Sunday, June 30, 2013

Book Review - Circles of Stone: Anthropology and Birth in One Great Story!

One of my favorite activities is hunting through a used bookstore (with a chai!) and searching for my next great find. During a recent visit to one of my favorite local shops, I serendipitously chose a book off the shelf that held a certain anthropological and feminist appeal. Imagine my utter excitement when I discovered that it contained a multitude of birth stories occurring throughout the evolution of man!

Great find for $3!
This anthropological fiction book, Circles of Stone by Joan Dahr Lambert, is rooted in historical evidence and theory, such as basing a character off the discovery of "Lucy's" body and theories about how she may have died.

The book is broken into three parts, three different but interwoven stories, which take place over the course of major evolutionary changes in prehuman and human history. Part I takes place in the Great Rift Valley of Africa approximately 1-1.5 million years ago, Part II occurs between the Rift Valley and the shores of the Red Sea from 500-200 thousand years ago, and Part III take place in the Pyrenees between France and Spain from 50-30 thousand years ago.

This book is a delightful find for a birth junkie such as myself and here's why. Not only was it choke-full of strong female figures, mother led tribes, and prehistoric worship of the Goddess Mother, it also contained stories of births that were used to describe the evolution of our human ancestors.

This book is literally describing the birth of humanity through the perspective of strong female figures and the challenges their bodies and tribes went through during human evolution! A fantastic story and journey through history!

I was particularly impressed with the story of the first cesarean section as described in Circles of Stone:

"Once again, she knelt and placed her palms against the stretched skin of her daughter's stomach. Her long fingers probed and pushed as she tried to feel what lay within so she would know how to accomplish the task the Mother had given her. The weight of her actions compressed her lips and furrowed her brow, but her hands did not falter. Taking a deep calming breath, she grasped her cutting stone. Slowly, with great deliberation, she cut a long, shallow slit across Mina's belly. Blood welled up; one of the women knelt and sopped it up with fresh leaves. Again, Kalar cut, deeper this time. Then she shoved her hands into the wound and felt for the life within. Around and around her hands went, feeling, exploring, hoping. ... She had done the thing that had come to her in a picture, a picture that had come from the Life-Giver. Never before had an infant been plucked alive from the belly of its dead mother. Now it had been done, and it could be done again. ...Until this time of change was over, they did not need to lose them all, (p127)."

From gestation's that last too long and cause babies to be too big, to fragile and weak babies that are born too soon and cannot survive; this book describes the trials and tribulations, but also the power and inspiration of birth throughout early human history.

This is a great book and an easy read. Recommended for those who enjoy anthropology, birth, and a good story about the early course of human history!

Happy Reading!
~Wisdom and Birth

If you've read Circles of Stone, please share a comment with your thoughts :)

Monday, June 24, 2013

What a birth educator wants YOU to know about birth!

I'm a birth junkie, plain and simple. I love learning all about birth and sharing all this knowledge with those around me.

Unfortunately though, my interest in birth has allowed me to witness, both individually and on a population scale, the widespread abuses of women in childbirth. Years of experience as a birth doula, home-based educator for new mothers, and my Master's education in the field of maternal and child health has led me to the firm conclusion that birth in the United States isn't as good for mothers and babies as it can AND should be!

This knowledge and experience has impassioned me to protect and inform women. I want my friends, family members, ALL WOMEN, to understand the options they have for their childbirth. That they don't have to be abused, pressured, or scared. It is my hope that women learn to trust themselves and their bodies and can say "enough" when they are disrespected in their care.

In my experience, many women have an upsetting, dis-empowering, or even abusive first-birth. This is often because they "just trusted" the doctors and the system to care for them - they didn’t research their birth choices, look into their hospital's practices, and ensure they had found a care provider that agreed with their vision of birth. Then, for their second birth they completely change everything and educate themselves so that they can feel more “in control” of their birth and take an active role in decision-making.

Most people will spend more time researching the next car they will buy than researching and preparing for their first birth… don’t be one of those people!!!


Whether this pregnancy was planned or unplanned, expected or unexpected, conceiving was easy or difficult... you have likely been through a great many emotions and decisions up to this point, so CONGRATULATIONS on your pregnancy and for making it this far!

This post is being written for a variety of women; I will recommend things, or just briefly mention an option/topic. If you feel something resonates with you, or you would like to know more about a topic, then by all means follow your intuition and look it up! 

That leads me to my first topic, your intuition. Please begin now in nurturing and developing this sixth sense you have. Learn to trust your heart and gut feelings. Often these intuitions, or "gut instincts", are right...learn to listen to them. 

On that same note, sometimes these instincts get confused with a nagging thought, a thought which stems from stress and fear, especially when we are experiencing the unknown; fear of the possibilities can build and build. Living in fear is never healthy and can lead to many life-long consequences. We know that increased stress across the life-span can lead to poor health outcomes... chronic stress during pregnancy can contribute to preterm birth. Fear guides stress into your life, into the corners of your mind. Banish this fear by educating yourself. There is more information available to you than you could ever ask for, educate the fear away. 


Birth works for the majority of women and babies, the majority of the time. The reality is that very few women and babies will have a true complication in birth. These complications are often apparent before active labor begins, birth occurs, and especially before anyone (mother or baby) were to die. There are very few births that ACTUALLY need medical intervention, but, in our medicalized birth model, there is fear of the "risks and complications" and all motherbabies are treated as ticking time bombs.

While this, of course, is not the case for all medical systems, hospitals, and doctors... it is often the case.

The fear and dangers we hear about in birth come from the doctors and hospitals themselves. They operate in a fear-based model that views birth as dysfunctional and in need of medical intervention to save women and babies from their dysfunctional bodies. Many times, a doctor has never witnessed a woman have a natural birth without any medical intervention - they've never witnessed birth actually work.

This can be further exemplified in the fact that the majority of births in the U.S. are attended by a surgeon, the Obstetrician. If we trusted women's ability to give birth, then midwives would attend the majority of women in birth with surgeons as back up. Fear of litigation has led to doctor's practicing offensive/defensive medicine to protect themselves from being sued in the event something does happen - if a doctor monitored the fetus continuously and then did a cesarean section when the monitor showed a little dip, then they feel safe from being sued because they can say "they did everything they could" - when in reality the mother likely ended up with an unnecessary surgery and will suffer from it.

I believe in your ability to give birth and so do MANY others! You, your baby, and your body were made to work perfectly together in unison to birth a baby safely! This being said, question every procedure, whether it is another ultrasound, amniocentesis, induction, labor augmentation, continuous fetal monitoring, laying on your back, episiotomy, etc… none of which are practiced in an evidence-based manner in hospitals across the U.S.

It is my sincerest wish that you and your baby are able to experience a better birth because you were educated about your birth choices and felt empowered to make them... long before the day when you have to refuse the wheelchair as you waddle into the hospital and begin advocating for yourself, (your partner), and your baby to have a happy, safe, and healthy birth!


Most people will see this headline and be confused because they think the ONLY place and/or the SAFEST place to give birth is the hospital... but this isn't necessarily true. For a healthy woman and baby, home birth can actually be safer than hospital birth due to some of the risks (i.e. hemorrhage) of routine interventions (i.e. Pitocin and Cesarean surgery), frequently overused in the hospital (1). For a healthy woman and baby without any medical indication, a Cesarean surgery carries more risks than a vaginal birth. Always.

HOSPITAL - If you choose to give birth in a hospital be sure to research the hospital and the doctor(s) you will be birthing with. Does the hospital have a high cesarean surgery rate? Do they "allow" Vaginal Births after a Cesarean (which are safer than repeat cesarean section for most women!). If they advertise having "birthing tubs" are they actually used? (more often than not they don't allow women to use them!)
Depending on the answers to these questions you can start to see whether the hospital will provide the kind of atmosphere you need.

If you are wanting a vaginal birth and thinking about trying to labor without medication, but the hospital you are birthing at has a 40% cesarean surgery rate, 85% epidural rate and doesn't allow VBACS... then you may be stacking the deck against yourself and your baby. Find another hospital, another provider, or stay out of the hospital and consider a birth center or staying home.

"High-risk" can be rather subjective at times, with  women over 35 being labeled "high-risk" as well as women with one prior Cesarean section - these cases aren't always high-risk. In some cases a birth center or home birth would be acceptable if the mother desired it, be sure to discuss your choices, risks, and benefits with your maternity care provider!

HOME BIRTH is often the most peaceful, intimate, and empowering for a mother, baby, father, and family. Generally, women and men who choose home birth are well educated about the risks and benefits. They trust the mother, her body, and the baby to work together to complete the birthing process. They believe and trust in birth. Here is a great post from Evidence-Based Birth with more information about home birth. Typically a midwife would assist in a home birth.

Of all the births I've attended, the home births are the ones I personally enjoy the most. I love all births and witnessing the first meeting between parents and baby. But the births that occur at home are so special, so intimate... the experience will keep you feeling whole and loved for weeks and weeks. Many women in developed countries around the world birth their babies at home and ALL those countries have better birth outcomes for mothers and infants than the U.S.

BIRTH CENTERS are a wonderful "middle ground" between hospitals and home birth. They are designed to feel more like home, but have access to much of the same maternity equipment as the hospital. Some birth centers are attached to hospitals and others operate independently, but with a local hospital as a partner in case of emergency. Birth Centers follow a midwifery model of care and as such they are more peaceful, respectful, and family friendly than a hospital birth. Here is an excellent summary of the options and the research from Childbirth Connection.

You also need to choose a care provider (or not, if you are going unassisted!). You can be with a physician such as an Obstetrician or Family Physician in the Hospital, in some hospitals you can also been seen by midwives. If you are delivering in the hospital and they have midwives, go with them! If you are giving birth in a birth center, there will be midwives! If you are delivering at home then you can use a midwife (such as a CNM or CPM). Interview the provider before choosing, to be sure your desires and choices align with their typical practice.

Remember, it is NEVER too late to switch care providers if you feel yours isn't right for you! Trust your gut, your mama instinct, and choose where you birth your baby based off how comfortable and safe you feel. You DO NOT have to give birth in a hospital and for many women the hospital isn't the best and safest place to give birth!


We can't do something without knowing how it works and what to do... and birth definitely isn't any different! You need to learn HOW the body and the baby work together and what can be expected from the labor and birth process. Far too many women enter pregnancy and childbirth with little to no idea how their body works, such as how the uterus works to expel the baby and how contractions open the cervix in two directions, opening wider and pulling up. Understanding how your body and baby work together will give you more confidence that the sensations you feel during labor are progressive and moving you toward meeting your baby.

READ - There are many, many wonderful books now for pregnancy and birth. Really, my only recommendation here is to avoid the book What to Expect when you are Expecting. This book is poorly written and is disgustingly biased toward intervention ridden birth. It is a dis-empowering birth book and is geared towards preparing a woman for how to willingly submit to the medical system.

I recommend reading lots and lots of positive birth stories and books that prepare you for childbirth while also advocating for your rights as a woman and mother to choose which care you receive or refuse. Some excellent books include: Birthing a Better Way: 12 Secrets to Natural Childbirth by Kalena Cook and Ina May Gaskin's Guide to Childbirth. Visit my Resource Recommendations page where I list a number of books with a short review to help you decide what is right for you!

CLASSES - Take a childbirth education class and a breastfeeding class before you give birth! In a class you will have the opportunity to meet other parents, perhaps some seasoned parents as well as new ones, and ask questions of a birth professional. You will learn about the physiologic process of birth, choices you have during labor and birth (such as pain management and infant procedures), and get to practice positions for labor and pushing, as well as natural pain management techniques such as massage. A childbirth education class offered in the hospital might be a little more geared towards preparing you for hospital interventions - rather than natural childbirth. There are many options for natural childbirth education (that also teach about hospital management and choices!) such as Lamaze and Hypnobirth. Learning about Breastfeeding before giving birth will only help you in the long run and make you more confident when any challenges do arise.

WATCH - The Business of Being Born. This documentary is available on Netflix and can be found on the internet. It is very intriguing to watch and provides an excellent overview of the current state of our maternity care system. 

I suggest EVERYONE watch this movie!! You won't be bored, trust me! Additionally, if you are feeling bold and ambitious, watch Orgasmic Birth - you'll be surprised at the secrets the medical community has worked so hard to cover up... that birth can be easy, pleasurable and even Orgasmic!

 Remember how to make those totally normal fears about birth go away? Educate yourself. Read and learn until you understand the things you are afraid of. Read positive birth stories, other people's positive experiences, until you know they are real and possible for you!


Seriously.  Every woman (and her partner) deserves a doula. In many hospital rooms, if a doula is present she is likely the ONLY evidence-based part of care the birthing woman is receiving. Doulas decrease the need for pain medication and epidurals, negative feelings about childbirth, the need for a cesarean birth or assisted vaginal delivery, and the length of time you are in labor; babies born with a doula assisting also had higher APGAR scores. Here is an excellent article from Evidence-Based Birth about Doulas.

Everyone benefits from the presence of a doula, even the dad! Birth is a laborious event and not just for the mother :) Dads are one incredibly important part of the birth team, but they get tired too! Having a doula makes for a very strong birth team where dad and doula can work together to support the mother, but also provide one another breaks without having to leave mom alone. Doulas can also help with questions about care options and providing all types of physical and emotional support.

You can find a doula in your area that you can afford, I promise! You can search for doulas online through an organization such as DONA International. You can also ask doulas that you call if they have other doulas they can recommend. Be sure to interview your doula and only choose one you feel witll fit well into your birth team and that "jives" well with you and your husband/partner. Some doulas in training will provide their service free or for a very minimal fee - please consider tipping these doulas as they work very hard to provide you the best supportive care!


You can go wherever your heart takes you on this one. If you are a writer, write out your birth story, as you want it to be. If you enjoy drawing, then create a picture, crafting, then make a vision board. 

This activity serves multiple purposes. While imagining, writing, or designing your birth vision, you may encounter some fears or concerns you have - then you can address these. You may decide you want to be able to walk around and squat while you push your baby out (best physiological position for birth!), then realize that this may not be possible in the hospital you are currently scheduled to give birth at - then you could change your provider, perhaps look into a birth center or home birth with a midwife.

You can also use your birth vision to create a birth plan. This should be a positively worded one-page document that explains (simply) what is important to you for your birth. One example might be: I wish to have my baby skin-to-skin after the birth, uninterrupted so we can meet one another and establish breastfeeding. I plan to breastfeed, please do not offer my baby any pacifiers, bottles, water, or formula. 

A birth plan may be the most important in a hospital birth to help the nurses and doctors to understand what is important to you. On the other hand... some hospitals, nurses, and doctors disregard them or see them as annoyances - avoid these places and people, they likely do not believe in your childbirth rights and your ability to give birth and make choices. Find someone who does, you and your baby deserve it!


If you have decided to have your baby in the hospital, then stay home as long as possible!! It is often said that the first intervention a woman has in her labor/birth is walking out her front door. The last thing you want is to get to the hospital too early and either 1. Be sent home, or 2. Get trapped at the hospital with their time-constraints and busy hands that may want to intervene. Your labor will likely slow down, even back track, when you leave home for the hospital. So stay home, eat, sleep, rest, shower, drink lots of fluids, BEFORE you go to the hospital and you are on someone else’s turf.

Labor, especially for first time mothers, is going to take quite some time. Having a doula can help you stay home longer by relieving your nerves about being alone without trained support.  Although she will not perform medical tasks, she can help you recognize signs of early labor or labor progress and help you with your decision of when to go to the hospital. If the baby comes when you are at home, don't panic. Many, many babies are born at home throughout time and around the world - birth works very well and it will be successful this time too :)

Bring your own birth gown to the hospital. Remaining in your own clothes gives you more power and confidence... wearing someone else's clothes in their territory makes you more submissive and less likely to feel in control.

Consider walking around outside the hospital for awhile before checking in. Remember how labor likely slowed down when you left home... well, get some progress back before getting locked into the hospital. If it isn't an emergency, and it likely isn't, then take your time :)

Once you are in the hospital - be sure to keep moving as much as possible. They will try to get you into a bed, hook you up to fetal monitors, do vaginal exams, insert an IV (or heplock), and then the intervention snowball begins to pick up speed. Now that you are in the hospital you may be feeling less anxious about the birth (because you feel safe), so try to deflect the interventions as long as possible... they will still be there later if you need them!

Breastfeeding - Breastfeeding gets off to the best start when mother and baby are skin-to-skin after birth and allowed to bond for the first 30min to 1 hour. Breastfeeding is a beautiful, natural way to feed and nourish your rapidly growing baby. Breast milk is the most optimal nutrition you can provide.

Many babies still receive formula or water supplements in the hospital, EVEN when the mother expressed a wish to exclusively breastfeed (some studies say up to 30%). Research shows that just one bottle of formula can alter the baby's gut bacteria (which may have serious consequences in some babies). Formula is not "second best" to breastfeeding, as many of us have been told, another woman's breastmilk is. If you do decide to use infant formula, look into goat milk derived formulas as these are healthier for the infant's system than cow's milk formulas. Cow derived formulas are associated with increased risk of infant illnesses, SIDS, childhood obesity, allergies, asthma, and more.

Even if you aren't sure you want to breast feed, your baby will want to nurse on you for comfort and love after they are born. Perhaps give breastfeeding a try a few times and see how you feel about it after you and your baby get a chance to experience it, together. You can always decide later if it isn't right for you or your baby, but it is harder to go back and try again later. I have personally supported many women who said they did not want to breastfeed, then after the baby was born and rooting around for their nipple, the mothers crumbled with love when their baby latched on. Many of these women ended up breastfeeding for many months :)

If you haven't seen or heard of the "newborn breast crawl" then you MUST watch the amazing process of a baby crawling themselves to their mother's breast and latching - all by themselves! No one needs to force baby to latch, let them find it on their own while you fall in love with your little one and watch the magic happen! Here is one short video of a newborn breast crawl:


If the mother and baby are healthy and there is no medical indication, the pregnancy should continue for AT LEAST 39 weeks. 
The March of Dimes has info about birth before 39 weeks and AWHONN has a 40 week campaign – in case you need some scientific, research-based support to not be induced early! The natural birth advocates around the world say that if mom and baby are healthy, there is no need to induce before 42 weeks. You are not “over-due” until 42 weeks (some would argue as far as 44 weeks because your estimated delivery date may be off by 2 whole weeks!!). In any case, if there is no medical reason to do so, do not induce labor or schedule a cesarean surgery before 39-40 weeks of gestation. Of course, for most women, letting pregnancy begin on its own is the safest choice.

Limit your ultrasounds - there isn’t enough research to PROVE they aren’t causing harm… there are many people (Doctors and researchers included) that are worried about how frequently ultrasounds are done on developing babies and the potential consequences of this. Many women receive more than 3 ultrasounds during their pregnancy without strong medical reasons and there is some evidence to suggest physical changes in the baby when more than 3 are performed... so limit your ultrasounds until we know more! See my post about Ultrasound Safety.

Infant Care - Delay cord clamping and cutting! There is plenty of research to demonstrate this is the best for the baby. Your baby doesn’t need a bath, shots, eye ointment, or anything else for the first hour or two –  protect this time for you, your partner, and the baby - and to establish breastfeeding. This is the first time you are meeting this new life that has grown within you for 10 months and worked with you for so long to get Earthside. Inform hospital staff that you would like some quiet family time - you will never get this moment in time back. The first time you meet your baby is important, make sure to remind the hospital staff to respect this precious moment as such! A doula can help protect this time, help you with initial breastfeeding, and take some pictures of you as a new family.

Prenatal and Perinatal Psychology -  This is a fascinating new field about your developing child and the things they experience and already know. I recommend the book Windows to the Womb by David Chamberlain and Pre-Parenting: Nurturing Your Child from Conception by Thomas Verny. You can read more about my thoughts and discoveries with PPN here.

Diapers and formula -plan now for saving money later... breastfeeding for as long as possible to save on health costs and formula. Consider cloth diapers, even if just sometimes at home, to cut down on expensive diapers. More info here.

In the end, it is ultimately about how informed and prepared you and your partner are, along with how supported you and your partner feel, that makes your birth experience memorable! 

Even mothers who planned all natural birth at home and then needed an emergency cesarean can be happy or content with their birth experience if they felt informed and knowledgeable enough to make choices and if they felt supported, heard, and loved during their birth!!

Trust the Mother inside you and have faith in your baby and your body
YOU are an incredible creation and you have the power to birth your baby! 
You, your baby, and your birth matter!

Congratulations and Happy Birthing!
~Wisdom and Birth

1. de Jonge A, Mesman JA, ManniĆ«n J, Zwart JJ, van Dillen J, & van Roosmalen J. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ 2013;346:f3263 

Thursday, June 20, 2013

Celebrating EBAW 2013 - We can do Better for Birth!

Happy 3rd Annual Empowered Birth Awareness Week!!!
September 2-9, 2013

This is my second year blogging as Wisdom and Birth for Empowered Birth Awareness Week (EBAW) and I am SO happy to see the movement growing!

Last year, for my first EBAW (which was actually the second annual EBAW, but the first one I was aware of!) I wrote a post about what you can do on Empowered Birth Awareness Week to spread the knowledge and advocate for better maternity care for mothers, babies, and families. You can read that post here.

Empowered Birth Awareness Week is one week, at the beginning of September, in which we ALL can do something, no matter how big or small, to improve birth for women all around the world.

Why do we need to improve birth for women in the U.S (and around the world)?


WE CAN DO BETTER than one out of every three babies being born surgically!

WE CAN DO BETTER than two-thirds of women pushing on their backs!

WE CAN DO BETTER than only 6% of women having a doula!

WE CAN DO BETTER than 30% of labors being medically induced!

WE CAN DO BETTER than 50% of mothers receiving Pitocin to induce or augment their labor!

WE CAN DO BETTER than 17% of vaginal births receiving an Episiotomy!

WE CAN DO BETTER than 10% of vaginal births receiving a pubic shave!

WE CAN DO BETTER than only a 14% VBAC rate!

Birth is important! Every woman deserves to feel her birth was special and that her and her baby mattered most during this experience. Unfortunately, the reality is that most women do not feel their birth mattered. Far too often we have to hear about how the "doctor delivered the baby".

Birth is not about doctors, it is not about hospitals, it is not about the caregiver, provider, doula, or nurse...   Birth is about the Mother and the Baby!

We will know that we have done better for mothers and babies when birth is not a feared. When a baby's schedule for birth is respected more than the doctor's and when a woman's body is trusted to give birth without routine and unnecessary medical intervention.

We will know we have finally done better for mothers when women rejoice in their ability to give birth and our culture praises them for it!

Join the movement!
~Wisdom and Birth

Here are some ideas of what YOU can do to for EBAW

Data above came from the Listening to Mothers Survey III

Sunday, June 16, 2013

For my Wonderful Dad, Happy Father's Day!

"Girls Can do..." was always my father's prompt

"ANYTHING!" I'd respond,

and I absolutely believed it.


My father taught me to be strong, passionate, and beautiful. He showed me that although I am the prettiest girl on the outside ;) I am even more beautiful within. He has always encouraged me to share that inner beauty with those I love, and with the world.

He has taught me what I am worth, what I am capable of, and how I deserve to be respected. He fostered dreams and independence within my energetic mind and he encouraged me to extend myself beyond any known boundary.

A father has the power to demonstrate to a young woman what she is worth, based on how he treats her and her mother. A father demonstrates what a man is, how a man should (or perhaps should not) act based on how he cares for his family, his work, and himself.

A father is most surely one of the most influential and important people in the life of their daughter.

A good father can love and support his daughter in many ways, but an incredible father becomes his daughter's best friend, slowly over time, because he knows her heart and has gently fostered her soul.

This is my father, the incredible one.

Happy Father's Day to a Wonderful Dad!

Dad, thank you for the countless diaper changes, late night feedings, and learning how to do 'pony-tails'. For the long walks, long talks, and trips to get ice cream. Thank you for the "ditch-days" from school, letting me shake the shake-n-bake, and our big vacations. Thank you for our motorcycle trips in the mountains, listening to music - just father and daughter for a day :) 

Thank you for our family. For all the people you have brought into my life who have taught me something treasured and valuable, who have shaped me into who I am. Thank you for driving 12 hours, through the night, every year for our annual Thanksgiving trip to Kansas, so we could see our aunts, uncles, and cousins. For showing me how to be devoted to your family and to love them, even when it may be so hard to do. Thank you for my siblings, (yes, all of them!), what an incredible group of people we have pulled together and called family.

Thank you for the hours and hours of phone calls - whether crying, stressed, or exuberant, you've always met me where I needed you to be. Thank you for all the interview advice, for always putting me first, and for reminding me how to be my best. For all the wise words, past examples, and reasons I shouldn't make the same mistakes you had. Thank you for forgiving me, when I made  mistakes.

Thank you for the times when you were hard on me, only because you expected more. Thank you for the times when you didn't give me enough, so I could find my own strength within. Thank you for unknowingly being my "fall guy", when I needed a good lie and thank you for your pushes, when I needed a good shove!

I want to thank you MOST for being a strong and loving example of a man. One who strives to put his family first and to provide for our all needs. For demonstrating what a man and a father are capable of - and for setting the 'bar' high for the man that could reasonably expect to be with me :)

I hope one day my (future) daughter proudly says that her father, the man I chose because of your example, is the best dad ever and that she, like me, is a Daddy's girl :)

So, Papa, Happy Father's Day!! and by the way, this is your 29th Father's Day, counting from pregnancy! may be only of your last few as 'just' a dad! ;)  

I LOVE You, Dad! Always and Forever!

~Daddy's girl,
Wisdom and Birth

Wednesday, June 12, 2013

The optimal inter-pregnancy interval, 18-23 Months

Today I learned how long the optimal inter-pregnancy interval should be. I was previously informed that pregnancies should be spaced at least two years and I had no real opinion on the issue of having "too long" an interval in between pregnancies... I was wrong!

This discovery was prompted by a project I am working on in my Internship with REACHUP, Inc. to create educational materials for consumers about preconception and inter-conception health - like the example below!

For those who don't know, preconception and inter-conception refers to the time before (pre) and between (inter) pregnancies.

Research demonstrates (and frankly so does common sense) that your health before you get pregnant and in between your pregnancies is important to your future health and that of your future baby! Planning your family can help you accomplish important goals, get healthy before pregnancy, and make decisions that will make your future family stronger.

For example, in the case of someone who is overweight, chronically stressed, and smoking, preconception health would mean this individual improves their diet, begins a sustainable exercise program, and gets help to quit smoking - all before becoming pregnant.

But enough about preconception health, I can talk more about that later. Let's look at the research about spacing pregnancies.

In regards to the optimal inter-pregnancy interval, Zhu (2005) evaluated the results of three VERY large studies which collected data on inter-pregnancy intervals and indicators such as preterm birth, low birth weight, and small for gestational age (SGA). All three studies came to strikingly similar conclusions, the optimal inter-pregnancy interval is approximately 18-23 months.

The lowest apparent risk for outcomes such as preterm birth, low birth weight, and being small for gestational age is between 18-23 months, however, an inter-pregnancy interval from approximately 6 months - 5 years demonstrated only slightly elevated risk.

It is in the "extreme" regions of the inter-pregnancy interval that the risks increase significantly. As you can see in the graph below (from the original research article - I have included it to demonstrate the "J-curve" for increased risk in the extremes of the inter-pregnancy interval) a subsequent pregnancy within 6 months increases the risk of adverse infant outcomes. Similarly, Inter-pregnancy intervals of about 4-5 years or greater also see an increase in risk.

Simply put, having babies too close together, or spaced too far apart, increases the risk of the subsequent baby being born preterm, low birth weight, or small for gestational age.

This may be most important for women who have had a previous pre-term, low birth weight, or SGA baby. These women should especially consider ensuring an adequate inter-pregnancy interval between their babies!

There are many ways to "space" your pregnancies, some of which include natural family planning methods such as exclusive breastfeeding and tracking your ovulation. Other methods can include barrier methods such as condoms and contraception like birth control or long-acting forms such as the IUD. Contact your health provider, a local clinic, or planned parenthood for more information about birth control.

Happy Family Planning!
~Wisdom and Birth

Monday, June 10, 2013

The Amazing Date... a Fruit for MORE than Just Pregnancy!

Another perfect food for Pregnancy, and everyone!

I discovered a research article about the beneficial effects of eating dates towards end of your pregnancy! I knew NOTHING about dates, and had to do some research, and I have discovered that dates are wonderful little fruits and should be consumed by everyone :)

The date (Phoenix dactylifera) is a sweet tasting fruit which grows on the date palm, originating in the Middle East and African Regions of the world. There are a variety of date palm species and over 14 varieties of date fruits. Dates may be one of the top 10 foods you should eat. You can use them in so many different recipes (sweet potatoes, salads, desserts!) and they have a long shelf life. The list of various fatty acids, minerals, nutrients, animo acids, vitamins, elements... is so long, this fruit is amazing!

Dates are composed of:
  • At least 15 different minerals such as Potassium, Calcium, Fluorine (great for teeth!), Iron, and Zinc
  • 14 types of fatty acids
  • 23 types of amino acids
  • At least 6 vitamins
  • Dietary fiber
  • and more! (Al-Shahib & Marshall, 2003)
I hope it is already clear that dates can be a healthy part of every diet, but now let's look specifically at what dates may be able to do during pregnancy.

A study from the Jordan University of Science and Technology and published in the Journal of Obstetrics and Gynecology (Al-Kuran et al., 2011) found significant effects on certain birth measures after women consumed dates for four weeks prior to delivery. Participants were recruited at 36 weeks of pregnancy and asked to either (1) consume six pieces (60-70g) of date fruit per day (n=69) or (2) consume NO date fruit (n=45) for the last four weeks of their pregnancy (until labor began).

They found statistically significant results for:
  • Cervical dilatation measured at hospital admission was significantly greater in the date-eating mothers (mean = 3.52cm) than the non-date-eating mothers (mean = 2.02cm). The early stage of labor (Latent Phase) may be shorter in women who consume dates than in women who don't.
  • Upon admission at the hospital, 83% of mothers who consumed dates had their membranes still intact and only 28% of these women were given Pitocin in their labor (synthetic Oxytocin); 60% of the non-date-eating mothers had their membranes intact upon admission and 43% were given Pitocin. Having your membranes (amniotic sac) intact upon admission to the hospital helps prevent additional hospital intervention and risks like infection. If your membranes are broken your risk of infection increases with time (and number of vaginal exams) putting you at risk of receiving Pitocin to "speed things up".
  • Spontaneous labor occurred in 96% of the women who ate dates and only 79% of the women who didn't. They didn't explain this more, such as when women were induced if the labor didn't begin spontaneously, but based on their study parameters that enrolled women at 36 weeks gestation with the intention to consume dates for four weeks likely means that their definition of a full-term pregnancy is 40-41 weeks (longer than our current idea of "full-term" from 37-39 weeks). 

Additionally, and I didn't bullet this because the finding wasn't statistically significant, but the cesarean section rate was higher in non-date-eating women (27%) than in the date-eating women (13%) - I think a larger sample size would show this is significant, but it wasn't for this small group...  just more food (or dates) for thought!

In the original article's introduction, the authors state "there is also anecdotal evidence to suggest that date fruit can contribute significantly to a healthy pregnancy by means of preventing anemia, reducing nausea, controlling blood pressure, regulating blood sugar levels, helping restore depleted calcium, expelling toxins, and increasing strength and immune resistance". They cite research by Al-Shahib & Marshall, 2003, the same authors as above, who have researched the components of dates and health benefits from eating them.

The original article also cites research by Khadem et al. (2007) which demonstrated a statistically significant reduction in the amount of postpartum bleeding experienced by women who consumed date fruit compared to women who received synthetic oxytocin (Pitocin). This was a large randomized controlled trial in two hospitals over a six month period. Women either received (1) dates administered orally or (2) an intramuscular injection of synthetic oxytocin. They list a variety of nutritional components from dates that are likely contributing to the beneficial health effects seen from date consumption, nutrients like Tannin, Linoleic acid, and Iron, which can help decrease bleeding and prevent anemia.

In all these studies the women ate 50-70g of dates per day, or right after birth. This is approximately 3-7 dates, depending on size. These studies are very interesting and since they were rather small their results warrant further research. But, since we have long known that what you eat greatly affects your mind and health, why not start eating healthier today!

Be sure to add dates to your shopping list! ...and make a joke to your sweetheart about picking up some dates at the grocery store ;)

~Wisdom and Birth

Friday, June 7, 2013

ACOG Report - Pitocin use may be bad for babies!

True to form, the medical community has routinely over-used an intervention on women and babies EXPERIMENTALLY before knowing the risks or benefits of wide-scale use. Mass experimentation on women and children has been an ongoing issue with modern western medicine and CLEARLY continues... this time with the drug Pitocin. 

Pitocin, a synthetic form of Oxytocin, is used all too frequently in maternity care to either induce (start) or augment (speed up) labor... a typical intervention on the 'cascade' that SO many women unnecessarily face in the hospital system today. It is WELL KNOWN that Pitocin makes contractions more frequent, more intense, and longer. how could it NOT adversely effect a newborn!? Additionally, research has demonstrated that Pitocin use to induce labor can double the risk of a surgical delivery (Cesarean Section).

According to Birth Certificate data from the CDC 2010 Report and the recently released Listening to Mother Survey III, somewhere between 23-40% of women receive Pitocin to induce their labor and approximately 31% receive Pitocin during labor to "speed things up"; 50% of mothers reported receiving synthetic Oxytocin to either induce or augment their labors! Half of women are being given a synthetic form of Oxytocin without research indicating it is safe for infants... and now a study that actually indicates the opposite.

The American College of Obstetricians and Gynecologists (ACOG) released a report on May 7, 2013 about a study that found Adverse Effects of Pitocin in Newborns. Researchers at Beth Israel Medical Center in New York City conducted a retrospective analysis of 3,000 deliveries of full-term infants, from 2009 to 2011, that were either induced or augmented with Pitocin. To assess infant outcomes, the researchers used the Adverse Outcome Index which is a tool used to measure unexpected perinatal and obstetric outcomes.

The researchers found that the use of Pitocin, for EITHER induction or augmentation, was an independent risk factor for unexpected NICU (Neonatal Intensive Care Unit) admission lasting more than 24 hours. This means that Pitocin alone contributed to babies needing NICU admission. Full-term infants should RARELY be transferred to the NICU - where the baby is separated form the parents, breastfeeding can be negatively impacted and routine procedures done to an infant in the NICU can be traumatic and increase the risk of infection...

They also found that augmentation with Pitocin was associated with lower 5-minute APGAR Scores (of less than 7), which demonstrates that this baby is not thriving. Healthy full-term babies should have an 8 or above on their 5-minute APGAR.  

This ACOG news release acknowledges that there are now CLEAR risks of Pitocin use for BOTH the mother and the infant. The results of this study suggest that medical practitioners need to use VALID MEDICAL INDICATIONS when using Pitocin! ...Such as NOT inducing a healthy pregnancy before 39 weeks. 

This is truly upsetting, to say the least, and an abuse of women and babies in childbirth! Be informed and talk to your provider about how THEY practice medicine and be sure that your provider BELIEVES in your ability to give birth. Remember that you don't have to give birth in a hospital, there are safe alternatives!

Want to know more? Here is an excellent resource about the Evidence for Pitocin use, from Evidence-Based Birth!

~Wisdom and Birth

Saturday, June 1, 2013

Gut Microbiota: a link between Autism, Cesearean Sections, and Infant Formula?

An interesting and possibly alarming connection...

Could the bacteria found in a baby's gut be a link between cesarean sections, infant formula, and Autism? 

Current research is demonstrating that the bacteria found in your gut affects your behavior - additionally, research is also demonstrating that infants fed infant formula and delivered by cesarean surgery have altered gut microbiota, is it possible this is a link between cesarean delivery, infant formula and behavioral disorders such as Autism? Such a link could have substantial repercussions on our population's health. 

Research from UCLA(1) demonstrates that the brain-gut communication flows in both directions.When women were fed yogurt with probiotics, their brainstem and prefrontal cortex were more active (measured using fMRI), meaning that the rational decision making center of their brain was receiving, interpreting, and responding to messages from the body. Conversely, a group of women who received no probiotics or yogurt had greater connectivity between the brainstem and emotional-sensation regions of the brain - think tantrums, road-rage... times when we are irrational and make decisions with our emotions.

Simply, what these women ate in their diets effected the manner in which their brain operated.

Furthermore, researchers in Ireland just published a study in Molecular Psychiatry(2) which found that mice with altered, inadequate, or missing bacteria in their intestinal flora demonstrated social impairments and behaviors similar to those seen in Autism. When treated with a better diet, one that brought microbiota back to normal levels, the mice improved in some, but not all behaviors.

 So, missing crucial bacteria in their gut appears to have altered the developing mouse brain... and led to behaviors similar to those seen in Autism models.

This alone is alarming considering the inadequate diets many of us consume, what that diet may be doing to our brains, and what this means for the brains of our rapidly developing children.
But this isn't necessarily what I am most concerned about. You see, research has also demonstrated that babies born by cesarean section (and babies fed infant formula) have altered and missing bacteria in their gut... could our cesarean epidemic and over-use of infant formula be contributing to our high rates of Autism?

So here is my question...

If gut microbiota influence the way the brain operates, and subsequently how behavior is expressed, AND common obstetrical and infant procedures such as cesarean delivery and infant formula feeding alter the gut microbiota in a rapidly developing infant, then could these routinely used interventions be contributing to some cases of Autism?

Cesarean Sections, gut microbiota and Autism.

Autism diagnosis has been increasing at a rather alarming rate. Some of this increase can be attributed to our improved ability to diagnose Autism, but just some. This increase in the rate of Autism is likely due to many factors, both environmental and genetic.

Researchers have been looking at the prenatal, perinatal, and postnatal periods of development to determine if any procedures, exposures, or experiences, were correlated with an increased risk for Autism. Of course, because Autism is so prevalent, many things are correlated with an increase (such as maternal and paternal age), but when researchers control for a variety of important factors, a few obstetrical events/procedures appear to be risk factors for Autism... one of those is planned Cesarean section (Pediatrics, 2009)(3).

Azad et al. (2013)(4) found that when compared to babies born vaginally, babies born by cesarean section had lower levels of certain bacteria, and were completely lacking bacteria from the phylum Bacteriodetes. Babies born by elective cesarean showed the greatest changes and decreases in gut bacteria. Could this absent bacteria be a factor in their Autistic behavior, such as that seen in the mouse model?

The authors make note that it isn't clear whether bacterial diversity and richness is clinically significant OR if specific "beneficial" organisms being present is more important. But either way, there are CLEAR differences in the gut microbiota of babies born vaginally compared to those born by cesarean, and something we should be concerned about considering about 1/3 of the babies in the U.S. are delivered by Cesarean.

Babies born by Cesarean section are not exposed to the wealth of maternal microbes that nature intended, what are the repercussions of this? Could this explain why Pediatrics (2009)(3) found an increased risk for Autism in babies delivered by planned (often elective) Cesarean deliveries?

What about Infant Formula?

A study from Tannock et al. (2013)(5) demonstrated differences between levels and types of bacterial flora in an infant's gut when fed breastmilk,goat-milk derived infant formula, and cow-milk derived infant formula. Their key findings were two-fold. First, the types of bacteria and amount of bacteria present in the infant's gut were VERY different between breast-fed babies and those fed formula. Secondly, goat-milk derived infant formula leads to bacteria levels and types that are more similar to breast-fed babies that those that are fed cow-milk derived formula. For example, Bacteroidaceae was more abundant in breast-fed babies, hardly found in infants fed goat-milk derived formulas, and absent in infants fed cow-milk derived formula. Unfortunately, cow-milk derived formula is what is most commonly fed to infants.

Azad et al. (2013)(4) found that babies fed infant formula had an overabundance of two bacteria, Peptostreptococcaceae and Verrucomicrobiaceae, what is important about this is that C. difficile, (a member of the Peptostreptococcaceae family) is a pathogen associated with enteric and atopic disease - of which babies fed infant formula suffer from more frequently! Exclusively breastfed babies actually had less bacterial diversity than babies fed infant formula... possibly due to a selective and protective effect of breastmilk, keeping out (destroying or weakening) dangerous bacteria such as C. difficile and keeping babies fed breastmilk healthier!

I am not saying that cesarean deliveries and feeding your baby infant formula will give them Autism, just that there is growing evidence of a relationship between gut bacteria, brain function, and behavior... and that cesarean sections and infant formula have been shown to alter the gut bacteria in an infant. On a population scale, the repercussions could be substantial.

I am not an expert on diet, the brain, or Autism. I am only trying to understand the research and evaluate an incredibly complex issue. However, I do think our routine OVER-USE of obstetrical procedures and medicine (Yes, infant formula is medicine!) are not without their consequences. We should not ignore the potential negative effect that our extremely high cesarean rate and our very high use of infant formula may be having on our children's health. I truly hope there is not a connection between Cesarean delivery and Autism, but why risk it if we aren't sure!?

PLEASE feel free to leave comments, I would LOVE to hear what you have to say!

And while you are at it, why not start eating healthier, it helps your brain function better!

~Wisdom and Birth

(1) Champeau, R. Changing gut bacteria through diet affects brain function, UCLA study shows. UCLA Newsroom, May 28, 2013. 
(2) Desbonnet L, Clarke G, Shanahan F, Dinan TG, Cryan JF. Microbiota is essential for social development in the mouse. Molecular Psychiarty; 21 May 2013. doi: 10.1038/mp.2013.65
(3) Guinchat V, Thorsen P, Laurent C, Cans C, Bodeau N, Cohen D. Pre-, Peri- and neonatal risk factors for autism. Acta Obstet Gynecol Scand, 2012 March; 91(3):287-300. doi: 10.1111/j.1600-0412.2011.01325.x.
(4) Azad MB, Konya T, Maughan H, Guttman DS, Field CJ, et al. Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months. Canadian Medical Association Journal, 2013 March; 185(5). DOI:10.1503/cmaj.121189
(5) Tannock GW, Lawley B, Munro K, Pathmanathan SG, Zhou SJ, et al. Comparison of the compositions of the stool microbiotas of infants fed goat milk formula, cow-milk based formula, or breast milk. Applied and Environmental Microbiology, 2013 May; 79(9):3040-3048.