Monday, November 29, 2010

Gift Ideas for the Birth Junkie

Hey, Birth Junkies and their lovers! I've got some ideas for birth-related Holiday gifts!

Perhaps your friends and relatives have been asking you what you'd like for the holidays, and you are at a loss at what to tell them. What is one simple, single, inexpensive, easy to find item that you could ask for from each of the people who ask?

Or maybe your friends are all birth junkies and you don't know gifts to get them!
Or perhaps you or someone you know is pregnant, and you want to get them something really helpful.

How about the thing that every birth junkie loves? An addition to their birth/breastfeeding/women's health book collection!

On the right sidebar of this blog I have my own Book Wish List, which includes:
And at the very bottom of this page, I list the books I've read and Recommend:

Other Ideas, especially if your friend is a Doula:
- Money towards additional doula training, such as postpartum doula or lactation counselor workshops
- Anything from http://yourdoulabag.com, like a birth ball and cover or a doula t-shirt
- DVDs: The Business of Being Born or Orgasmic Birth are great ones! ADDED: Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing


Or if your wife or friend is pregnant, consider gifting Doula Services, for labor and/or postpartum. 


Happy Shopping!

Sunday, November 28, 2010

Biomedical Model of Care vs Midwife Model of Care

I posted this about a year ago, but I thought it was worth sharing once more, as I come back to it again and again myself.

I am a fan of the Midwife Model of Care

Click to Enlarge



If the above strikes a cord with you, I urge you to Consider a Midwife

   

Sunday, November 21, 2010

Are Ultrasounds Safe?


Ah, the ubiquitous ultrasound.

Ultrasound technology is spreading across the world like wildfire. Parents like it because they can "see" their baby, which makes the pregnancy and their connection to their baby feel more real. Doctors and medical staff like it because of the authoritative knowledge it confers upon them. (for more on this, see Robbie Davis-Floyd's Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives)

Prenatal ultrasounds are used for confirming the pregnancy early on, figuring out gestational age, and checking for the location of the placenta. They can also be used to detect any fetal abnormalities, multiple pregnancies, and fetal position (the latter of which can also be determined using palpation).
Ultrasounds are also used to take measurements of the baby's size, which a computer then uses to guess at a weight (but as I have mentioned before here and here, this can be off by several pounds, so think twice before being talked into induction or c-section due to "big baby" diagnoses from an ultrasound).

What exactly is an ultrasound?
An  ultrasound uses high frequency sound waves which are transmitted through the mother’s abdomen and creates an “echo” where the sound waves bounce off the object (the baby!)
 
Most people don't question the safety of ultrasound, based on the fact that it is done so frequently (so it must be safe, right?). In reality, ultrasound was developed extremely quickly and not many random control trials have been done to determine its safety and even if its use is more accurate than other methods (such as examinations by hand, etc). It should also be noted that pregnant women were undergoing X-rays for 50 years to determine fetal size and pelvic proportion before it was discovered that this was causing birth defects and other serious side effects.

There have been a few studies on the safety of ultrasound, which I believe should be reviewed by anyone wishing to make an informed decision. 
 
While I personally believe ultrasound can have a purpose, the research below has me considering keeping the ultrasound visits to a minimum. 
 




Think Ultrasound for Babies Is Safe?

Research shows ultrasound populations have a quadrupled perinatal death rate, increased rates of brain damage, dyslexia, speech delays, epilepsy, and learning difficulties.
  • Perinatal death rate quadrupled in ultrasound group.  (2,475 woman study by Davies et al., 1993); Midwifery Today.
  • Ultrasound babies more likely to develop epilepsy and learning difficulties.  Ultrasound Abstracts.
  • Males babies exposed to two or more ultrasounds were 32% more likely to be lefthanded (which is thought to be caused by brain damage).  Ultrasound Abstracts.
  • Four hours after ultrasound, cell death doubles and rate of cell division drops by 22% in mammals and researchers believe results same in humans.  Ultrasound Abstracts.
  • Risk of miscarriage significantly increased among women who perform ultrasound more than 20 hours a week.  (Taskinen et al., 1990); Midwifery Today.
  • Babies who had serious problems and were ultrasounded died more often than non-ultrasounded babies with serious problems.  Midwifery Today
  • Ultrasounded babies who were growth retarded were three times more likely more likely to be admitted to ICU than non-ultrasounded babies who were growth restricted.  Midwifery Today
  • Preterm labor more than doubled in ultrasounded women.  (Lorenz et al., 1990); Midwifery Today
  • Researchers who developed ultrasound admitted possibility of hazard from ultrasound and said that it should never, ever be used on babies under three months.  Midwifery Today
  • Cells exposed to single dose of ultrasound behave abnormally ten generations after insonation.  Midwifery Today
  • Even if the above stats don’t give you pause, how about the fact that ultrasound measures 100 decibels in utero – that’s the equivalent of having your infant stand on a subway platform as a train comes roaring in and screeches to a halt  New Scientist.  As one writer notes, if you’ve ever heard of on opera singer breaking a sheet of glass with her voice, that is an example of what just one slow sound wave can do . . . but ultrasound uses ultra high frequency sound waves which bombard the child at an extremely high rate of speed.  New Scientist.
Perhaps most ironic and compelling is this quote from one of Yale’s MD elite (Dr. Kenneth Taylor, M.D., Professor of Diagnostic Radiology and Chief of the Ultrasound Section at Yale University School of Medicine) who states:  I would not let anybody get near my infant’s head with a transducer [ultrasound wand] . . .” A Prudent Approach to Ultrasound Imaging of the Fetus and Newborn by Kenneth Taylor, M.D.

Further References:
  • Beech, B. & Robinson, J. (1996). Ultrasound? Unsound. London: Association for Improvements in the Maternity Services (AIMS).
  • Bolsen, B. (1982). Question of risk still hovers over routine prenatal use of ultrasound. JAMA, 247: 2195-2197.
  • Donald, I. (1979). Practical Obstetric Problems. (5th ed). London: Lloyd-Luke, Medical Books Ltd.
  • Donald, I. (1980). Sonar—Its present status in medicine. In A. Jurjak (Ed), Progress in Medical Ultrasound, 1: 001–04. Amsterdam: Excerpta Medica.
  • Jahn, A. et al. (1998). Routine screening for intrauterine growth retardation in Germany; low sensitivity and questionable benefit for diagnosed cases. Acta Ob Gyn Scand, 77: 643–89.
  • Lorenz, R.P. et al. (1990, June). Randomised prospective trial comparing ultrasonography and pelvic examination for preterm labor surveillance. Am. J. Obstet. Gynecol, 1603–10.
  • Mason, G. and Baillie, C. (1997). Counselling should be provided before parents are told of the presence of ultrasonographic ‘soft markers’ of fetal abnormality (Letter). BMJ 315: 180–81.
  • Newnham, J.P. et al. (1991). Effects of frequent ultrasound during pregnancy: a randomized controlled trial. The Lancet, 342: 887–90.
  • Saari-Kemppainen et al. (1990). Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy. The Lancet, 336: 387–91.
  • Salvesen, K.A. et al. (1992). Routine ultrasonography in utero and school performance at age 8–9 years. The Lancet, 339.
  • Skari, H. et al. (1998). Consequences of prenatal ultrasound diagnosis: a preliminary report on neonates with congenital malformations.
  • Tarantal, A.F. et al. (1993). Evaluation of the bioeffects of prenatal ultrasound exposure in the Cynomolgus Macaque (Macaca fascicularis). Chapter III in Developmental and Mematologic Studies, Teratology 47: 159–70.
  • Taskinen, H. et al. (1990). Effects of ultrasound, shortwaves, and physical exertion on pregnancy outcome in physiotherapists. Journal of Epidemiology and Community Health 44: 196–201.

Thursday, November 18, 2010

History of the Cesarean Section

text from the US National Library of Science
National Institutes of Health

Cesarean section has been part of human culture since ancient times and there are tales in both Western and non-Western cultures of this procedure resulting in live mothers and offspring. According to Greek mythology Apollo removed Asclepius, founder of the famous cult of religious medicine, from his mother's abdomen. Numerous references to cesarean section appear in ancient Hindu, Egyptian, Grecian, Roman, and other European folklore. Ancient Chinese etchings depict the procedure on apparently living women. The Mischnagoth and Talmud prohibited primogeniture when twins were born by cesarean section and waived the purification rituals for women delivered by surgery.

Yet, the early history of cesarean section remains shrouded in myth and is of dubious accuracy. Even the origin of "cesarean" has apparently been distorted over time. It is commonly believed to be derived from the surgical birth of Julius Caesar, however this seems unlikely since his mother Aurelia is reputed to have lived to hear of her son's invasion of Britain. At that time the procedure was performed only when the mother was dead or dying, as an attempt to save the child for a state wishing to increase its population. Roman law under Caesar decreed that all women who were so fated by childbirth must be cut open; hence, cesarean. Other possible Latin origins include the verb "caedare," meaning to cut, and the term "caesones" that was applied to infants born by postmortem operations. Ultimately, though, we cannot be sure of where or when the term cesarean was derived. Until the sixteenth and seventeenth centuries the procedure was known as cesarean operation. This began to change following the publication in 1598 of Jacques Guillimeau's book on midwifery in which he introduced the term "section." Increasingly thereafter "section" replaced "operation."

During its evolution cesarean section has meant different things to different people at different times. The indications for it have changed dramatically from ancient to modern times. Despite rare references to the operation on living women, the initial purpose was essentially to retrieve the infant from a dead or dying mother; this was conducted either in the rather vain hope of saving the baby's life, or as commonly required by religious edicts, so the infant might be buried separately from the mother. Above all it was a measure of last resort, and the operation was not intended to preserve the mother's life. It was not until the nineteenth century that such a possibility really came within the grasp of the medical profession.

There were, though, sporadic early reports of heroic efforts to save women's lives. While the Middle Ages have been largely viewed as a period of stagnation in science and medicine, some of the stories of cesarean section actually helped to develop and sustain hopes that the operation could ultimately be accomplished. Perhaps the first written record we have of a mother and baby surviving a cesarean section comes from Switzerland in 1500 when a sow gelder, Jacob Nufer, performed the operation on his wife. After several days in labor and help from thirteen midwives, the woman was unable to deliver her baby. Her desperate husband eventually gained permission from the local authorities to attempt a cesarean. The mother lived and subsequently gave birth normally to five children, including twins. The cesarean baby lived to be 77 years old. Since this story was not recorded until 82 years later historians question its accuracy. Similar skepticism might be applied to other early reports of abdominal delivery รพ those performed by women on themselves and births resulting from attacks by horned livestock, during which the peritoneal cavity was ripped open.

The history of cesarean section can be understood best in the broader context of the history of childbirth and general medicine histories that also have been characterized by dramatic changes. Many of the earliest successful cesarean sections took place in remote rural areas lacking in medical staff and facilities. In the absence of strong medical communities, operations could be carried out without professional consultation. This meant that cesareans could be undertaken at an earlier stage in failing labor when the mother was not near death and the fetus was less distressed. Under these circumstances the chances of one or both surviving were greater. These operations were performed on kitchen tables and beds, without access to hospital facilities, and this was probably an advantage until the late nineteenth century. Surgery in hospitals was bedeviled by infections passed between patients, often by the unclean hands of medical attendants. These factors may help to explain such successes as Jacob Nufer's.

By dint of his work in animal husbandry, Nufer also possessed a modicum of anatomical knowledge. One of the first steps in performing any operation is understanding the organs and tissues involved, knowledge that was scarcely obtainable until the modern era. During the sixteenth and seventeenth centuries with the blossoming of the Renaissance, numerous works illustrated human anatomy in detail. Andreas Vesalius's monumental general anatomical text De Corporis Humani Fabrica, for example, published in 1543, depicts normal female genital and abdominal structures. (see this video post: European Birth Images from the 1500s)

In the eighteenth and early nineteenth centuries anatomists and surgeons substantially extended their knowledge of the normal and pathological anatomy of the human body. By the later 1800s, greater access to human cadavers and changing emphases in medical education permitted medical students to learn anatomy through personal dissection. This practical experience improved their understanding and better prepared them to undertake operations. (For more on birth in the 1800's see this post)

At the time, of course, this new type of medical education was still only available to men. With gathering momentum since the seventeenth century, female attendants had been demoted in the childbirth arena. In the early 1600s, the Chamberlen clan in England introduced obstetrical forceps to pull from the birth canal fetuses that otherwise might have been destroyed. Men's claims to authority over such instruments assisted them in establishing professional control over childbirth. Over the next three centuries or more, the male-midwife and obstetrician gradually wrested that control from the female midwife, thus diminishing her role. (For more on this see my video post on Changes in Birth Practices)


I encourage you to read Part I, Part II, Part III and Part IV from the NIH site itself; its long but fascinating. Here are some historical photographs from the site: 

The extraction of Asclepius from the abdomen of his mother Coronis by his father Apollo.
Woodcut from the 1549 edition of Alessandro Beneditti's De Re Medica.
 
 One of the earliest printed illustrations of Cesarean section. Purportedly the birth of Julius Caesar. A live infant being surgically removed from a dead woman. From Suetonius' Lives of the Twelve Caesars, 1506 woodcut.
 
Cesarean section performed on a living woman by a female practitioner. 
Miniature from a fourteenth-century "Historie Ancienne."

Successful Cesarean section performed by indigenous healers in Kahura, Uganda. 
As observed by R. W. Felkin in 1879.
 
 A Cesarean patient prior to dressing the wound, 1822.

Wednesday, November 17, 2010

Baby is NOT at Term at 37 Weeks

I've already blogged about the inaccuracy of due dates, but I wanted to take the time to emphasize the fact that though many women and their doctors believe that 37 weeks is "at term" it is NOT.

A recent study conducted by a group of physicians associated with the March of Dimes organization points out that considering babies term at 37 weeks may not be such a good idea after all. There seems to be new evidence that suggests that the outcome for a baby born after less than 37 completed weeks of pregnancy is significantly different for one born after 38 completed weeks.
The study proposes that the phrase “late preterm” be used when describing neonates born between 37 0/7 weeks and 38 6/7 weeks because of the new research which states that babies born during this period suffer from increased mortality and neonatal morbidity when compared to children born later in the pregnancy. (via the unnecesarean)

Why is this a concern?
Many women find the end of pregnancy uncomfortable and exhausting. They and their family members have been waiting for months and they are anxious to finally meet their new baby. Women frequently request that their doctors deliver their baby once they've reached term, which many believe to be 37 weeks. Doctors are frequently happy to oblige to an induction or a cesarean section before the due date is reached. However, a baby that does not reach full gestation and initiate spontaneous labor may face severe complications.

Complications of non-medically indicated deliveries between 37 and 39 weeks:

    • increased NICU admissions
    • increased transient tachypnea of the newborn
    • increased respiratory distress syndrome
    • increased ventilator support
    • increased suspected of proven sepsis
    • increased newborn feeding problems and other transition issues
    • Morbidity rates double for each gestational week earlier than 38 weeks

Via dou-la-la:
New research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called "late preterm."

A study in the American Journal of Obstetrics and Gynecology in October calculated that for each week a baby stayed in the womb between 32 and 39 weeks, there is a 23% decrease in problems such as respiratory distress, jaundice, seizures, temperature instability and brain hemorrhages.

A study of nearly 15,000 children in the Journal of Pediatrics in July found that those born between 32 and 36 weeks had lower reading and math scores in first grade than babies who went to full term. New research also suggests that late preterm infants are at higher risk for mild cognitive and behavioral problems and may have lower I.Q.s than those who go full term.

What's more, experts warn that a fetus's estimated age may be off by as much as two weeks either way, meaning that a baby thought to be 36 weeks along might be only 34.

Timing of Fetal Brain Development: cortex volume increases by 50% between 34 and 40 weeks gestation, brain volume increases at a rate of 15mL/week between 29 and 40 weeks gestation
Furthermore, the process of generating a due date relies on sometimes faulty memories of mothers about their cycle, and assumes all women’s cycles are the same length. Research shows that women’s cycles can vary widely, and these variances can profoundly impact when a baby will be mature enough to be born. (via lamaze)

Don't believe it when your doctor tells you he can tell by ultrasound that the baby is nice and big and so ready to come out -- ultrasound for measuring the baby's weight can be 1-1.5 lbs off!

And please please please do not ask your doctor to perform an induction or cesarean section once you've reached "term at 37 weeks." Baby is ready to come when he/she comes!

Monday, November 15, 2010

Biocultural Approach to Breastfeeding

A Biocultural Approach to Breastfeeding

By Judithe A. Thompson
Gallipolis OH USA
From: NEW BEGINNINGS, Vol. 13 No. 6, November-December 1996, pp. 164-167

The biocultural model is useful for understanding breastfeeding and helping mothers to breastfeed. This model comes from anthropology, the social science which studies the relationship between biology and culture. Culture is defined by anthropologists as a people's way of life. Anthropologists consider humans to be biological organisms who constantly adapt to and modify their environment through culture.

For years, anthropologists have been collecting data on breastfeeding, but their findings have been largely ignored. Medical researchers studied every milk-producing mammal except for Homo sapiens. Anthropologists amassed enormous amounts of information about breastfeeding in human societies where the vast majority of women still breastfed, but until recently the opinion of the medical profession and of the general public about that data could be summarized as: "They are savages! What can we possibly learn from them?"

Timeless and Trustworthy

Anthropologists maintain that a process which has nourished human children since the earliest known humans must work and have advantages for mothers, infants, and the whole species. Such a process deserves respect. Successful lactation has usually meant survival for mammalian infants and an opportunity for them to grow and reproduce.

From the understanding of natural selection and adaptation has come a new area of study called evolutionary medicine (Nesse and Williams 1994). This new way of understanding health and illness, normality and abnormality, does not ask "What is wrong with this body?" but rather "What is it about being human that makes our bodies work the way they do?" A biocultural approach provides a powerful argument for why we nurse our babies, why our babies behave the way they do, and why mothers, babies, and fathers respond in certain ways to one another.

A biocultural approach is not a "back to nature" approach, it is the realization that culture and biology interact. Culture is what makes us human. Therefore, it is difficult to say what is "natural" for humans; culture plays so large a role in the decisions we make. For example, many mothers wonder how long they should nurse their babies and what the natural, or normal, age to wean is. An anthropologist would say that the timing of weaning is culturally defined and varies from one culture to another, ranging from birth (no breastfeeding) to approximately seven years. Sometimes there is also a gender difference; in some cultures boys are allowed to wean at a later age than girls. A similar question arises over the issue of tandem nursing. Bioculturally speaking, tandem nursing is uncommon. Instances of tandem nursing are extremely rare in the ethnographic literature.

Biocultural Support for Extended Nursing

Human milk is low in fat and protein. It is relatively high in carbohydrates, especially lactose. Lactose is the sugar that feeds our large brains. This explains why human milk has nearly twice as much lactose as cows' milk--cows are not expected to learn algebra! Like other primates, our infants are born relatively undeveloped, nurse frequently, and grow slowly (Stuart-Macadam and Dettwyler 1995). Primates nurse for a significant portion of their lives, partially because they have such long periods of infancy. In Breastfeeding: Biocultural Perspectives, Katherine Dettwyler says:

If humans weaned their offspring according to the primate pattern, without regard to beliefs and customs, most children would be weaned somewhere between 2.5 and 7 years of age....Age at quadrupling of birth weight, and six times the length at gestation, would be more accurate "rules of thumb" to use based on studies of large-bodied nonhuman primates....Sharply curtailing the duration of breastfeeding below what the human child has evolved to expect, has significant deleterious health consequences for modern humans.

Of course, humans do very little without regard to belief systems and customs. But this type of comparative study is helpful in countering the argument that children who nurse for an extended period of time are abnormal or that the mothers who continue to nurse them are encouraging dependency or are nursing for their own selfish reasons.

Cultural behavior can also be spectacularly non-adaptive. In 18th-century northern Europe, it was considered low-class to feed babies at the breast or even to feed them milk. Mozart considered it proper that his babies would be raised as he was--on sugar water. Four of his six children died in the first three years of life primarily because as infants they were fed mainly sugar water. The terrible health that took Mozart's life at a tragically young age may have been related in part to his "proper" Austrian diet as an infant.

Infant-Parent Co-Sleeping

Infant-parent co-sleeping is another issue where biological data clarifies a cultural pattern (Stuart-Macadam and Dettwyler 1995). Human infants are so immature and need to feed so frequently that it should surprise no one that most human infants, in most places and at most times, have slept with their mothers and often, with both parents. This was still the pattern in the United States until about 75-100 years ago when parents began to be warned about the dangers of sleeping with their babies. Popular infant care books warned about the danger of sexually stimulating the infant by putting him in bed with the mother. Some experts warned that sleeping with infants predisposed them to homosexuality.

The possibility of "overlaying," or inadvertently smothering the baby, was spoken of in very serious tones. Ironically, most of the parents who read these books had slept with their parents! The good sense of generations of families to ignore many of these reports has been supported by the work of anthropologist James McKenna. In a carefully planned and executed study, he observed mother-infant pairs sleeping in a laboratory environment. The laboratory environment, of course, is certainly not a normal way to sleep, but the ethical and logistical problems of observing mother-infant co-sleeping in the home makes the laboratory situation acceptable. The study was a controlled one which observed each mother-infant pair while both co-sleeping and sleeping separately. Along with other related studies, the research indicates:

In situations where mothers breastfeed, do not smoke, and keep their infants next to them for nocturnal sleep, SIDS death rates appear to be extremely low (Stuart-Macadam and Dettwyler 1995).

Co-Sleeping and SIDS

No one suggests that breastfeeding and/or sleeping with infants will entirely eliminate the complex causes of Sudden Infant Death Syndrome (SIDS), but research suggests that they are an important part of SIDS prevention. Because of their immature nervous systems, infants do "forget" to breathe at times. This may be related to death from SIDS. However, breastfed infants wake to nurse frequently, which probably keeps them from sleeping too long and too deeply to experience breathing problems.

Also, they have a tendency to imitate the breathing of nearby adults, which can keep them breathing. If they stop breathing for an instant the difference in breathing patterns may cause the mother or father to shift or move, which in turn may stimulate the baby to take a breath. Infants face their mother much of the time when they sleep with her and the exhaled carbon dioxide from her breath also may stimulate the baby to breathe.

There are some other hypothesized benefits of co-sleeping. If some women do vary in milk production capability (which seems likely), extending the part of the day when baby can breastfeed would increase the baby's intake. The same may apply to the intake of immune factors, since production of these probably also varies from woman to woman.

Culture-Induced Colic?

Infants sleep, but they also cry; some cry a great deal. Ronald Barr, a pediatrician at McGill University in Montreal, Quebec, Canada, has studied infant crying patterns. He discovered that infants with supposed colic do not cry more often or at particular times of the day; they just cry longer each time.

His suggestion is that such crying is normal but may be prolonged by modern practices such as longer intervals between feedings. Dr. Barr compared the results of a study done of the !Kung of South Africa with the typical ways in which American and European infants are handled and fed. The !Kung carry their babies with them constantly and feed the babies whenever they cry. Babies may be fed three or four times an hour for a minute or two at each feeding (Konner and Worthman 1980). In the United States, the average number of feedings in a day is seven and the average length of time between feedings is three hours. So Barr asked American mothers to carry their babies at least three hours a day. These mothers reported that their babies cried only half as long as babies whose mothers did not carry them for the extra three hours (Barr 1989).

Insufficient Milk Syndrome

Any mention of crying in breastfed infants brings us to an issue that has appeared recently (and sensationally) in the popular press: insufficient milk. A common reason for discontinuing breastfeeding in the US is, "I don't have enough milk." While there are instances of a genuine inability to produce enough milk, it often turns out that the one who is concerned about the breastfeeding is not the mother, but a relative or friend who argues "If that baby was getting enough to eat he wouldn't be doing all that crying."

What about insufficient milk supply? The issue has appeared in the anthropological literature for some time. In 1980, Gussler and Briesemeister published an article arguing that the feeding patterns dictated by life in urban, industrial societies--infrequent feedings, lasting for long periods of time--actually caused women to produce less milk. In response, Greiner, Van Esterik, and Latham (1981) argued several hypotheses to account for the insufficient milk syndrome. These focused on the introduction of artificial feeding and, therefore, less nipple stimulation, as the real cause of insufficient milk:

When women or health workers in close geographical proximity share the belief that insufficient milk is a common phenomena, they may become acutely watchful for signs of it. Thus they may interpret normal physiological events in the mother (e.g., cessation of milk dripping from the breasts) or non-hunger-related crying as signs of insufficient milk. Milk company promotional activities may have initiated or furthered the belief that insufficient milk is common and in other ways undermined mothers' confidence in their milk supply.

In short, breastfeeding occurs above the eyebrows as much as or more than it occurs in the mammary glands. The word "insufficient" is like the word "inadequate"--once it has been directed at a mother it can never be retracted, and her confidence in her body's ability to nurture and nourish at the breast often plummets.

Are there biological reasons for low milk supply? There could be, simply because biological diversity is such an important factor in all of life. Breasts and nipples come in all different shapes and sizes, which is one reason for concern when nipples and breasts are vigorously "assessed" before the baby is even born. Babies have different shaped mouths, different sucking patterns, and different levels of physical strength. What looks to the analyst like small size or odd shape may be perfect for a given baby. Even when a newborn and his mother struggle a bit with breastfeeding at the beginning, it is important to remember that babies grow. Facial structure changes. Muscle strength develops. Never underestimate the power of a mother and baby to find a position that works well for them. McKenna and Mosko (1993) discovered just this when they watched co-sleeping infants positioning and repositioning themselves with respect to their mothers, mostly to achieve a position to make nursing easier. A variety of studies have shown that infants can regulate their intake volume and the amount of fat in their feedings. There is evidence of infant-led variation in the degree of breast emptying, the length of feedings, and the interval between feedings (Stuart-Macadam and Dettwyler 1995). If a mother and infant are encouraged to find a pattern that suits them, they are less likely to experience any problems with milk supply.

Which Side First?

Women in traditional societies tend not to nurse in the same way as women in modern industrial societies in another respect: They pay very little attention to which breast baby nursed from at the last feeding. When baby cries he is picked up and nursed briefly on whichever side is convenient (Stuart-Macadam and Dettwyler 1995). It is interesting to note that in most women the right breast is smaller and most humans are right-handed. Size of breast does not predict quantity of milk produced, but there are often asymmetries in breast milk output, even if there is no obvious bias in breast use. The Koran tells women to start every feeding on the right breast; this probably has more to do with ideas of ritual purity than concern with asymmetrical supply, but it is certainly one way to deal with variation in milk supply. Newborns often go through a phase of preferring one breast over the other, often the left, but this usually passes. Of course, it is a very poor idea for a mother to nurse exclusively at every feeding on the same breast. Milk supply is very likely to be affected. Women are worried that they will look "lopsided" if they nurse twice in a row on the same breast, but it is rare for a woman's breasts to be the same size and shape. Most of us are unaware of this until we breastfeed, when we begin to look at our breasts in a different way and at a different angle.

Weighing the Evidence

Flexibility is the secret to successful breastfeeding. Many people are uncomfortable with flexible patterns that permit the mother and infant to find workable solutions to breastfeeding challenges. But breastfeeding is an art, not a science; there are few things that work for all mothers and all babies everywhere all the time (Stuart-Macadam and Dettwyler 1995).

Conversely, excessive rigidity often makes breastfeeding impossible. At various times and places throughout history, there was a tremendous emphasis on rigid practices in breastfeeding. Babies were weighed before and after each feeding to regulate the amount of milk consumed by the infant. Inaccurate weighing procedures were common. Not surprisingly, few women reported feeling a let-down and breastfeeding rates fell dramatically. This is not to suggest that babies should not be weighed and measured. Babies need to be weighed and measured occasionally to document growth. However, standards of growth are sometimes too doctrinaire and do not take population and individual differences into account.

Nature or Culture?

An emphasis on the biocultural along with examples from cross cultural studies may lead some to think that there is one perfect "natural" way to nurse a baby or raise a child. It is tempting for nursing mothers living in a society which is not very supportive of breastfeeding to fantasize about some perfect society where all babies are born into a warm and supportive environment, where breastfeeding is the only way to feed a baby, and weaning is never mentioned. Such a society does not exist. We live in an imperfect universe and our societies reflect that reality.

Cultures are more alike than anyone can imagine--and more different than a person can possibly believe. Birth may occur in a beautiful, comfortable environment, but in many cultures colostrum is considered unfit for babies and the mother may be forbidden to nurse until the colostrum begins to change to milk. Children may nurse until age three, but among the Dinka, the child then is taken to live with his grandparents in another village for a period of time. He or she may nurse until age six in some places, but among the Palau, the child then is abruptly forbidden to nurse and his cries and entreaties are ignored. A baby may be biologically programmed to sleep with his parents, but his culture may have a rule that says that on the day the new baby is born he must begin to sleep by himself. Early solids may be discouraged, but in many African cultures, certain protein-rich foods are not considered appropriate for toddlers, which is the beginning of a struggle with protein-deficiency diseases that some do not survive. Concepts like attachment parenting and natural weaning are beautiful concepts to many mothers, but to an anthropologist, they are cultural, not biological, in nature.

In every culture there is much to admire and emulate and much that others would reject. One of the benefits of life in a large, heterogeneous society is a diversity of customs and belief systems which provides parents with a range of child rearing choices. It's up to them to decide what best meets the needs of their family.


REFERENCES

Barr, R.G., M.S. Kramer et al. Feeding and temperament as determinants of early infant crying/fussing behavior. Pediatrics 1989; 84:514-521.
Greiner T., R Van Esterik, and M. C. Latham. The insufficient milk syndrome: an alternative explanation. Medical Anthropology 1981; 5:233-247.
Gussler, J. D. and L. H. Briesemeister. The insufficient milk syndrome: a biocultural explanation. Medical Anthropology 1980; 4:145-174.
Hellman, C. G. Culture, Health and Illness. Butterworth-Heinemann Ltd. Oxford. 1994.
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About the Author: Judithe Thompson teaches Anthropology and Political Science at the University of Rio Grande, Rio Grande, Ohio, where she is also Co-Director of the Honors Program. Judithe and her husband (and fellow anthropologist) Barry are the parents of Alta, 20, and Chrys, 18. She is Area Professional Liaison for Ohio/West Virginia and has been an LLL Leader since 1981.

Sunday, November 7, 2010

Its My Blogoversary!


HAPPY ONE YEAR BLOGOVERSARY TO ME!


It has been one year today since I started my doula blog. It has been a long, strange year, but I have come a long way since the beginning and learned so much! Today's post will be my 297th blog post.

I am so so excited to have so many followers and fans on facebook, twitter, and google friend connect. THANK YOU for liking my blog! It warms my bloggin' heart.

I know I am not the only one who has learned a lot about birth and breastfeeding over the past year - I've gotten my friends and family talking about the benefits of having a doula, the rising cesarean section rate in our country and even the positives of home birth. Furthermore, my wonderful boyfriend, who was the one to convince me to follow my passion and train as a doula, has learned a thing or two about all things birthy.

And to celebrate my one year blog anniversary, he has created this wonderful comic! Enjoy!

(Click to Enlarge)


He has explained to me that this is some of what he has absorbed from my doula blog... "What to Expect When You're Expecting" is terrible, any book written by Penny Simkin is awesome, and episiotomies are bad. I am endlessly amused!

Monday, November 1, 2010

Colostrum and "dirty milk" in India

Colostrum, aka "pre-milk" or "first milk," is the yellow-tinged milk that women produce in the first few days after giving birth, before producing traditional breast milk. It is sometimes called "liquid gold" because of all its amazing properties. 
It is loaded with many, many white blood cells. There are up to 5 million white cells in each milliliter of colostrum, and the average is 1 million. One million cells in each milliliter is 100 times more than in your blood. And it is jam-packed with antibodies. It is also a laxative, which is important for clearing out the babies intestines, reducing the level of jaundice and preparing the baby to digest breastmilk. - Dr. Jack Newman

But in some cultures colostrum is seen as "dirty" or "old" milk? And when this belief prevails, women do not feed their babies this wonderful liquid gold.

Below, via Motherwear Breastfeeding Blog, is a TV ad on TV for a project in India to help women understand that colostrum is important. Take a look!

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