I am PRO Bikinis-while-pregnant!

I have noticed that all of the maternity swimsuits have a few things in common. They are all big, ugly concoctions with way too much fabric and ruching. They often have strange, little skirt-like things around the bottom. And they are expensive and impossible to wear when you are not pregnant. I say, if you were the kind of girl who liked wearing bikinis on the beach to start with, keep it up while you are pregnant!

We were in Maine last weekend for Jo and Tyler's wedding. The whole weekend was amazingly beautiful and I couldn't pass up some morning beach time before the festivities. I had brought with me a (non-maternity) one-piece. But it looked ridiculous stretched over my tummy and made me look like a cow. Luckily, I had also brought a bright pink bikini, which was adorable. I was proud to show off the bump and I actually felt more confident and less self-concious than I ever have before. Because... If you are obviously pregnant, who really cares that your tummy is huge? (And the extra-big, pregnant boobs are kind of a fun accesory, as well.)

I have seen this practice discouraged because people think it's "gross" and/or a risk because you have more exposed skin availble to be sun-burned. I think it's a little old-fashioned to be offended by pregnant-ness... Enough said about that. And people need to get over this irrational fear of the sun. The sun is good for you. Just be diligent with the sunscreen and stay well-hydrated.

Here are some pics of famous people looking pregnant and fabulous in bikinis.

Bethany Frankel (my favoritie real housewife)

Carla Bruni and Nicolas Sarkozy. (Sarkozy looks a bit troll-like, but Carla looks amazing!!!)

Tori Spelling and her adorable (growing) family.

Dumping my OB/GYN

At this point it has become clear that I've made a mistake in how I handled choosing an OB. Although all the books recommend it, I didn't go through the whole process of interviewing OBs and finding one that was on the same page as me. I just took the first one that had an open spot. I figured they couldn't really be all that different, and my choices of OB clinics are limited by insurance stuff, anyway.

I've met this person about 6 times now. I thought she was kind of in a hurry and a little overly "clinical" with her manner, but nice enough. I also hadn't really tried to ask any questions or had any major concerns. My pregnancy has been text-book normal and uncomplicated so far, so I didn't think much of it. At my appointment last week, I brought up when she thought we should talk about my birth plan. Right away it seemed like she had no interest in talking about anything of the sort. She said that they didn't usually set aside a specific time to discuss such things and there was no formal way that it worked. I said that was OK, and I hadn't actually written one yet. I then mentioned that my major desires for my birth were that I'd like to try and avoid aggressive induction measures (like pitocin) and I'd like to also avoid epidural pain medication, although I was open to other things. I also added, that the main reason for wanting to avoid these things was to reduce my chances of needing a c-section. She looked bored and exasperated and kept repeating that I could write down what I wanted but there are certain things that they have to do and she wasn't going to sign any birth plan that I brought in. She then suggested, that if I didn't want a lot of unnecessary interventions, I should labor at home for as long as possible, Because  - get this -  "This isn't a hotel"

This whole conversation couldn't have lasted more than 3 minutes, and ended with me sitting there staring at her with my mouth open. NOT A HOTEL??? Are you kidding me???  At this point, I'm thinking that I don't want this woman anywhere near my laboring uterus.

I guess the implication is that if you aren't going to submit to being pumped full of drugs while you are in labor you might as well just be hanging out in your comfy hotel room. What is she talking about? Oh, she also graciously explained to me that at the hospital there was typically more interventions than most people want or need, but these things are done for medical liability reasons. It's just appalling. The primary incentives of an OB is to get people in and out as quickly as possible, while keeping lawsuits at a minimum. Only after those conditions are met does the concern switch to making sure the babies and moms are healthy. Or at least this seemed to be the attitude of this particular OB, whom I have the misfortune of having to deal with.

I understand that there are policies that need to be followed at a hospital, like fetal monitoring and an IV during delivery. I like the idea of monitoring the baby, and having drugs and modern medicine and surgery immediately available. That's why we're going to the hospital (OK. We're also going because this is the only option that is covered by insurance). But I thought that I would be treated like an educated adult and giving birth at the hospital would give me more options and make me feel safer. I feel like this OB not only does not care about what my desires are, she finds the fact that I have opinions about my childbirth.... annoying. I don't trust that she considers me an active participant in the birth of this baby. I definitely don't trust her to do the healthiest thing for me and my baby.

That's where it ended. I called the office and I'm trying to switch to someone else. Unfortunately, it's sort of difficult to switch OBs this late in a pregnancy and there aren't too many other ones available. I'm also assuming that her attitude is atypical. I could be wrong. Either way, I'm really hoping that it works out I can find someone else.

Interestingly, I found out from the office nurse that the OB I have now is leaving the field of obstetrics in October. I'd probably be her last birth. Maybe this explains her dismissive attitude?

Baby Shower in Rochester!

We spent the weekend out in Rochester at Chris's parents' house. Sue and Lisa were lovely enough to throw a beautiful baby shower with an adorable "owl" theme. My Mom and sisters all made it up and it was awesome to see them. I was absolutely delighted and so so so greatful for all the gifts! This baby is going to be the best outfitted baby on earth. We now have some big essential things. The all important crib and infant car seat are ordered and on the way to our house. We also got a baby swing and a portable bassinet. We have a fancy little whirlpool baby tub with a detachable shower hose (I think I want one in my size!) with cute matching bath towels and baby shampoo. Diapers! with a special trash bin especially made to handle poopy stuff. And of course lots of teeny tiny socks, hats, dresses, and onesies.  

I've already unpacked and assembled some of the stuff, so the nursery is well on its way to completion (well, as complete as it can get, minus the baby).

Tummy at 30 weeks :)

My Mom and I (for some reason, only half the picture would upload)

Fun with home blood type tests

Blood type tests are fun and readily available on Amazon.com for less than $10 each! I suggest ordering one for an educational and interesting home experiment to determine your blood type and Rh factor.    :) 

Even though it was really fun, we ordered the test for an actual practical reason. We needed to check Chris's blood type. I'm Rh negative which occurs in about 15% of the population. This means that if Chris is positive, I have to get immunized against the Rh factor to prevent potential immunoincompatibility with the baby (who has a 50% chance of being positive). Rh incompatibility occurs if the baby is Rh positive and the mother is negative. Late in the pregancy or during delivery it is possible that some of the fetal blood cells can cross over into the mothers body, and sensitize her immune system to the Rh protein. This means that in subsequent pregnancies, if the baby is positive, the mothers immune system will attack the blood of the fetus and cause all sorts of problems. For example, miscarriages will be much more common, and if the fetus does manage to grow,  there is a risk of anemia and neurological disorders/mental retardation (eek!). There are risks to having the immunization (inducing an immune response in the mother is generally something to be avoided), but the possible complications with subsequent pregnancies are so extreme that the benefits out weigh the minor disadvantages.

However, if Chris is negative, then I can avoid having the immunization because the baby will definetly be negative. So we ordered the Eldon blood typing kit from amazon. It consists of a blood type card, an alcohol swab for your finger, a lancet (i.e. finger poking device), 4 little spreaders for applying blood to the card and a chart to determine your type. The card has 4 circles on it. The first one has antibodies to blood antigen A, the next has anti- B, the next has Anti-D (or Rh), and the last is a control circle that has no specific antibodies on it. The first two circles tell you if you have A, B, AB, or O blood and the Anti-D circle tells you if you are Rh negative or positive. Basically, if you are positive for that antigen, your blood will react with the antibodies and get all clumpy, if you are negative, nothing will happen and the blood will just sit there.

This is what a test for A positive blood should look like. Note the clumpiness in the first Anti-A circle and clumpiness in the Anti-D circle. This is what Chris's blood type turned out to be.

This is what the actual test ended up looking like, much messier and grosser, but we could still figure out the blood type. Mine is on the left, I'm A postive and Rh negative. Chris's is on the right, he is indeed A positive and Rh positive (although this is quite hard to see in the picture). So, it turns out that I need to get the immunization. This wasn't too surprising since Chris had an 85% chance of being positive, but it was worth confirming it ourselves to be sure. And like I said above, very fun. Go science!



The Enigma of Placentophagia: To eat, or not to eat?

On monday, we had our second visit with the Doula, Jessica, to go over medical history, concerns, and things to think about over the next few months. Over the course of our talk, Chris revealed to Jessica that one of his biggest fears was that I would have terrible post-partum depression (PPD) after the baby was born (Except, he didn't say it like that, instead he said, "I'm afraid that she will go crazy". Isn't that adorable?). So, here's the crazy thing, Jessica asked if we had considered encapsulating the placenta after birth. To which we replied, "What the heck is that, and what does it have to do with PPD??". Very briefly, placental encapsulation in when the placenta is carefully dried out after the birth, pounded into a fine powder and then encapsulated into pill form. The idea is that your hormone levels go totally wacky aftery you give birth. So, you take these placenta pills in the few weeks after birth and the hormones and other substances even out your hormone levels and this is thought to reduce PPD, stimulate milk production, and generally just be good for you.

You probably have the same incredulous face that I had when I first heard of this idea. Needless to say, I COULDN'T WAIT to blog about this topic. Is this practice weird pseudoscientific crunchy granola hippy crap? Or is it an adaptive evolutionary behavior that has been lost in modern human society to the detriment of women and babies worldwide? The debate is fascinating, please read on.

The most striking piece of evidence in this debate is that almost all mammals immediately consume the placenta and amniotic fluid that is delivered during birth. This behavior is called placentophagy. This behavior is exhibited by rodents, cows, carnivores, horses, primates, apes, etc. etc. There are very few exceptions to this rule (e.g. aquatic mammals do not eat the placenta, and marsupials reabsorb the placenta rather than delivering it, and therefore cannot eat it). This behavior is remarkably evolutionarily conserved. Even our most closely related relatives, the higher non-human primates and apes, universally display placentophagy. In all of recorded anthropological studies, however, there is no mention of humans eating placentas. In modern cultures where what happens to the placenta is known, the placenta is usually burned ceremoniously (or unceremoniously, as the case may be). Or it may be buried to fertilize a tree, and the fruit produced by the tree is eaten. Or a piece may be dried and saved as a talisman. Other cultures, like in china, the placenta is dryed and used in traditional medicines. There is no recorded history of direct placentophagy in humans similar to what is displayed by animals (Ober 1979. Bull. N.Y. Acad. Med. 55;6, p591-599).

The lack of a mention of placentophagy in our most ancient writings isn't neccesarily proof that it did not happen. Birth practices have traditionally been shrouded in mystery. In fact, there is very little recorded history about birth, in general. Interestingly, the most direct references to the fate of the placenta is in strict taboos against eating the placenta. For example, in the bible, Deuteronomy (Chapter 28), there is detailed descriptions of the good things that will happen if the Israelites follow the laws and statutes of God, and the horrible punishments that will befall them if they choose not to do so. Verses 52 to 57 describe how if the people were to disobey God, the men will practice cannibalism and the, "tender and delicate women among you will consume the afterbirth for want of [more appropriate food]" (Ober 1979). The fact that this was considered taboo, indicates to me that there may have been tribes of early pagans that practiced placentophagy and early religions seized on the practice as a way of separating God-following humans from other animals (or to place other humans that did not follow that particular God on the same level as animals). This would not be the only example of a common practice being arbitrarily banned by "God". It seems that God bans things as a convenient way of separating in-groups from out-groups (eating pork, leaving your head uncovered, homosexuality, to name a few). If these speculations are true, it is possible that very early humans did practice placentophagy before the beginning of recorded history and have since lost the practice. I tend to think this is a likely scenario, given our common ancestory with primates, which would lend credence to the evolutionary argument for placentophagy, but this is very difficult to prove.

So regardless of the human question, to which we will return to later, we still have the enigma of almost universal consumption of the placenta by all other mammals. Why would any mammal eat the placenta? There are a few hypotheses to explain placentophagy. [I'm paraphrasing from a review written by Mark B. Kristal in Neuroscience and Behavioral Reviews (Vol. 4, p141- 150, February 1980).] The main explanations are that 1) mammals consume the placenta simply because they are hungry after the exertion of giving birth and need the extra nutrition, 2) the placenta is consumed to remove it from the nest where it might attract predators, and 3) the mother is responding to specific nutritional or hormonal needs that are satisfied by consuming the placenta. The hunger hypothesis is relatively easily disproved by the fact that given a choice between placenta and a variety of other foods shortly before birth and immediatly after, rhesus monkeys will exclusively eat the placenta. Similar behavior is found in rats. The prevention of predation hypothesis is attractive, but is also easily argued against. It still doesn't explain why the mother would eat the placenta. Why not bury it? or move away from the site of the birth? Or, in the case of tree-dwelling monkeys, why not drop the placenta out of the nest to the ground far below? Instead, tree-dwelling monkeys will keep the placenta around for a while and take an hour or two to finish eating it. In addition, mothers that have little risk of predation will also enthusiastically eat the placenta.

This leaves the third hypothesis, that for some reason, the placenta becomes extremely attractive and tasty to the mother immediately before or during birth, likely for evolutionary reasons, in which mothers that ate the placenta produced young that survived better than mothers that shunned the placenta, thus conserving the trait. The reasons that placenta-eating might be evolutionarily adaptive stem from the fact that the placenta contains a variety of hormones, including progesterone, estrogen, and prolactin that have positive effects on the mother and/or babies. Studies show that ingestion of the placenta has a profound effect on the production and presence of these hormones in the blood of the mother. In one study, pregnant rats were either allowed to consume the placenta or the placenta was removed before the mother could consume it. Mothers that were prevented from eating the placenta showed a dramatic increase of progesterone levels on days 6 and 8 following birth. On the other hand, mothers that were allowed to eat the placenta maintained relatively steady levels of progesterone, they also showed an early boost of prolactin production that was absent in the non-placenta eaters (Blank and Frieson 1980. J. Reprod. Fert. 60, p273-278). These results are relevant because the fluctuation of progesterone levels following birth is hypothesized to be a risk factor for the development of PPD in humans. Also, an early boost of prolactin, a lactation hormone, could stimulate more efficient milk production in the placenta-eaters. In another study, when foster rat pups were given to a lactating female they had a much better chance of surviving when the placenta was still attached, presumably due to the beneficial hormonal effects of consuming the placenta in the mother (Deneberg et al. 1963. J. Reprod. Fert. 5, p131-141). More recent work from Kristal's group at the University of Buffalo shows that placentophagy in rats enahnces opioid-mediated pain suppression (DiPirro et al., 2004. Brain Research) and opioid activity in a certain part of the brain, in addition to suppressing pain, also stimulates maternal behavior (Neumann et al. 2009, Brain Research). These data, although limited mostly to rats, indicate that placentophagy can alter hormone levels and prodcution, induce maternal behaviors, increase lactation, and suppress pain. Even with all these beneficial effects, there doesn't seem to be an enormous deficit in maternal behavior if the placenta is removed before eating, indicating that it is not an essential factor in proper rearing of pups. Nevertheless, there do not seem to be negative effects associated with placentophagy.

If you have read up to here, I applaud and thank you! Annnnd you are probably thinking, "OK, now what about all the human studies?"  There are none. There are absolutely zero studies where placentophagy has been studied with any sort of rigor in humans. Ok, there is one study, but it's somewhat fluffy, according to Kristal:

"In 1954 a group of women that had recently given birth were fed disguised freeze dried placenta [the women did not know that they were ingesting placenta]. Apparently, 86% of the subjects showed improved milk production and flow, whereas among control subjects, fed beef treated identically to the placenta, only 33% showed improvement. Further more, the authors classified more than a third of the placenta-improved subjects, but none of the beef-improved subjects, as having an "extremely strong" positive reaction. (Soyková-Pachnerová et. al., 1954. Gyneacologia, 138: 617-627"

Even with this relative lack of human-based studies, there is an extremely vocal and adamant movement towards encouraging placentophagy in humans. This is not all fringe either, it has even been popping up in USA today articles! These people, like my Doula, believe that consuming placenta pills after their birth prevents depression, enhances milk production, and makes them feel better. The personal testimonials are very interesting. Momaroo talks about her first experience with Placenta pills. She says that after the birth of her first children, she had debilitating PPD, but with her most recent pregancy, she has had much better symptoms. She says that even with being sleep deprived she feels cheerful and maternal, which is a complete turn-around from how she felt in the weeks following her first births. Of course these testimonials don't prove much of anything, but I doubt these women are lying about their personal experiences. Perhaps there is some sort of placebo effect that reduces the PPD? There is no way to know without randomized, controlled studies. My question is that with PPD being such a prevalent and horrible condition (almost 25% of women will experience moderate to severe PPD), why isn't this easy and inexpensive solution being taken seriously?

I would love to see continued research done on this. The animal data is encouraging, but this topic is vastly under researched. I have trouble believing that mere yuckiness factors and general prejudice against natural birth practices would prevent science from moving forward on something so important!