Browsing Tag

Risk

I Had The Measles 48 Years Ago and I Still Suffer Its Effects

By June 15, 2015 4 Comments
Share:

I have just finished reading a plea that went viral on Facebook from a Winnipeg, Manitoba father, Neal Cohen, whose five-month-old baby girl was just diagnosed with the measles. My heart and my thoughts go out to Neal, his wife, and their little girl. The rage this father expressed in his open letter is completely understandable. In a society that has more information at their fingertips than they have ever had, it amazes me that the opinion of a celebrity such as Jenny McCarthy or some selective information can sway people away from their common sense.

I am a mother of two and a grandmother of three (soon to be four) and I am not going to offer my opinion, only my experience. You see, I had the measles when I was a child. I am nearly 60 now, but the experience was so horrible that I still vividly remember it.

It was deep in the summer and very hot. For no reason I could think of, I just started feeling listless. Considering the time of year I thought it could be from the heat. It didn’t get better so I went to bed early that day.

The next morning was my 12th birthday. I woke up from a bad night’s sleep with a raging fever, my eyes felt like they were on fire, and I couldn’t see properly. My head was pounding out an anvil chorus so badly that I wanted to scream and every bone in my body ached. On the heels of that I realized I had developed a rash. It seemed like every time I checked, the rash was moving at record pace, soon covering my entire body from head to toe. I was very, very sick.

I remember my mother on the phone with the doctor and watching the rash come out on my brother. Yes, misery was going to have company. My mother was terrified that my brother and I were going to be left permanently disabled. She was terrified for my hearing; you see as an early 12th birthday present, she’d just let me get my ears pierced. Later as a mother myself I could understand her visceral fear for my life and my brother’s.

The doctor told my mother that for me it was going to be bad. Apparently 12 was somewhat old to have the measles, so the old style of treatment applied. I was to stay in bed nursing chills that rocked my body. My eyes were not to be strained under ANY circumstances; I was not allowed to read books, no TV, no daylight, nothing that could take my mind off the excruciating pain I was in. I had no energy for any of those activities anyways, I was in so much pain I wished I would die.

I spent a week like this, and my mother spent a week fearing the worst, but I obviously survived. Even so, I have been living with the effects of the measles for nearly 48 years. While I had been the picture of health before, since the measles, I continue to suffer from blinding headaches and middle ear issues that have only gotten worse as I have gotten older. I’ve been told that each of these problems – which did not exist before the measles – is likely the result of the severity of the virus’ attack on my body.

Now as a grandmother knowing what the measles is like personally I don’t understand why anyone would think of putting their child through something like what my brother and I went through. A simple shot can prevent terrible illness and lifelong suffering. It bothers me when I hear antivaxxers say, “nobody dies from the measles.” While I survived, I did not survive unscathed. Even the word “antivaxxer” sounds like a new disease.

I now have two precious grandsons, a granddaughter and one more grandchild on the way. I cannot imagine them being endangered by someone who listened to a celebrity, or cherry-picked information on the internet instead of referring to their doctor. Please give your children a fighting chance and talk to your doctor about vaccines. Don’t let your child, or my grandchildren, suffer like I had to. – Edited by Leslie Waghorn

 

Tags: , , , , ,
Categories: Accidents, Injuries, + Abuse, Chronic Illnesses + Conditions, Infectious Disease + Vaccines, Policy, Politics, + Pop Health

The Deadly Toxin You May Not Have Heard About

By June 10, 2015 1 Comment
Share:

In Spain a little boy is being kept alive by machines and eight other children have been hospitalized after being infected with a deadly toxin. This toxin can cause the nose of an infected individual to drip blood and pus-filled infection, the roof of their mouth to bleed and turn green and black, can obstruct their airways, and can cause patches of skin to become scaly and leather-like.

The toxin invades the body’s mucus membranes, enters the blood stream, and multiplies rapidly. Most alarming is that the first symptoms this toxin in the body are similar to that of a cold, until the inside of the victim’s mouth turns gray and scaly, by which point the toxin has likely already entered the bloodstream and attacked the other mucus membranes in the body, and the patient has likely already infected other people.

Twenty percent of infected patients under the age of five will die and 5-10% of patients over the age of five will die. That mortality rate has remained unchanged for 50 years, despite medical advances.

This toxin is caused by a naturally occurring bacteria of the same name called Corynebacterium diphtheriae, better known as diphtheria.

Diphtheria is one of those diseases we think about in the same way we think about cholera, typhoid, and consumption (TB). We think of it as a disease that people used to die from on The Oregon Trail, but that it’s not actually a thing anymore. Except that it is.

In the 1930s, diphtheria killed between 13,000 and 15,000 individuals annually in the United States. A diphtheria vaccine was developed in the 1920s, and became widely available in the ‘40s and ‘50s. The disease’s prevalence rate dropped off to a statistical zero by the 1980s.   Most people are vaccinated against diphtheria in childhood as a part of the DTaP vaccine, which protects against diphtheria, tetanus and pertussis (whooping cough). People older than the age of 11 need a Tdap booster shot every seven to nine years. The differences between the DTaP and Tdap vaccines are the antigen concentrations in each shot.

Diphtheria InfocardDiphtheria is in the news again due to a cluster of cases in Spain; in the Girona province of Catalonia, Spain (very close to the border of France), the index case (“patient zero”) is an unvaccinated little boy. Heartbreakingly, as of the writing this post the boy is in critical condition on life support, and his parents have expressed that they “feel terrible guilt” over not vaccinating their son and feel hoodwinked by the antivaccine community. Several months ago Tara Hills, a mother of seven, wrote on our blog about the guilt she felt after not vaccinating her children and their subsequent battle with whooping cough.

While the index patient in Spain was not vaccinated, initial reports of the subsequent eight infections indicate that the other patients were vaccinated. The reports, however, don’t indicate the age of the new patients (diphtheria is particularly virulent in those under age five) or if the eight had completed the World Health Organization’s full vaccination schedule. Additionally, those who have been vaccinated against diphtheria tend to develop a milder form of the disease as their bodies already have some of the antibodies needed to fight the bacteria and the toxin.

Treating diphtheria is complicated, many impacting factors including the age of the individual, their vaccination status, when in the disease’s progress they sought medical treatment, and how the bacteria entered the body can all vary the severity of the illness. Prevention is the first line of defense (get your shots, people!) but once infected, antitoxins, antibiotics and supportive care are the standard treatment. Complicating matters even further is that the diphtheria antitoxin is not a standard drug that hospitals keep on hand. In fact it’s only available through the CDC directly for us here in the US. The antitoxin also won’t neutralize existing pockets in the mucus membranes, it will only prevents the progression of the disease by neutralizing the toxin that’s circulating in the bloodstream. This is why the death rate from diphtheria remains so high.

As Rene Najera pointed out on Monday, many diseases are just a plane ride away. This disease could even easily spread to areas of southern France given its proximity to the border and the nature of cross-European transit, which is largely train and short-flight based. Even if you don’t plan to travel to Spain any time soon, now may be a good idea to check in with your doctor and make sure you and your family are up to date on your Tdap and DTaP shots. Heck, most health departments give them away for free (FREE!).

Editor’s note: Since the publication of this post, the little boy has since passed away. You can read more here.

Tags: , , , , ,
Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

Parents: If You Want To Be Right, Prove Yourself Wrong

By June 2, 2015 1 Comment
Share:

Like most suburban Washington, DC neighborhoods, ours is off a small street that has become shortcut for commuters looking to avoid a congested intersection, most of whom fly down the street well above the speed limit. In this area, everybody’s neighborhood is somebody’s super secret traffic hack (DC traffic is the worst, well… almost).

Last summer we received a letter in the mail notifying us that the city was giving us options to help reduce speeding. Our options, put to an informal mail-in vote were:

  1. Speed bumps or
  2. Pay for additional police enforcement.

My husband and I groaned at the option of speed bumps. Anyone who has ever had a sleeping infant or toddler in a car knows that speed bumps are sleeping baby landmines. We both supported paying for increased police enforcement. Besides, we reasoned, speed bumps don’t slow people down, people just speed up between them, right?

Being a data nerd, before we voted I dug into the peer-reviewed research and it turns out we were absolutely wrong.

Speed bumps were far more effective in reducing risk than increased police enforcement. And I discovered that decades of study across the world showed that not only do speed bumps slow drivers down, but they reduce both car accidents and pedestrian deaths. So we changed our vote, and the speed bumps were added a few months ago.

But this isn’t about speed bumps or traffic. It’s about not being afraid to be wrong and changing your mind with new information, even if it’s inconvenient.

Our generation of parents has been trained to view actions as synonymous with character. If a parent makes a less-than-ideal decision (or hell, a benign decision that we wouldn’t make) we’ve been trained to believe they must be a bad parent. My husband and I weren’t bad parents because we initially thought speed bumps wouldn’t reduce the traffic issue. We were just wrong about that issue. When we had better information we changed our opinion.

So why do many of us persist in our current beliefs even when we’re confronted with evidence hat those beliefs are incorrect? Our brains don’t help matters. In fact the brain is hard wired to reassure us that we’re right, even when we’re wrong. Even the smartest among us are guilty of persisting in beliefs even when confronted with contradictory information. The ways in which we convince ourselves that we’re right when we’re actually wrong are called confirmation biases, and there are a few different types.

Leslie's son itching to make a run for freedom (and danger).

Leslie’s son itching to make a run for freedom (and danger).

I wanted to escape the confirmation bias trap with the speed bump issue and do what was truly safest for our toddler – who incidentally wasn’t always consistent when told that the street wasn’t for playing – so I did what I usually do in these situations: Try to prove myself wrong.

The first thing I did was to voice my opinion to others who I didn’t think would necessarily agree with me. This was an example of avoiding the confirmation bias known as the echo chamber, wherein we seek information from sources we think are likely to agree with us.

While chatting with neighbors I mentioned that we were thinking of voting for increased enforcement, to which my neighbor replied that he’d been at a meeting with a city planner who explained that speed bumps were much more effective at reducing pedestrian deaths. I was a little skeptical of what the city planner had apparently said. “Of course he’d say that,” I thought, “increased enforcement probably costs the county a ton in police overtime and he’s looking to save money.”

My dismissal of the city planner’s statement is an example of a phenomenon called motivated reasoning, first identified in the 1950s. Motivated reasoning is often subconscious, meaning that we don’t do it on purpose. In this process we often discard, or put less emphasis on evidence that contradicts our current point of view, and include or put heavy emphasis on evidence that supports it.

Motivated reasoning happens in a few ways, including only looking for information that we know supports our beliefs. For example, my neighbor’s statement was enough to make me investigate how wrong I may actually be. So I turned to the peer-reviewed literature, but I knew I had to search smartly if I wanted to get an accurate answer.

Had I been looking simply to confirm my hypothesis I could have searched for “speed bumps” ineffective traffic deaths, in JStor, in which case the results focus on citizen’s individual freedom and less on the statistical data. Instead I searched for traffic deaths “speed bumps”. I specifically kept the search terms neutral because I wanted to know what the data actually said and the resulting studies showed me that I was wrong.

When I brought the evidence to my husband and told him we were going to be changing our vote, he groaned and protested. I gave him a little while to think it over and he eventually came around acknowledging that the improvements in safety outweighed the inconvenience of the speed bumps. Not that he had any say in it, I’d already changed our vote and mailed in our ballot.

Tags: , ,
Categories: Accidents, Injuries, + Abuse, Science 101 + Mythbusting

PART 2: Can Bananas Make You Bleed to Death? Will BHT in Kids Cereal Cause Cancer? What is Chemophobia?

By May 19, 2015 2 Comments
Share:
All Natural Banana

Everything is made of chemicals, even an all-natural sun-ripened banana. Does a banana naturally include a chemical used by big pharma and a chemical that can cause your blood to stop clotting?! Image via James Kennedy. CLICK TO ENLARGE

In Part 1 of this two-part series, I addressed The Food Babe’s allegation that said if your food contains an ingredient your third grader can’t pronounce you shouldn’t eat it – and my stance on that is, then no one would ever eat an organic banana, which contains naturally-occurring phylloquine, tocopherol and palmitoleic acid, which are tongue twisters.

Today in Part 2, as we continue our BHT discussion, let’s start back at that example of our all-natural organic banana.  What if I was to tell you that the same chemical found in bananas, that has been shown to cause a 7% increase in lung cancer in non-smokers, has also been found to act as an anticoagulant in large doses and can cause bleeding issues?  Yes, it’s tocopherol again. You would need to eat 5,000 bananas in one day to reach the levels (1,000mg) that cause bleeding issues. If you eat a banana or two a day, you won’t develop bleeding issues, as the dose makes the poison.

Using that frame of reference, many research groups have tested the hypothesis that BHT contributes to cancer.   Most reports discuss BHT feeding trials in rats, and the data follow two central trends:

The first is that the tumor incidence observed in small studies is not replicated in larger studies.  In science we need our sample sizes to be considered ‘representative’ in order to be considered ‘generalizable.’  That means that we need a large sample population in order to say that the findings can be applied to the general population.  This is because small sample sizes are prone to sampling errors.  A study’s findings are problematic when you see a result in a small sample population but don’t see those same results in a larger population.  In this case we’d want to see the same patterns in both the small and larger studies, but we don’t.  But, small studies are subject to statistical noise, as a blip in the particular set of rodents makes results appear to be significant—yet they don’t repeat in a larger statistical set.

The second trend observed is what scientists refer to as a dose-response failure.  This basically means that if a small amount of a test compound causes a problem, then higher amounts should cause an equal or greater response.  It makes sense, as I said above, that the dose can make the poison.  Taken in total, there is absolutely no credible evidence that BHT causes cancer in animals, and the IRAC notes its carcinogenicity as “inconclusive”, which means nothing has been observed. Some studies in petri dishes are suggestive, but not conclusive about a BHT cancer risk.

Other BHT feeding studies in monkeys were shown to induce potent effects on the liver, resulting in physiological and cellular abnormalities.  However, these studies fed monkeys 500 mg/kg of body weight of BHT for 50 days.  That’s akin to a 200lb person eating 50 g (the weight of a tennis ball) of BHT every day for 50 days.  The average American consumes approximately 2 mg/day, or 25,000 times lower (per day) than the amount shown to induce these problems in primates.  Lung problems were observed in dogs and mice when they were given 75,000-100,000 times the human daily intake.

Of course, there are many fear mongers in the anti-additive space that don’t understand the science.  They read the headline or article title and draw a conclusion.  These interpretations are not consistent with the science, yet they spread like wildfire throughout electronic media.

Ironically, there are just as many papers that suggest preventative effects from BHT.  Of course, these are no fun for fear mongering and are also rather preliminary science, so you don’t have too many health advisers suggesting increased consumption.

Like any chemical added to food it is critical to carefully consider the benefits and risks at realistic concentrations encountered.  As I said in my previous post, it is certainly easy to read the reports on risk assessment and toxicity and become worried about possible effects, as they do seem so plausible.  However, I reiterate, that careful analysis reveals that biological effects are not observed at the levels actually consumed in the typical diet.  BHT, like most food additives, is present in vanishingly low amounts, and its benefits as a product to keep food fresh far outweigh any risks.

While I’m not a parent myself I’m very close to my niece and feel protective of her.  I have given her food with BHT in it and I’m not concerned about the long-term impacts on her health, or my own.  I also give her bananas, and I’m pretty sure she’ll be OK.

 

Editor’s Note 2.7.17: After this post was published Dr. Folta came under attack for alleged financial conflicts of interest. These allegations were later found to be misrepresented. In response to reader questions after the initial allegations we added an editor’s note on his articles on this site that acknowledged the claims, but reiterated the scientific accuracy of his writing for TheScientificParent.org. As the claims have been debunked we have removed our original editor’s note.

 


 

Resources:
Wikipedia. Chemophobia Entry. Retrieved May 17, 2015.
Office of Dietary Supplements. Vitamin E Fact Sheet for Health Professionals. National Institutes of Health. Last reviewed June 5, 2013. Retrieved May 18, 2015.
EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS). Scientific Opinion on the re-evaluation of butylated hydroxytoluene BHT (E 321) as a food additive. European Food Safety Commission. EFSA Journal 2012;10(3):2588. Retrieved May 17, 2015.
Wu, QJ. Xiang, YB. Yang, G. et al. Vitamin E intake and the lung cancer risk among female nonsmokers: a report from the Shanghai Women’s Health Study. International Journal of Cancer.2015 Feb 1;136(3):610-7. doi: 10.1002/ijc.29016 Retrieved May 17, 2015.
National Toxicology Program. Bioassay of Butylated Hydroxytoluene (BHT) for Possible Carcinogenicity (CAS No. 128-37-0). U.S. Department of Health and Human Services. Report date, 1979. Retrieved May 17, 2015.
Malkinson, A., Koski, K., Evans, W. et al. Butylated Hydroxytoluene. Exposure Is Necessary to Induce Lung Tumors in BALB Mice Treated with 3-Methylcholanthrene. Journal of Cancer Research. July 15, 1997. Retrieved May 18, 2015.
United States Environmental Protection Agency. Dose-Response Assessment. Last updated July 31, 2012. Retrieved May 18, 2015.
Matsuo, M., Mihara, K., Okuno, M., eat al. Comparative metabolism of 3,5-di-tert-butyl-4-hydroxytoluene (BHT) in mice and rats. Journal of Food Chemistry and Toxicology.1984 May;22(5):345-54
United States Food and Drug Administration. Select Committee on GRAS Substances (SCOGS) Opinion: Butylated Hydroxytoluene (BHT). Last updated April 18, 2013. Retrieved May 18, 2015.
Tags: , , , ,
Categories: Food, Nutrition, + Infant Feeding, Science 101 + Mythbusting

PART 1: Can Bananas Make You Bleed to Death? Will BHT in Kids Cereal Cause Cancer? What is Chemophobia?

By May 18, 2015 4 Comments
Share:

The Food Babe once said that if your food contains an ingredient your third grader can’t pronounce you shouldn’t eat it.  I say that in that case no one would ever eat an organic banana, which contains the naturally occurring, yet difficult to pronounce phylloquine, tocopherol and palmitoleic acid.  These chemicals are tongue twisters for sure but naturally occurring, harmless and good for you chemicals that nature put in your sun-ripened banana.

We all share concern about the safety of food and food additives.  Scary-sounding chemical names create suspicion and fear, and with our endless exposure to information everyone seems to be an expert in deciphering just how dangerous chemicals really are. In fact, a thriving industry that capitalizes on fear of chemicals has cropped up, and of course they profit from selling supplements and organic food that are supposed to be chemical free (spoiler alert, everything is made up of chemicals).  We call this scare tactic chemophobia.

Often, this chemophobic industry focuses on food additives – chemicals that impart important properties to food nutrition, stability, or quality – as chemicals to be afraid of.  As a professor of horticultural sciences I can tell you food additives are chosen because they are safe for human consumption in the quantities used.

The Food Babe, a member of the chemophobia industry has put a common additive in her crosshairs: butylated hydroxytoluene (BHT), found in everything from cereals to gum to food packaging itself.  BHT has an outstanding safety record—yet has become the target of recent commentary by scientifically dubious sources.

It may sound strange to eat a chemical that’s also used in food packaging, but what if I told you that one of those chemicals in the all-natural sun-ripened banana has been shown to increase a non-smoker’s risk of lung cancer by 7%?

 The Food Babe says that if your third grader can't pronounce an ingredient, you shouldn't eat it. Unfortunately, that means we wouldn't be able to eat fresh fruits and vegetables, that are composed of tongue-twisting, naturally-occurring chemicals.

The Food Babe says that if your third grader can’t pronounce an ingredient, you shouldn’t eat it. Unfortunately, that means we wouldn’t be able to eat fresh fruits and vegetables, that are composed of tongue-twisting, naturally-occurring chemicals.

That chemical is tocopherol and it doesn’t make your banana a dangerous carcinogen.  It just means that in large doses the small amount of tocopherol in your banana can do more harm than good, but at lower levels, it’s perfectly healthy.

BHT is simply a synthetic antioxidant.  It does the same job that all antioxidants do- it delays changes in food quality that occur from exposure to oxygen and other reactive molecules.  It is typically found as a stabilizing agent in food, but also is important in the manufacturing of cosmetics, and even has a role in rubber production.  It is most commonly encountered in food containing fats, as it is highly effective in deterring rancidity.

I can understand those that are afraid of BHT. There is a lot of research that shows the relative toxicity of BHT and when those studies are viewed in isolation they can seem reasonably alarming.

Some studies show that BHT can be toxic when consumed in large quantities used lab mice, with some examination of how the compound is metabolized in humans.  Rats and humans were fed relatively high levels to determine its biological fate—and found that while it is possible to accumulate BHT in fat tissue if high levels are consumed for days.  To reach these toxic levels you’d need to eat almost two tons of cereal in one day.  Even at these high levels, BHT is rapidly eliminated as normal consumption continues. About half is gone after a day.

Certainly it is easy to read the reports on risk assessment and toxicity and become worried about possible effects, as they seem so plausible.  However, careful analysis reveals that biological effects are not observed at the levels actually consumed in the typical diet. In tomorrow’s post, I will break down the studies and science behind BHT, and dispel some of the biggest myths surrounding this chemical compound.

Editor’s Note 2.7.17: After this post was published Dr. Folta came under attack for alleged financial conflicts of interest. These allegations were later found to be misrepresented. In response to reader questions after the initial allegations we added an editor’s note on his articles on this site that acknowledged the claims, but reiterated the scientific accuracy of his writing for TheScientificParent.org. As the claims have been debunked we have removed our original editor’s note.

 


Resources:
Wikipedia. Chemophobia Entry. Retrieved May 17, 2015.
Deborah Kotz. Worried too much about chemicals? You may have chemophobia. The Boston Globe. August 20, 2013. Retrieved May 17, 2015.
EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS). Scientific Opinion on the re-evaluation of butylated hydroxytoluene BHT (E 321) as a food additive. European Food Safety Commission. EFSA Journal 2012;10(3):2588. Retrieved May 17, 2015.
Wu, QJ. Xiang, YB. Yang, G. et al. Vitamin E intake and the lung cancer risk among female nonsmokers: a report from the Shanghai Women’s Health Study. International Journal of Cancer.2015 Feb 1;136(3):610-7. doi: 10.1002/ijc.29016 Retrieved May 17, 2015.
Melody M. Bromgardner. General Mills to Remove BHT From Its Cereals. Chemical and Engineering News. February 23, 2015. Retrieved May 17, 2015.
National Toxicology Program. Bioassay of Butylated Hydroxytoluene (BHT) for Possible Carcinogenicity (CAS No. 128-37-0). U.S. Department of Health and Human Services. Report date, 1979. Retrieved May 17, 2015.
Sadri Hassani. Warning: Do Not Eat 1.7 Tons of Cereal A Day! The Skeptical Educator Blog. March 3, 2015. Retrieved May 17, 2015.
Tags: , , , ,
Categories: Food, Nutrition, + Infant Feeding, Science 101 + Mythbusting

What Your Doctor May Not Have Told You About Pregnancy Spacing

By April 20, 2015 2 Comments
Share:

“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.

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

With 7 Kids in Recovery from Whooping Cough, Tara Hills Answers Your Questions

By and April 15, 2015 12 Comments
Share:
Tara Hills Luke

Tara cuddling with her recovering 10 month old.

When I wrote our story last week, I had no idea our story would go ‘viral’ (no pun intended).  We are a private family, as most homeschooling families are, so we thought that maybe a few people in our community would see it.  We never imagined that our story would travel around the globe.  As encouraged as we are to hear about the positive impact our decision to share it has had on many others, it has also been hard handling a real medical crisis in the face of intense global media and public scrutiny. Last Tuesday, when the positive test results came in 4 days late, the waves of chaos hit us with a fury that we can’t possibly describe. Everything that day was a blur, from me editing my original post to include our diagnosis, to the reality of dealing with 7 active cases of pertussis.  

Tags: , , , ,
Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

How to NOT Risk-Assess Yourself into a Panic: Stepmother Training 101

By April 13, 2015 1 Comment
Share:

I’m brilliant at over-intellectualizing any challenge that comes my way. I can feel the earth shift at this very moment as my friends collectively roll their eyes in agreement on this one. As someone with a journalism undergrad, and a health policy and international health policy and development master’s degree (super quantitative, mind you), I am compelled to both over-research, and over-analyze things that I don’t know what to do with…until I know what to do with them. That both drives me and my loved ones batty at times. Mea culpa, loved ones. You’re a patient lot.

That being said, my latest obsession is learning all there is to learn about step parenting, as though there’s some sort of manual that will give me the magical information to make every
thing happen perfectly once we make it official. The fabled Cinderella stigma hangs over the head of every woman marrying a man with children – even look at the top photo associated with “stepfamily” on Google! I know, this quest to avoid being associated with a Disney villain by just acquiring the title of stepmother is ridiculous. From peer-reviewed articles to anecdotal self-help books, I’ve read myself silly, and frankly, I’m just about over it.

This past week with the wolfpack was busy, but I took the opportunity to get back to my reading, yet another anecdotal book on step parenting called The Single Girl’s Guide to Marrying A Man, His Kids, and His Ex-Wife. Instead of an informative read as I’d hoped, it was a series of horror stories: children tripping their stepmothers, spitting in stepparents’ faces, and name calling in the worst possible way, all kinds of awful behavior that I couldn’t even fathom coming from these two lovely, wonderful young men in my life.

Developing secure attachments with one another takes time, as does understanding how to respect and love one another on appropriate terms, making sure everyone’s needs are met, and creating space for each of us in the others’ lives. I’m finding that it takes time, patience, and a tireless sense of humor. I was raised in a house of women except for my even-keeled and god love him, very patient father. This house is a pack of the male species…where in their natural habitat, farts, smelly shoes, and rough housing are essential components of life. As a woman, I don’t relate to it very well (I love you, Dad. I’m sorry for puberty!), but I’m also learning I don’t need to try to be one of the guys. We’re inherently psychologically different, and we’re learning that that is ok.

But it hasn’t been all rainbows and bunnies; we all have our bad days, and adjusting to new people is a challenge. Fortunately, we’re not alone. According to clinical psychologist E. Mavis Hetherington (excerpted in the book Stepmonster), the divorce rate is 65% for marriages in which one partner has children from a previous marriage, with the key issues often related to the process of blending the family into a cohesive unit. Another study in the book suggests that once a stepfamily has surpassed the three-year mark, those marriages are more likely to survive than first marriages; with 5 years in, these stepfamily marriages are more likely to succeed than any other type of marriage. Those numbers seem daunting when I consider them and the marathon that 5 years could be if things were different than they are now. Perhaps most alarming of all is the general data that suggests that approximately 50% of children in the U.S. under the age of 13 are in a parent-stepparent home. Add that all together and it leaves plenty of people (including adolescents of divorce) cautiously approaching child-stepparental relationships as temporary and impermanent scenarios.

I’ve looked to psychology, evolution, biology and anthropology for answers, and the results are split. Some studies show that stepparents should actively engage with their stepchildren as a parent and guardian, while others say it’s best to emotionally disengage and step back, sometimes almost completely. As the science is as clear as mud on the subject, this means this is a path that the wolfpack and I have to clear on our own. I would urge others in my shoes to consider the same.

But I digress. Sitting on my bed, reading that book filled with chaotic tales, I was jarred back to the reality of what was so – what my current experience and current life looks like. Science and stories aside, my future stepsons and I have had the experiences we have had, and all the rest of these things I was reading were just fodder that I could choose or not choose to use to skew my perception of what my reality is. In that moment, I felt very grateful, and I put my book down and rushed out to find the oldest playing a video game, and I gave him a hug and thanked him for not being the kind of kid who would knock me down. In his typical teenage way, eyes still glued to the TV as I squeezed him tight, he said, incredulous, “uh, who DOES that?” Amen, dude. Who DOES that? Neither of them, fortunately.

When I fell in love with my fiance, I had no idea I would eventually fall in love with his boys. But I have, and I think that’s a precious gift. It makes it easier to deal with them when conflict comes up, which, because we’re all alive and human, it inevitably will.

 


 

Resources:

Bjornsen, Sally. The Single Girl’s Guide to Marrying A Man, His Kids, and His Ex-Wife

Martin, Wednesday. Stepmonster: A New Look at Why Real Stepmothers Think, Feel, and Act the Way We Do

Hetherington, Mavis. For Better or for Worse: Divorce Reconsidered (findings from the 30 year Virginia Longitudinal Study)

http://www.stepfamily.org/stepfamily-statistics.html

http://www.pewsocialtrends.org/2011/01/13/a-portrait-of-stepfamilies/

Tags: , , , ,
Categories: Mental, Emotional, + Behavioral Health