus to contract, and encourages the placenta to be born.
• If the baby has not started breathing spontaneously within a few seconds, rubbing the baby’s back encourages breathing, and clearing the nose and mouth of mucus is sometimes necessary. Some UC-ers take infant resuscitation classes.
• Allowing the umbilical cord to remain intact at least until it stops pulsing ensures the baby receives the highest blood volume possible and gives it access to oxygen for a short time.
• Pulling on the umbilical cord to force the placenta out, as done in some hospitals, is a dangerous practice that can lead to post-partum hemorrhage. • The placenta will normally be born spontaneously relatively soon after the baby.
An Amazing Homebirth With Children and Dad
There are so many awesome things about this video. The children helping, the mother toning, dad being the midwife. I think my favorite thing is how undramatic this natural event is at home, how there is a cord wrapped around baby’s neck and all they do is lift it around and how blue baby is before he pinks up, without crying. Babies don’t need to cry to “work their lungs out.”
Continue reading »Latch and Alternating Breasts During a Feeding can Cause Colic
A mother with her infant at a Government hospital in Chennai during the `World Breast Feeding Week' in August 2004. — Photo: V. Ganesan
TWO WEEKS after our son Louis was born, three months ago, he started showing signs of colic.
At around six in the evening, he would cry loudly and inconsolably for no apparent reason, his back arched and his legs doubled up. Since our daughter Olive (now three) had done the same, we were not altogether surprised.
To add to the grief, my wife got mastitis, which we assumed was the reason each feed felt as if she were having her nipples slashed with razor blades. The antibiotics to treat it only made our son worse, upsetting his tummy. As we lurched towards meltdown and bottle-feeding, a health visitor suggested we visit midwives Chloe Fisher and Sally Inch, said to be the international queens of breastfeeding, at their drop-in clinic at Oxford’s John Radcliffe Hospital in southern England.
That they could help us with the mastitis seemed plausible, but I was sceptical when Fisher told us that the colic was also to do with my wife’s breastfeeding technique. No one had told us that colic had anything to do with how you breastfeed.
The ailment has baffled medical scientists seeking a biological cause. Only social, rather than medical, science seems to provide some clues. Most, if not all, babies in developed nations get some of the symptoms, yet it is rare or unknown in developing ones. A possible reason is that in the latter countries, babies are constantly held, fed effectively and on demand. Babies cry less whose mothers carry them for three hours or more, or feed on demand during the first two months. Another reason could be the lack of social support and the hard-working, stressful lives of pregnant mothers in developed nations.
It came, therefore, as a great surprise to me when Fisher told us that colic in the breastfed baby is primarily due to something as simple as not attaching the baby to the breast correctly, which means that the baby is unable to `drain’ the breast properly during feeds.
Fisher enunciated two principles: “First, don’t assume the breast is like a bottle. The milk is in the breast, not in the nipple, whereas with a bottle, the milk is in the teat. To feed effectively from the breast the baby must scoop in a deep mouthful of breast, whereas with a bottle, it can just suck on the end of the teat.
Wrong assumption
Second, people wrongly assume the middle of the baby’s mouth is halfway between the top and bottom lip. In fact, the middle is between the upper surface of the tongue and the upper palate.
For the baby to draw sufficient breast tissue into its mouth, it must be able to get its tongue well away from the base of the nipple and that won’t happen unless the breast is presented between the tongue and the upper palate.”
If the baby did not attach properly, the midwives told us, it would not drain the breast properly and would keep compressing the nipple between the tongue and hard palate, turning it into something resembling minced lamb.
Next came the other important point: “Only switch breasts when the well-attached baby comes off the breast spontaneously and seems completely satisfied,” said Fisher.
“In offering the second breast, let the baby decide whether he wants it. If the mother starts each feed on alternate breasts (regardless of whether the baby has had one or two at a feed), the breasts will get roughly even use.
The important thing is to allow the baby to finish the first breast first.” Failing to do this is the main cause of colic. Fisher also told us that the initial milk is low in fat and calories.
If you switch breasts before the high-fat milk has been drunk, the baby will take more from the second breast than he would otherwise have done.
Despite the relatively huge volume of liquid in its stomach, the baby will then be wanting another feed before long, because low-fat feeds are processed quickly, leading to a pattern of frequent feeding.
This can cause mental illness-inducing sleep deprivation, but worst of all, it will cause colic. Both poor attachment and breast switching result in the baby taking frequent, large-volume, low-fat feeds, which in turn lead to rapid emptying of the stomach into the large intestine.
If too much gets there too fast, there is not enough of the enzyme lactase to break the sugar in the milk (lactose) down. The gut turns into a malfunctioning brewery, with fermentation of the sugar in the excess milk creating gas and explosive poos. The crying, arched back, rigid tummy and irritability of colic follow.
I was flabbergasted. If all this were really true, why on earth was not everyone told about it, especially considering the damage done to the mental health of parents by colic? Fisher replied that she and Dr MikeWoolridge had published the hypothesis in the journal the Lancet 17 years ago.
Fisher believes she is right because she has seen thousands of mothers solve the problem by following their advice, but since the 1988 paper, her theory has been scientifically tested. Inch doubted that my wife actually had infectious mastitis or had needed antibiotics for it and easily proved her point.
Back pressure
The inflamed breast was due to back pressure within the ductal system of the breast, she said. Ineffective milk removal was not keeping pace with milk production so the milk could no longer be contained within the ductal system.
It was forced into the connective tissue of the breast, where it gets treated as a foreign protein, with subsequent inflammation and pain. All of which was of more than academic interest to us.
While we returned to the Thursday clinic for a booster course in attaching to the breast, from the first moment my wife did it properly, the pain was much less. From that very night our son was free of colic and within a week, the `mastitis’ was disappearing. — ©Guardian Newspapers Limited 2005
This story reprinted from: http://www.hinduonnet.com/seta/2005/04/07/stories/2005040700141700.htm
Continue reading »Doctor Treating Pregnant Women With Experimental Drug To Prevent Lesbianism
Article from The Stranger: http://www.thestranger.com/slog/archives/2010/06/29/doctor-treating-pregnant-women-with-experimental-drug-to-prevent-lesbianism
That’s not fair, as Hanna Rosin at Slate will shortly point out. Pediatric endocrinologist Maria New—of the Mount Sinai School of Medicine and Florida International University—isn’t just trying to prevent lesbianism by treating pregnant women with an experimental hormone. She’s also trying to prevent the births of girls who display an “abnormal” disinterest in babies, don’t want to play with girls’ toys or become mothers, and whose “career preferences” are deemed to “masculine.” Unbelievable:
The majority of researchers and clinicians interested in the use of prenatal “dex” focus on preventing development of ambiguous genitalia in girls with CAH. CAH results in an excess of androgens prenatally, and this can lead to a “masculinizing” of a female fetus’s genitals. One group of researchers, however, seems to be suggesting that prenatal dex also might prevent affected girls from turning out to be homosexual or bisexual.
Pediatric endocrinologist Maria New, of Mount Sinai School of Medicine and Florida International University, and her long-time collaborator, psychologist Heino F. L. Meyer-Bahlburg, of Columbia University, have been tracing evidence for the influence of prenatal androgens in sexual orientation…. They specifically point to reasons to believe that it is prenatal androgens that have an impact on the development of sexual orientation. The authors write, “Most women were heterosexual, but the rates of bisexual and homosexual orientation were increased above controls . . . and correlated with the degree of prenatal androgenization.” They go on to suggest that the work might offer some insight into the influence of prenatal hormones on the development of sexual orientation in general. “That this may apply also to sexual orientation in at least a subgroup of women is suggested by the fact that earlier research has repeatedly shown that about one-third of homosexual women have (modestly) increased levels of androgens.” They “conclude that the findings support a sexual-differentiation perspective involving prenatal androgens on the development of sexual orientation.”
And it isn’t just that many women with CAH have a lower interest, compared to other women, in having sex with men. In another paper entitled “What Causes Low Rates of Child-Bearing in Congenital Adrenal Hyperplasia?” Meyer-Bahlburg writes that “CAH women as a group have a lower interest than controls in getting married and performing the traditional child-care/housewife role. As children, they show an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups.”
In the same article, Meyer-Bahlburg suggests that treatments with prenatal dexamethasone might cause these girls’ behavior to be closer to the expectation of heterosexual norms: “Long term follow-up studies of the behavioral outcome will show whether dexamethasone treatment also prevents the effects of prenatal androgens on brain and behavior.”
In a paper published just this year in the Annals of the New York Academy of Sciences, New and her colleague, pediatric endocrinologist Saroj Nimkarn of Weill Cornell Medical College, go further, constructing low interest in babies and men—and even interest in what they consider to be men’s occupations and games—as “abnormal,” and potentially preventable with prenatal dex:
“Gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation become masculinized in 46,XX girls and women with 21OHD deficiency [CAH]. These abnormalities have been attributed to the effects of excessive prenatal androgen levels on the sexual differentiation of the brain and later on behavior.” Nimkarn and New continue: “We anticipate that prenatal dexamethasone therapy will reduce the well-documented behavioral masculinization…”
It seems more than a little ironic to have New, one of the first women pediatric endocrinologists and a member of the National Academy of Sciences, constructing women who go into “men’s” fields as “abnormal.” And yet it appears that New is suggesting that the “prevention” of “behavioral masculinization” is a benefit of treatment to parents with whom she speaks about prenatal dex. In a 2001 presentation to the CARES Foundation (a videotape of which we have), New seemed to suggest to parents that one of the goals of treatment of girls with CAH is to turn them into wives and mothers. Showing a slide of the ambiguous genitals of a girl with CAH, New told the assembled parents:
“The challenge here is… to see what could be done to restore this baby to the normal female appearance which would be compatible with her parents presenting her as a girl, with her eventually becoming somebody’s wife, and having normal sexual development, and becoming a mother. And she has all the machinery for motherhood, and therefore nothing should stop that, if we can repair her surgically and help her psychologically to continue to grow and develop as a girl.”
In the Q&A period, during a discussion of prenatal dex treatments, an audience member asked New, “Isn’t there a benefit to the female babies in terms of reducing the androgen effects on the brain?” New answered, “You know, when the babies who have been treated with dex prenatally get to an age in which they are sexually active, I’ll be able to answer that question.” At that point, she’ll know if they are interested in taking men and making babies.
In a previous Bioethics Forum post, Alice Dreger noted an instance of a prospective father using knowledge of the fraternal birth order effect to try to avoid having a gay son by a surrogate pregnancy. There may be other individualized instances of parents trying to ensure heterosexual children before birth. But the use of prenatal dexamethasone treatments for CAH represents, to our knowledge, the first systematic medical effort attached to a “paradigm” of attempting in utero to reduce rates of homosexuality, bisexuality, and “low maternal interest.”
So no more Elena Kagans, no more Donna Shalalas, no more Martina Navratilovas, no more k.d. langs, no more Constance McMillens—because all women must grow up to suck dick, crank out babies, and do women’s work. And the existence of adult women who are not interested in “becoming someone’s wife” and “making babies” constitutes a medical emergency that requires women who are currently pregnant to be treated with an experimental hormone. Otherwise their daughters could grow up to, um, be nominated to sit on the Supreme Court, serve as cabinet secretaries, take 18 Grand Slam singles titles, win Grammies, or take their girlfriends to prom.
And we can’t have that.
Two things: Gay people have been stressing out about a day arriving when scientists developed treatments to prevent homosexuality. You can read about the preventing gay sheep freak out here, you can read about Twilight of the Golds here, and I recall—but can’t quickly find a link for—a “fellow” at the Family Research Council or the American Family Association who backed in-utero hormone treatments to prevent homosexuality. Well, here we are—the day appears to have arrived. Now what are we going to do about it?
And will the Republicans on the Judiciary Committee invite Maria New to testify at Elana Kagan’s confirmation hearings? New could argue that Kagan—childless, unmarried Kagan—is unfit to serve on our highest court because her “low maternal interest” pegs her as abnormal, well outside the “maternal mainstream.” Maybe GOP senators would be mollified if Kagan knocked back a few bottles of dex during her confirmation hearings?
UPDATE: A little more about dex from Alice Dreger:
The specific drug we’re talking about, dexamethasone, is not a benign drug for pregnant women, nor for the children exposed in utero. The studies we do have on the early prenatal use of “dex” are worrisome. The number of women and children missing from the follow-up studies of this drug use is more worrisome still.
This drug is unequivocally experimental and risky. That’s why, back in February, I organized interested members of the Bioethics community to fight to make sure every woman offered dex for CAH knows the truth about its experimental and risky nature. (You can read about our efforts in Time magazine. And you can about the medical establishment’s resultant mad scampering to make sure everyone knows this is experimental here.) Make no mistake: In spite of Dr. Maria New’s outrageous FDA-regulation-flaunting claims that this off-label drug use “has been found safe for mother and child,” it ain’t been. New is a rogue pediatrician whom medical societies have been nudging (and sometimes yelling at) for years. Because she apparently wouldn’t stop experimenting on these women and children without ethics oversight, in January I got called in to help by a few freaked-out clinicians. And I called in my colleagues to call out the feds. New just looks and sounds safe for mothers and children. Which is why she’s really dangerous.
Breastfeeding Myths
I’ve pulled these tidbits from various breastfeeding and parenting books and from personal conversations. Shout out goes to Bestfeeding, an awesome awesome breastfeeding book, which is where the majority of this chart is from.
Myth: You must toughen your nipple in pregnancy so they don’t get sore during breastfeeding
Reality: Nipple must be soft and pliable for baby. If baby has a good latch, your nipples won’t get damaged.
Myth: Women who have fair skin, red hair or blue eyes are sensitive and breastfeeding will hurt.
Reality: If that were true, how would these fair skinned beauties survived all these thousands of years before formula was invented? If women who fit this description have sore nipples, then they need help with positioning and latching.
Myth: You must feed baby immediately after birth or breastfeeding won’t work.
Reality: There is no crucial time when breastfeeding has to take place or it won’t happen at all. Studies do show that women who breastfeed within the first two hours after birth do go on to have a longer breastfeeding relationship with their baby.
Myth: You must time your baby’s feeds to prevent sore nipples.
Reality: Sore nipples are caused from improper positioning, not from baby spending too much time at the breast. In fact, the more time baby spends sucking, the more milk your body will produce.
Myth: You will make as much milk as the amount of water you drink per day.
Reality: Milk production depends on how much time baby is allowed to spend suckineg at the breast. Though moms often get very thirsty when breastfeeding and should drink to thirst, milk supply is not directly related to water intake.
Myth: Babies need bottles of water or they will become dehydrated.
Reality: Supplementing water can interfere with your milk supply. Babies get everything they need from breastfeeding as long as the latch is good and baby is not limited to breast access.
Myth: The amount of milk a baby gets in a session is related to the length of that session.
Reality: Each baby has her own rate of feeding and each mother has her own rate of letdown. One baby can get the same amount of milk in four minutes as another baby gets in twenty-five minutes. Each mother and baby will figure out their own routine.
Myth: In order to help nipples heal, a mother with sore nipples should rest her nipples, use a nipple shield, use a cream or stop breastfeeding.
Reality: Unless mom solves the cause of the problem (poor latch, infection or skin reaction) then nothing will help. Some of the proposed treatments may make the issue worse.
Myth: If you’ve breastfed before, you must know what you’re doing.
Reality: Each baby is different and you must learn each time how to interact in this new breastfeeding relationship.
Myth: Feeding on demand is hard on the mother.
Reality: Feeding your baby whenever she wants is the best way to keep her content and healthy.
Myth: If your baby feeds only from the breast, you will never get enough sleep in the night.
Reality: It is true that breastfed babies wake int he night more often than bottle-fed babies. Unlike bottle-feeding, once you and baby are breastfeeding well you do not have to be fully awake to breastfeed, especially if you share a bed with the baby.
Myth: Young babies always cry a lot, so you should leave your baby to cy.
Reality: A baby has all the feelings an adult has and crying is her way of expressing pain or upset. She needs her parents to take her crying seriously.
Myth: You must stop breastfeeding by nine months or you will never get baby to stop.
Reality: You and your baby can work out the best time for you both to cut down and then stop breastfeeding. There are no hard and fast rules.
Low Milk Supply
The amount of milk a mother produces depends on the frequency and effectiveness of the sucking her baby does at the breast. Sucking at the breast causes oxytocin and prolactin to be released by the mother’s pituitary gland. Oxytocin causes contractions in the breasts which squeeze the milk down and prolactin produces milk.
Milk supply usually reaches a plateau (25-30 oz per day per baby) by about one month after birth and stays there until baby is about six months old. Less than 1% of women are truly not able to produce enough milk to feed their babies.
Physical indicators in the mother that put her at risk for low milk supply include: breast surgery, insufficient glandular tissue, low thyroid, pituitary problems, hormone issues, postpartum hemorrhage, retained placenta and prolonged severe engorgement.
Common Substances That Inhibit Milk Production
Some prescription medications
Sudafed
Alcohol
Cigarettes
Sage (large amounts)
Parsley (large amounts)
Peppermint (large amounts)
If a mother has any of the above risk factors, she should plan to breastfeed early and often, at least 8 – 12 times every 24 hours.
Avoid pacifiers because a hungry baby cry can often be soothed by a pacifier rather than eating.
Adequate Milk Intake Criteria for Exclusively Breastfed Babies
Mom can keep an input/output journal, writing down each nursing and each wet and dirty diaper to determine if baby is getting enough milk.
Baby regains birth weight by two weeks of age.
Between days two and three, baby’s poop changes from black/green to yellow with “seeds” by day five.
After day four, there are 3 – 4 poop diapers that are bigger than a quarter every 24 hours. After the first four to six weeks poop may be less frequent and bigger.
24 hours after milk comes in, baby has at least 5 very wet diapers that are odorless and colorless
Treatment of Low Milk Supply
One of the most common causes of low milk production is latch problems.
Clues for poor attachment:
The breasts will not soften much during nursing because milk is not being drained.
Friction to the nipple causes pain and damage.
As the situation worsens baby becomes fussy at the breast, pulling off or falling asleep too quickly.
Diaper output is scant, weight gain is insufficient and jaundice occurs.
Optimize milk removal by massaging breasts before and during feeding or pumping.
Pump for a few minutes after as many feedings as possible for the first three weeks.
Don’t skip nighttime feedings
Warm, moist compresses applied to the breast just prior to nursing/pumping can help start milk flowing.
Galactogogues: Foods and Herbs That Stimulate Milk Production
It usually takes at least four to seven days to see the initial galactogogue effect.
Steel-cut or rolled oats that can bring in more milk. Eat a bowl everyday.
Barley water, made with 1/2 cup of flaked or pearled barley simmered in 1 quart of water and a handful of fennel seeds for 20 minutes is an Old-World remedy.
Fenugreek seed is the most popular galactogogue herb in North America. Take 3-6 grams per day. Sweat and urine may smell like maple syrup when taking it.
Nettle in capsule form has a consistent history when used for low milk supply. Take according to bottle.
Drinking 3 quarts of nursing tea combinations like Mother’s Milk tea can help bring in milk.
Coping with Low Milk Supply
Can you make peace with your milk supply
Take it one day at a time
Set short goals
Realize that you are a successful breastfeeding mother. It’s about the commitment you have made to give your baby the best start in life.
Risk Factors for Preterm Labor
- Poor nutrition
- Inadequate hydration
- Insuffucuent omega-3 fatty acids in the diet
- Physical trauma, abuse
- Hard physical labor, standing all day, tiring travel
- African American ethnicity
- Substance abuse: tobacco, alcohol, street drugs
- Emotional stress and fear
- Finanical stress
- Fear of increased body size by term
- Fear of birthing 2 or more babies (in the case of multiples)
- History of preterm labor in the maternal line (preterm labor may ne a pattern for several generations)
- Low pre-pregnancy weight
- Chronic cough (risk of preterm rupture of membranes)
- Obesity or underweight
- Placental problems (placental abruption, placenta previa, mid-pregnancy vaginal bleeding)
- Preclampsia
- Infection in the genital tract
- Congenital anomalies
- Fibroids
- Chromosomal anomalies
- Uterine anomalies
- DES exposure
- Diabetes
- Insufficient or excessive amniotic fluid
- Car accident
- Severe gum disease
- 2 or more second trimester abortions
Information from Having Twins, by Elizabeth Noble
Continue reading »Twins!!!
There are 2 types of twins
Monozygotic twins result from the union of 1 egg and 1 sperm. These identical twins are the same sex, though there have been very rare cases of male and female identical twins.
MZ twins can have the following configurations in the uterus (the chorion and amnion refer to the layers of membrane that enclose the baby and the bag of waters. Chorion is the outside membrane and amnion is the inner).
~ 1 chorion, 2 amnions and 1 placenta (most common). This means babies are divided by 2 thin membranes.
~ 2 chorions, 2 amnions and a fused placenta
~ 2 chorions, 2 amnions and 2 placentas
~ 1 chorion, 1 amnion and 1 placenta (rare). This means the babies can have skin to skin contact with each other.
The other type of twin is known as Dizygotic and results from the fertilization of 2 eggs by 2 sperm. This type of twinning is simply a double birth resulting in siblings who share the same uterine environment, birthday and have between 25-75% of their genes in common.
DZ twins can have the following configuration in the womb:
~ 2 chorions, 2 amnions and a fused placenta
~ 2 chorions, 2 amnions and 2 placentas
Prenatal Care
Eat, eat, eat!! Daily intake of 3,100 calories and 140-150 grams of protein are REQUIRED for a twin pregnancy. That’s a lot of calories and protein, but it’s the only way to grow healthy babies and carry them to full term. Tips for getting that much into a body when the stomach has little room to expand: protein smoothies, snacks by the bed for every bathroom break, eat every hour or two. As Elizabeth Noble says, “Your babies’ health depends on your weight gain!”
Unlike with singletons, mothers of multiples show the greatest weight gain in early and late pregnancy. Start eating early in pregnancy to build reserves for when babies grow rapidly later.
Women expecting multiples, if possible, should stop working by 24 weeks. Laying down for an hour, twice a day, every day is also needed so the body can rest.
Omega-3 fatty acids are essential for all childbearing women and especially those carrying twins. EFAs are depleted from women’s bodies by baby brain-building during pregnancy. Each subsequent fetus gets fewer EFAs and further depletes the mother unless she augments her diet and supplements.
What about birth
Twins present headfirst (vertex) less than 50% of the time. The first twin (Twin A) is in a nonvertex position about 20% of the time. One is vertex and one is breech in about 40% of twin births. More commonly, Twin B is breech. Both present breech about 8% of the time.
Nursing two together
It may be easier to nurse one a time in the beginning but when you can nurse two at once you’ll be saving yourself tons of time. It’s a good idea to meet with a lactation consultant immediately after the birth so she can help you with positions and holds. And yes, most women can make enough milk: Milk is made based on how frequently babies nurse. If you’re nursing two at once, you’ll have double the milk of a mom with only one baby. Two boobs, two babies.
The Postpartum
Caring for two babies is too much for parents in the early days. Enlist help before the birth. Ask family or friends to spend the night or day with you. Hire help. Look for a postpartum doula – do whatever you can to have someone at your home helping everyday for the first month. After that you can begin to think about reducing the hours of help needed, but experience has shown that you’ll need dedicated help with twins for the first 6 months. This is not a job for two people only. Newborn twins really do require a lot of help.
Continue reading »
