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Pregnancy

Parents Matter. We Need to Stop Telling Them They Don’t.

By July 30, 2015 2 Comments
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At my 22-week checkup my Obstetrician had a frank discussion with me about “how I’m doing.” This wasn’t a discussion I ever had with my previous OB during my first pregnancy so I was a little surprised when it happened.

Before having been pregnant, I had expectations of loving the experience. Friends had said the time had some “uncomfortable” aspects, but that they felt better, healthier, and more in touch with their bodies during pregnancy. Meanwhile I was all of eight weeks pregnant with my first when I sobbed to my husband, “I don’t know if I can do this for another seven months!”

I went into this pregnancy expecting it to be different.  I knew what to expect this time and how to work around it, or so I thought.  And while the first few weeks were much better than my first pregnancy, I soon experienced terrible morning sickness that lasted until week 17 and have never really bounced back from it.

So, when my OB asked me how I was doing my response was, “I’m pregnant. I’ve been better.”

He broke the news to me that I was anemic, which didn’t shock me as anemia runs in my family. “So, iron supplements?” I asked, thinking this would be a simple solution. He said yes, but he also wanted me to take vitamin C and take care of myself because he could tell I wasn’t. How could he tell I wasn’t taking care of myself? I was showered, my hair was combed, I had on clean clothes, I was gaining weight, my prenatal tests were all normal.

What I realize now is that he was trying to tell me that I looked like I’d been hit in the face with a frying pan, and while I wasn’t aware of it at the time, I felt like I had too. He ordered that I get more sleep, eat healthier, and that my in-laws take my son for the weekend so I could fully rest. He even offered to write the last order down on a prescription pad.

Our conversation completely threw me. It was not a conversation I was expecting to have with my OB and for sure one I hadn’t come prepared to have that day.  I thought I had been taking care of myself. I took my prenatal vitamins, I was going to the gym whenever I could, and I was sleeping better than I had in my first pregnancy. My husband had taken on a huge chunk of the child care and housework, and my in-laws even watched my toddler son once a week, sometimes twice.

I told him that I had a lot more help than many women do. His response was that having help wasn’t the same as having enough help.

How Leslie usually spends her evenings.

How Leslie usually spends her evenings.

He asked me what I thought at the time were a series of unrelated questions.  What did I usually eat for breakfast? If I got breakfast it was usually a granola bar. How often did I eat? Three times a day, usually a snack before bed. What did I eat for dinner? Lean protein. What did I do when my in-laws took my son? Client work. Why was I still doing cardio at the gym despite ligament pain? It was best for the baby. How often did I wake up at night? How many fingers do you have? How was my energy level? I’m pregnant, I’m tired all the time. Did I ever have dizzy spells? Yes, a few times a day but I’m pregnant, that’s par for the course. When was the last time I did something for myself like take a long bath, read a book or have dinner with friends? I’m a parent and pregnant again, those aren’t things I have time for.

His words rung in my head as he said them, “pregnancy is not just about the baby. You matter too.”

During my first pregnancy when I’d brought up complaints of feeling excessively tired or not having the capacity to eat as healthily as I’d like, my previous OB’s response was that pregnancy was hard, nothing was out of the ordinary, and it was all about doing what was necessary to have a healthy baby at the end. After my son was born, family joked, “nobody cares about you now, we’re all here for the baby.” It took a week for my milk to come in and in the hospital when I fed my hungry son some formula to supplement what I couldn’t produce, a nurse admonished me, “you’re doing what’s easiest for you, not what’s best for him.”

The message was clear: You don’t matter.

I didn’t realize how closely I’d taken that message to heart until my new OB pointed out that much of what I’d categorized as taking care of myself was actually taking care of others.

I held back tears long enough to get out of the office and into my car, and bawled the entire way home. A blubbering mess, I arrived home to a very confused but concerned husband.

“But it’s just anemia, you can take a pill for it, right?” he asked,

“It’s so much more than that!” I sobbed.

Until that day I don’t think I’d processed how much the overt and implied messaging from those around me had truly impacted how I viewed myself. I really didn’t think that I mattered and trying to make myself matter to me involved a significant mental shift.

Since surviving my son’s first colicky few weeks I have said repeatedly that Western society does a terrible job of supporting new parents, but I hadn’t taken my own message to heart. From healthcare infrastructure to family structure, to societal expectations, we essentially give new parents a pamphlet on swimming, throw them into the deep end, and act confused when they start to drown or annoyed when they ask for a life raft.

When I asked other friends if they felt like they didn’t matter after having had a child the response was overwhelmingly in the affirmative. Many mentioned family that offered to help initially didn’t come through, or had nothing but ‘helpful advice’ about what was best for the baby, watched while they were struggling. Others mentioned how specific language made the feel like non-persons:

“I felt like a cow.  My family thought it was a joke to hand [my daughter] to me when she was hungry and say ‘this is your job now.’ Even when I had pumped milk in the fridge my mom refused to use it because she only wanted the best for her granddaughter.  What about her daughter?”  said one friend.

Another confided, “we had this big family dinner the night we brought [my son] home from the hospital. Everyone was there and it was this running gag for everyone to ask ‘oh are you still here?’ to my husband and I. Yes, I’m still here, cleaning up the dishes because everyone is cooing over the baby and I can’t sit down because I pushed another human out of my body 48 hours ago. Thanks for asking.”

The general state of Leslie's home office and living room over the last two weeks.

The general state of Leslie’s home office and living room over the last two weeks.  This is the definition of confessional blogging.

While these may seem like awkward jokes from friends, study after study after study has shown that new and expectant parents feel unsupported ,and that lack of support leads to poorer outcomes for the parent(s) and baby. Yet we as a society seem to persist in the mentality that in order for a baby to thrive the mother’s well-being has to be sacrificed.

The last two weeks has been a learning experience for me. I have been slowly re-learning how to take care of myself, while still working and caring for my family. It has not been easy and at times self-care has felt like one more thing on my to-do list. But I’ve noticed a difference.

Mentally, I’m more focused and my mood has improved. I have more energy and I no longer feel like I’ve been hit in the face with a frying pan. I’ve gone back to the gym, but I’ve traded in the treadmill and elliptical for the recumbent bike and am focusing on strengthening the muscles in my back and shoulders which will help me survive the impending third trimester.

Some things have had to be sacrificed. Our living room and basement perpetually look like they’ve been hit by a tornado. The laundry is washed, but hasn’t been folded and put away in two weeks and the stairs haven’t been vacuumed for the same amount of time. I’ve learned that these are signs that I am a good mother, actually. Because when I’m ok, it supports my family. Today, I feel better.

 

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Categories: Mental, Emotional, + Behavioral Health

This Post Isn’t About Bristol Palin: Why Teens Aren’t the Ones With the Unplanned Pregnancy Problem

By July 1, 2015 No Comments
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 At this point, you’ve probably heard about Bristol Palin’s second pregnancy. She announced her news via a blog post last week. She originally suggested that this pregnancy wasn’t planned but followed up that post a few days later with a second one clarifying that her pregnancy was planned…just mistimed.

Planned, unplanned, or mistimed, this post isn’t about judging Bristol Palin or her choices about sex and motherhood. She’s an adult now and deserves to have both the autonomy to make her own decisions about her own body and the privacy to go through whatever she’s dealing with. But I just cannot wrap my brain around how she found herself in this situation. Again.

Bristol’s situation brings up some interesting points that, as a 10-year veteran of reproductive health, I cannot stop considering; mainly, why in the year 2015 do women often struggle to manage their reproductive health? What I really want to talk about is unplanned pregnancy and how incredibly easy it is to prevent with just a little bit of education.

What would you say if I asked which age group has the highest rates of unplanned pregnancy in the nation? If you’re like 70% of Americans, you’d answer “teens.” And like 70% of Americans, you’d be dead wrong. Rather than skyrocketing as most US adults believe, the teen birth rate is in fact dropping like a rock. In 2014 alone, US teen births declined 9% and rates have dropped a staggering 61% since peaking in 1991.

While we like to blame teens for so many of our nation’s ills (get off my lawn!), they’re actually doing a fantastic job of not getting pregnant. The group with the highest rates of unplanned pregnancy in the US are actually right in Bristol’s demographic; young women age 18-29. Bristol is smack in the middle of the current unplanned pregnancy crisis (think crisis is too strong a word? Consider this: more than half of all unplanned pregnancies* in the US occurred for women in their 20s and, of those unplanned pregnancies, 65% were women in their early 20s). She is part of the club of women who are having sex, not effectively using birth control (or at all), and—shocker—getting pregnant before they’re ready.

So why are teens kicking so much butt and young adults—who are older (and we assume?) wiser—falling so far behind?

Comparison of birth control method efficacy via The National Campaign to Prevent Teen and Unplanned Pregnancy

Comparison of birth control methods used by female family planning providers via The National Campaign to Prevent Teen and Unplanned Pregnancy

There’s no magic bullet answer to explain why the teen birth and pregnancy rates are plummeting while the rates for 20-somethings remain so stubbornly high. Some suggest that the recession forced many families to take stock of their finances and teens, who witnessed the day-to-day financial struggles their parents dealt with, and took notice—babies are pretty expensive, after all. Some suggest that shows like MTV’s 16 and Pregnant and Teen Mom have been instrumental in demonstrating the harsh reality of having a baby as a teen; rather than glamorizing these young moms, these shows provided a window into an incredibly challenging and rough time and, again, teens took notice. Some point to the recent American Academy of Pediatrics recommendation that pediatricians begin recommending long-acting methods like the IUD and implant to their teenage patients (there has been a modest uptick in adoption of these methods among teens but it’s still too early to tell if there is a causal relationship to decreases in the teen birth rate). I like to think the best answer is also the simplest: simply put, teens are having less sex AND using contraception more carefully and consistently when they do have sex. So bravo young people!

They are also, to some extent, being exposed to more education about the most effective methods of contraception available to them and they’re taking notice. In 2009, the Obama Administration signed the Consolidated Appropriations Act of 2010, which included $110 million for the President’s Teen Pregnancy Prevention Initiative (TPPI). TPPI created the first federal funding stream available for more comprehensive (ie—abstinence AND birth control) approaches to sex education. Currently, the federal government has recognized nearly 30 programs that have been rigorously evaluated and shown to help teens delay sex and/or use birth control more effectively. Since the implementation of TPPI, the teen birth rate has seen steady and sharp declines…coincidence? Maybe…but it seems unlikely.…**

So, teens are (for the moment) getting all this great education and learning about better methods and/or how to delay sex more effectively and the rates show that things are humming along nicely, but what about those 20-somethings like Bristol?

Well, as most of us know, once you hit adulthood—i.e. graduate high school—everyone assumes you’re good to go on the human body, how it works, and how it reproduces. Beyond a bowl of freebie condoms at the local clinic, there is rarely sexual health education in college curricula and there certainly isn’t much for those young people who skip college for other things. This forces 20-somethings to be proactive about their sexual health—if they want to find a better method (or ANY method) it’s on them to make it happen. For many women, this is just fine. But for many, many more, the stigma, fear, embarrassment, and other issues attached to simply admitting one is sexually active prevents them from seeking out even the simplest methods of birth control or learning about how their bodies really work. They may have grown up in a culture that forbids sex before marriage and so they wouldn’t dream of getting birth control…even when they know they may become sexually active. Or perhaps they simply rely what they know: the humble condom (that they may hate) or perhaps the pill they’ve been taking since high school (that they may not take consistently). Some think they can’t get pregnant during their periods, trust that the man is pulling out on time, they think they can’t get pregnant at that time (or that this will be the ONLY time they have sex), or they just believe that it won’t happen to them. This myth-believing and misinformation about their bodies affects all kinds of women from all different socio-economic backgrounds. Unplanned pregnancy doesn’t have a type; it can (and does) happen to anyone.

It can even happen to a young woman with a famous name, and famous mother who stands on a platform of pro-abstinence rhetoric. Because you don’t know what you don’t know and it can happen to you. So Bristol—best wishes on your new addition; I hope this next adventure is a fun and rewarding one…as a mom myself, I know just how much fun kids can be. But when you’ve had your child, please think seriously about birth control; there is nothing wrong with taking charge of your sexual health and your future and actively planning when you want to next get pregnant. – Edited by Leslie Waghorn

* In this case, “unplanned” indicates that the women themselves reported that they either did not want to get pregnant at that time or did not want to get pregnant ever.

…**As an aside, despite this remarkable progress and clear evidence that the programs funded by this money actually, you know, work, Congress is currently gunning to defund both TPPI and Title X, the nation’s low-income family planning funding stream. I could spend a whole other post detailing how those funding cuts impact millions of Americans but I’ll let this issue brief do it for me.)

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Categories: Ages + Stages, Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning, Tweens + Teens

What in the Bloody Bleep Can’t This $2,000 Dress Hide?

By and May 6, 2015 1 Comment
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Let’s talk about The Duchess of Cambridge’s body, because she just had a baby so of course we’ve got to get on the chatter bandwagon.  Let us state for the record: we think Duchess Kate is gorgeous. We look at her photos and videos of her interacting with others, and we think she’s just lovely, and we’re not talking just about her styled hair, or makeup, or impeccably chosen clothing. We’d also like to state that we’re not an avid fans of following celebrities, save for Alan Rickman, with whom Julia is slightly obsessed, or Ryan Gosling, Leslie’s favorite.

That being said, with all of the coverage on our blog, it’s hard for us to avoid (and not be baffled by) the recent photos taken outside of St. Mary’s hospital, with Duchess Kate, Prince William, and wee Princess Charlotte, a mere 12 hours after giving birth. Kate looks gorgeous, well-pulled together as always in a sundress, nude pumps, and full hair and makeup – about 12 hours after pushing another human being out of her body. Baby. Human. Out. Of. Her. Body. At breakfast time. In front of the press at dinner time.(!!!). Think about it. (Julia here: I can’t even pull myself that awake and together 12 hours after running a 5k, naps and spandex be damned!)

It seems we’re not alone as our Facebook and Twitter feeds have blown up with women from all backgrounds asking, “Where does this bleep get off looking like that, 12 hours after giving birth.”  We’re inclined to agree with them, except we think Kate’s dress and heels belie the same physical changes (and horrors) that every woman who has given birth have to deal with.

Most mothers leave the hospital still looking five months pregnant, wearing maternity clothes, hair in a messy knot and walking gingerly.  Forget about makeup and high heels.  But in this case appearances are deceiving. Beneath that $2,000 bespoke sun dress are likely the unifying bane of every postpartum mother’s existence: The mesh underwear and mega pad.  If you look at the photos Kate’s dress is loose fitting, easily hiding the pad that would even make your grandmother recoil in horror. We’re recoiling just looking at that thing in the photo to the right.

Why the giant pad?  After giving birth women can expect to experience lochia for days to weeks after giving birth.  This discharge resembles a heavy period and is about as fun as one too.  Women are given disposable underwear for two reasons: 1. To protect their own underwear from blood stains and 2. Regular underwear doesn’t tend to accommodate the girth of the postnatal pads. Girth!

The dreaded postpartum pad and mesh underwear. As thick as it is long, not even The Duchess of Cambridge could likely escape this.

The dreaded postpartum pad and mesh underwear. As thick as it is long, not even The Duchess of Cambridge could likely escape this.

The last time Duchess Kate was seen in public before giving birth was just a few days before going into labor when she took Prince George to swim in the Queen’s pool.  Can we just stop for a moment and acknowledge that might be the most British sentence ever written on the subject of pregnancy?  Anyway, you’ll note in the paparazzi photos her face looks the same as it has for most of her pregnancy.  But in the now famous photos outside of St. Mary’s hospital, her face and legs look noticeably puffy.   Which, come on, let’s cut her a break, she’d just given birth.

But this is yet another postpartum side effect.  As we’ve mentioned here before, a woman’s blood volume increases by 50% during pregnancy, and her body retains much more fluid.  This fluid helps, in part, the joints and tissues expand to make room for the growing baby.  But once the baby is born, all this extra fluid no longer has a purpose and escapes into the face and extremities, leaving most new mothers feeling like a float in the Macy’s Thanksgiving Day Parade.  Despite her dress and always gorgeous hair, it looks like Kate’s face and legs did not escape this post-pregnancy side effect.

And let’s talk about that dress one last time.  Gorgeous, loose fitting, but still it can’t hide that post-pregnancy belly. That’s right, as Kate showed the world after she gave birth to Prince George, your stomach doesn’t go back to six-pack flat once you give birth.  Your uterus can take six to eight weeks to contract to it’s normal size, during that time, you still kind of look pregnant – which is not a surprise because with baby, fluids, and placenta, it’s the volume equivalent of having a small watermelon stretching out your insides.  And if you ignore Princess Charlotte in those photos outside of St. Mary’s (we know it’s hard, she’s so little and perfect) you can clearly see Kate’s rounded belly, $2,000 bspoke dress or $20 gap maternity dress.

Now the heels, we have no earthly explanation for those, except princesses being princesses.

Let us be clear: We’re not criticizing her. How could we? She’s under constant scrutiny, has an immense amount of pressure on her shoulders in terms of parenting, navigating royal politics, and trying to carve a life out within that framework –  AND she owns the image fabulously. We’re proud of her, in fact, for whatever that’s worth. We’re just incredibly concerned that society as a whole has created an expectation of perfection from women, that it no one expects any less than it.

Come on, people. We complain and whine when we have to fast for a blood test, mope and dress down in practically potato sacks when we get a small biopsy. Someone needs to give this woman an award, and convince the Royal press team to release some laid-back pictures of the Duchess looking as real as any woman would right now. We’re sure her feet would thank them.

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning, Science 101 + Mythbusting

Royal Baby 2.0 – What We Got Right and What We Got Wrong

By May 4, 2015 1 Comment
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“Her Royal Highness The Duchess of Cambridge was safely delivered of a daughter” – they were the words the media and bookies across the world were waiting to hear. Last week we wrote about what the Duchess of Cambridge (aka Kate Middleton) could expect in her second labor based on what we knew about her labor with Prince George. Now that the blessed event has occurred, let’s double back and see if our predictions were right.

  1. PREDICTION 1: Royal Baby #2 would be late: CONFIRMED
    The Duke and Duchess of Cambridge with the new Princess. Image c/o Kensington Palace/The Press Association

    The Duke and Duchess of Cambridge with the new Princess. Image c/o Kensington Palace/Press Association

    Based on her rumored due date, the newest Windsor Princess is estimated to be about 1 week late. According to rumors with Prince George, he was estimated to have arrived about a week and a half late. While this isn’t abnormal for first pregnancies (first babies are 66% more likely to be late than subsequent babies) we know that late babies tend to recur with subsequent pregnancies. The science isn’t clear on why first babies tend to be late or why late babies tend to recur, but there are lots of theories, most of which have to do with babies taking the time they need until they’re ready to make their appearance.

  2. PREDICTION #2: Royal Baby #2 wouldn’t be as late as Prince George: CONFIRMED
    While we’ve established that first babies are notoriously late and that late babies tent to recur, we predicted that Kate would likely be a little late with this baby as well, but she wouldn’t be nearly as late as Prince George. . The same aforementioned study that found that late pregnancies tend to recur,  also found that subsequent pregnancies tend to not extend as late as those of the first babies. George’s rumored due date was July 13, 2013 and he arrived on July 22, 2013, making him approximately 10 days overdue. The new yet-to-be-named Princess’ due date was rumored to be April 25, and she arrived May 2 making her only about a week overdue.
  3. PREDICTION #3: Kate’s second labor would be much faster than her first: CONFIRMED
    Again, while details are sketchy, the consensus seems to be that Kate was in active labor with Prince George for about 11 hours. Anyone who has gone through labor and delivery knows that’s nothing to sneeze at. This time around, Kate was admitted to hospital at 6am and gave birth at 8:34am, making her second labor a whopping 154 minutes. That’s right, we’re measuring this one in minutes. Second labors tend to be faster as both a woman’s abdominal and vaginal muscles have lost tone they are unlikely regain. This is why Benito Alvarez, MD, formerly the codirector of obstetrics and gynecology at the Cleveland Clinic told Parents.com “Which is why we have a rule here: never turn your back on a woman who’s already had a baby or two.”

Pregnancy Bell CurveSo what does all this mean? In short, not a whole lot. We know that one woman’s pregnancy (on that just so happened to be of the royal variety) conformed to the ever-present statistical bell curve. For those of us who have willed ourselves to forget the dreaded bell curve, might I offer a quick refresher: a bell curve is a statistical distribution of data points, which shows the “normal” range of probabilities for a set of statistics (statistics like, those surrounding giving birth). What we know is that Kate Middleton’s second pregnancy and delivery statistics fell into the “average” distribution of the curve…nothing unusual about any of it. As most OBs and midwives know, every pregnancy is different, but different can be, and often is, still captured under the vast array of what’s considered normal. And that’s science, folks!

 

Resources:

National Survey of Family Growth. 2011-2013 NSFG: Public Use Data Files, Codebooks, and Documentation. Centers for Disease Control and Prevention. Last Updated January 25, 2015. Retrieved May 3, 2015.

Kortekaas, J., Kazemier, B., Ravellia, A et al. Recurrence rate of postterm delivery, a national cohort study. Journal of Obstetrics and Gynecology. Supplement to January 2013. pp S298

Institute for Quality and Efficiency in Health Care. Pregnancy and Birth: When Your Baby’s Due Date Has Passed. PubMed Health. Last update March 1, 2014. Retrieved May 3, 2015.

Nicole Caccavo Kear. Pregnancy, Take Two. Parents.com January 2008. Retrieved May 3, 2015.

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning

Royal Baby Watch 2.0: What Can Kate Expect When She’s Expecting Again

By April 28, 2015 1 Comment
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 As the Duchess of Cambridge (the erstwhile Kate Middleton) prepares to give birth to her second child, the media storm surrounding the birth seems more like a spring shower than the hurricane of coverage that was the lead up to Prince George’s birth. In fact a good chunk of the media coverage has focused on how the new prince or princess is already falling victim to second child syndrome, that phenomenon wherein less attention, patience and resources are lavished on the second child when compared to the first.

Enough about poor prince or princess #2, what about Kate? What’s likely to be different for her this time around? Is there any science to second pregnancies and labors being different than the first or is it the stuff of old wives tales?

We know that Kate suffered from hyperemesis gravidarum in the first trimester with both pregnancies. While hyperemesis gravidarum is rare, affecting between 0.3-2% of pregnancies, women that experienced hyperemesis gravidarum with a first pregnancy are somewhere in the realm of 70-90% likely to experience it again with subsequent pregnancies. Unfortunately the illness strikes women at the same rate, even if there’s a change in paternity from one pregnancy to the next and is so severe that nearly 40% of women that experience it with one pregnancy refuse to have a second pregnancy out of fear of suffering through it again.

The Duchess of Cambridge leaving the hospital after being treated for hyperemesis gravidarum in 2012. Image c/o Sun News.

The Duchess of Cambridge leaving the hospital after being treated for hyperemesis gravidarum in 2012. Image c/o Sun News.

To help her through her first trimester the Duchess likely had plenty of help (including a devoted OB, nanny and maids), so while hyperemesis gravidarum was likely miserable for her, she likely had it easier than other second time mothers that suffer from the illness and don’t have help. In her second trimester it looked like her hyperemesis gravidarum lifted and she admitted this time around she sometimes forgets she’s pregnant. According to a highly informal poll of my friends this is also common the second time around. With that said, those in my informal poll reported feeling much more tired at the end of the day during their second pregnancies, which at 40+ weeks pregnant, we can fairly confidently speculate that Kate is also experiencing.

Kate’s pregnancy with Prince George went a little late leading to a media circus outside the hospital that ventured into the bizarre. Anyone who has been pregnant likely knows the rage that the question, “haven’t you had that baby yet?” causes in a woman in those last weeks of pregnancy, forget the entire world asking the same question in unison. I don’t think you need a peer-reviewed study to know that by those last few weeks, royalty or not, most women are done being pregnant. And it looks like it’s not an old wives tale that first pregnancies tend to go a little long, and Kate’s pregnancy with Prince George followed that trend, to the chagrin of the media dutifully waiting outside. Also likely to vex the media this time around is that post-term pregnancies tend to recur. Thus, as George was a few weeks late, his sibling is also likely to make a fashionably late appearance.

On the bright side, even though he or she is likely to be late, Kate’s second delivery is likely to be shorter and easier than her first. Interestingly, studies have shown that in first-time mothers, the duration of labor increases with the gestational week in which labor begins (meaning, a woman who gives birth at 39 weeks will likely have a shorter labor than a woman who gives birth at 42 weeks). With that said, labor with second babies tends to be quicker and easier than labor the first time around, to the tune of half the time to the tune of about half the length, in large part due to lost vaginal muscle tone.

 


Resources:

Hyperemesis Gravidarum Facts. American Pregnancy Association. Accessed April 27, 2015.

 

Magtira, A., et al. Psychiatric factors do not affect recurrence risk of hyperemesis gravidarum. The Journal of Obstetrics and Gynaecology Research. Volume 41, Issue 4, pages 512–516, April 2015. Accessed April 27, 2015.

 

Fejzo, M.S., Ching, C.Y., et al. Change in Paternity and Recurrence of Hyperemesis Gravidarum. The Journal of Maternal-Fetal & Neonatal Medicine 2012 25:8 , 1241-1245. Accessed April 27, 2015.

 

Fejzo, M.S., et al. Recurrence Risk of Hyperemesis Gravidarum. Journal of Midwifery & Women’s Health. Volume 56, Issue 2, pages 132-136, March/April 2011. Accessed April 27, 2015.

 

Rachel McRady and Omid Scobie. Kate Middleton: “I Sometimes Forget I’m Pregnant,” I “Chase After” Prince George. Us Weekly Magazine. March 11, 2015. Accessed April 27, 2015.

 

Norwitz, E.R.. Patient Information: Postterm Pregnancy (Beyond the Basics). Up To Date (Uptodate.com). Accessed April 27, 2015.

 

Lurie, S., et al. Duration of labor by gestational week in nulliparous women. Journal of Maternal-Fetal and Neonatal Medicine. March 2014, Vol. 27, No. 4 , Pages 372-375. Accessed April 27, 2015.

 

My Doctor Online – Labor and Delivery Information. Kaiser Permanente.

 

 

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning

What Your Doctor May Not Have Told You About Pregnancy Spacing

By April 20, 2015 2 Comments
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“Whatever you do, don’t do what Jessica Simpson did,” my OB told me with a look of disgust on her face. “And if you wind up with a c-section definitely don’t do what Jessica Simpson did! Her OB has got to be livid with her right now.”

I was 20 weeks into my pregnancy when my OB gave me this lecture. I’d been reading a copy of US Weekly with Simpson on the cover when my doctor walked into the room. “Getting pregnant four months after a c-section, we’re talking double the risk of fetal demise and pre-term birth, and triple the risk of uterine rupture. Promise me you won’t do what Jessica Simpson did.”

I promised, and then didn’t really give her warning another thought until the other day. I heard a story on the radio about a new CDC study that shows 30% of women space their pregnancies too close together. But what does that even mean, why does it matter and does anyone care?

For parents that are able to have kids the traditional way, pregnancy spacing is a very personal issue. Factors such as age, medical history, access to health care, wealth, family histories, partner relationships, and career aspirations all factor into the decision. But what we do know is that spacing pregnancies less than 18 months apart is more likely to lead to lasting negative health impacts for the mother and baby.  In addition to the risks my OB outlined, there are increased risks of anemia, repeated miscarriages, placental abruption, pre-eclampsia, hysterectomies and postpartum depression.

Ask any woman who has been pregnant (except maybe Beyonce, Gwyneth Paltrow and Heidi Klum) and they will tell you that pregnancy is hard. Even the easiest pregnancy puts a lot of strain on the body. A pregnant woman’s blood volume increases by 50%, as does kidney size, the uterus will increase from the size of a lemon to the size of a watermelon, while at the same time the growing fetus is grabbing every spare nutrient your body has to offer. Our bodies need time to recover before becoming pregnant again, similar to the way a marathon runner needs to rest after a big race. If pregnancies are spaced too close together, a mother’s body is too drained to properly support the subsequent pregnancy, leading to complications.

Of the 30% of women that don’t wait the recommended 18-24 months, there tend to be two distinct groups: 1. Teens, aged 15-19; and 2. White college educated married women who began childbearing after age 30 and intentionally space their pregnancies close together. As a woman who falls into the latter category (except for the last variable, my son is two) I can see the motivations for this demographic. Warnings of infertility and complications from ‘advanced maternal age’ loom heavily in the zeitgeist.  For this cohort (speaking as a focus group of one) it can seem as if we’re damned by our OBs if we don’t wait 18-24 months, and we’re damned if we’re 35 and pregnant.

But there’s another factor here that matters: The, shall we say, “surprises.”  In fact, if accidental pregnancies were eliminated, there’d actually be a 12% decrease in the suboptimal interpregnancy interval rate. Jessica Simpson’s second pregnancy falls into this category. In a quick survey of my own friends, this seems to hold true. When asked friends if they planned to conceive less than 18 months after a pregnancy the response was usually along the lines of, “we knew we wanted a second baby, but not that soon.” So it looks like there’s an issue with interpregnancy contraception as well.

Contraception between pregnancies is a bit of a fraught issue in the same way that sex after a baby can be fraught. Some, but not all, IUDs require the presence of a menstrual period before they can be inserted, which if a mother is breastfeeding can mean waiting months. Myths abound about hormonal contraceptives and breastfeeding, but studies have shown that they are safe and don’t impact milk production. There’s also the misconception that you can’t get pregnant while breastfeeding (you can, for the love of  bleep, you can). This means that it’s important for not just patients but for providers to have a frank discussion about birth control at the postpartum checkup.

Update 4.20.15: An earlier version of this post stated that all IUDs need to be inserted during a menstrual period.  Hat tip to Facebook commenter Alice C. who pointed out that many IUDs can be inserted without a period.


 

Resources:

Gemmill, A., & Lindberg, L. D. (2013). Short Interpregnancy Intervals in the United States. Obstetrics and Gynecology, 122(1), 64–71. doi:10.1097/AOG.0b013e3182955e58

Copen, C., Thoma, M. and Kirmeyer, S. Interpregnancy Intervals in the United States: Data from the Birth Certificate and National Survey of Family Growth. National VItal Statistics Report. 64:3. April 2015.

Mike Stobbe. Study: US moms typically space pregnancies 2 1/2 years apart. WTOP.com, April 16, 2015.

Smith, G., Pell, J. and Dobbie, R. Interpregnancy Interval and Risk of Preterm Birth and Neonatal Death: Retrospective Cohort Study. British Medical Journal.doi: http://dx.doi.org/10.1136/bmj.327.7410.313 (Published 07 August 2003)

Howard, E., Harville, E., Kissinger, P. et al. The Association Between Short Interpregnancy Interval and Preterm Birth in Louisiana: A Comparison of Methods. Maternal and Child Health Journal. 17:5.pp 933-939 (2012)

Shachar, B. and Lyell, D. Interpregnancy Interval and Obstetrical Complications. Obstetrical and Gynecological Survey. 67:9 pp 584-596 (2012)

Thiel de Bocanegra, H., Chang, R. Menz, R. et al. Postpartum Contraception in Publicly-Funded Programs and Interpregnancy Intervals. Obstetrics and Gynecology. 122:2:1 pp 296-303.

Bahamondes, L., Bahamondes, M.B., Modesto, W. et al. Effect of hormonal contraceptives during breastfeeding on infant’s milk ingestion and growth. Fertility and Sterility. 100:2 (2013).

WebMD. Breast-Feeding as Birth Control – Topic Overview. Updated May 3, 2012. Retrieved April 19, 2015.

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning

A Rejection of Eva Mendes H1 and a Confirmation of the Gosling Sweatpants Null Hypothesis

By March 22, 2015 No Comments
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According to Eva Mendes sweatpants are the number one cause of divorce after the birth of a baby. We’d like to live in Eva Mendes’ world (hello Gosling!) wherein one can comfortably wear jeans and flouncy summer dresses immediately after giving birth, but that’s not the norm for most women. If you’ve become a mother by giving birth, your body needs time to heal and the cotton and stretch offered by yoga pants, pajamas, leggings and yes, the dreaded sweatpants is often doctor recommended.

Even if your path to parenthood came through different means, soft, cotton clothes for those first few months are often a necessity. A friend who became a mother through surrogacy swore by her comfy cotton clothes after she and her husband brought their son home, “yoga pants, tees and always a pony tail. I could rest comfortably without changing and they’re spit-up proof, and [our son] spit-up a lot … and my husband didn’t cheat on me.”

But my friend’s claim is what we call anecdotal evidence and it doesn’t hold a lot of scientific weight, so let’s test the substance of Mendes’ claim: New mothers’ use of sweatpants postpartum is the primary cause of divorce in America. We’ll set aside the gender norms and implications of her statement and put only her hypothesis to the test.

Divorce is a complex subject and not one that can be neatly summed up in a few paragraphs. For now I’m going to focus on data surrounding first marriages ending in “irreconcilable differences” divorces, meaning those where violence, substance abuse, adultery or incarceration were not factors. I’m also going to look at the broad strokes of the issue, because with everything, the data is nuanced once by age and socioeconomic status.

Mendes’ claim pertains to women of childbearing years that were married at the time of their child’s birth. This accounts for approximately 59.5% of all births in the United States.

Within that age bracket, approximately 42% of those marriages entered into during childbearing years will result in divorce, by the end of the individuals’ childbearing years, according to the U.S. Bureau of Labor Statistics. The average length of a marriage that ends in divorce is 9.2 years.

What the data seems to support is that across Western nations, the number one cause of divorce oscillates between communication issues (‘we grew apart,’ ‘we never talked,’ ‘we became strangers’) to financial problems/differences in spending and saving. Note, sweatpants are not mentioned. That’s not to say that the birth of a child is a smooth transition for married couples, with about 20% reporting that the birth of their child caused a crisis in their marriage. With that said, the “crisis” appears to be additional strain added to preexisting stressors in the marriage.

Postpartum depression also seems to be an additional risk factor for divorce, however, the correlation doesn’t appear to be clear: does the divorce exacerbate the postpartum depression, or does the postpartum depression exacerbate the end of a marriage?

But what’s important to note is that sweatpants are not mentioned in any of the literature as being a cause of divorce. What we can say now is that we have confirmed Eva Mendes’ null hypothesis, meaning that there is no correlation between divorce and sweatpants.

Now, this is a subject I feel passionate about. I am Canadian and grew up in the same area as Ryan Gosling at around the same time. Just as there was an audible gasp when Gosling and Rachel McAdams split up, I also heard the gasp from this land when we saw that Gosling’s wife criticized sweatpants. This is a land where sweatpants are just shy of being our official national costume, so we come to their defense rather quickly. It’s been great to see that Gosling hasn’t forgotten his roots (pun intended) and also came to their defense.


 

Resources:

Resources:

Martinez, G., Daniels, K, and Chandra, A. Fertility of Men and Women Aged 15-44 Years in the United States: National Survey of Family Growth, 2006-2010. National Health Statistics Reports. April 12, 2012. Retrieved 3.22.15.

Bodenmann, G., Charvox, L., Bradbury, T. et al. The role of stress in divorce: A three-nation retrospective study. Journal of Social and Personal Relationships. pp 707-728. October 2007. Retrieved 3.22.15

Dakin, J. and Wampler, R. Money doesn’t buy happiness but it helps: Marital satisfaction, psychological distress and demographic differences between low- and middle-income clinic couples. The American Journal of Family Therapy. pp 300-311

Michaels, G. The Transition to parenthood: Current Theory and research. Cambridge University Press, New York. 1988.

Hawkins, A., Willoughby, B. and Doherty, W. Reasons for divorce and openness to marital reconciliation. Journal of Divorce and marriage. pp 453-463, August 13, 2012. Retrieved 3.22.15.

Gigy, L. and Kelly, J. Reasons for Divorce: Perspectives of Divorcing Men and Women. Journal of Divorce and Marriage. pp 169-188. October 18, 2008. Retrieved 3.22.15.

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Categories: Science 101 + Mythbusting

The Science of Kelly Clarkson’s Baby Fat, Because We Apparently Need to Talk About It.

By March 12, 2015 No Comments
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Let’s talk about something that’s none of our business: Kelly Clarkson’s postpartum body. We’re not going to talk about her third number one album on the billboard charts, her awesome duet with Jimmy Fallon or her adorable baby girl. We’re going to put her recent accomplishments aside and talk about her postpartum body because she had the nerve to have a baby in June and not be “skinny again” by March, and that’s what really matters.</sarcasm>

Before we talk about Clarkson specifically, let’s talk about what’s average and what’s recommended in terms of pregnancy and postpartum weight gain. The American College of Obstetricians and Gynecologists (ACOG) recommends a gestational weight gain (GWG) of 25-35 pounds for a

Trends in Gestational Weight Gain 1990-2005 via http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf

Trends in Gestational Weight Gain 1990-2005 via http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf

woman that began her pregnancy with a body mass index of 18.5-24.9 and is pregnant with a single fetus. In reality what we’re seeing is an increasing trend in women gaining both less than and more than the recommended GWG. This is because more women are beginning their pregnancies with a BMI considered overweight or obese.

Postpartum trends also show that a year after giving birth, women that began their pregnancy at a “normal” weight and gained the recommended amount retained three pounds of their pregnancy weight a year later. Those that gained more than the recommended weight retained about 10 pounds. Within some weight ranges the retained gestational weight can become problematic, putting women at risk for the development of type 2 diabetes post-pregnancy.

Postpartum GWG by week via http://www.ncbi.nlm.nih.gov/books/NBK32810/

Postpartum GWG by week via http://www.ncbi.nlm.nih.gov/books/NBK32810/

Retained gestational weight gain can compound with subsequent pregnancies, increasing a woman’s pre-pregnancy BMI and putting them at risk for gestational complications such as gestational diabetesHELLP syndrome and preeclampsia.

A major assumption in previous research (and it seems by society in general) is that postpartum “baby weight” serves no purpose, but that assumption is being challenged by evolutionary biologists.  Research in this field over the last decade has posited that postpartum weight retention plays an important role in lactation, providing nursing mothers with energy reserves should their baby’s need for milk outpace the mother’s energy (food) intake.

Pregnancy is hard, recovering from childbirth is hard, new motherhood is hard and in the West we do an abysmal job of supporting new mothers. One of the unspoken rules of new motherhood is that if you’re not pregnant anymore, you have to look like you never were. That’s an incredibly powerful but negative message to send to a woman.  This is where we get Tori Spelling’s “Just Keep Your [Bleeping] Mouth Shut and Eat Air [postpartum] diet,” which is incredibly dangerous, new mother or not.

I’m glad that we can now put Kelly Clarkson in the category of women who have openly taken a healthy approach to postpartum weight loss, along with Tia Mowry, Hilary Duff, Jenna Fisher and Bryce Dallas Howard.  At the end of the day, what Kelly Clarkson’s postpartum body matters only to herself and her doctor, new album or not.

 


Resources:
Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines; Rasmussen KM, Yaktine AL, editors. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press (US); 2009. 2, Descriptive Epidemiology and Trends. Retrieved March 11, 2015.

Centers for Disease Control and Prevention. Pediatric and Pregnancy Nutrition Surveillance System (PNSS). Updated December 17, 2014. Retrieved March 11, 2015.

Centers for Disease Control and Prevention. Infant Feeding Practices Study II and its Year Six Follow-Up. Updated August 26, 2014. Retrieved March 11, 2015.
Weight gain during pregnancy. Committee Opinion No. 548. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:210–2.

Leahy-Warren, P., McCarthy, G. and Corcoran, P. First-time mothers: social support, maternal parental self-efficacy and postnatal depression. Journal of Clinical Nursing. March 25, 2011. Retrieved March 11, 2015.

Bedor, E. and Tajima, A. No Fat Moms! Celebrity Mothers’ Weight-Loss Narratives in People Magazine Journal of Magazine & New Media Research Summer 2012. Retrieved March 11, 2015.

American Pregnancy Association. Pregnancy Complications: HELLP Syndrome. Retrieved March 11, 2015.

Mayo Clinic. Preeclampsia Risk Factors. Retrieved March 11, 2015.

Mayo Clinic. Gestational Diabetes Risk Factors. Retrieved March 11, 2015.

Dufour, D.L. and Sauther, M.L. Comparative and evolutionary dimensions of the energetics of human pregnancy and lactation. American Journal of Human Biology. August 21, 2002. Retrieved March 11, 2015.

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Categories: Pregnancy, Birth + Family Planning