Anesthesia and future learning disabilities…

Ok, I just read about this study, and haven’t really “ruminated” on it, which I normally do, so I’m just shooting from the hip with this. Basically, researchers went back and reviewed birth records of children born in one locality in Minnesota from 1976-1982, to see if they were born vaginally or by C-section, and if by C-section, then with the mom under regional or general anesthesia. Then, they looked at the children to see if they had any learning disabilities during school…

I’d like to read the entire article, and not just the abstract. I wonder if they controlled for enough stuff in this study. I was born in another state during the time period of this study, and my mom was knocked out during a routine vaginal birth; I assume I was dragged out by the head with forceps. Obviously, I have no learning disability — or if I do, imagine just how brilliant I would have been, if I hadn’t been born that way! ;-P But just because a woman gave birth vaginally does not mean she did not have general anesthesia nor regional anesthesia. Was this controlled for? It appears that all vaginal births were lumped into one group, regardless of whether or not a woman had drugs either for pain (such as an epidural, pudendal block, IV or IM or SQ narcotics or other drugs), or to speed up her labor (pitocin); it also is not noted in the abstract whether there were any forceps or vacuum (if applicable at the time) births; nor was the neonates’ condition noted (such as Apgars, NICU admittance, etc.).

Some women may have gotten general anesthesia, and were “under” a lot longer with their babies inside of them, during a vaginal birth than during a C-section — a typical C-section takes an hour, but the actual time from giving drugs to getting the baby out is in the neighborhood of 5-15 minutes — quicker if an emergency, slower if not. I recently read a nurse’s first experience with attending a C-section with general anesthesia, and she said the doctors worked in double-quick time, because they wanted the baby out as quickly as possible, so it wouldn’t have negative effects from the drugs given to the mother. I don’t know how long women were usually knocked out for either vaginal or C-section births, but this would seem to be  a relevant factor. After all, sometimes a little of something might not be bad, but a lot of it could be. Drugs definitely fall into this category.

I find it interesting that “drugs don’t harm the baby” yet somehow babies whose mothers were given regional anesthesia for C-sections had fewer LDs than mothers given general anesthesia for the same operation. It would seem, then, that general anesthesia was more harmful to babies than regional anesthesia. Were there *any* mothers not given *any* drugs? These should have been the control, not just “vaginal birth” which can come with a plethora of drugs and other interventions.

I first read about the study on “Mommy Myth Busters,” and they look at this from another angle, and include more information, including that “The team is investigating whether use of an epidural on a mother during natural labor has similar effects on the incidence of learning disabilities in children as a C-section with an epidural.” So, this research doesn’t look at women who give birth vaginally or by C-section with an epidural. If I remember correctly, the drugs and procedures used 30 years ago were quite different from what is the current norm today, with much of the then-standard practices going the way of pubic shaves and 3-H enemas (high, hot, and a helluva lot).

So, I think this research may be important, but it is probably going to be pretty well mangled by the press, leading women to think that their babies may even be better off to have a C-section with an epidural than to have them vaginally without drugs. When that wasn’t what was even looked at in the study. We’re looking back through time at what was perhaps standard operating procedure three decades ago, which is quite a bit different from current norms.

Allow me to say that this myth may not be quite as “busted” as one might think from reading the popular press. I remain skeptical. Perhaps time will tell…

Fetal Memory

This was quite intriguing — an article written about a study into fetal memory. Basically, they looked at babies under ultrasound and played some sound outside the womb (a buzzer, like they typically use during biophysical profiles to startle the baby to see how his or her heartrate changes), and kept on buzzing until the baby no longer reacted; then they buzzed the baby again several weeks later, and the baby again didn’t react — possibly indicating that the baby recognized and remembered that sound.

That’s not too surprising to me, nor to a lot of other parents, particularly mothers. But it is refreshing to see science catching up. It also has some possible practical implications — in the opening of the article, it talked about a young woman who as an infant was best soothed by her mom singing the Aerosmith song “Angel.” And it turns out, that the mom had frequently played that song (and others), when pregnant with her — when the song came out. [I've got to insert here, completely unrelated, that it is still a huge shock to me, to see that this young woman was 21 years old, and was born in 1988 when "Angel" came out. That is just so wrong! NO! Babies born in 1988 are only, like, 5 years old! Right?? No?! Ok, so I feel old. Sigh... End non sequitur.]

Anyway, it sounds like this young woman as a fetus developed a memory for “Angel,” and when her mom sang it to her after birth, she was calmed by the familiarity of the song. So, pregnant women today might be able to intentionally do something similar — get a CD of some sort and play it frequently, and then remember to play it (or sing or hum songs from it) when the baby is fussy. Of course, it’s not guaranteed to work — especially every time the baby is fussy — but if it works sometime, that would be very cool.

It is known that babies can distinguish their mother’s voice best, and they also know the voices of people who were around the most when they were in utero — typically the father, older siblings, perhaps close friends and family who were in frequent contact with the mother. And I remember one story years and years ago — I can’t even remember for sure where I read it, but I think it was in Reader’s Digest possibly 20 years ago or so (which means that this could have been researched years and years ago, if somebody wanted to badly enough), of a man who would sing a particular song to his pregnant wife’s belly, and then soon after his baby was born, he started singing it to her, and she turned her head towards him. She remembered the song, or at least recognized his voice.

Actually, in a way, it seems like a no-brainer that babies remember. Of course they do! They know their mother’s smell, voice, and heartbeat from having those things all the time during pregnancy. Even leaving aside the hidden or latent memories that some people have when hypnotized, of being in utero themselves or newly born (I’ve read a few things that gave me chills, of young children matter-of-factly stating what happened to them just after birth, although they had never been told), it is nonsensical to suggest that memories only start happening at three or four years of age, or whatever is the earliest that the average person remembers. Of course we remember. We just forget later, as more and more memories are laid down, and the past becomes shrouded in the mists of time. Just like I don’t particularly remember more than a handful of meals I’ve eaten in my life — yet it is obvious that the effects (for good or for bad) are still with me, even so I don’t necessarily remember very much of my life prior to the age of three, but the pathways of memory stretch much further back than that.

This research reminds me of the research done into “infant pain” back in the 1950s or so. The assumption was that newborns don’t feel pain. I don’t know which idiots came up with that insanity, but they obviously fooled their teachers enough to be awarded the title of “doctor” — but they’re still idiots in my book, because they had no common sense. So, they’d stick babies with pins and note their “primal responses.” Um, yeah. How ’bout I stick you with pins and note your “primal response”? Of course, later, more open-minded research was done to show that the “primal response” of babies crying and flinching away from the source of the pain was, believe it or not, actually a pain response. Even later research has demonstrated that early third-trimester fetuses feel pain, just like premature infants (nothing magic about coming out of the mother’s womb — what the baby is after birth, it was before birth — only the location is different). This shouldn’t surprise anyone, particularly those who work with premature infants, and note their fragility and the need to keep them calm because handling and touching them can cause much bigger stress reactions than happens in term infants.

Maybe next time researchers have some bright, new idea, they should run it past a few mothers first. Because we’ve been right for generations. We’ve just been waiting for the brilliant researchers to catch up with our innate knowledge. :-)

404 — Unnecesarean Link Update

For more information, read Jill’s latest post, but the Unnecesarean.com (and blog) is now TheUnnecesarean.com (and blog) Make sure you update your subscription to Google Reader or however you keep up with the blogs you read.

By the way… how do you keep up with your blogs? [see embedded poll]

I must admit that I don’t know very many ways to keep up with blogs, so if you click “other,” please let me know specifically what you use.

Also, as you read through posts, if you come across a link that is broken or dead, please drop me a line and let me know, so I can update the links, if possible. Since I’ve linked to Unnecesarean quite frequently in the past, I’ll have to find and update all of those links — unfortunately, I don’t know of an automatic way to do it, and I don’t always reference that I’m linking to the blog by name (many times I just link with “this blog post”). So, if you find a broken link that was supposed to go to Unnecesarean, leave a comment or shoot me an email, and in the meantime, just add “THE” to the URL before “Unnecesarean”. Quite simple, really.

Stress affects fertility

We know that stress can cause lots of bad things in the body — it’s been demonstrated as a factor in heart attacks, strokes, ulcers, indigestion — and many people have pointed to it as an element in fertility. This article says that last bit seems to be true. Let me say that this is merely one factor, and perhaps not the most important one, as I detailed in this previous post, so it is still hurtful and quite possibly completely untrue to tell someone that he or she “just needs to relax” in order to conceive. But it may be one factor (do check out this comic that Jill @ The Unnecessarean posted on another blog, because it may be more than appropriate for this post and this topic, considering the research that is under consideration). Which in itself is a hard thing to bear — as the article pointed out (and as many women who are undergoing or who have undergone fertility treatments attest), infertility is a stress. And waiting is stressful, and fertility treatments are stressful, and waiting every month to see if the fertility treatment has been successful is a stress, and life is a stress, and waiting is a stress, and hoping is a stress, and more waiting is even more stress.

This research is preliminary — the article mentioned that some of the studies have been done in rats, and other results have been inferred from studies of birds — so it’s too early to say exactly what effect and how strong the effect is. The article did say that this may be part of the reason why animals in captivity have low rates of reproduction — which is particularly problematic for some species, since many endangered species are captured so that they will be bred and reproduce and build up their numbers.

But isn’t that just a kick in the teeth — that stress, which is just about inherent in wanting a child but not being able to have one [I think of Rachel in the Bible's plea to her husband, Jacob, "Give me children, or I die!"], may actually be a factor in keeping it from happening? And what is to be done? Telling women, “Aw, just relax!” isn’t going to help. Perhaps giving them a gift certificate to a spa might help. But we’re talking about chronic stress — probably typically a life situation that doesn’t just vanish overnight — financial troubles, marital troubles, a death in the family, long-term illness, work troubles, lack of work, etc. And these are not going to go away with a deep tissue massage.

I’d think more of this research if (can I be optimistic and say “when”?) it leads to something concrete and beneficial. Sometimes research and news is like astronomy studies that talk about the possibility of an asteroid strike on earth, or the sun exploding and consuming the earth, or something that is either so remote a chance of happening as to be almost zero, or something so far in the future (millions or billions of years), that it makes almost no actual impact on life as we know it today, or, “if it happened tomorrow, so what? we can’t do anything about it anyway!”). So, let’s say that this research is true for humans, and true in a big way. What can be done to reduce the stress level of women who are experiencing infertility (and are stressing out because they can’t conceive)? Now that would be some research worth undertaking. Because if you can’t do anything with the end results, does it really matter what the results are?

Considering the other deleterious effects of stress on the body, it makes sense to try to reduce or eliminate stress, particularly chronic stress, if at all possible, even if this research turns out to be overblown. Exercise can help; so can meditation. If you’re stressing out over infertility, perhaps you should just take a break for a few months or so. While you’re taking a break from trying to get pregnant, you can then try to eliminate the causes of particular stresses — finances? learn how to manage money better; marital troubles? seek counseling, etc. There’s no point in just continuing to stay in the hamster wheel of chronic stress when you don’t have to. Even if you don’t have a child from this, or never have a child — you’ll still be better off if you’re not living under chronic stress. And I can say that positively, without any research!

You might be a birth junkie if…

With a tip of the hat to Jeff Foxworthy of “You Might Be a Redneck…” fame, I thought of a series of things that may be tip-offs that you just might be a birth junkie (in no particular order). (By my definition, which is, I suppose, an infatuation bordering on addiction [if not actually there] for birth and all things related to it.) Without further ado…

You might be a Birth Junkie…

  1. if you blog about birth (more than just your own birth for historical purposes) or if your birth story is at least two pages long
  2. if you failed math, but can quickly convert grams to pounds and ounces (approximately)
  3. if you can say “vagina” in a sentence without blushing
  4. if you can correctly use “os” in a sentence
  5. if you can’t remember who won any gold medals for the US in the last Olympics, but you know US statistics for maternal and infant mortality, and the national C-section rate (bonus points if you know your local hospital(s) epidural, induction, and C-section rates) — if you’re not from the US, insert your own country
  6. if you can list the mother-friendly and baby-friendly guidelines from memory, and know which hospital in your area (if any) fulfills those goals
  7. if you can recite the midwifery model of care
  8. if when you’re discussing something related to birth, you receive those polite but puzzled looks… right before your conversation partner moves away
  9. if you see a circle about 4″ big, and you think “that’s fully dilated”
  10. if you have birth-related artwork somewhere in your house (includes placenta pictures and belly casts, etc.)
  11. if you currently have or ever did have a placenta in your freezer
  12. if you have ever consumed placenta
  13. if you have a model of a pelvis, uterus, or some other female organ
  14. if you always keep honey sticks on hand
  15. if you’ve ever gone to the bookstore and hidden “What to Expect When You’re Expecting” (or some other similar non birth-junkie book) and replaced it with some pro natural-birth book
  16. if other women get tired of telling you their birth stories before you get tired of hearing them
  17. if you have a library (or would love to acquire one) of birth-related books and videos
  18. if you have 10 or more birth-related videos saved to your account on YouTube
  19. if you appear on any YouTube (any internet) video talking about birth, in labor, or giving birth (picture montages count)
  20. if at least half of the blogs you regularly read are birth-related
  21. if someone tells you she “had to have” a particular intervention and you can come up with several alternatives that were never mentioned to her (bonus points if she doesn’t get mad or defensive)
  22. if you refuse to play the “my birth was worse than your birth” game
  23. if you feel like you know your fellow online birth junkies (even though you’ve never actually met them) better than you know some of your flesh-and-blood friends
  24. if ten or more of your Facebook friends (or other equivalent) are people you’ve never actually met but know them through birth-related functions (blogs, email lists, etc.)
  25. if you’ve ever gone to a birth conference
  26. if you’ve ever emailed, mailed or called your state or national representatives about a birth-related matter
  27. if someone tells you her baby is breech and you give her names (bonus points if you know phone numbers) of chiropractors skilled in the Webster technique or people who can perform moxibustion
  28. if you know what counterpressure is and how to apply it (bonus points if you’ve done it)
  29. if you know what a rebozo is (bonus points if you’ve used one)
  30. if you encourage your children, especially young children, to watch birth videos
  31. if you can get hoarse from watching TV birth shows (like A Baby Story), because you’re yelling through the screen at the woman or her care providers
  32. if you hear “prom” and don’t think about dancing, but think “preterm/premature rupture of the membranes” [thanks to Desirre for that one!]
  33. if you carry a “due date calculator” in your purse [again, thanks to Desirre!]
  34. if you get paid to catch babies all day, and you come home and talk about it all night with your husband who just nods his head and say “uh huh”. [Reality Rounds in the comments]
  35. if a majority of your internet bookmarks are contained under the heading “birth” [Cuddlebaby in the comments]
  36. if you sit as far away from others at the restaurant after a birth so you can discuss the birth without offending anyone. [Sally Stevens in the comments]
  37. if the ‘user ID’ that you most frequently use has something about birth in it. [Knitted in the Womb, in the comments]
  38. if you see someone else’s poop and you are happy! [this and the next two from Brenda, in the comments]
  39. if you can wake, dress and leave your house in less than 20 minutes with enough supplies to last you until you come home – with no idea how long that may actually be.
  40. if you can be next to a woman groaning, howling and sweating and know that it’s a good sign.
  41. if you have 10 or more birth related apps on your iPhone [Juliet in the comments]
  42. if you see someone spell epitome “epitomy” and you do a double-take as your mind registers “episiotomy” [added June 20, 2010]
  43. if you see “perennial” and your mind registers “perineal” [added Aug. 10, 2010]
  44. if you’re searching your email for “Frank” and you have more birth-related emails (“frank breech”) than you have from your friend or family member named Frank [added Sep. 1, 2010]
  45. this whole blog post written by my friend Diana — funnily accurate! [added Sep. 4, 2010]

And finally

  • if you regularly read this blog, you know you’re a birth junkie!

What others can/would you add to the list? :-)

Update: Welcome SOBers!

I just saw that Dr. Amy, now calling herself the Skeptical OB has linked to this post. Denigrating it and me of course — wouldn’t expect anything else from good ol’ Amy Tuteur!

To those of you who are not familiar with my blog, look around yourself and see if you agree with the SOB’s opinion of me and my blog. Do your own research — don’t just believe everything the good doctor says, because she loves to twist what I and other like-minded people say.]

Why I chose midwifery

Rebirth Nurse is going to be doing a “blog carnival”:

When I first started blogging, I really enjoyed reading blog carnivals covering different nursing topics. But with school, and now a “real” job, I’ve gotten away from really reading or contributing to them.

So, I was thinking that I would start up one!

My unofficial blog carnivals will be posted here, twice monthly. The carnival will be called The Rebirth Carnival (how original, I know, I know…). I will announce the carnival topic about two weeks in advance. Submissions can include old posts, or something written specifically for the carnival.

The first carnival will be up on August 9. I’m looking for posts about why you chose midwifery, either for your care or for your career.

Please pass the word!

Submit your post link to my email: knitting-fool AT hotmail DOT com.

This sounds cool. Now, why did I choose midwifery?

It was a long road. As a teenager, I had no particular desire to have a natural birth — in fact, I remember saying at one point that I’d have an epidural, or it was stupid not to have an epidural, or why go through that pain if you didn’t have to? — that sort of thing. Undoubtedly, I was heavily influenced by the current culture (it hasn’t really changed much “out there” in the normal world, which is why I like my little blogging world so much), including a friend who had just become a nurse and gone into L&D, and sang the praises loud and long for epidurals, professing confusion as to why women would not get one if they could.

Then a few years later, I regularly babysat for a woman, and when she became pregnant for the third time, dragged out all her pregnancy, labor, and birth books. Voracious reader that I am, I read through them. Plus, I wanted to make sure that I knew what to do if she had a precipitous labor, and I ended up being her only birth attendant! She wasn’t particularly pro-natural birth (I know she had epidurals with at least three of her births; although the third labor went so fast that the epidural didn’t have a chance to take effect before birth, and the fourth labor was similarly quick, so I’m not sure if she managed to get the ol’ needle-in-the-spine that time either), but she liked Dr. Sears for his baby advice, and had his Birth Book among other books.

It would be several years before I first got pregnant, and I wasn’t particularly interested in birth, but would sometimes make note of birth stories, interventions, complications, etc., and by the time I got pregnant, I had made the switch into planning not just a natural birth but a home birth. Honestly, I can’t remember what clinched it for me — why I changed. Probably, my oldest sister’s first birth had something to do with it, although I was already leaning towards “natural” at that time. Many women in my church and among other friends had home births, which made it seem more normal to me. I knew two midwives, both of whom were CNMs, both of whom attended home births. So, perhaps I was heavily influenced by a pro-home/natural-birth subculture.

When I got pregnant, I already knew I would be having a home birth. There were several factors in it, as listed above, but another factor was the financial one — I didn’t have health insurance, and home birth is a lot cheaper than a hospital birth. That by itself is not a good enough reason to have a home birth; but it is one consideration. Novice that I was, I didn’t realize all the politics surrounding birth — primarily that many states had outlawed midwives except CNMs, and in states that had CNMs, they may be heavily regulated. So, modern, internet-savvy gal that I am, I turned to the web to find a local midwife. I’m not sure what I would have done had I not been able to find one. Living in the suburbs of Chicago at the time, there were several midwives who served the Chicagoland, so I actually had a pick of midwives. However, I didn’t know enough to even know what to ask in an interview, or how to find out if the midwife was a good “fit” for me or not (not all personalities jive, after all). But I liked what she said and how she acted, so I went with the one and only midwife I interviewed. That’s not a course of action I would wholesale recommend, although it worked out for me. It might not work out for everyone.

Why did I choose a midwife? Partly because I assumed that only midwives attended home births. Actually, there is a doctor practice that attends home births in Chicago (Dr. Mayer Eisenstein of HomeFirst), but I didn’t know that at the time. Would I have gone with him had I known? Probably not. Even then, there was just something about a female birth attendant that appealed to me. Not saying that men can’t be a good birth attendant… just that I wanted a woman to attend me in labor. So I’m sexist that way. :-) It was more the “doula” aspects of midwifery care that appealed to me than simply giving birth at home, or having a female OB. To me, in general, there’s not a dime’s worth of difference between a male OB and a female OB — I’ve heard so many good and bad birth stories with doctors of both sexes, that I wouldn’t make the doctor’s gender to be a deciding thing. I expect a doctor to be a doctor — reserved, clinical, doing his job, most likely coming in only to catch, and otherwise managing birth over the phone. I expect a midwife to be a midwife — touching, comforting, helping, guiding, aiding, being there — “with woman,” as the original term meant. It’s the difference between choosing a mechanic and a husband — totally different expectations and criteria — not really in the same ballpark. Perhaps that seems nonsensical to you, but that’s a fitting analogy in my mind. (Now, if you can find a husband who is also a mechanic, that might make him a doubly-good choice; likewise, if you can find a doctor with a midwife’s qualities. But from what I’ve seen and heard, those doctors are few and far between.)

Why did I choose a midwife? Because as far as I’m concerned, that’s the only choice to make!

Maternal Nutrition Study in Canada

This sounds cool. It’s something a lot of us in the birthing world have wanted to see for quite some time. Rather ambitious and expensive (to the tune of $5,000,000!), and it will take 5 years to complete, but it might provide some answers to questions. A lot of questions. If you are pregnant (26 weeks or earlier) and live in Edmonton or Calgary, you may qualify to join the study (I don’t know the study parameters, so you’d have to get in touch with the researchers — To participate in the study or, for more information, please contact Jacqueline Jumpsen at 780-240-1133 or visit http://www.apronstudy.ca).

Basically, they are going to interview women throughout their pregnancies and then again once the babies are born (and apparently yearly for 4 years), to see what effect, if any, prenatal nutrition has on the developing fetus, newborn, and young child. Women will give blood so researchers can look at the nutrient levels in their blood, then see if that has any effect on their children. They will also complete questionnaires about themselves, the baby’s father, their nutrition (hopefully more than just weight gained, but actual foods consumed), etc., before birth; and after birth, the baby will be assessed (perhaps by the mothers filling out another questionnaire, perhaps by taking them to a research center for the scientists to assess), blood drawn, etc.

“A lot of studies start when the baby is born,” Field said. “There are quite a few studies that are following cohorts of babies and they try to estimate what the women consumed during pregnancy, but they won’t have the detailed data we have. This may be a rich database for many people to look at with questions completely different from ours.”

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