Natural Childbirth and Science-based Medicine

I've recently figured out that I have become a passionate natural childbirth advocate. How do I know this? Because I literally can not shut-up about it when people ask me! So, I think it's time for a blog post about this topic.

While I was pregnant I spent a lot of time reviewing literature concerning the merits of various childbirth practices. I wrote some posts about some more flashy topics that I thought other people might find interesting, such as alcohol and marijuana use during pregnancy, treatment for vaginal group B strep, and placentophagia (see old posts). But most of what I read is technical, detaily, and in general, very boring to most other humans. What struck me as I learned more and more was the effect of standard hospital practices on babies and mothers. There are many standard obstetrical interventions that are used commonly. These include artificial induction of labor, the use of pitocin to augment contractions, manually breaking a woman's water, epidural anesthesia, an IV drip of antibiotics, and most concerningly, a sky-rocketing cesarean section rate (upwards of 35% for many hospitals). I began to find that each of these interventions increases the chance of harm to the mother and baby. And not only that, but it robs women of the experience that they were hoping for. It doesn't have to be this way. In many other countries, such as Norway, Sweden, and Finland, many women give birth at home or at specialized birthing centers with very little medical intervention. Babies born at home with minimal intervention are just as healthy (if not even a little better) and mothers are much more satisfied with their experiences, while in the USA, we continue to have some of the highest rates of infant and maternal mortality for any industrialized country (Check here for current stats).

I believe that the birth process has become medicalized partly because of the cultural attitude surrounding birth. Most Americans believe that giving birth is terrifying, horribly painful, and extermely dangerous. Furthermore, if you only watch TLC birth shows or see pregnancy and childbirth depicted in movies, you would have no reason to believe anything to the contrary! It's this attitude that leads women to expect that there is little they can do while giving birth. They must depend on drugs to take away the pain while their obstetrician "gets the baby out". I am sincerely heartbroken that this is the experience that many women get.

To illustrate this situation, here is a common scenario depicted on TLC's show, A Baby Story: A very pregnant lady is sitting in front of the camera. She is saying that she'd like to give birth as naturally as possible, but she knows that you can never control what is going to happen during childbirth. She is in early labor and the nurses have her laying in bed with an IV drip in her arm and a fetal monitor wrapped around her stomach. She is trying to breath through the contractions, but is having trouble. She just knows that is going to get much, much worse and even though she's OK now, she knows she won't be able to handle the pain coming up! The nurses bring in the anesthesiologist and she agrees to get the epidural.

(Note: from experience, I know that labor is much more painful when you are lying down. If she was standing up and moving her hips she would have felt much better. The difference is night and day. But rather than suggesting that she get up and try moving her hips in a circle, the nurses suggest she numb the bottom half of her body with powerful narcotics... go figure. Additionally, labor doesn't neccesarily get steadily worse and worse. It changes as the baby moves down and your endorphins naturally regulate your pain. I felt a lot better as I got towards the end. OK, back to the story.)

So now she's numb and completely out of control of her birth. The pain is gone, except the catheter in in her urinary tract is bothering her and the medicine is making her shiver uncontrollably. The medicine also begins to slow down her labor, so the nurses give her some pitocin in her IV to increase the speed and intensity of her contractions. The contractions start coming more powerfully now, so the nurses increase her epidural to take the pain away. But the increased epidural slows down the contractions again, so they bump up the pitocin a bit too. Now the contractions are coming very strong, much stronger than her body would be producing naturally, but for some reason her cervix has stopped dilating and she is stuck at 5 cm. The obstetrician uses a hook to break her water in the hope that it will make her labor begin progressing again. Now the baby has no cushioning and is being subjected to very strong contractions, the baby's heartrate becomes a bit erratic, this is called fetal distress. The obstetrician tells the women that she is not progressing and now it seems like the baby is not tolerating labor well (as if it is her fault), the Ob recommends a C-section. The women tearfully asks why this is happening and the Ob explains that, "The baby's head may just be too big to fit out of your pelvis. Oh well,  you can't control childbirth!" (This statement is especially ironic, because given all the intereventions that were performed, it seems like "controlling childbirth" was exactly what they were trying to do.) At the end the woman is left holding a perfectly healthy, normal sized baby and everyone is nodding their heads saying, "all that matters is that the baby and mother are healthy." 

Someone watching this show might think, "That person needed to have an emergency C-section. If she hadn't been in the hospital the baby would have been in great danger!". The truth is that each intervention performed increases the chance that the baby will have to be removed from the mother's womb by C-section. Although many women think that a C-section seems "easier", it's not. It's major abdominal surgery with substantial risks and a much tougher recovery. And this happens all too often just because of a misconception that labor is dangerous and unbearably painful.

Of course there are risks involved with birth. C-sections can save lives in situations where the baby is mal-positioned and cannot be delivered easily. Pitocin can help when a women is exhausted and needs help pushing the baby out. Pain medications can help with very difficult labors. The problems begin when these interventions are used routinely, rather than sparingly and according to medical need.

Let's imagine a different story. One where the woman mentally prepared to give birth. Where she followed her body's cues during labor to make herself as comfortable as possible and help the baby move down. Where she was able to feel how to move and know when it was time to push. Avoiding interventions doesn't guarantee a problem-free birth, but it does make it much less likely.

I think the world would be a better place if people thought about childbirth like this, as an intensely amazing experience that usually will go very smoothly. And let's not focus on the pain so much. Anxiety and fear are a great way to take a manageable situation and turn it into something excruciating. Pain is involved with childbirth, but it's not the wall of insurmountable, unbearable pain that people assume. You probably won't get a lot of help with natural childbirth if you ask your Ob about it. So read as much as you can and get support in your community or from friends who have gone through it before. Here is a good blog that really helped me- Birth Sense. Good luck! 

Anti-vaccine craziness...

This story made me sick to my stomach.

We've all heard of "chicken-pox" parties. This was the practice where the parents of children who had chicken pox would host a party to get all the kids exposed together. In the days before the chicken pox vaccine, this made some sort of sense. It allowed everyone to get sick at the same, predictable time and prevent infection in adulthood, which can be more severe. Let me say that again, IN THE DAYS BEFORE THE VACCINE, this sort of made sense. The chicken pox vaccine (aka. the varicella voster vaccine) has been available in the US since 1995 and is extremely effective at eliminating the risk of infection or making the infection very mild, if it does occur at all. This really is a wonderful thing.

Unfortunately, some parents are so distrustful of vaccines, that they prefer to expose their children to chicken pox, rather than getting them the vaccine. And now, there is a facebook group dedicated the helping parents get together for chicken pox parties.This is fucking crazy. But even crazier, is the practice of mailing pox-infected bodily fluids to other parents who are interested in intentionally exposing their children to a dangerous disease. You can read about this practice here at "Respectful Insolence". Briefly, here is an excerpt from Orac's blog:

True, such complications are fairly uncommon but they can be quite serious, all in the name of being "natural" and avoiding those evil vaccines. It turns out that some parents, apparently having difficulty finding children with active chickenpox in their area (thanks to the aforementioned evil vaccine, no doubt), are mailing the virus to each other:

Here's the local Arizona news report:

Doctors and medical experts are concerned about a new trend taking place on Facebook. Parents are trading live viruses through the mail in order to infect their children.

The Facebook group is called "Find a Pox Party in Your Area." According to the group's page, it is geared toward "parents who want their children to obtain natural immunity for the chicken pox."

On the page, parents post where they live and ask if anyone with a child who has the chicken pox would be willing to send saliva, infected lollipops or clothing through the mail.

Parents also use the page to set up play dates with children who currently have chicken pox.

Medical experts say the most troubling part of this is parents are taking pathogens from complete strangers and deliberately infecting their children.

One concern is that they are sending the virus through the mail.

This is not only idiotic, reckless endangerment of children and postal workers. It's also a federal offense, tantamount to bioterrorism.

Why would people do this? Because they have been swindled by anti-vaccine propaganda that uses sciencey sounding words to convince people that there are significant dangers associated with vaccines (there are not). When not using fake science and made up statistics, they take advantage of popular mistrust of doctors and bizarre conspiracy theories ("You can't believe doctors and scientists, they are all under the control of big pharma" etc).

Although it's true that most children will recover from chicken pox with little to no side effects, the risks of getting the disease are dramatically higher than those associated with getting the vaccine. In addition to prevented a very nasty, uncomfortable illness, the vaccine has reduced deaths caused by chicken pox by more than 90%. Also, 1 in 10 adults who had chicken pox in childhood will develop a painful nerve condition called Shingles, when the virus is reactivated during a stressful time. The vaccine likely prevents against this condition as well. Let's not forget about the value of herd immunity to protect people who cannot get the vaccine or are immunocompromised, including very young infants, children with leukemia, and pregnant women.

Please stop sending infectious packages through the mail, it's very illegal and dangerous. And please stop infecting your children with chicken pox. Its not "natural", its not safer than the vaccine, and to do so is nothing less than child-abuse.

Priceless...

At the end of my last post, I mentioned the adorable face that little one makes when she *ahem* eliminates. And by "eliminates", I mean she makes a huge explosive poo into her diaper. I finally got this sequence on film and I plan on keeping it forever and showing it to her when she's 15. 

Unfortunately, You can't hear the actual "poop" sound, although it was quite loud if you were in the room. The microphone wasn't picking it up. I'll just have to tell her about that.