Two months, 25 blog posts!

Bring on the party hats!

I started my blog on Jan 3, full of trepidation about whether I would be able to keep up with posting three times a week about pregnancy, childbirth, medical history, maternal mortality, etc. After all, I have a job, a family, a dog, and on and on.

But I can do this! And I've learned a lot!

Rubber Ducks

What's next?

My most popular post so far was "Birth in Haiti." You could've knocked me over with a feather.

My own favorites were the two posts I wrote after interviewing Robbie Goodrich, who lost his wife, Susan, last year to amniotic fluid embolism. Robbie was kind enough to talk with me while planning a big birthday celebration for his son, Charles Moses, and honoring Susan's memory on the anniversary of her death.

Career adviser Penelope Trunk tells bloggers not to succumb to the temptation to start that second blog. Penelope, you read my mind! I have been thinking how much fun it would be to lighten up a little, loosen up the voice, write about something else besides the point in childbirth at which bliss and safety concerns intersect.

But you know what? Penelope is right. "Birth Story" is my topic, because for 12 years, since I survived an amniotic fluid embolism during my younger daughter's birth, I have been fascinated with extreme childbirth. So I am going to stay with the difficult stories, the life-saving innovations and all those mixed emotions.

I enjoy the immediacy of blogging, and "meeting" other bloggers, many of whom are moms as well. I've settled into a Monday/Wednesday/Friday publishing schedule. And I'm still finding my voice.

So now we'll embark on the next leg of the journey. Maybe every couple of months I'll drop in a totally irrelevant picture like the one above and celebrate a little, just like today!

Medicine is only as good as its evidence.

People talk about "evidence-based medicine" in obstetrics, and in the holistic birthing community as well, as if it's a sleek, shiny package tied up with a bow and ready for Christmas morning.

But evidence-based medicine is a shambling, messy thing, always on the move, only as reliable as the researchers who conduct it -- and as the research that has gone before and serves as its foundation.

The Lancet's retraction earlier this month of a 1998 study that appeared to establish a link between the development of autism in young children and the vaccine for measles, mumps and rubella is a good demonstration of the fallibility of evidence-based medicine.

One reason the original Lancet study collapsed was that other researchers could not duplicate lead author Andrew Wakefield MD et al.'s results. But even while 10 of the 13 original co-authors withdrew their support for the study, the public absorbed the idea that a cause-effect relationship exists between vaccination and autism.  That idea has not been eradicated by the Lancet's retraction.

And while such a retraction is unusual, it is unfortunately not unheard of.

Last July, anesthesiology researcher Scott S. Reuben MD of Baystate Medical Center in Springfield, Mass., was revealed to have falsified results in at least 21 studies that appeared in several peer-reviewed journals. Anesthesia and Analgesia alone retracted 10 of Dr. Reuben's articles.

Dr. Reuben specialized in multimodal analgesia, a drug-delivery system designed to control the pain of surgery.

In January, Dr. Reuben pleaded guilty to fraud for such audacious creations as a 2005 trial of Pfizer's drug Celebrex as an agent in a multimodal analgesia model. Dr. Reuben accepted $74,000 from Pfizer to conduct the study, simply did not do the work, and then published fabricated results in Anesthesia and Analgesia.

Unfortunately, other researchers based their own work on those phony results.

The collapse of Reuben's data has left multimodal analgesia “in shambles....The big chunk of what people have based their protocol on is gone,” said Jacques Chelly,  an anesthesiologist at the University of Pittsburgh Medical Center, in Anesthesiology News last March.

Pregnant women and drug trials

Should pregnant women participate in trials to discover the effectiveness and potential side effects of new drugs?

This is a controversial topic, because participating in drug tests exposes pregnant women and their babies to possible harm.

Ruth Macklin, an ethicist writing in The Lancet, makes a compelling case for enrolling pregnant women in drug research and retaining women in studies if they become pregnant.Pregnant Graffiti

After all, once approved, drugs go on the market, where doctors will prescribe them to many people across the board, including pregnant women in potentially large numbers, Macklin notes. If researchers haven't had a chance to see the effects of a particular drug on pregnant women and their fetuses, then drugs that cause damage might injure large numbers of people before an alarm is sounded.

We don't have to imagine such an event. Thalidomide, a multi-purpose drug introduced in Europe in 1957, was prescribed for morning sickness for pregnant women. It took four years for researchers to realize and then prove that the drug was causing devastating birth defects. More than 10,000 babies in 46 countries whose mothers had taken thalidomide were born with deformed, often truncated limbs.

"Had the drug been tested in very few women in a ... clinical trial, the mutagenic effect would more likely have been discovered and the number of babies born with deformities would have been much smaller," Macklin writes.

Various governmental bodies, including the U.S. Food and Drug Administration, have gone back and forth on whether to test drugs on pregnant women since it became known that drugs can cross the placenta and affect babies.

HIV-AIDS has forced the issue because not only will pregnant women likely take the drugs that are being developed to combat the fatal disease, but clinical trials also present an opportunity for infected women to obtain potentially life-saving treatment that has not been approved for general use. It is "essential" to include infected pregnant women in these trials, Macklin writes.

The Microbicide Trials Network, based at the University of Pittsburgh and Magee-Womens Research Institute in Pittsburgh, which is working to develop new treatments for HIV-AIDS, is doing just that. In a drug study now under way, MTN is retaining women who become pregnant, and is enrolling pregnant women as well, including healthy, HIV-negative pregnant women, Macklin writes.

However, researchers who enroll pregnant women in studies must "ensure that the informed consent process meets the highest standards," so the women who choose to participate in trials understand the risks to them and their fetuses, Macklin writes.

Image from "Pregnant Graffiti" by Petteri Sulonen

What a difference a century makes!

At the beginning of the 20th century, pregnant women put their affairs in order and kissed their families with fervor before they went into labor, knowing they might not survive their "travail."

A decade into the 21st century, birth has become so safe in industrialized countries that we tend to take that safety for granted. The vast majority of women sail through birth without a hitch.

In addition, women who 100 years ago could not have hopefully embarked on a pregnancy -- women with diabetes, for example -- now are able to bear children with careful monitoring.

Some women do still encounter problems that can be life-threatening, however, and it's not always possible to predict which women those will be.

Nature is not always our friend

The World Health Organization estimates that the "natural" maternal mortality rate, which women with no access to health care could be expected to suffer, is between 1,000 and 1,500 per 100,000 births.

In Ireland, which has the world's lowest rate of maternal mortality, one woman dies per 100,000 births, so attention to laboring mothers makes a difference. In 2005, the worldwide maternal mortality rate was 402 deaths per 100,000 births.

The highest rates occur in politically unstable parts of Africa and Asia, notably Sierra Leone (2,000 deaths) and Afghanistan (1,900). The rate in the United States is 13, up from 12 the previous year. (All figures are from 2005.)

WHO defines maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of the duration or site of the pregnancy, as long as the cause of death is related to or aggravated by the pregnancy or its management, and not from accidental or incidental causes.