Friday, October 31, 2008

Consumer Reports Health Condemns Common Obstetric Practices

Consumer Reports Health is a new public service from the well-known Consumer Reports. They are now providing reporting data on medical procedures and treatments in an effort to assist consumers of health care to be more informed. I am impressed, and pleasantly surprised, that they are present the research-based evidence regarding obstetric practice, instead of what the American College of Obstetrics and Gynoecologists is promoting. This is what Consumer Reports Health have to say about basic obstetric practice:

Despite growing evidence of harm, many obstetricians and maternity hospitals still overuse high-tech procedures that can mean poorer outcomes for baby and Mom. Test your knowledge with our quiz below.

T/F: An obstetrician will deliver better maternity care, overall, than a midwife or family doctor.False. Studies show that the 8 percent to 9 percent of U.S. women who use midwives and the 6 to 7 percent who choose family physicians generally experienced just-as-good results as those who go to obstetricians. Those who used midwives also ended up with fewer technological interventions. For example, women who received midwifery care were less likely to experience induced labor, have their water broken for them, episiotomies, pain medications, intravenous fluids, and electronic fetal monitoring, and were more likely to give birth vaginally with no vacuum extraction or forceps, than similar women receiving medical care. Note that an obstetric specialist is best for the small proportion of women with serious health concerns.

Induced labor can halt fetal development.
True. The vital organs (including the brain and lungs) continue to develop beyond the 37th week of gestation. There is also a five-fold increase in the brain's white matter volume between 35 and 41 weeks after conception. Inducing labor (with synthetic oxytocin, for example) might stop this growth if the fetus is not fully developed. Between 1990 and 2005, the number of women whose labor was induced more than doubled.

Due-date estimates can be off by up to two weeks.
True. This inaccuracy can lead to a baby being delivered by induction or Caesarean section up to two weeks earlier than its estimated due-date, cutting off important weeks of fetal development.

"Breaking the waters" helps hasten labor.
False. There is no evidence to support the fact that this common practice (about 47% of women) shortens labor, increases maternal satisfaction, or improves outcomes for newborns.

Induced labor increases the likelihood of Caesarean section in first-time mothers.
True. The cervix may not be ready for labor. Other effects of induced labor include an increased likelihood of an epidural, an assisted delivery with vacuum extraction or forceps, and extreme bleeding postpartum.

Once you've had a C-section, it's best to do it again.
False. Studies show that, as the number of a woman's previous C-sections increased, so did the likelihood of harmful conditions, including: trouble getting pregnant again, problems delivering the placenta (placenta accreta), longer hospital stays, intensive-care (ICU) admission, hysterectomy, and blood transfusion.

Labor itself can benefit a newborn's immunity.
True. When babies do not experience labor (if the mother has a C-section before entering into labor, for example), they fail to benefit from changes that help to clear fluid from their lungs. That clearance can protect against serious breathing problems outside the womb. Passage through the vagina might also increase the likelihood that the newborn's intestines will be colonized with "good" bacteria after the sterile womb environment.

Epidural anesthesia is a low-risk way to make labor easier.

False. Many women welcome the pain relief, but might not be well-informed about the increased risk of its side-effects, including lack of mobility, sedation, fever, longer pushing, and serious perineal tears.

Epidural anesthesia presents risks to newborns.
True. Babies whose mothers received epidurals during labor are at risk for rapid heart rate, hyperbilirubinemia (the presence of an excess of bilirubin in the blood), need for antibiotics, and poorer performance on newborn assessment tests.

Episiotomies reduce the risk of perineal tearing.
False. Evidence shows that routine use of episiotomy offers no benefits but rather increases women's risk of experiencing perineal injury, stitches, pain and tenderness, leaking stool or gas, and pain during sexual intercourse. Yet in 2005, 25 percent of women with vaginal births continued to experience this intervention. Episiotomy is one of several obstetric practices adopted into common usage before being adequately studied.

Source: "Evidence-Based Maternity Care: What It Is and What It Can Achieve," a detailed review of clinical evidence by Carol Sakala and Maureen P. Corry published by the Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund, October 2008.

Saga of a Deep Pelvis

I learned I had a deep pelvis when I was pregnant with Willem and went to get the 20 week ultrasound. The technician had a difficult time capturing him because he was tucked so entirely in my pelvis. With his pregnancy, my torso did not ever get to the tell-tale this-woman-is-ready-to-birth size. At 38 weeks (when Willem was born), many people thought I looked closer to 7- 7 1/2 months pregnant.

So being 10 weeks with another pregnancy, I'm not surprised that I can't feel the fundus of my uterus above my pelvic bone yet. Its not strange that I can't feel it yet, even though it should be more likely since my uterus has already expanded in size before. Yesterday was our first appointment with my midwife and we hoped that we would hear the heartbeat.

It would have been a very exciting and happy way to end a difficult week for both me and my husband. I have been making the final revisions to my thesis and my husband had taken the written portion of his qualifying exams to become a Ph.D. candidate (4 days of intense testing). So hearing our babies heartbeat would be a comforting way to end the week.

Not surprising, we didn't hear the heartbeat using a doppler. I chalk it up to the deep pelvis of mine and being at the early cut-off for hearing a baby's heartbeat using a doppler. I thought I could handle that slight disappointment without needing proof of pregnancy. At an OB's office, I could have been very tempted to agree to a transvaginal ultrasound so I'm glad that temptation was removed. Instead, I got a few laughs when I asked for a pregnancy test from the midwife, just to see some indication that I am still pregnant.

I'm still laughing at myself for that. But yes, indeed, two lines appeared. I still feel pregnant and at least my urine is indicating that I am.

My readers may remember posting about a dream where I miscarried this pregnancy at 11 weeks. I'm still not there yet and I'm trying to remain optimistic that the dream was a product of my fears and not preparation for reality.

By way of other updates, my due date club of friends is growing. A friend from high school whose little boy is a little bit younger than Willem called to tell me that she is also pregnant again. Another friend local to me is also expecting. I'm glad to have at least one local friend who we can share our pregnancies together.

Wednesday, October 15, 2008

A Happy Birthday to me!

On Saturday, it was my 24 birthday. That's not the remarkable part, its that I really enjoyed it!

Birthdays are just kind of days to me even though I appreciate it when others try to make it special. This year everyone succeeded very well. I think it was helped by being on a Saturday. Everyone's birthday should be on a Saturday.

I was expecially happy to receive the gifts I received. A number of them were books, you know the kind that can be read for enjoyment. Being pretty much finished with my degree program makes me very happy to see a stack of unread books to read.

The books on that list (no birth books, but that may be what I get with the money I was given):
Irish Crystal by Andrew Greeley (in the Nuala Anne McGrail series)
Feeding the Whole Family: Cooking with Whole Foods by Cynthia Lair
Brisingr by Christopher Paolini (book three in the Eragon triology)
Wise Woman's Herbal for the Childbearing Year by Susan Weed
World Without end by Ken Follet (the sequal to my favorite historical novel: Pillars of the Earth)

I was also given a super soft robe and blanket set that has replaced my favorite purple robe. I know I'll be enjoying the comfort of that set for the next few months. I also was given a hand carved nativity set from the Philipenes and a lovely ivory pendant from Alaska. The pendant reminds me of the full beauty of a pregnant belly complete with eternity knot at the top. I will treasure that during my pregnancy.

Peter also was very good to me that day. He made me breakfast. It would have been in bed but I got up before he finishied making it. Then we took a walk as a family to the park and then napped when we got home. I really enjoyed cuddling with Willem and getting a birthday nap. I highly recommend it! After we woke up, we were greeted with dinner (coconut curry chicken) and a fresh baked cheesecake. Many thanks to Peter for making my birthday special and to the family members who sent thoughtful gifts that I enjoy.

Tuesday, October 14, 2008

Moving to Canada

That's not true, but based on the current economic status of the United States, my husband and I have been in serious talks about moving out of the country, temporarily, after he finishes his PhD. To underscore some of our reasons why we would move out of the United States, see this funny from

Its not about the abortion, or medical marijuana but I do admit that public radio sans pledge drives is very appealing. Really, my husband and I see ourselves as elitists who are in need of the Expatriot, Liberal, Intellectual's Theocracy Escape Plan.

Wednesday, October 8, 2008

Willem News

There have been a few Willem anecdotes from the last few days that I've been particularly impressed with so I'm sharing them here:

The other night, Peter, Willem and I were getting ready for bed by sharing a bit of chocolate. We finished the chocolate bar and we had the resulting wrapper. I handed the wrapper to Willem and told him to go throw it in the trash can in the bathroom (one room away). He held onto it, climbed of the bed and walked out of the room. He came back into the room a short bit later without the wrapper. Both Peter and I knew it could be anywhere--the toilet, the other bedroom, the floor in the hallwa--and we knew that when we got up in the morning, we'd find out where it ended up. The next morning, I found the wrapper...guess where? The trash can! Way to go, Willem!

Yesterday, I was busy with something online and Willem was telling me he wanted to go outside. He brought me his shoes but he was only wearing a diaper and a shirt. I told him that he needed socks and pants. The next thing I knew he was gone from my knee and had gone off somewhere. Then I heard him coming down the stairs, he came over to me and handed me 3 socks. Two of them matched well enough and I put them on. I was impressed that he would follow such complex directions and bring me socks!

We have kind of started potty learning with Willem. He will let me when he needs a new diaper (if his diaper is off) or that he needs a diaper change after he's used the diaper he's wearing. He also will sometimes sit on the potty that we have for him. Today while I was making lunch, I looked up and saw him sitting on his potty in the living, reading a book. He had a diaper on but he was doing exactly what I've been trying to show him. Other times that he's sat on the potty, he's sat perfectly well without a diaper on, but he still hasn't actually relieved himself into it. That will come with time. I'm wondering if I should get some of those cloth training pants that he could pull down by himself (no pull-ups around here!).

He's also learned where Grandpa and Grandma live. The other night, Peter and I were talking and I mentioned a town in Texas. Willem heard the reference and immediately said (and signed) Baba (his way of saying Grandpa). He hasn't said Texas yet, but he knows that's where his grandparents are! He'll also point to airplanes that fly over head and say Baba and Nana. I'm pretty sure that means he wants to get on the airplane and fly to Texas to see them.

He is also starting to show empathy. On Saturday, I came home from an Irish dance performance with sock glue residue on my leg. The fuzz and lint from my pants stuck to the glue and I had these furry rings on my calves. Willem say them, touched it gently and said "Uh-oh! Oww..." He also gives kisses to ouches, like when Peter had some road rash from a bike accident. Willem would gently kiss Peter's elbow. Willem also kisses his knees when they have scrapes on them. One time, something fell on my toe and he kissed it for me.

He also is starting to think symbolically. He "pretends" that blocks are cars or that his finger is an airplane.

He's also learning to pray. Last night, I told him it was time to pray and he folded his arms across his chest. I started the prayer and then asked him who he wanted to pray for. I started with Grandpa, and he said Baba and then Nana and then Daddy and then Mama. I finished the prayer and at the end when I said Amen. He said May-may (which is what he calls our neighbor Eamon).

I am happy that Willem is learning skills that are needed to be successful in life. Following directions, empathy, praying, dressing oneself and toileting are important milestones that he needs to learn and I'm impressed that he is working on some many of those skills at his age.

His language (as seen from above) is coming along and he is learning new words frequently, including the signs for many of those words. His favorite newest sign is seal--clapping your hands together like a seal clapping its flippers.

A Scary and Weird Dream

Last week I had a scary pregnancy dream. Ever since that blessing my dreams have been centered around the things that could go wrong with this pregnancy. The worst one so far was dreaming of miscarrying the baby.

I dreamt that I started bleeding and was spending a lot of time on the toilet letting the bleeding happen and then I noticed some tissue that was different from the rest. I reached down and caught it in my hand and found a 2 in fetus where I could see the anatomy is detail. I was saddened to know that I had lost my baby but at the same time I was amazed to actually hold a baby at that stage in development.

Because my husband and I are both scientifically minded, my first thought was that he would like to preserve the body of this child the same way he had preserved the body of his pet octopus that died last year (he works in an animal behavior lab so he's got all the materials and chemicals available to him). I was okay with that. I'm also no stranger to having family member's remains in my home as I kept my brother's ashes on my bookcase for years when I was growing up, and my father's ashes are kept in my mother's home still.

The end of the dream was when I walked by my dresser and saw the little vial with my baby floating in it, and I was glad to see it there.

Aside: A baby is generally around 11 weeks when its 2 inches long. I've got 4 more weeks until I can be comforted that I won't actually experience that.

Friday, October 3, 2008


Today was the big day to print off all 125 pages of my thesis and put 4 copies of the whole thing in the mail. Such a relief!

This last week has been so frustrating. I think my advisor has revised and made changes to each section of my thesis a minimum of 4 times. Even today, after she had okay'd it to be sent to my committee, she emailed with me changes to the title page and abstract. Even after it had been sent to Fedex for printing! Oh I cried.

But here's a big, glowing recommendation for Fedex business services (I will conveniently ignore that they are also Kinkos--being the grandaughter of a competitor's franchise owener). Not only was I able to email my documents to them, they completely understood when I had to resend with the changes that had been made. And to make it all good, they are going out tonight in their shipment.

In two weeks, I meet with my committee by phone and discuss my work. And then (I'm trying not to think about this) they'll tell me what changes I need to make. Then I'll have 18 days to make those changes (and get it approved by my advisor who will probably kick it back to me a few times...argh!!) before I print it again and then mail it to the Graduate Division. But I have a few days before I have to think about that...