Saliva test for risk of preterm birth

This was an interesting article in the British Journal of Obstetrics and Gynecology. (If you can’t read the study, you may have to register, but it’s free.)

An exploratory study to be published in BJOG, has shown that women going into early preterm labour (before 34 weeks gestation) have low-levels of progesterone in their saliva as early as 24 weeks, and that moreover, these levels fail to rise during pregnancy in the normal way. This offers the possibility of developing a simple, non-invasive test to identify women at increased risk of delivering early.

The study was a small one (less than 100 women), and all of the women had at least one risk factor for preterm birth.

The results show that the concentration of progesterone in the saliva of women delivering after spontaneous labour before 34 weeks was significantly lower than those giving birth at term (after 37 weeks) at all gestational ages from 24 weeks onwards.

I presume that a larger study will soon be undertaken to confirm and strengthen these results, and perhaps to see if they are applicable to a general population. If so, I wonder how much it would cost to test everyone, or just those considered at risk. And also, how accurate it is (false positive and false negative rate), and what benefits might exist from finding out that this test predicts you will be having your baby early.

Not having the study as such (it’s restricted to paying subscribers), it’s possible that it’s not highly accurate. For example, let’s say that the average progesterone rate of women giving birth prior to 34 weeks was 10, while the average rate for 34-37 weeks was 15, and the average for 37 weeks+ was 20. Sounds good; but if the range of progesterone of women giving birth prior to 34 weeks was 7-14, and that for 34-37 weeks was 12-18, and that for 37 weeks+ was 16-25, then you see that there is quite an overlap there. If there is no overlap between the groups, then that would be more accurate. And another factor would be what benefits there are — which might be significant, because if you’re at high risk of giving birth prior to 34 weeks, you may be given steroids to mature your baby’s lungs much earlier than you otherwise would, which would probably increase your baby’s chances of surviving and decrease his hospital stay. Some women only realize that they are at risk for a preterm birth when they suddenly go into labor at 33 weeks; doctors may try to delay labor long enough to mature the baby’s lungs, but often that is not possible. If these at-risk women could be given steroids starting at 32 weeks, rather than waiting until they’re already in preterm labor, then that could be highly beneficial. Or, even better, to stop labor altogether until the baby is mature.

This is speculative on my part, but it’s a good and positive speculation. It’ll be interesting to see how it will ultimately work out.

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Fantastic Kangaroo Care and Skin-to-Skin Contact Resources

One of my friends emailed this to a childbirth educators list I’m on, and I thought it was fantastic, so wanted to share with others.

First, is a Power-Point presentation (in pdf format) from  Dr. Bergman on the importance of skin-to-skin contact for full-term newborns, and even greater importance of kangaroo care for preemies. Drawing on developmental curves of other mammals, Dr. Bergman points out that humans are basically born immature — dogs, cats, monkeys, etc., are all born more highly developed (as measured by percentage of brain growth, etc.); and preemies are born more on the “marsupial” level of immaturity and prematurity. Animals are born with brains that are 80% of the size of adult brains; humans are not. Based on brain development (as a percentage of the adult size, compared to newborn/adult brains of animals), humans don’t reach the 80% marker until about a year after full-term birth. When born premature, they are even less that. The presentation presents powerful and compelling arguments for attachment parenting concepts (such as, sleeping with the baby, carrying the baby in an infant carrier on the mother or father, breastfeeding on demand, skin-to-skin contact, not crying it out which can be harmful, etc.), and even stronger arguments for “kangaroo care” for preemies.

The second resource is the Kangaroo Mother Care website which has even more links, stories, research, etc., on kangaroo care and premature birth. Dr. Bergman draws a distinction between “Kangaroo Care” as practiced in U.S. hospitals (“This has been defined as “intra-hospital maternal-infant skin-to-skin contact”. KC is generally started later, and on stabilised prematures, and is used an adjunct to technological care”) and “Kangaroo Mother Care” which in part includes NEVER separating the mother and the baby — if the baby needs additional care, then technology is brought to him, rather than him taken away from the mother to go to the technology.

Dr Nils Bergman was the Doctor who introduced Kangaroo Mother Care (KMC) to South Africa. He has recently published the results of a strict scientific trial (in Acta Paediatrica) comparing skin to skin immediately after birth to incubator care . What he found was that skin to skin care was much better for the newborn than the incubator. Babies were warmer and calmer, breathed better and had a more stable heart rate with skin to skin care.

Surprisingly, the smaller the baby was-down to 1200grams- the more stable they were, and the more unstable in the incubator! This is opposite to what people think!

In fact there is other research suggesting that the incubator is harmful! Babies’ brain development requires skin to skin contact and being held and carried, and eye to eye contact to form the right brain pathways. Depriving babies of this skin to skin care makes alternative stress pathways which can lead to ADD, colic, sleep disorders etc.

Surprisingly incubators are still used for the very reason of stabilizing the baby when they in fact do the opposite!

There is a lot of information on the website, and I can’t do it justice, so just explore it for yourself, share with friends, and remember for future reference. Although the following story is anecdotal (although if a doctor wrote it, it would not be a mere “anecdote” but would be a “case study”), this woman saved her baby’s life by instinctively picking her up and putting her on her chest. The baby was born at 24 weeks gestation, weighing 20 oz (566 grams), and doctors didn’t believe she would live — her heart was beating only every 10 seconds and she wasn’t breathing.

She said: “I didn’t want her to die being cold. So I lifted her out of her blanket and put her against my skin to warm her up. Her feet were so cold.

“It was the only cuddle I was going to have with her, so I wanted to remember the moment.” Then something remarkable happened. The warmth of her mother’s skin kickstarted Rachael’s heart into beating properly, which allowed her to take little breaths of her own.

Miss Isbister said: “We couldn’t believe it – and neither could the doctors. She let out a tiny cry.

The baby was eventually taken and put on a respirator, but “Her heart rate and breathing would suddenly sometimes drop without warning” — which reminds me of one of the graphs in either the PDF or the website — that the baby’s heart rate and breathing and temperature were all more stable and regular when on the mother than in an incubator.

I don’t think that this doctor is suggesting that the only thing a premature baby needs, no matter how early it is born, is to be put on his mother’s chest — after all, he pointedly says that technology needs to be brought to the mother-baby when needed. But what if the interventions that are currently being done on premature infants are actually harmful, or at least, would be more helpful if the baby is on his mother’s chest (unless that is totally impossible). Yes, I’m sure there is a ton of research showing that babies receiving the current standard of care do better than babies in a “control group” — but what if standard interventions done on the mother’s chest were vastly superior than standard interventions done in a plastic box?

As an example of what I’m angling at, consider a hypothetical research project: babies are born, and divided into two groups — the first group is put in an orphanage where their physical needs are met (they are fed, clothed, and given diaper changes) but are basically kept in cribs all the time. The second group is put in a different orphanage where their physical needs are met and they also receive some social interaction, playing with other orphans and also sometimes the caregivers who are not as overwhelmed and busy as in the first orphanage. Obviously, the second group is likely going to do much better. However, neither of these settings is natural or normal — consider that there is also the possibility of babies not taken from the mother at all, but are given the level of maternal care and attention that you and I take for granted — breastfed, lovingly held and cared for, played with on a one-to-one basis, read to, etc. (in addition to the basic physical needs being met). Don’t you think that this third group would greatly excel either of the first two groups? Of course! So, is it not possible that our current standard of care, while better than that of the 70s or 80s, still pales in comparison to what might be possible if the technology (breathing assistance, drugs, fluids, nourishment, etc.) were done in the context of kangaroo care, rather than KC being more or less an afterthought?

“First, do no harm.” If, as that newspaper article demonstrated, it could shown that a mother’s natural inclination is to hold her premature infant on her chest, and that it holds some benefit to the baby (in this case, warming her, starting her breathing, and regulating her heartbeat), then that should be promoted — not necessarily at the expense of technology that has also been proven beneficial, but in conjunction with that technology to attain even better outcomes.

Several months ago, Reality Rounds posted a couple of heart-wrenching posts. She got a lot of flak, too, for it — all of it undeserved. I’m linking to them so that you can get a better idea of what’s involved in extremely preterm birth care; but, as my mother always says, “If you don’t have something nice to say, don’t say it at all.” First, “For they know not what they do” — which describes the extreme fragility of tiny babies, and the great caution the NICU team must employ not to hurt the baby as they try to help and save the baby:

We do everything.  Dry the infant with towels.  Careful.   Not too rough.  Do not want the gelatinous, friable skin to break and bleed unto the blankets. Listen for heart sounds.  Heart rate is barely 60 beats per minute.  No need for chest compressions.  We breathe air and oxygen into the tiny lungs.  Careful.  Too much air can blow a hole in the tiny lungs.  Too much oxygen can cause lung damage and blindness. We walk the wire.

It must be so extremely difficult to do everything that can be done to save the babies, knowing that it is hurting them physically (needles hurt! and worse for preemies — not to mention everything else). I liken it to what nurses in burn units must go through, as they try to save people who are badly burned — knowing that what they are doing, while necessary, is torture. And that even in the best of circumstances, the patient will endure untold pain, and be scarred for life — perhaps even unrecognizably scarred, perhaps losing fingers or toes or arms or legs. And perhaps when all is said and done and the patient is released to go home, he may even wish himself dead. Yet some people beat the odds and their injuries are not as life-altering or as scarring as they might have been; and many people are glad to be alive. But some people die in burn units, in spite of all the care given; and nurses and doctors must occasionally feel guilty that they did not “let nature take its course,” because then the person’s pain would have been shorter — when people die despite the best care given them, and die in pain, we can say in retrospect that it “would have been better” for them to have had no care at all and died quickly, than to have had their pain dragged out over days and weeks. But until we have a crystal ball to know which ones will have good results and which will not, we have to take care of them all.

The second post is NICU is a war zone — stressful for the parents, stressful for the baby, stressful for the workers. Finally, “Is letting a 21-week baby die health care rationing?” which includes the following paragraph on “Benevolent Injustice”:

I have cared for many infants at the edge of viability.  It is always emotionally draining.  There is no justice to it.  The extreme measures involved to keep a 22-23 week infant alive is staggering, and it is ugly.   I once had a patient who had an IV placed on the side of her knee due to such poor IV access.  When that IV infiltrated, I gently pulled the catheter out, and her entire skin and musculature surrounding the knee came with it, leaving the patella bone exposed.  I have seen micro-preemies lose their entire ear due to scalp vein IV’s.  I have watched 500 gram infants suffer from pulmonary hemorrhages, literally drowning in their own blood.  I have seen their tiny bellies become severely distended and turn black before my very eyes, as their intestines necrose and die off.  I have seen their fontanelles bulge and their vital signs plummet as the ventricles surrounding their brains fill with blood.  I have seen their skin fall off.  I have seen them become overwhelmingly septic as we pump them with high powered antibiotics that threatened to shut down their kidneys, while fighting the infection.  I have seen many more extremely premature infants die painful deaths  in the NICU, then live.

I do not claim any knowledge much less prowess in the field of premature birth. I do not blame anyone for allowing their extremely preterm baby die a natural death, rather than be subjected to these procedures. Nor do I blame parents who request that “everything” be done to save their babies. But care for premature babies is heart-wrenching either way, and painful. But what if there is a better way? I don’t know if this Kangaroo Mother Care extends to the micro-preemies, or there is some sort of cut-off point where it no longer helps — previously, I quoted that “babies down to 1200 grams” did better with KMC — which is about 2.5 pounds, and probably all late-second or early-third-trimester, much bigger than 20-23 week babies, for the most part (which is primarily the focus of the above blog posts). But what if current care is like the hypothetical orphanage study above — better than nothing, but not as good as kangaroo care in conjunction with life-saving interventions.

Sr Agneta Jurisoo studied what little literature was available on KMC during 1987. The following year she and Dr Bergman arrived at a small mission hospital in Zimbabwe, where premature births were common. There were no incubators, poor transport over great distances, and overloaded referral centres: only one of ten premature babies survived.

In the absence of incubators, they started a care plan in which the mother became the incubator. Instead of waiting for the baby to “stabilise”, the mother was used to stabilise premature infants immediately after birth. It was immediately clear this was highly effective, no matter how small or how premature, stabilisation took a mere six hours. With this care, now five of ten very low birth weight babies survived.

One problem is that current care is so entrenched, that it is very scary (and may even seem to be malpractice) to make the huge paradigm shift from taking the baby away from the mother for care, to putting the baby on the mother for care. Obviously, doctors and nurses are trained to take care of the baby alone, in an incubator — much like doctors are trained to have the mother on her back with her legs in stirrups when she gives birth. It can be very disorienting to have the baby come out “the wrong way” when the mother is on hands-and-knees or is squatting or kneeling. In the same way (only much, much bigger), it will take someone with a lot of guts to bring the NICU to the mother-baby pair, instead of taking the baby to the NICU. Who am I kidding? — it is a big shift to have full-term healthy babies put directly on the mother’s chest and kept there, instead of being put almost immediately into the warmer. Technology is very deeply entrenched in normal births and normal postpartum, and much more so in premature births! But “first do no harm” — first make sure that what you’re doing that is not physiologically normal (taking the baby from the mother) is going to first be not harmful, and second be beneficial. Certainly, there are times when babies need immediate surgery or other care that is not feasible or practical to be done on the mother. But I think steps need to be taken to keep mothers and babies together, if possible.

What’s the Rush?

Reality Rounds has been posting on different issues with her role as a NICU nurse, and a recent comment inspired this post. The post itself was on the realities of prematurity, and the struggles that the babies (and their parents, nurses, and doctors) face when they’re born too soon.

The comment was from a mother whose two children were both born early — at 30 and 31.5 weeks. She relates:

As a side note, one day when my second was still in the NICU, I was taking the elevator up to the NICU floor and another NICU mom was in there with me. There were a couple of pregnant women going to see their OBs on a higher floor and they were lamenting that they wished their babies would just come *now*. As the elevator doors opened at the NICU floor, the other NICU mom and I gave each other knowing looks and as we walked out the door, we simultaneously said “No, you don’t.”

Yes, indeed! I remember what it’s like to be “great with child,” getting anxious for the pregnancy to be done, to meet the baby, to no longer have him kicking you 24/7, to get your body back, to not have your back hurt any more, etc., etc. But you don’t really want your baby born too soon!

I think it may would probably cut down on the numbers of elective inductions (and requests for early inductions or C-sections that are not medically indicated), if women were to be given a tour of the NICU sometime in their second trimester (much like they might take a tour of the L&D unit prior to giving birth), so that they could see the realities of premature birth. And it doesn’t even have to be really preterm birth — even slightly preterm may have problems, as At Your Cervix attests:

A [fetal lung maturity] test was done and showed “mature” levels for a recent “near term” gestation infant. Baby was delivered. Guess what? Baby had respiratory distress shortly after birth and was sent to the NICU. Baby was NOT ready to be born. The lungs were NOT fully ready for life outside the confines of his former uterine home. One can only wonder how much brain growth and development was also lost, from not having the last few precious weeks in the womb.

[Make sure you read all the comments at AYC, especially “Lonely Midwife.”]

Plus, there is research to show that babies born by elective C-section at 37 weeks have double the risk of problems as those born at 38 weeks; and the 38-weekers have double the problems of those born at 39 weeks. So, what’s the rush?!?

I don’t know. Have we gotten so arrogant, that we are doing what Jeff Goldblum’s character said in Jurassic Park? — “Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.”

Obviously, doctors will not induce before 36 weeks for no maternal or fetal indication. At least, I hope that would not be the case! So, it’s not like most preemies are intentional. Yet, if a baby is born before his due time, but is born just because “well, it’s term, and you’re tired of being pregnant, so why not?” he will likely have complications that he would not have had, had birth started naturally. While the worst and most difficult NICU stays are likely to be unavoidable, there are some that could be avoided — like the one AYC mentioned — by waiting on nature. What’s the rush?

Well now I’ve heard everything!

The “Little Blue Pill” saved a premature baby’s life! When Baby Lewis, born at 24 weeks gestation, was having trouble with getting enough oxygen due to his premature heart and lung capabilities, even after surgery, doctors gave him Viagra, which saved his life, by allowing his tiny lung arteries to expand. Now that’s an off-label use of medication. And one I can agree with!

When you think of it, though, it’s not really that odd — if you know a bit of the history of Viagra, anyway. Sildenafil Citrate was being tested as a new and improved blood pressure or heart medicine, when the test group (which would typically be older men, since they are usually past the age of fathering children) started reporting an, um, increased benefit in their… “abilities.” So, Pfizer started researching it simply for its sexual benefit, which is why they were able to sell it for five bucks a pop. And also why people who take Viagra are warned not to take certain other medications for heart or blood pressure — it could cause disastrously low blood pressure if accidentally used in combination.

I’m struggling with not telling all the Viagra jokes I know, but I’ll instead tell a funny story that actually happened:

A lady came into our pharmacy soon after Viagra was released, and said she wanted to buy some. She said she was going to put it on her tomato plants… so she wouldn’t have to stake ’em.

There’s your smile for the day! 🙂

Totally Stressed

I’m pretty much freaking out right now — complete body stress reaction — I can feel the adrenalin pumping through my body — my nerves are on edge — my mind is racing — my heart is pounding. Why? Long story.

I’m writing this out because it will help calm my nerves and help me think through this and process all of my feelings.

I started having this reaction when I was writing the last comment (at the time of this writing, May 23, 12:47 a.m. — my blog is set to Greenwich Mean Time — it’s really not quite 8 p.m. right now in my time zone) on this post, the one about delayed cord clamping. Pinky and Reality Rounds and I have been having a nice conversation (in case you haven’t “met” them yet, they’re both L&D nurses, and both are skeptical about delayed cord clamping because of what the NICU docs they work with have said, and how they practice), and I started thinking about some of the bone-headed things doctors used to do, and used to train others to do, which were not supported by medical literature prior to them being done, and were eventually stopped when it was finally shown to be either not helpful, or possibly even harmful. Of course, it’s not too hard to find things — pubic shaving, enemas, 100% episiotomy-and-forceps birth, etc. But since we’re talking about babies and the harm or benefit to them from either delayed or immediate cord clamping, I thought about stuff that used to be done to babies that has changed. The big thing that came to my mind was that they used to perform surgeries on babies, particularly premature babies, without anesthesia, because doctors were trained and taught that babies didn’t feel pain, or at least did not feel pain like older children or even adults. You may say, “Oh, here she goes again — that was what they used to say about circumcision.” Yes, but more than circumcision — we’re talking major surgery — heart operations, drilling holes in a baby’s neck — that sort of thing.

So, I knew they had done this for years — I remember reading about research done in the 50s and 60s in which doctors poked babies with pins and noted — not their pain response — but their “primal reaction”. They  had made up their minds that babies didn’t feel pain, so when the babies were very obviously showing that they were in pain by crying, screaming, trying to move away from the painful stimuli, etc., they had such blinders on that they didn’t even register that the babies were in pain. IDIOTS!! So these stupid doctors taught the next generation of doctors these “facts” who taught the next generation, etc.

If you check out the link above, you’ll see that these surgeries were performed on babies up through the mid-80s (and perhaps beyond)!

[Ok, I was getting less stress as I was typing the above, and now it’s just come flooding back.]

The babies were given paralytic drugs, so that they couldn’t move — i.e. STRUGGLE BECAUSE OF THE PAIN — but were not given anything for pain. Many babies died because of the shock and trauma. Their little systems just couldn’t handle it. Most if not all parents did not even know that their babies had been sliced open without so much as a Tylenol, until one set of parents found out and went public. Then more parents asked questions, got their children’s hospital records, etc., and raised such a big stink about it that practices changed. But it was butchery that went on in the name of medicine. If animals had been treated in such a way, the perpetrators would have been put behind bars. But it was not questioned because doctors in white coats who all that medical training, so knew what is best. [HAH!]

I’ve known that preemies were operated on without anesthesia, but I did not know that it extended past that time — perhaps a few days or weeks, maybe a few months. Also, I thought that the reason they thought preemies couldn’t feel pain is that they assumed that babies weren’t developed enough prior to term; so I thought that they only operated on these helpless infants, without anesthesia, up until when the baby would have been “term” had s/he not been born prematurely. I was wrong.

Just a few minutes ago, when I was looking at when this barbaric practice ended, I saw this link, a letter to the editor, which had the following quote:

Your article on infant pain and its belated recognition by the medical community (Science Times, Nov. 24) suggests that unanesthetized surgery has been limited to newborns and that the practice had largely ended by the late 1970’s. However, surveys of medical professionals indicate that as recently as 1986 infants as old as 15 months were receiving no anesthesia during surgery at most American hospitals.

Now here’s where it gets personal. Intensely personal.

I was born in the late 70s. When I was about 3 months old, I underwent a heart operation due to holes in my heart. Frankly, I now believe that I was not given anesthesia. And that is what caused my stress reaction when writing the comment I did that I mentioned above.

Although the overwhelming feelings I listed above have faded, the only other time I remember feeling like this completely out of the blue, was when I wrote this post, last October, when I felt the same sort of near-panic attack kind of feelings, when I read what a typical C-section was like, and started flipping out thinking about being completely numb and unable to move. [Just to be honest, even though it is getting to be very stream-of-consciousness here, and I apologize for that — writing the last sentence made me almost cry. The rational part of my brain says that that is totally nutso; but the tightening in my chest is returning regardless of logic and reason.]

I don’t remember my surgeries, and have good memories of the hospital. But I have no choice but to say — logic be damned! — that my body remembers the surgeries (whether I had anesthesia or not — and I say probably, almost definitely NOT).

I hate this feeling. HATE IT! It’s the same way I felt when my brother (who is six years older than me) would tease and torment me, and I couldn’t stop him because he was so much bigger than me. It’s this feeling of utter helplessness. Like my arms are bound by my sides, unable to move. It’s horrible.

In all honesty, right now, my body just feels basically numb (except for my fingers) – -my arms literally feel very heavy, as if they have weights attached to them… or have been medically paralyzed.

Sorry that this isn’t an uplifting post. It also has nothing to do with cord clamping (feel free to read the comments on that post, though, because it has been a most interesting conversation). Nor does it really have anything to do with birth — although it doubles or triples my stance against circumcision, particularly without anesthesia. But don’t let anybody tell you that babies don’t feel pain. And if you or someone you know endured something painful as a baby, at least be open to the idea that s/he remembers it, even if s/he doesn’t “remember” it. I used to think that it was hogwash, myself, but not any more. Now, I’m a firm believer. There is just no other explanation I can offer as to why I have such a visceral reaction when these topics are brought up.

Oral Hygiene, Preeclampsia, Preterm Birth

I’d previously read that gingivitis is associated with higher rates of preeclampsia, but that it was not known if it was a “cause and effect” or just an association. If gingivitis causes preeclampsia, then better oral hygiene might prevent some cases of preeclampsia; but if it’s just an association — that women who are predisposed to either gingivitis or preeclampsia, or just are in poorer health or have an underlying health condition — then combatting gingivitis would do nothing.

In that vein, I was intrigued when I read this article, which said that bacteria has been found in the amniotic fluid of women who have given birth prematurely. One possible pathway given was that a kind of bacteria normally found in the mouth (and harmless there) may make its way into the bloodstream, and from there through the placenta into the baby’s amniotic fluid. This might weaken the amniotic sac, or perhaps cause some sort of uterine infection or fetal infection, or something that would account for the preterm birth. This is a new discovery, because this bacteria does not respond to traditional culturing, but instead requires examining DNA.

I wonder if preeclampsia might also be a manifestation of some sort of infection, perhaps transmitted through the weakened areas of the mouth when gingivitis occurs — the puffy and bleeding gums just seem like wide-open places for bacteria to cross into the blood-stream.

As an aside, I had two heart surgeries as a young child, and am supposed to take antibiotics for life whenever I have dental work done. It’s to prevent this sort of thing from happening — nasty oral bacteria (that may do nothing worse than cause bad breath, plaque or cavities when kept in the mouth) upon entering the bloodstream move to the weakest point, which for heart patients would typically be the heart. Southern humorist Lewis Grizzard eventually lost his life because of this — after four heart surgeries. In a pregnant woman, the baby may be “the weakest point” which is attacked, or at least may be the area with the least defenses. Antibiotics are given with the hope and assumption that if the dental patient’s mouth is pricked or otherwise open and/or bleeding, and oral bacteria enter the bloodstream, that the prescription antibiotics will prevent these bacteria from setting up a heart infection.

When I was pregnant the first time, I didn’t know about the gingivitis-preeclampsia risk, much less this newly released bacteria-preterm birth link. But I did know about the possibility that always exists (no matter how small) for oral bacteria to enter the bloodstream through an open sore in the mouth. I assume the risk is much greater when, say, the pick that cleans your teeth and may have untold numbers of bacteria on it jabs into the gum and more or less “injects” the bacteria below the surface. However, when my gums bled during pregnancy — which is not uncommon — I was concerned and wondered what to do about it. Sometime in the past, I had read that gingivitis might be caused by a lack of vitamin C, or at least, that taking vitamin C would stop it. You’re not supposed to take large amounts of vitamin C while pregnant because the baby might develop scurvy (although I think this is mostly talking about large doses around the time of birth, causing the baby to develop scurvy after birth when he’s withdrawn from the maternal vitamin C; and I’ve read one doctor who prescribes large doses of vitamin C, and his protocol for dealing with this is to give the baby vitamin C as well, and then gradually wean him off of it), so do your own research before doing anything! So I took a couple of grams of vitamin C for a few days, in addition to whatever was in my prenatal vitamin, whenever my gums started bleeding, and usually within a day it would stop. I only had to do this a few times during pregnancy.

Two Great Posts in One

Kangaroo Care (snuggling a premature infant skin-to-skin 24/7) has been a topic I’ve meant to research and write about. But this post has an article which sums it up nicely. Why reinvent the wheel? — just go and read it.

Also on that post (the first half of it), it talks about another topic related to premature infants that I’d never thought of before: additives, including alcohol, dyes and sweeteners, being given to premature infants at amounts much higher than they should receive for their weight. The article urges that medicines given to premies be manufactured in forms that are free from unnecessary additives. I guess I assumed that most medications would be given through an IV; but it makes sense that if a premature infant needs a medication that is available in oral form, that it would be given it. Unfortunately, a lot of these medicines contain too much of bad things, including alcohol, red dye and aspartame. Can anyone explain why a medication given to a child of, say, less than a year old need to include dye? The purpose of the dye is to make it look tasty and palatable, and I don’t think infants really care that much; even if older infants do, premies likely never even see the medicine coming, so certainly don’t need for it to look pretty. Sweetness is an acquired taste, to a certain degree. While the human tongue is attuned to sweetness, medicines don’t have to be sweet (a spoonful of sugar, à la Mary Poppins) to make it go down — especially babies too tiny to fight nasty-flavored medicines going into their mouths. May not be pleasant for the wee babes, but they really can’t struggle too much, the way a child of even six months can. Besides, things are overly sweetened these days — and I say that as someone with a very developed sweet tooth! (I’ve recently given up sugar, and am surprised at how sickeningly sweet my kids’ jam is on their PB&J; I never used to notice it.) Even if these babies can taste well, and should be given stuff that is palatable, it doesn’t have to be as sweet as it is made in order for them not to dislike it. And don’t even get me started on alcohol for infants! Here we have pregnant women who risk society’s wrath if they ever take so much as a sip of an alcoholic beverage while pregnant, yet these babies (who should still be gestating but were born too early) are getting alcohol straight from their medicine, not even diluted via the mother’s blood-alcohol content. Kinda makes ya think, hmm?

So, if you are pregnant now, or know someone who is, or are planning on having more children in the future, go read this article, because there is always the possibility that you will have a premature baby (even if you think you won’t because you’re so healthy or you’ve never had a problem before, you could be involved in a car wreck and have the placenta dislodged — rare possibility, but still there — so still read it). Many hospitals may be unfamiliar with kangaroo care, and tell you instead that the babies need to be left alone so that they reduce the risk of infection. That is a consideration, but one to counterbalance against all the benefits of kangaroo care laid out in the article. At least read the article and discuss it with your care-givers. And nurses may also not even think about all the additives they are giving your baby along with the medication. You can help educate them, and perhaps save your baby from some negative effects of, say, alcohol poisoning.