Friday, December 17, 2010

Cytotec Is Dangerous, No Matter What Your Doctor Told You...

There has been renewed conversation about Cytotec in my local doula community recently because a doula was concerned that this was what a doctor had prescribed for her client. A few doulas commented that their clients had experienced medically-induced labor with Cytotec and had good outcomes. But we must remember that a few happy endings are not evidence that the practice is safe.

This article by Marsden Wagner in a 2001 issue of Midwifery Today covers the major points...

Induction with Cytotec should never be attempted anywhere, most especially in out-of-hospital settings. Incredibly, the American College of Obstetricians and Gynecologists (ACOG) recently approved Cytotec induction: 1) in spite of lack of FDA approval; 2) in spite of a letter to doctors earlier this year from Searle (which manufactures Cytotec) imploring doctors not to use it for induction; 3) in spite of lack of approval from the Cochrane Library (the best scientific opinion); and 4) in spite of the fact that it is not approved nor used for induction in any country in Western Europe.

Recent articles in prestigious medical journals such as The Lancet have questioned the validity of standards of practice from professional organizations like ACOG, because their goal of protecting the health of women through using scientific evidence to guide members toward best practices too often conflicts with their other role as a trade union representing the interest of their members. As a result of this "trade union" role, ACOG recommendations are too often compromised by the needs of the obstetricians. A classic example of putting the doctors' needs ahead of the families' needs is the ACOG recommendation not to permit videotaping by families of a hospital birth.

So ACOG quotes studies of Cytotec induction, none of which have a sufficient number of research subjects, and consequently, none of the studies quoted have sufficient statistical power to detect small but potentially important risks such as uterine hyperstimulation and uterine rupture. Furthermore, because published studies of Cytotec induction have such wide methodological variability, meta-analysis is impossible and the published attempts at such meta-analysis are seriously flawed. But Cytotec is a godsend for busy obstetricians, as its use allows them to schedule the woman's labor at a convenient time and speeds up the labor, resulting in a return to "daylight obstetrics"-pharmacological induction of labor has increased from 10 percent to 20 percent in the past decade in the United States. So with their members' needs in mind, ACOG plows ahead, ignoring the best scientific evidence as well as the recommendations of the best scientific bodies, of government agencies not only in the United States but in every country in Western Europe, and of the pharmaceutical company. Instead, ACOG uses weak, inadequate evidence to approve Cytotec induction. Midwives should stay as far away as possible from such vigilante obstetrics-obstetricians taking matters into their own hands while ignoring the recommendations of the real judges.

article from Midwifery Today, Issue 57, Spring 2001, page 44

by Marsden Wagner MD, MSPH

Cover photo of Jessie and Hans © 2000 by Caroline E. Brown, DEd, MS, RNC.

Debunking Doula Myths

This is a column by Danielle Elwood from Babble, a parenting website. I have included part of it and you can find the rest here:

"The longer I’ve worked in the birth community the more I’ve learned just how many mainstream forums carry horrible inaccuracies about doulas. I wanted to write something to kind of set the record straight and let women, especially pregnant women, or women who will some day plan to have a child of their own what is real, and what is a big ol’ myth."

Myth: A doula shows up only for the birth, and leaves immediately after.
The relationship a doula builds with a mother and her family starts during pregnancy, and expands to labor and postpartum care. When labor begins your doula will accompany you fromstart to finish, and even in the hours after, no matter what setting you have chosen for your birth. After your baby is born you should expect your doula to check in on you a couple times to see how you are adjusting to your new life and roles.

Myth: Doulas are only for crazy hippies.
Contrary to popular belief, all doulas are not going to show up with bongos and magical healing crystals. Most doulas may be into natural healing, or holistic health care, but are not going to be pushy if this is something you do not want to choose for your own birth.

Myth: Doulas take over the role a husband has during labor.
This is probably the most common myth I hear. A doula’s role in labor is to not only be of help tothe mother and her partner, but to work on enhancing the relationship the couple has with the hospital staff. She will advocate for the mother and function as a liason between the couple and hospital staff such as residents and nurses. During labor, mom and dad are often too preoccupied to deal with lots of details– this is one reason a doula comes in handy.
As Penny Simkin says: “While a doula probably knows more than then partner about birth, hospitals and maternity care, the partner knows more about the woman and her personality, likes and dislikes, and needs. Moreover, he or she loves the woman more than anyone else there.”

Myth: Doulas take the place of Midwives or OB/GYNs.
This is another huge myth I constantly hear. Many people mistakenly think that a doula takes the place of a midwife, or medical professional who handles prenatal care and delivery. Or that a doula and midwife are interchangeable. While some doulas may carry other certifications in the medical field they are not midwives or doctors and should not be treated as such. They are there to provide labor support and guidance, not medical care.Myth: Doulas cost too much!
Doulas are not only for the rich, or for those with kick ass health insurance that will cover doula care. Doulas are for all women. In some areas they can range up to about $600 for a birth, but many doulas are willing to work on a sliding scale, or even for free while working on their certification. Many hospitals across the country have programs with doulas on staff that can cost as low as $100 for an entire birth.

Myth: If you have a doula, you cannot have an epidural or pain relief.
While women who make the choice to have a doula do not typically wish to have medical pain relief during labor, doulas are not going to judge your choices for what you want during your birth. They are there to support your labor and birth, not dictate what they think you should be doing. Heck, I had a doula with my second birth and after laboring for nearly a day opted for an epidural for some sleep. There is nothing wrong with it as long as you are educated on your choices.

Thursday, December 2, 2010

Study Shows Pregnant Mother's Diet Impacts Infant's Sense of Smell


A major new study shows that a pregnant mother's diet not only sensitizes the baby to those smells and flavors, but physically changes the brain, directly impacting what the infant eats and drinks in the future.

"This highlights the importance of eating a healthy diet and refraining from drinking alcohol during pregnancy and nursing," said Josephine Todrank, PhD, who conducted the two-year study while a visiting scientist at the University of Colorado School of Medicine. "If the mother drinks alcohol, her child may be more attracted to alcohol because the developing baby "expects" that whatever comes from the mother must be safe. If she eats healthy food, the child will prefer healthy food."

Researchers studying mice found that the pups' sense of smell is changed by what their mothers eat, teaching them to like the flavors in her diet. At the same time, they found significant changes in the structure of the brain's olfactory glomeruli, which processes smells, because odors in the amniotic fluid affect how this system develops.

"This is the first study to address the changes in the brain that occur upon steady exposure to flavors in utero and early in postnatal life when the newborn is receiving milk from the mother," said Diego Restrepo, PhD, co-director of the Center for NeuroScience at the University of Colorado School of Medicine and sponsor of the study. "During these periods the pup is exposed to flavors found in the food the mom is eating."

The research, he said, could have important public health implications.

"Many diseases plaguing society involve excess consumption or avoidance of certain kinds of foods," said Restrepo, a professor of cell and developmental biology. "Understanding the factors that determine choice and ingestion, particularly the early factors, is important in designing strategies to enhance the health of the infant, child, and adult."

In her study, Josephine Todrank fed one group of pregnant and nursing mice a bland diet and another a flavored diet. At weaning age, the pups from mothers on the flavored diet had significantly larger glomeruli than those on the bland diet. They also preferred the same flavor their mother ate, while the other pups had no preference.

"Exposure to odor or flavor in the womb elicits the preference but also shapes the brain development," said Todrank, whose work was funded by a grant from the National Institutes of Health and was published December 1, 2010 in the
Proceedings of the Royal Society B, a major biological research journal.

"From the fetus' point of view, whatever is in the womb is considered "good." If your mother ate it and survived to give birth to you then it was probably safe," she said. "This is a good strategy for a mouse that is foraging for food. It treats those same foods as safe."

Due to the similarities in mammalian development, she said, there is no reason to think that experiments would produce different results in humans.

"What an expectant mother chooses to eat and drink has long-term effects – for better or worse – on her child's sensory anatomy as well his or her odor memory and food preferences in the future," Todrank said. "It is not yet clear how long these changes and preferences last, but we are currently investigating that question."