Friday, December 31, 2010

My Popular Posts of 2010

Another New Year! Thank you for following my blog in 2010. Here is a list of some of the most popular posts on this blog over the past year.

7 Reasons You Can't Have an Epidural
Planning on having epidural anesthesia?  Just because you want one doesn't mean you'll get it! 
Here are seven reasons why you may not be able to have one. 

Where is the Evidence-Based Medicine?  
Complete with references, here are 10 Common Obstetric Procedures Not Supported By Science, including: 

  • inductions/elective c-sections for suspected macrosomia (big baby)
  • pitocin/amniotomy to speed labor
  • continuous electronic fetal monitoring
  • requirement of “immediate” emergency services for women attempting a VBAC
  • routine episiotomy 
  • routine ultrasounds to determine fetal size
  • immediate cord clamping
  • directed and supine pushing

My Review of the BABIES Movie 
A cross-cultural look at moms and babies? yes!

Coca Cola and Pregnancy 
I love my coca cola! Is it safe to have caffeine during pregnancy?

Pregnancy Beliefs Around the World
Superstition-type beliefs regarding pregnancy in India, China, Latin America, Spain, Germany, Australia, Sweden, England and Canada

How to Avoid a C-Section 
The Cesarean section is something that many women list as one of their number one fears of birth. Many women dread the possibility of a c-section and want to avoid them at all costs. Of course we all acknowledge that in a true obstetrical emergency the c-section can be a lifesaver, but most women would rather not be part of the growing number of iatrogenic, arguably unnecessary, cesarean sections. Here is some advice on how to avoid a C-section.

Did You Know Doula Services Are Covered By Insurance? 
Would you love to hire a Doula but you honestly can't afford one? Fear not! Your Health Insurance may cover it!

Breastfeeding Art Worldwide 
Beautiful breastfeeding artwork from around the world.



Do you have a favorite post of mine that isn't mentioned here? Let me know!

HAPPY NEW YEAR! See you all in 2011! 

Tuesday, December 28, 2010

Book Review: Ancient Bodies, Modern Lives

Book Review of Ancient Bodies, Modern Lives: How Evolution Has Shaped Women’s Health by Wenda Trevathan. Oxford University Press, 2010

Through an exploration of the female reproductive life cycle from an evolutionary perspective, Wenda Trevathan’s book Ancient Bodies, Modern Lives shows the reader how such an approach can improve understanding of women’s health. Drawing on evolutionary medicine, she centers her investigation on the female reproductive life cycle in order to understand the implications of millions of years of evolution for modern women’s health. Her overall argument is for readers to take human evolutionary history, which is fundamentally about reproduction, into consideration when regarding modern women’s health issues. She organizes the book along the order of the female reproductive cycle, from menarche to menopause, concluding with a discussion of the implications for modern women’s health.  

The evolutionary medicine evaluation is a fascinating and unique approach to the topic of health. One key theme that the book addresses is the importance of life history theory and the idea of trade-offs. Life history theory predicts how and why humans adapt to their environments and societies by allocating energy to one thing and not to another (trade-offs) in order to increase reproductive success. Trevathan notes that despite the need for trade-offs, humans have the unique ability to maximize reproductive success, “through cultural interventions,” which she addresses throughout the book (13). In the discussion of every aspect of the reproductive lifecycle her consideration of the cultural, societal, and ecological impact on biology, and vice versa, is excellent.

Another key theme of the book is the mismatch between our evolved bodies and our present culture and lifestyles. For instance, she discusses how, as compared with most of human history, the onset of menarche now occurs earlier in health-rich nations. These women also become pregnant later and have fewer overall pregnancies and decreased breastfeeding rates, all for socio-cultural reasons. The result of this is a change in hormone levels present in the body over the lifetime, which has serious effects on health.  Age of first menarche, pregnancy and breastfeeding are all biological processes that have been shaped by evolution, but “evolutionary medicine and life history theory remind us,” that they are “sensitive to local environmental” and sociological situations (40).

Trevathan provides a captivating analysis of the medical implications for childbirth of the evolution of bipedalism and large brains and the trade-offs that must be made as a result. Walking upright meant a restructuring of the pelvis, which made it narrower than that of our ancestors and made fitting our larger brains much more difficult during childbirth. Furthermore, the shape of the pelvis changed so that the infant rotates more than once in order for the head and then the shoulders to make their way down into the birth canal. As a result, the baby is born facing the mother’s back, which makes it difficult for the mother to catch her own child without causing damage or death to the infant. Trevathan argues that this accounts for the nearly universal practice of having birth attendants present at birth to assist the mother in catching the baby.

Additionally, obstructed labor is becoming a problem for many women at time of birth, which contributes to the need for surgical delivery of the infant. One reason for this is the biomedical custom of giving birth in the lithotomy position, which is the least optimal position for birth. Also, women living in health-rich nations have increasingly larger babies, possibly due to higher body mass and/or diabetes. Trevathan notes, however, that Cesarean sections have a number of health risks for mother and child, such as increased respiratory distress in the infant. Children not born normally miss out on the many advantages of vaginal birth, many of which contribute to better mother-infant bonding. She argues persuasively that culture and our evolved bodies may not be the most compatible for optimal health.

The chapter on breastfeeding is one of the book’s most captivating. She writes about the myriad ways in which breastfeeding is one of the most important evolutionary adaptations for the survival of both mother and child after birth. Beyond the innumerable benefits for the infant, such as increased immune function and perfect nutrition, breastfeeding is also incredibly important for mothers. For one, newborns suckling immediately postpartum reduces the size of the uterus and prevents postpartum hemorrhage, which was especially important before the advent of biomedicine. Additionally, breastfeeding has lifelong positive effects on the mother’s health, such as lowered incidence of type 2 diabetes, osteoporosis, breast cancer, atherosclerosis, and more. So, Trevathan asks, why would anyone not breastfeed? This is where the sociocultural aspects come into play and Trevathan takes breastfeeding culture into account. She perceptively notes that, “‘breast is best’ is not sufficient in a culture that has devalued breastfeeding for two to three generations and where role models for successful breastfeeding have been rare” (125).

Though breastfeeding is an evolved biological process it, like mating and birthing, is culturally influenced. Trevathan recognizes that the reproductive life cycle of women is a process that is both deeply biological and cultural. This is what biocultural medical anthropology seeks to explore – the relationship between biology, health and culture. Biology and culture are mutually consequential. Though the book doesn’t delve too deeply into socio-political factors and their effect on health, I appreciate that Trevathan is cognizant of the fact that, “an evolutionary perspective tends to ignore some of the most important factors that impact women’s health – SES, cultural norms, education, media and peer influences [and] geopolitical forces” (191). While this is true, Trevathan does an excellent job explaining the link between evolutionary history and sociocultural context in most of the book. She acknowledges that though all reproductive life processes can be explained biologically we cannot stop the analysis there, or we would entirely miss what it means to be human.

This is a biological anthropology text that scholars in the field of medical anthropology would greatly benefit from. Medical anthropologists strive to dispel the myth that modern medicine adheres to:  that there is such thing as “normal” when it comes to human biology and health. This book also addresses the falsity of the concept of normal, as it aids in the quest to make medicine aware of the great amount of variability in “normal health” that exists among humans. Women growing up in health-rich nations have a different biological “normal” than women in health-poor nations, which may also be a different “normal” from the ancestral past. For instance, Trevathan explains that for some women a “normal” menstrual cycle is less than the typical 28 days in length as a result of having a different “normal” level of hormones. Thusly, the success of various methods of birth control, especially hormonal contraception, will differ. Furthermore, though the cessation of menses is a universal phenomenon, anthropologists have found that women in different cultures physically and psychosocially experience menopause differently than how biomedicine defines it. The evolutionary medicine lens assumes that humans are “highly diverse with a biology that unfolds in a context rather than in predictable unvarying ways” and that there is a “broad range within which growth and development can occur” (11-12).

A rich addition to the field of medical anthropology, Ancient Bodies, Modern Lives demonstrates that in an effort to understand and improve health we must look at health holistically. Just as medical workers should take into account cultural factors that affect health, so should cultural anthropologists take into account evolutionary history of women’s biology. Trevathan writes, “we are more likely to develop ways of promoting positive health if we know and understand…our evolved biology” (193). Moreover, it is an important book for medical and public health scholars, because of Trevathan’s perspective on the topic of “normal.” Health workers will learn from this book to look beyond the biomedical concept of normal and take cultural norms, socioeconomics and geopolitics into consideration when attempting to improve health.

The multitudes of examples in the book illustrate how millions of years of human evolution collide with modern-day environment and culture to create numerous health issues. But there are lessons to be learned as a result of Trevathan’s evolutionary medicine review of the female reproductive life cycle. We can get our evolved bodies and our lifestyles in tune if we follow prescriptions gleaned from this book, such as Trevathan’s advice to give birth in an upright position and to breastfeed our babies. Trevathan believes that if medical and lifestyle choices are made as a result of taking evolutionary processes into account, women’s overall health will be improved. This is one of the most important takeaways of the book – the fact that “we are more likely to develop ways of promoting positive health if we know and understand genetics and our evolved biology” (193). Despite its academic style, this is an excellent book for all women to read.

Overall, Wenda Trevathan’s book is a tremendous addition to the fields of biological and medical anthropology, especially in regards to women’s reproductive health. It is a compelling composition that thoroughly convinces the reader that in order to make improvements in health, we need to pay attention to what our evolved bodies are telling us.

Friday, December 24, 2010

Happy Holidays!

Seasons Greetings from these adorable Christmas babies:

Thank you for following my blog! :)

Tuesday, December 21, 2010

News Link Roundup: Articles You Should Read!

The CNN Home Birth After Cesarean story everyone is talking about this week: Mom defies doctor, has baby her way

A mom has a VBAC at home. Shocking to those not in the birth world. Excellent that this story has started the conversation that it has! Yes, women should be able to attempt VBACs "in facilities with staff immediately available to provide emergency care," as the ACOG suggests, but unfortunately doctors will not agree to even allow women to attempt it. And so they turn to other options.

(Bonus: the doula in this article is the woman I shadowed when I first became a doula!) 

Another highly talked-about article worth reading, all about how people are discovering that Kangaroo Care is the BEST: The Human Incubator

"Sometimes, the best way to progress isn’t to advance — to step up with more money, more technology, more modernity. It’s to retreat."

"Kangaroo care, however, is modern medical care, by which I mean that its effectiveness is proven in randomized controlled trials — the strongest kind of evidence. And because it is powered by the human body alone, it is theoretically available to hundreds of millions of mothers who would otherwise have no hope of saving their babies."

Should Black Women Feel Guilty for Not Breastfeeding? on Blacktating

"Until we can change the circumstances for working class moms, how can we expect to convince them to breastfeed? Isn't energy better spent securing real paid maternity leave for women and laws to protect a woman's right to express milk at work, even at blue collar jobs?...When it comes to the working poor there is not even the guise of an even playing field. How do we expect breastfeeding rates to change when the life circumstances for these moms is still the same?"

Birth Around the World at Stand and Deliver:

A Tale of Two Births in Canada and European Court of Human Rights Rules Home Birth Legal in Hungary


U.S. Cesarean Rate Reaches Record High, Rises for 13th Consecutive Year at The Unnecesarean 

The national cesarean rate, according to The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) report Births: Preliminary Data for 2009, is now 32.9% (which is up from 32.3 in 2008) and is especially on the rise for Black Moms (via Time)

Possible factors, according to the Time article, are obesity and other health problems, maternal choice, patient education, and physician practice patterns. 

“The rate is going up but we are not really improving the health of babies or moms.”



Friday, December 17, 2010

Human Gestation from a Medical Anthropology Perspective

Information from Ancient Bodies, Modern Lives: How Evolution Has Shaped Women's Health and Medical Anthropology: A Biocultural Approach

In the first trimester, the zygote (fertilized egg) grows and transforms into an embryo, with millions of cells differentiated into functionally distinct tissues.

It is estimated that 10 percent of recognized pregnancies end in spontaneous abortion during the first trimester. Around 50 percent of all fertilization end very early, before a woman even recognizes that she is pregnant, and these are most often due to genetic abnormalities of the zygote.

There are numerous situations in which failure of a pregnancy at this stage is a "good thing" from the perspective of evolutionary medicine.The zygote that results from the union of egg and sperm is unique, and genetically different from both the mother and father. Our immune systems are designed to deal harshly with organisms that are not familiar by damaging or rejecting them. During the luteal phase following ovulation, the mother's immune system is slightly dampened, which serves the zygote well because it is less likely to be detected and rejected.

Once the embryo is implanted into the wall of the uterus, HCG begins to be secreted and a urine test can now be used to reveal pregnancy. But a high percentage of embryos fail to implant. This is a loss for couples who are trying to conceive, but from an evolutionary perspective, it makes sense that embryos that may not have a good chance of surviving are discarded before the mother's body invests too much time and energy to gestation.

In some cases the mother may reject a fetus that is too much like her. If a woman mates with a man whose histocompatibility genes are similar to her, the resulting embryo will also be genetically similar to her. In this situation she may not recognize the embryo when it begins to implant and may not depress her immune system to prevent rejection. One suggestion is that this is an "anti-inbreeding" mechanism and it may also explain why women who have trouble conceiving with one man are easily able to get pregnant when they have a different partner.

Systems that develop during the first few weeks of pregnancy:
circulatory system (week 2)
nervous system (week 3)
limb buds, heart and most organs (week 4)
Brain and sexual development accelerate (week 5)

Nausea during early pregnancy may have evolved as a protection against toxins and other dangerous substances that could harm the developing embryo and thus may be a defense rather than a defect. This is on hypothesis of many. Morning sickness is most pronounced during the weeks when the embryo is most vulnerable. Cultural taboos are common for women, especially consumption of certain foods. Meat is a common category of forbidden food, which, as we know, meat can expose a person to dangerous contaminants.
Given that a lack of morning sickness is associated with miscarriages, it may be that nausea in early pregnancy is a signal of embryo viability and thus has selective value in itself.

By the start of the second trimester, tissue differentiation is largely complete, and the embryo is now considered a fetus. During these three months, the fetus grows rapidly in length as its skeleton grows. The mother's nutrient needs increase to support this growth.

Pregnant women will notice a lot of fetal movement early in the second trimester, beginning with frequent position changes and then smoothing out. The fetus even does some somersaults and loop-de-loops, some of which account for the umbilical cord being wrapped around the neck at birth. Movements decrease as the fetus grows bigger and movement is impeded. 

The third trimester is characterized by rapid growth in weight and disposition of fat. It is also during this time that further maturation of the respiratory, gastrointestinal, and circulatory systems occurs, in preparation for the myriad changes the baby will experience after birth. Energy requirements for the mother are particularly high during this time to support the continued growth of an ever larger baby. About 80 percent of the newborn's weight is accumulated during the third trimester. Restriction of caloric intake during this time will likely reduce the weight of the newborn.

Because the fetus is entirely dependent on nutrient flow from the mother, if a mother's health is compromised in some way - due to undernutrition, infection, or stress - during pregnancy, there are likely to be consequences to birth outcome. The fetus is both vulnerable to the mother's own health problems and to some extent buffered from them.

If the fetus is gestating in a non-optimal environment, trade-offs will be made. For example, if food is restricted, available nutrients will go to the brain and not to the development of other organs. The fetal origins or fetal programming hypothesis proposes that the developing fetus uses cues to assess not only the environment of gestation but also the postnatal environment. The baby becomes programmed to expect the same conditions it experienced in utero. This can cause problems when the postnatal environment does not match the gestation environment.

These effects are also transgenerational. Cues can come not only from the mother, but also from her entire matrilineage. Because the effects are not just limited to a single pregnancy, the implication is that public health measures to improve infant birth weight should begin long before pregnancy and should not be judged as successful or failed based on data from a single generation.

Healthy pregnancies yield health children yield healthy adults, no matter what the postnatal environment is, just as unhealthy pregnancies yield unhealthy adults, even in seemingly optimal postnatal environments.

Tuesday, December 14, 2010

Extended Breastfeeding

Recently, the topic of extended breastfeeding, or breastfeeding past infancy, has come up among my friends and acquaintances. 

Many pediatricians tell mothers that there is no benefit to breastfeeding after 6 months. They say breast milk is no longer nutritious after 6 months, or provides no immunological benefits, or that a nursing toddler will be socially mal-adjusted.

In the most recent case occurrence, for me, it was a husband telling his wife that breastfeeding their 18 month old (not even 2 years old!) would never teach him to be soothed by anything but the breast as he grows older. Also, daddy didn't feel like sharing mommy's breasts anymore and he wanted them back. Yes, this really happens.

A typical response to a mother who is nursing her toddler is "eww gross" and "if he/she is old enough to ask for it, he/she is too old to nurse."  If you have the urge to say or think this, I encourage you to continue reading. 

Below, I am going to provide what I know and have found to support extended breastfeeding, especially of toddlers.

Photo via tendresses lactees

The information comes from Breastfeed a Toddler - Why on Earth? by Dr. Jack Newman, Nursing After the First Year from (which lists a great deal of references), and Anthropologist Katherine Dettwyler's A Natural Age of Weaning.

Now that more and more women are breastfeeding their babies, more and more are also finding that they enjoy breastfeeding enough to want to continue longer than the usual few months they initially thought they would. UNICEF has long encouraged breastfeeding for two years and longer, and the American Academy of Pediatrics is now on record as encouraging mothers to breastfeed at least one year and then for as long after as the mother and baby desire. Even the Canadian Paediatric Society, in its latest feeding statement acknowledges that women may want to breastfeed for two years or longer and Health Canada has put out a statement similar to UNICEF’s. 

Breastfeeding to 3 and 4 years of age has been common in much of the world until recently in human history, and it is still common in many societies for toddlers to breastfeed. (Newman)

A survey of 64 "traditional" studies done prior to the 1940s showed a median duration of breastfeeding of about 2.8 years, but with some societies breastfeeding for much shorter, and some for much longer. It is meaningless, statistically, to speak of an average age of weaning worldwide, as so many children never nurse at all, or their mothers give up in the first few days, or at six weeks when they go back to work. It is true that there are still many societies in the world where children are routinely breastfed until the age of four or five years or older, and even in the United States, some children are nursed for this long and longer. In societies where children are allowed to nurse "as long as they want" they usually self-wean, with no arguments or emotional trauma, between 3 and 4 years of age. (Dettwyler)

Breastfeeding your child past infancy is NORMAL (kellymom):

  • The American Academy of Pediatrics recommends that "Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child... Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother... There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer." (AAP 2005)
  • The American Academy of Family Physicians recommends that breastfeeding continue throughout the first year of life and that "As recommended by the WHO, breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement. It has been estimated that a natural weaning age for humans is between two and seven years. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment, and having a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer." They also note that "If the child is younger than two years of age, the child is at increased risk of illness if weaned." (AAFP 2008)
  • A US Surgeon General has stated that it is a lucky baby who continues to nurse until age two. (Novello 1990)
  • The World Health Organization emphasizes the importance of nursing up to two years of age or beyond (WHO 1993, WHO 2002).
  • Scientific research by Katherine A. Dettwyler, PhD shows that 2.5 to 7.0 years of nursing is what our children have been designed to expect (Dettwyler 1995).

Anthropologist Kathy Dettwyler compared primate biology and behavior, particularly gorillas and chimpanzees (who share 98% of our genes) with human biology and behavior to try to come up with what a "natural" weaning age, outside of cultural rules, might be. 

She writes:
  • It has been common for pediatricians to claim that length of gestation is approximately equal to length of nursing in many species, suggesting a weaning age of 9 months for humans. However, this relationship turns out to be affected by how large the adult animals are -- the larger the adults, the longer the length of breastfeeding relative to gestation. For chimpanzees and gorillas, the two primates closest in size to humans and also the most closely genetically related, the relationship is 6 to 1. That is to say, they nurse their offspring for SIX times the length of gestation (actually 6.1 for chimps and 6.4 for gorillas, with humans mid-way in size between these two). In humans, that would be: 4.5 years of nursing (six times the 9 months of gestation).
  • It has been common for pediatricians to claim that most mammals wean their offspring when they have tripled their birth weight, suggesting a weaning age of 1 year in humans. Again though, this is affected by body weight, with larger mammals nursing their offspring until they have quadrupled their birth weight. In humans, quadrupling of birth weight occurs between 2.5 and 3.5 years, usually.
  • In a group of 21 species of non-human primates (monkeys and apes) studied by Holly Smith, she found that the offspring were weaned at the same time they were getting their first permanent molars. In humans, that would be: 5.5-6.0 years. 
Her conclusion: the natural age of weaning for humans would be somewhere between 2.5 to 7 years.

Why should breastfeeding continue past six months?

Because mothers and babies often enjoy breastfeeding a lot. Why stop an enjoyable relationship? And continued breastfeeding is good for the health and welfare of both the mother and child.


But it is said that breastmilk has no value after six months.

Perhaps this is said, but it is patently wrong. That anyone (including paediatricians) can say such a thing only shows how ill-informed so many people in our society are about breastfeeding. Breastmilk is, after all, milk. Even after six months, it still contains protein, fat, and other nutritionally important and appropriate elements which babies and children need. (Newman)

Breastfeeding children benefit NUTRITIONALLY (Kellymom):

  • Although there has been little research done on children who breastfeed beyond the age of two, the available information indicates that breastfeeding continues to be a valuable source of nutrition and disease protection for as long as breastfeeding continues.
  • "Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant."
    -- Mandel 2005
  • "Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins."
    -- Dewey 2001
  • In the second year (12-23 months), 448 mL of breastmilk provides:
    • 29% of energy requirements
    • 43% of protein requirements
    • 36% of calcium requirements
    • 75% of vitamin A requirements
    • 76% of folate requirements
    • 94% of vitamin B12 requirements
    • 60% of vitamin C requirements
    -- Dewey 2001
  • Studies done in rural Bangladesh have shown that breastmilk continues to be an important source of vitamin A in the second and third year of life.
    -- Persson 1998
  • It's not uncommon for weaning to be recommended for toddlers who are eating few solids. However, this recommendation is not supported by research. According to Sally Kneidel in "Nursing Beyond One Year" (New Beginnings, Vol. 6 No. 4, July-August 1990, pp. 99-103.):
    Some doctors may feel that nursing will interfere with a child's appetite for other foods. Yet there has been no documentation that nursing children are more likely than weaned children to refuse supplementary foods. In fact, most researchers in Third World countries, where a malnourished toddler's appetite may be of critical importance, recommend continued nursing for even the severely malnourished (Briend et al, 1988; Rhode, 1988; Shattock and Stephens, 1975; Whitehead, 1985). Most suggest helping the malnourished older nursing child not by weaning but by supplementing the mother's diet to improve the nutritional quality of her milk (Ahn and MacLean. 1980; Jelliffe and Jelliffe, 1978) and by offering the child more varied and more palatable foods to improve his or her appetite (Rohde, 1988; Tangermann, 1988; Underwood, 1985).

Breastmilk still contains immunologic factors that help protect the child even if he is 2 or older. In fact, some immune factors in breastmilk that protect the baby against infection are present in greater amounts in the second year of life than in the first. This is, of course as it should be, since children older than a year are generally exposed to more infections than young babies. Breastmilk still contains special growth factors that help the immune system to mature, and which help the brain, gut, and other organs to develop and mature.

It has been well shown that children in daycare who are still breastfeeding have far fewer and less severe infections than the children who are not breastfeeding. The mother thus loses less work time if she continues breastfeeding her baby once she is back at her paid work. (Newman)

I have heard that the immunologic factors in breastmilk prevent the baby from developing his own immunity if I breastfeed past six months.

This is untrue; in fact, this is absurd. It is unbelievable how so many people in our society twist around the advantages of breastfeeding and turn them into disadvantages. We give babies immunizations so that they are able to defend themselves against the real infection. Breastmilk also helps the baby to fight off infections. When the baby fights off these infections, he becomes immune. Naturally.(Newman)

Breastfeeding children are SICK LESS OFTEN (Kellymom):

  • The American Academy of Family Physicians notes that children weaned before two years of age are at increased risk of illness (AAFP 2001).
  • Nursing toddlers between the ages of 16 and 30 months have been found to have fewer illnesses and illnesses of shorter duration than their non-nursing peers (Gulick 1986).
  • "Antibodies are abundant in human milk throughout lactation" (Nutrition During Lactation 1991; p. 134). In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991).
  • Per the World Health Organization, "a modest increase in breastfeeding rates could prevent up to 10% of all deaths of children under five: Breastfeeding plays an essential and sometimes underestimated role in the treatment and prevention of childhood illness." [emphasis added]

Breastfeeding children have FEWER ALLERGIES (Kellymom):

  • Many studies have shown that one of the best ways to prevent allergies and asthma is to breastfeed exclusively for at least 6 months and continue breastfeeding long-term after that point.

    Breastfeeding can be helpful for preventing allergy by:
    1. reducing exposure to potential allergens (the later baby is exposed, the less likely that there will be an allergic reaction),
    2. speeding maturation of the protective intestinal barrier in baby's gut,
    3. coating the gut and providing a barrier to potentially allergenic molecules,
    4. providing anti-inflammatory properties that reduce the risk of infections (which can act as allergy triggers).

It is interesting that formula company marketing pushes the use of formula (a very poor copy of breastmilk) for a year, yet implies that breastmilk (which formula tries unsuccessfully to copy) is only worthwhile for 6 months or even less (“the best nutrition for newborns”). Too many health professionals have taken up the refrain. (Newman)

But I want my baby to become independent

And breastfeeding makes the toddler dependent? Don’t believe it. The child who breastfeeds until he weans himself (usually from 2 to 4 years), is usually more independent, and, perhaps, more importantly, more secure in his independence. He has received comfort and security from the breast, until he is ready to make the step himself to stop. And when a child makes that step himself, he knows he has achieved something, he knows he has moved ahead. It is a milestone in his life of which he is proud.

Often we push children to become ‘independent” too quickly. To sleep alone too soon, to wean from the breast too soon, to do without their parents too soon, to do everything too soon. Don’t push and the child will become independent soon enough. What’s the rush? Soon they will be leaving home. You want them to leave home at 14? If a need is met, it goes away. If a need is unmet (such as the need to breastfeed and be close to his mother), it remains a need well into childhood and even the teenage years.

Breastfeeding children are WELL ADJUSTED SOCIALLY (kellymom):

  • According to Sally Kneidel in "Nursing Beyond One Year" (New Beginnings, Vol. 6 No. 4, July-August 1990, pp. 99-103.):

    "Research reports on the psychological aspects of nursing are scarce. One study that dealt specifically with babies nursed longer than a year showed a significant link between the duration of nursing and mothers' and teachers' ratings of social adjustment in six- to eight-year-old children (Ferguson et al, 1987). In the words of the researchers, 'There are statistically significant tendencies for conduct disorder scores to decline with increasing duration of breastfeeding.'"
  • According to Elizabeth N. Baldwin, Esq. in "Extended Breastfeeding and the Law":
    "Breastfeeding is a warm and loving way to meet the needs of toddlers and young children. It not only perks them up and energizes them; it also soothes the frustrations, bumps and bruises, and daily stresses of early childhood. In addition, nursing past infancy helps little ones make a gradual transition to childhood."
  • Baldwin continues: "Meeting a child's dependency needs is the key to helping that child achieve independence. And children outgrow these needs according to their own unique timetable." Children who achieve independence at their own pace are more secure in that independence then children forced into independence prematurely.

Possibly the most important aspect of breastfeeding a toddler is not the nutritional or immunologic benefits, important as they are. I believe the most important aspect of breastfeeding a toddler is the special relationship between child and his mother. Breastfeeding is a life-affirming act of love that repeats itself every time the child goes to the breast. This continues when the baby becomes a toddler. Anyone without prejudices, who has ever observed an older baby or toddler breastfeeding can testify that there is something special, something far beyond food, going on. A toddler will sometimes spontaneously, for no obvious reason, break into laughter while he is breastfeeding. His delight in the breast goes far beyond a source of food. And if the mother allows herself, breastfeeding becomes a source of delight for her as well, far beyond the pleasure of providing food. Of course, it’s not always great, but what is? And when it is, it makes it all so worthwhile.

And if the child does become ill or gets hurt (and they do as they meet other children and become more daring), what easier way to comfort the child than breastfeeding? I remember nights in the emergency department when mothers would walk their ill, non-breastfeeding babies or toddlers up and down the halls trying, often unsuccessfully, to console them, while the breastfeeding mothers were sitting quietly with their comforted, if not necessarily happy, babies at the breast. The mother comforts the sick child with breastfeeding and the child comforts the mother by breastfeeding. (Newman)

MOTHERS also benefit from breastfeeding past infancy (kellymom):

  • Extended nursing delays the return of fertility in some women by suppressing ovulation.
  • Breastfeeding reduces the risk of breast cancer. Studies have found a significant inverse association between duration of lactation and breast cancer risk.
  • Breastfeeding reduces the risk of ovarian cancer.
  • Breastfeeding reduces the risk of uterine cancer.
  • Breastfeeding reduces the risk of endometrial cancer.
  • Breastfeeding protects against osteoporosis. During lactation a mother may experience decreases of bone mineral. A nursing mom's bone mineral density may be reduced in the whole body by 1 to 2 percent while she is still nursing. This is gained back, and bone mineral density may actually increase, when the baby is weaned from the breast. This is not dependent on additional calcium supplementation in the mother's diet. 
  • Breastfeeding reduces the risk of rheumatoid arthritis.
  • Breastfeeding has been shown to decrease insulin requirements in diabetic women.
  • Breastfeeding moms tend to lose weight easier.

Thursday, December 9, 2010

Doula: The Essential Ingredient

Doula: The Essential Ingredient

DONA International, the organization through which I am seeking certification, has made this short but comprehensive informational video all about what a doula is, what a doula does, and why doulas are the essential ingredient.


The Essential Ingredient: Doula from DONA International on Vimeo.

Monday, December 6, 2010

THIS is What We're Working Towards

In this interview with Indie Birth, Robbie Davis-Floyd puts everything that us birth activists always want to say and do into words, and she does it perfectly and succinctly! This is why she is my favorite lady...

How would you describe yourself: mother, birth activist, cultural and medical anthropologist specializing in the anthropology of reproduction

1. What change(s) do you want to see in birth?

I want to see midwives attending the majority of births, under the woman-centered midwifery model of care, with obs reserved for those 15% or so of cases in which their skills are truly needed. Midwife-attended births in homes and birth centers would be fully and freely available. In my vision, women would not even be admitted to the hospital until they are a full 5 cm dilated, so that early labor can take its own course and time. Except in rare cases, labors would never be induced before 42 weeks. No interventions would be routinely used, and any use of interventions would be evidence-based. Women giving birth in hospitals would eat and drink at will and move about freely with one-on-one doula support, and support from the other companions of their choice. Women could choose epidurals if they wish, after 5 cm. Upright positions for labor and birth would be the norm. Normal babies would never be separated from their mothers, nor would viable preemies–they would receive full-on kangaroo care. Breastfeeding would be supported and encouraged, formula would not be available but breastmilk from other mothers would be. That’s the short version!

2. What people/places/philosophies/things do you envision being some of the catalysts in birth change?

A massive paradigm shift from the technocratic to the humanistic and holistic (midwifery) models, brought about by individual practitioners making that shift and implementing it in practice as a model for others. The most fundamental change needs to take place in the education of ob/gyns. I envision that the various obs in the US who have already made the paradigm shift will take leadership in changing ob education. The evidence that they are doing almost everything wrong in their treatment of normal labor and birth is very clear.

3. What is the first thing that needs to change with how the average person views natural birth? What are your ideas (big and small) to help this change?

  1. We need to make a cultural shift towards appreciating women’s valor, bravery, and courage in birthgiving and celebrate them as we celebrate our soldiers for their courage, so that giving birth normally can become a rite of passage culturally recognized as brave and empowering.
  2. Women need to be educated in the physiology of normal birth and the techniques (such as doula massage techniques), people (midwives and doulas), and technologies that support that normal physiology (such as birthing balls, chairs, and stools, wall ladders, floor mats and futons, ropes from the ceiling, birthing tubs and how to use them).

4. What is the best advice you would give a pregnant mama who is looking into her birth choices?

5. If you could give a few words of advice to all the women (even those not pregnant) that haven’t found their voices yet, what would it be?

“You are a child of the universe, you have a right to be here” and a right to be heard!

6. What encouraging advice would you give anybody in birth (mama or any birth worker) when faced with that seems like the present “doom and gloom” situation?

First, eat if you’re hungry and drink if you’re thirsty, and don’t let anyone tell you you can’t. Leap out of the bed, strip off the monitor, open the windows, put on a CD, and dance wildly and happily! In other words, change your attitude, change the energy!!

7. What do you think “We” can do to help women find their truth, their trust and their responsibility in birth?

I think “we”–many thousands of us–are doing our best. We are writing articles, books, and blogs. We are lobbying legislators for better laws. We are monitoring every study that comes out and supporting it if it’s good and if it’s not, pointing out very specifically what’s wrong with it and widely disseminating that information. We are educating women. We need to put a great deal more work into educating doctors! They are not bad guys, they are just not trained at all in how to support the normal physiology of birth. We need to re-educate most of them, with grace, charm, and a sense of fun so as not to antagonize them, and we need to get into medical schools and work to educate obs-in-training in the physiology of normal birth and their appropriate roles from the get-go.

Sunday, December 5, 2010

The Cascade of Interventions

The Cascade of Interventions aka the Snowball Effect

In a hospital setting where your care providers are actively managing your labor, once you have one intervention it makes more interventions more likley to be needed in order to remedy the effects of the previous ones. 

You go to your hospital in labor and you are hooked up to a continuous electronic fetal monitor so that they may know when the baby is in distress. Having this monitor on means you are nearly confined to the bed, so that the monitor can have an accurate read of your contractions and the baby's heart rate. Inactivity slows your labor and you are not dilating quickly "enough," so the nurses give you pitocin through an IV. Pitocin, aka synthetic oxytocin, makes your contractions much too intense and you are in pain. You now ask for narcotics and/or analgesia, like an epidural. The epidural gives you a fever, so the nurses administer antibiotics. It also slows your labor down again and so the doctor artificially ruptures the membranes of your amniotic sac. Now your baby has abnormal fetal heart rate patterns, which may or may not be accurate. When you are encouraged to push, you can't push effectively because you are numb from the epidural. The doctor either cuts an episiotomy and uses a vacuum to get the baby out, or orders a Cesarean section.

Cesarean section means baby will have respiratory and other problems and will be most likely taken to the NICU. Mother and baby are separated, which reduces bonding and leads to difficulties in breastfeeding. Separation also means that babies have reduced glucose levels because they are not being fed by mom nor being kept warm by mom, so the nursing staff give baby some formula. The c-section and being fed formula instead of colostrum means baby has a reduction in immune protections. Mother now has to stay in the hospital longer, with lasting abdominal and scar pain, reduced future fertility and the possibility that they can only have a cesarean section if they want another child.

Obstetrical interventions can be life-savers for mothers and babies. They are not, however, needed for low-risk mothers where the mother and the baby are both fine and healthy.

Saturday, December 4, 2010

Winnie Cooper Has a Baby!

 I used to watch The Wonder Years all the time growing up and I loved it when people told me that I looked like Winnie Cooper. I thought she was so nice and pretty!

Well now that cute girl is all grown up and makin' babies. Danica McKellar recently gave birth to a son after a 36 hour natural labor! She and her husband named the baby Draco. Unfortunately the name has nothing to do with Harry Potter... He is named after a constellation (and it also happens to mean dragon - awesome).

Huzzah for celebrity role models, especially for women of my generation, going for natural birth and breastfeeding and talking about it.

Danica is also an awesome role model for girls in other ways... I had no idea that she was a NY Times best-selling author of Math books for girls! She has published 3 books - Math Doesn't Suck, Kiss My Math and Hot X! Algebra Exposed. 

Very cool, Winnie Cooper! 

Wednesday, December 1, 2010

Won't My L&D Nurse Do That?

...yet another post on why to bring a doula with you to birth!

Before having heard of a doula, or even stopping to consider hiring one, women believe that their nurse in labor and delivery will be able to provide all of the support during labor that they might need. They ask "Why should I bring another support person with me?  Can't the nurse help with informational/physical/emotional support?"

A study published in the journal Birth took a look at women's perceptions during their last trimester of the type of support they would receive from their labor and delivery nurses during childbirth.

The question “What do you think your nurse's role will be during labor and delivery? You may list as many things as you wish.” was asked of women who were pregnant for the first time at their childbirth education class.

Approximately 29 percent of the nursing tasks listed by the nulliparous women were related to providing them with physical comfort and emotional support, 24 percent related to providing informational support, almost 21 percent were related to providing technical nursing care, and 21 percent related to monitoring of the baby, mother, or labor progress; approximately 5 percent related to indirect care (outside the room).

In contrast with the expectations of mothers reported in this study, two work sampling studies indicated that nurses spend little time giving women physical comfort and information support during labor. One study indicated that the proportion of time that nurses spent in supportive versus all other activities was 9.9 percent, and another study showed 6.1 percent was spent in supportive care. This supports the suggestion that women's expectations of care and their actual care might not agree.

Doulas frequently inform women that they will probably see very little of their nurse, who has many patients to tend to and a lot of paperwork, tech equipment, and other responsibilities that keep them from providing continuous emotional and physical support to the laboring woman. A limited number of available nurses and financial resources are barriers to availability of nurse bedside care. Additionally, nurses are frequently not educated in non-pharmacological forms of coping techniques.

touching the computer, but not the mom...

Labor and delivery nurses are compassionate, hardworking individuals who desire to provide quality support and care to their patients. This study showed that although the women valued technical help during labor, they also have a strong desire for “high-touch,” personalized care. Meeting women's expectations during labor can increase their satisfaction with the overall birth experiences. This, in turn, can help them gain confidence to be strong parents who will provide nurturing care to their infants, thereby creating stronger families.

So, if women have a strong desire for high-touch, personalized care, which in turn creates better births and stronger families, but the nurses aren't going to give it to them, what to do?

This is the point in the post when I say... HIRE A DOULA!  

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