Tehelka Article on Alternatives to Hospital Births in Urban India

Here's an article in Tehelka -- an independent news magazine -- that I was interviewed for. The title, in my opinion, doesn't really reflect the content of the article, but oh well.

Exercise During Pregnancy Benefits Babies

If anyone - your doctor, your mother-in-law, etc - tells you that it's not good to exercise while pregnant, think again! A new study found that moderate exercise - that is, moderate intensity aerobic exercise for 30 minutes, at least three times a week - has cardiovascular benefits for the baby as well as for the mother. Read more about it here.

Delayed Cord Cutting Benefits Babies

In most hospital settings, doctors routinely clamp the umbilical cord as soon as the baby is born, cutting off blood and oxygen flow from the placenta to the baby. However, waiting until the cord has stopped pulsating (just a few minutes) allows the baby to get his or her maximum blood flow and iron stores, and makes the placenta less bulky and thus easier to detach from the uterine wall.

A new study out of Canada, recently published in the Journal of the American Medical Association, challenges the common practice of immediate cord cutting. Read more about it here.

Dais in India, and I'd guess other Traditional Birth Attendants around the world, are quite puzzled and sometimes even appalled at immediate cord cutting. Here's an excerpt from Hearing Dais' Voices, a publication by Matrika:

"The practice of not cutting the cord until the placenta is delivered is common in all the areas we have studied. Doctors, health workers and anthropological literature report the custom throughout the country. Dais have the utmost respect for these parts of the female body usually considered as waste products by the bio-medical system or highly polluting by the Brahmanic religious texts. Dais consider the infant-cord-placenta as a package. They have been together for nine months with cord and placenta functioning to nurture the fetus -- why should they be severed too quickly? The placenta is considered 'another mother' to the baby. Sometimes this afterbirth is buried with rituals and prayers for the well being of the infant. It is believed that how the placenta-cord-sac is handled influences the child's health in later life."

Readers Respond to New York Times Article About Doulas

A couple of weeks ago, the New York Times ran this pretty negative article about doulas and lactation consultants. I wanted to post the letters to the editor that were published a week later.

New York Times
March 9, 2008
Letters in Defense of Doulas

To the Editor:

Re "And the Doula Makes Four," by Pamela Paul (Sunday Styles, March 2): I recently gave birth to my son with the assistance of an experienced doula, without an epidural and other interventions that I had hoped to avoid. Your article, in emphasizing negative experiences with doulas who seem to be acting inappropriately and outside their scope, does a disservice to parents. Medical literature has demonstrated that with a qualified doula, a mother is likely to have a shorter labor with fewer complications, including a lower chance of Caesarean section.
Diana Graham, M.D.Raleigh, N.C.

***

To the Editor:

Your article reported that "44 percent of women described the relationship between their hospital nurses and doulas as hostile, resentful and confrontational." In fact, this study - which surveyed a total of nine women from a single hospital in north-central Alabama - found that four women described their nurses as behaving that way. The doulas, on the other hand, were described as "calm," "respectful" and "the best investment I have ever made in my life." In my experience as a doula, the vast majority of nurses welcome doulas' respectful support and nonmedical role. I can only hope doulas will become more widely available so every woman who wants one can have this kind of support during childbirth.
Dorian Solot
Albany
The writer is a birth doula certified by DONA International, a
professional organization that provides training and certification as
well as information for prospective clients.

***

To the Editor:

It seems Americans do more research on car purchases than on medical providers and hospitals. I did my research and had an amazing doula for the birth of my first child. When my second son was born, we had trouble with breast-feeding. A certified lactation consultant saved our breast-feeding relationship. While I am sure there are bad doulas and lactation consultants, I believe the majority are excellent and much needed in our over-medicalized birth environment and pro-formula society.
Corinne Griswold
North Granby, Conn.

Wagner Article: Being Seduced to Induce

Being Seduced to Induce: What Women Should Know About Their OBs

By Marsden Wagner M.D.

Women will only agree to caesarean section if they are convinced it is safe for them and their baby. One of the first efforts of obstetricians promoting caesarean section has been to take the scientific evidence on risks of caesarean section and torture the data until it confesses to what they want it to say.

One example: Obstetric hype in popular and professional magazines says research shows 60% of women who have vaginal birth have urinary and faecal incontinence. But a careful reading of the research papers they refer to reveals something very different. The hype lumps all women with vaginal birth together instead of doing what the researchers did – dividing them into risk groups. When analysis of risk was done, they found that women at high risk for urinary and faecal incontinence have had large numbers of births; have had babies weighing over ten pounds at birth; and most importantly, have been the victims of unnecessary, aggressive obstetric interventions during their labour and birth.

What are these aggressive, invasive obstetric interventions that have been proven scientifically to cause permanent damage to the pelvic floor and urinary tract and also lead to more otherwise unnecessary caesarean section? One example is the use of powerful and dangerous drugs to start or accelerate labour, a practice that has doubled during the past 10 years. These drugs make labour abnormal with violent contractions that can damage the uterus and pelvic floor. The only reason women agree to such induction is because they are not told the truth about the drugs, for example that Pitocin (oxytocin), a drug used for decades to induce labour, doubles the chance the woman will have urinary incontinence in the future. By withholding such facts doctors seduce to induce.

Induction with drugs is not the only aggressive, invasive intervention that is frequently used in vaginal birth and is associated with damage to the urinary system, pelvic floor and rectal areas. Episiotomy has been scientifically shown to result in more pelvic floor damage than a natural tear. When an effort was made in the 1980s to reduce caesarean section in the United States, the rate of using forceps or vacuum extractor to pull the baby out went up—some doctors just can’t stop doing invasive interventions. And there is good data that using forceps or vacuum to pull the baby out has more risk of pelvic floor damage than any other form of birth.

Obstetricians have turned birth into a surgical procedure and done damage to women’s bodies and now suggest the solution is to promote yet even more radical and aggressive surgery; caesarean section. The solution is less unnecessary invasive surgical procedures during birth, not more.

[Re: the Midwifery Today E-News article, Issue 3:23]: The two obstetricians tried to say that vaginal birth can damage a woman, but they never pointed out the ways in which caesarean section can do harm not only to the woman but to the baby as well. The following excerpt from my article “Choosing Caesarean Section” in The Lancet of November 11, 2000, reviews some of the dangers associated with caesarean section, the alternative to vaginal birth that some doctors are trying to promote:

‘In addition to the increased risk the woman will die with an elective caesarean section, there are other risks for the woman including the usual morbidity associated with any major abdominal surgical procedure—anaesthesia accidents, damage to blood vessels, accidental extension of the uterine incision, damage to the urinary bladder and other abdominal organs.1 Some of these risks are common: 20% of women develop fever after caesarean section, most due to iatrogenic infections requiring diagnostic fever evaluation for both woman and baby.1

There are also risks women carry to subsequent pregnancies due to scarring of the uterus including decreased fertility, increased miscarriage, increased ectopic pregnancy, increased placenta abruptio, increased placenta previa.1,2, 3 Recently in the United States the widespread use of the unapproved drug misoprostol (Cytotec) for labour induction has created a new risk of caesarean section in subsequent pregnancies. Women attempting VBAC (Vaginal Birth After Ceasarean) who are given misoprostol have a rate of uterine rupture of 5.6% compared with a rupture rate of 0.2% for women attempting VBAC not given misoprostol, a 28-fold increase in risk of uterine rupture.4 For women choosing caesarean section, all of these risks exist in all of their subsequent pregnancies even if the original caesarean section was not an emergency. The increased risks of ectopic pregnancy, abruptio placenta, placenta previa and ruptured uterus are all life threatening to both woman and baby.

For whatever reasons women choose caesarean section, very few are clearly informed about foetal risks. In an emergency caesarean section where the baby has developed a problem during the labour, the risks to the baby of doing the caesarean section will likely be outweighed by the risks to the baby of not doing it. In an elective caesarean section where the baby is not in trouble, the risks to the baby from doing a caesarean section still exist, meaning the woman who chooses caesarean section puts her baby in unnecessary danger. That some women are choosing caesarean section strongly suggests women are not told these scientific facts.

The first danger to the baby during caesarean section is the 1.9% chance the surgeon’s knife will accidentally lacerate the foetus (6.0% when there is a non-vertex foetal position). (5) Obstetricians may be less aware of this risk — in one study only one of the 17 documented foetal lacerations was recorded by the obstetrician doing the surgery.5 A much more serious risk to babies born by caesarean section is respiratory distress. Many reports in the scientific literature document the caesarean section procedure per se is a potent risk factor for respiratory distress syndrome (RDS) in preterm infants and for other forms of respiratory distress in mature infants.1 RDS is a major cause of neonatal mortality. The risk of newborn RDS is greatly reduced if the woman is allowed to go into labour prior to the caesarean section. Another serious risk to the baby born by caesarean section is iatrogenic prematurity (the baby is premature because the caesarean section was performed too early). Even with repeated ultrasound scans, the standard deviation for estimating gestational age is large, creating errors in judging when to do an elective caesarean section. Doing the elective caesarean section after the woman goes into spontaneous labour would markedly reduce this risk as well. A vast literature documents the increased mortality and morbidity, including neurological disability, associated with premature birth.’

So beware. Surgeons try to sell surgery. Never forget that obstetricians are, after all, surgeons. Women must be extremely cautious in the face of this hard sell and get the facts from those who do not have a vested interest in surgery.


Thanks to Leila McCracken and www.birthlove.com

For more about Dr. Wagner.

1. Wagner M, 1994. Pursuing the Birth Machine: The Search for Appropriate Birth Technology, Sydney, Australia: ACE Graphics.
2. Enkin M, Keirse M, Renfrew M, Neilson J, 1995. A Guide to Effective Care in Pregnancy and Childbirth, 2nd ed, Oxford University Press.
3. Goer, H, 1999. The Thinking Woman’s Guide to a Better Birth. Putnam, New York: Penguin.
4. Plaut M, Schwartz M, Lubarsky S, 1999. “Uterine rupture associated with the use of misoprostol in the gravid patient with a previous caesarean section,” Am J Obstet Gyn 180:1535-42.
5. Smith J, Hernandez C, Wax J, 1997. “Fetal laceration injury at cesarean delivery,” Obstet & Gynecol 90:344-6.


First published in byronchild/Kindred, issue 1, March 02

More research that breastmilk boosts IQ

Smarty Gene: Breast-fed kids show DNA-aided IQ boost

Bruce Bower

Scientists have achieved a breakthrough in deciphering the genetics of intelligence. Ironically, they did it by accounting for a key environmental factor.

Breast-feeding boosts children's IQs by 6 to 7 points over the IQs of kids who weren't breast-fed, but only if the breast-fed youngsters have inherited a gene variant associated with enhanced chemical processing of mothers' milk, reports a team led by psychologist Avshalom Caspi of King's College London.

The new finding supports the controversial hypothesis that fatty acids in breast milk enhance newborn babies' brain development. Moreover, the results demonstrate that intelligence researchers must examine how children's genetic natures interact with the ways in which they're nurtured.

"Genes work via specific environmental experiences to shape intellectual development," Caspi says.

He and his colleagues present their data in an upcoming Proceedings of the National Academy of Sciences.

Two groups of children participated in the study: 1,037 boys and girls born 34 to 35 years ago in New Zealand, who are still living there; and 2,232 boys and girls born 12 to 13 years ago who are growing up in England.

In DNA isolated from blood samples, the researchers probed the gene fatty acid desaturase 2, or FADS2. This gene assists in breaking down fatty acids present in human milk. FADS2 comes in two forms, one of which enables the body to process fatty acids more efficiently than the other does.

Only breast-fed children who carried one or two copies of the more efficient gene displayed an IQ advantage.

In the two groups of children, 90 percent of youngsters possessed the critical FADS2 gene variant. Roughly half of all participants were breast-fed regularly during infancy, according to reports collected from the mothers when their children were 1 to 3 years old. The formula-fed infants typically received no fatty acids in their diets.

The New Zealand children completed standard IQ tests at ages 7, 9, 11, and 13. The British children took an IQ test at age five.

The scientists ruled out several alternative explanations of the findings. For instance, normal- and low-birth-weight babies carrying the critical FADS2 gene displayed equal IQ hikes when breast-fed. The same held for children from wealthy and poor families, and for kids with high-IQ and low-IQ mothers.

Also, no evidence indicated that mothers carrying the more efficient FADS2 gene produced better-quality milk or breast-fed more often than mothers carrying the other gene variant did.

Until now, researchers have largely failed in attempts to find genes that affect intelligence independently of environmental factors, Caspi says. However, a new genomewide analysis of more than 10,000 7-year-olds tagged six regions as weakly but significantly associated with IQ, including one on FADS3, another fatty acid gene. That study, directed by King's College psychologist Lee M. Butcher, appears online Nov. 2 in Genes, Brain and Behavior.

"Both of these new findings suggest an important role for the regulatory mechanism of dietary fatty acids and its possible interaction with environmental factors in intelligence," remarks biological psychologist Danielle Posthuma of the Free University of Amsterdam.

Adds psychologist Jeremy R. Gray of Yale University, "An IQ advantage of 6 to 7 points is unquestionably large enough to have a real-world impact on individuals."

If you have a comment on this article that you would like considered for publication in Science News, send it to editors@sciencenews.org. Please include your name and location.

Movement and positions during labor

I've heard many accounts of women who've given birth in Bangalore who say that nurses and doctors in hospitals constantly ask them to lie in bed. This makes no sense! Especially when it's not to check the baby's heartbeat or to do a vaginal exam. I've never seen or even heard of a woman (who is not medicated for pain) want to be in bed. movement -- rocking, swaying, walking, squatting, etc. -- helps women cope with pain and uses gravity to encourage the descent of the baby.

here's a recent new york times article about how the hands-and-knees position helps ease delivery.

More evidence that women shouldn't be made to labor alone

Many, many women in India, especially poor women, go through labor alone. Government and even private hospitals do not allow anyone to accompany the laboring woman. This practice is not only ludicrous and inhumane, it makes no sense given what we know about how women who are supported in labor have better health outcomes, as do their babies. I think this should be one of the first issues to be tackled by our newly forming Bangalore Birth Network (BBN)!

Women happier with childbirth when accompanied

NEW YORK (Reuters Health) - Women who go through labor and childbirth with a companion of their choice are more satisfied with the experience, and the care they receive, than women who deliver alone, Brazilian researchers report.

Furthermore, the presence of a companion did not create any safety issues, In fact, women with a companion on hand were about half as likely as unaccompanied women to have amniotic fluid stained with fetal stool -- meconium -- which can be dangerous to infants if it is inhaled.

While having a companion to provide support during labor and delivery is accepted practice in much of the world, many health facilities do not allow companions or discourage their presence, Dr. Odalea M. Bruggemann of the Federal University of Santa Catarina in Florianopolis and her colleagues note. This is especially common in the developing world, they add.

Bruggemann and her team randomly assigned 212 women to solo labor or labor with a companion of their choice, to compare childbirth experiences.

About half of the accompanied woman (47 percent) chose their partner or the child's father, while 30 percent chose their mother and 23 percent chose another female relative or a friend.

The women who received support from a companion were significantly more satisfied with labor and delivery than those who went through childbirth alone. They were eight times more likely to be satisfied with their labor experience and nearly six times as likely to be satisfied with delivery.

The accompanied women were also more satisfied with their medical care and medical guidance during labor and delivery. "Perhaps because there was someone else in the room, medical staff were more forthcoming and user-friendly than when no support person was present," the researchers note in their report in the online journal Reproductive Health.

Women with companions were 49 percent less likely to have amniotic fluid stained with meconium than women who delivered on their own. This may have been because they were less anxious and fearful, Bruggemann and her team suggest.

"If on one hand there is a general belief that a labor companion has always positive effects, there are, on the other hand, still a lot of health facilities where companions are not allowed, especially in developing settings," the researchers write. "It is expected that the results of this study could help providers to acknowledge and respect women's rights during birth."

SOURCE: Reproductive Health, July 6, 2007.

Copyright 2007 Reuters News Service. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Copyright © 2007 ABC News Internet Ventures

"Cry it out" approach found to be harmful

Children Need Touching and Attention, Harvard Researchers Say

By Alvin Powell
Contributing Writer

America's "let them cry" attitude toward children may lead to more fears and tears among adults, according to two Harvard Medical School researchers.

Instead of letting infants cry, American parents should keep their babies close, console them when they cry, and bring them to bed with them, where they'll feel safe, according to Michael L. Commons and Patrice M. Miller, researchers at the Medical School's Department of Psychiatry.

The pair examined childrearing practices here and in other cultures and say the widespread American practice of putting babies in separate beds -- even separate rooms -- and not responding quickly to their cries may lead to incidents of post-traumatic stress and panic disorders when these children reach adulthood.

The early stress resulting from separation causes changes in infant brains that makes future adults more susceptible to stress in their lives, say Commons and Miller.

"Parents should recognize that having their babies cry unnecessarily harms the baby permanently," Commons said. "It changes the nervous system so they're overly sensitive to future trauma."

The Harvard researchers' work is unique because it takes a cross-disciplinary approach, examining brain function, emotional learning in infants, and cultural differences, according to Charles R. Figley, director of the Traumatology Institute at Florida State University and editor of The Journal of Traumatology.

"It is very unusual but extremely important to find this kind of interdisciplinary and multidisciplinary research report," Figley said. "It accounts for cross-cultural differences in children's emotional response and their ability to cope with stress, including traumatic stress."

Figley said Commons and Miller's work illuminates a route of further study and could have implications for everything from parents' efforts to intellectually stimulate infants to practices such as circumcision.

Commons has been a lecturer and research associate at the Medical School's Department of Psychiatry since 1987 and is a member of the Department's Program in Psychiatry and the Law.

Miller has been a research associate at the School's Program in Psychiatry and the Law since 1994 and an assistant professor of psychology at Salem State College since 1993. She received master's and doctorate degrees in human development from the Graduate School of Education.

The pair say that American childrearing practices are influenced by fears that children will grow up dependent. But they say that parents are on the wrong track: physical contact and reassurance will make children more secure and better able to form adult relationships when they finally head out on their own.

"We've stressed independence so much that it's having some very negative side effects," Miller said.

The two gained the spotlight in February when they presented their ideas at the American Association for the Advancement of Science's annual meeting in Philadelphia.

Commons and Miller, using data Miller had worked on that was compiled by Robert A. LeVine, Roy Edward Larsen Professor of Education and Human Development, contrasted American childrearing practices with those of other cultures, particularly the Gusii people of Kenya. Gusii mothers sleep with their babies and respond rapidly when the baby cries.

"Gusii mothers watching videotapes of U.S. mothers were upset by how long it took these mothers to respond to infant crying," Commons and Miller said in their paper on the subject.

The way we are brought up colors our entire society, Commons and Miller say. Americans in general don't like to be touched and pride themselves on independence to the point of isolation, even when undergoing a difficult or stressful time.

Despite the conventional wisdom that babies should learn to be alone, Miller said she believes many parents "cheat," keeping the baby in the room with them, at least initially. In addition, once the child can crawl around, she believes many find their way into their parents' room on their own.

American parents shouldn't worry about this behavior or be afraid to baby their babies, Commons and Miller said. Parents should feel free to sleep with their infant children, to keep their toddlers nearby, perhaps on a mattress in the same room, and to comfort a baby when it cries.

"There are ways to grow up and be independent without putting babies through this trauma," Commons said. "My advice is to keep the kids secure so they can grow up and take some risks."

Besides fears of dependence, the pair said other factors have helped form our childrearing practices, including fears that children would interfere with sex if they shared their parents' room and doctors' concerns that a baby would be injured by a parent rolling on it if the parent and baby shared the bed. Additionally, the nation's growing wealth has helped the trend toward separation by giving families the means to buy larger homes with separate rooms for children.

The result, Commons and Miller said, is a nation that doesn't like caring for its own children, a violent nation marked by loose, nonphysical relationships.

"I think there's a real resistance in this culture to caring for children," Commons said. But "punishment and abandonment has never been a good way to get warm, caring, independent people."

Article about doulas on CNN.com

Doulas Deliver Help for Laboring Moms
By Judy Fortin

ROSWELL, Georgia (CNN) -- The lights were dimmed, soft music was playing and a scented candle burned on the counter. In the center of it all was Julie Trotter -- moaning through hard labor contractions.

Doula Kai Martin Short works to ease Julie Trotter's pain during labor.

For more than six hours, Trotter, a 23-year-old from Duluth, Georgia, tried different techniques to ease the pain of natural childbirth. Not only was her husband offering encouragement, but so was her doula, Kai Martin Short.

"She definitely was a lifesaver for sure," Trotter says. "She used a lot of counter-pressure through each contraction, and that helped so much."

Doula is a Greek word meaning "woman's servant." Part birthing coach, part mother's assistant, doulas are showing up in more delivery rooms than ever before.

Short, from Atlanta, Georgia, is among 2,500 certified doulas in the United States.

"Doulas trust birth and are not afraid of it even when the mom and dad get afraid," Short said. "We're there to just say things are fine; you're doing great; this is all normal."Video Health Minute: Watch how a doula helps a woman through labor »

Short offers more than comforting words. For a flat fee of $700 per client, she meets with the parents before the baby's due date to talk about their expectations and to share techniques to be used during labor. She is by the mother's side in the delivery room and visits the parents at home after the baby is born to offer advice on such topics as breastfeeding.

In her three years as a doula, Short has attended more than 30 births. Her training with a group called DONA International involved 26 hours of instruction on pregnancy, childbirth and comfort measures. "Whatever [mothers] need, whether it be changing positions, encouragement, massage or saying comforting words, there are so many things we do to help with the process," Short said.

Short tries to create a calm atmosphere in the delivery room with music and candles. Throughout the labor, she massages the birthing mother's back and rubs her head. Another one of her tricks to relieve pain involves having the woman sit on a big rubber exercise ball during contractions.

She encourages the father or other family members to get involved in the process and shows them how to help the mother breathe through contractions.

"I think it's really hard for a loved one to see their loved one in pain," Short said. "They don't really know how to help them."

While Short has plenty of advice for parents, she has no medical training and is not supposed to offer a medical opinion. She does not take the place of a doctor, midwife or nurse. Her role is to strictly work with the family and motivate the mother during labor and delivery.

But Dr. Sean Lambert, an OB/GYN who delivered Trotter's baby at North Fulton Hospital in Alpharetta, Georgia, says that sometimes, doulas can cross the line.

"It's almost as if some women and some couples have turned to them for too much advice and guidance," he said. "Occasionally, it will cut across what we recommend on a medical basis."

Short says she's never had any clashes with medical professionals. "Really, it's separate roles," she said. But she can understand how the relationship can get tricky. "It can be territorial sometimes if the doula is a little bit more strong-minded or opinionated."

Short encourages her clients to ask questions, and she's careful in her approach to the answers she gives.

Ten days after the birth of her son, Braydon, Trotter reflected on the experience. "It was a perfect one in my eyes," she said. "I think having a doula definitely would be helpful for anybody, and I wouldn't change anything about the birth."

Short enjoys seeing new families come to life and concludes, "The best part for me is helping women realize what their bodies can do. Just having that support can make all the difference."

Judy Fortin is a correspondent with CNN Medical News. Producer Leslie Wade contributed to this report.

More research on baby videos

In a previous post, I linked to an article about how children under two benefit more from human interaction than watching television. Here's another article with new research on how Baby Einstein videos might actually delay language development instead of enhance it.

CDC survey: new moms turn to formula too soon

The US centers for disease control (CDC) just came out with a survey that found that only about 30% of new moms breastfeed exclusively at three months of age, and at six months, only 11% are breastfeeding exclusively. Why are these number so low when we know that breastfeeding results in better health outcomes for both mothers and babies?! I think it points to a few problems:

1) Traumatic birth experiences for women and babies: the cesarean rate is at an all-time high in the US, at 30%. In India it's likely to be double that in many hospitals. Babies born by cesarean are often separated from their mamas for several hours, making establishing breastfeeding particularly challenging. Even women who have vaginal births are often separated from their babies due to unnecessary hospital routines and policies.

2) Lack of support for breastfeeding moms: I've seen many women have trouble getting their newborn to latch on properly. Nurses in hospitals are not trained as Lactation Consultants, and when a hospital does have an LC, often they are overworked and extremely difficult to track down. I realize this varies by hospital, but certainly in India there are no LCs in any hospital, and it is very hard for women to get support early on.

3) An emphasis on independence: well-meaning advice-givers stress the importance of not being held too much, feeding schedules, and baby sleeping alone in a crib. These parenting practices make it difficult to breastfeed.

4) Short maternity leave: going back to work--often after only six weeks--means separation between mama and baby for many, many hours. Pumping is not always easy or convenient, and many nursing mothers face discrimination at work.

5) The insidious nature of formula companies' advertisements: many women in hospitals receive free formula samples in their discharge packs instead of helpful information on breastfeeding. Formula companies distribute posters and pamphlets to doctors and hospitals to leave in their waiting rooms. Because these materials are so prolific, women get the message that bottle-feeding is the norm.

As long as women receive mixed messages and are not properly educated, encouraged or supported, we can't expect these rates to go up. If E've totally depressed you, or even if i haven't, please watch this video which celebrates 50 years of La Leche league:

CNN article: Avoid episiotomies

Here's an excerpt from a recently published article on CNN.com, entitled 5 operations you don't want to get -- and what to do instead.

Episiotomy

It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.

"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"

What to do instead

Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And when you get pregnant, have your preference to avoid the surgery written on your chart.

Get ready with Kegels. Working with a nurse or midwife may reduce the chance of such surgery, experts say; she can teach Kegel exercises for stronger vaginal muscles, or perform perineal and pelvic-floor massage before and during labor. Health.com: Me and my Kegels

Ingesting placenta could mitigate Postpartum Depression

Pregnancy & Childbirth | USA Today Examines Practice of Ingesting Placenta To Mitigate Postpartum Depression
[Jul 20, 2007]

USA Today on Thursday examined the practice known as placentophagy, in which the placenta of a pregnant woman is saved, dried and emulsified, then placed in gelatin capsules and taken by the mother in the months after childbirth. Hospitals usually store placentas for a few days to allow for testing if there is a postpregnancy complication but then destroy them, according to USA Today. Some hospitals regard placentas as "hazardous medical waste" and are reluctant to let women keep them, while other hospitals allow women to keep the organ, USA Today reports.

According to USA Today, the practice of ingesting placenta "is far from widespread" and has been received with "great skepticism by more traditional medical experts." However, a "small but vocal contingent" of pregnant women and advocates "strongly" believe that the placenta is "rich in chemicals that can help mitigate fluctuations in hormones believed to cause postpartum depression," USA Today reports.

"I feel that it is what we as women are meant to do with the placenta," Jodi Selander -- who provides the encapsulation service at no cost to clients and is collecting testimonials of women who have ingested placenta for her Web site placentabenefits.info -- said, adding that other mammals eat their placentas. Mark Kristal -- a professor at State University of New York-Buffalo, who focused his 1971 doctoral dissertation on why animals eat their placentas -- said, "People can believe what they want, but there's no research to substantiate claims of human benefit." He added, "The cooking process will destroy all the protein and the hormones. ... Drying it out or freezing it would destroy other things."

Selander said she has sought FDA guidance but received no clear answers. FDA spokesperson Kris Mejia said the agency considers some statements on Selander's Web site to be unsubstantiated medical claims and will be reviewing the matter. "Human placental capsules that make treatment claims ... must be accompanied by well-designed and controlled clinical studies to support approval/licensure," Mejia wrote in an e-mail (Friess, USA Today, 7/19).

An article I wrote for an Indian website

I wrote this article about preparing for childbirth and the services I offer.