Birth Story

“Driving under those conditions is obviously a bad idea," said David Teator of Amanda Norgaard McBride's incredible feat of delivering a baby while driving 70 miles an hour. Teator is senior director of transportation strategies and initiatives for the National Safety Council and an expert on distracted driving, Paul Stenquist reported on the New York Times' "Wheels" blog last week.

The Bemidji (Minn.) Pioneer reported that McBride , 29, who was in labor, and Joseph Phillips, 33, of Bagley, Minn., were on their way to North Country Hospital in Bemidji to deliver their baby when McBride's water broke. McBride was driving; Phillips was not able to drive because of a medical condition.

Phillips thought they should pull over but McBride was anxious to get to the hospital.

Phillips steered while McBride operated the pedals of their 2005 Chevy Cobalt — and delivered the baby, their first child together (each has two other children). Joseph Dominick Phillips was born at 12:20 a.m., weighing 8 pounds. Once the family reached the hospital, McBride and little Joseph were taken into the emergency room area to finish up the birth process, Bethany Wesley reported in the Pioneer. Both mother and baby appeared to be doing well.

Chevrolet announced that it was giving the family a stroller, a safety seat, a year's supply of diapers and other baby gear to celebrate the role of the family's Cobalt in getting everyone safely to the hospital.

Humans aren’t the only ones who have the occasional difficult birth. Here’s a video from the University of Minnesota about Henry and William, a couple of little guys who beat the odds: Only 1 percent of twin births to horses end with two living foals.

(I can’t help wondering how any horses get born at all with those long pointy legs!)

Preterm births in the United States went up steadily from 1981 to 2006, but now they seem to be going back down, according to a new report from the National Center for Health Statistics in Hyattsville, Md.

This is the first two-year downturn in nearly three decades, the report states.

The peak year for preterm births was 2006, when they accounted for 12.8 percent of all births. The rate in 2008 was 12.3 percent.

A preterm birth is one that occurs before 37 weeks of gestation. Babies born before this point are more likely to have serious health problems compared with infants born later in pregnancy. Even babies just shy of 37 weeks are more likely to have "neurodevelopmental problems," or to die before they turn one year old, than are babies born at term, the report states.

Preterm rates appear to be falling among women of all age groups younger than 40, among all ethnic groups, in all types of deliveries and in most parts the country. Several states saw a flat rate of preterm births over the last two years, but only Hawaii experienced an increase. The decrease was similar for singleton and multiple births.

However, the report notes that "the U.S. preterm birth rate remains higher than in any year from 1981 to 2002, with large differences still evident by race and Hispanic origin. Further research is necessary to explain the factors behind the current downturn and to develop approaches to help ensure its continued decline."

There is no arguing with death, except through art.

Here is a poem I found through an Art of Medicine essay by physician-writer Caroline Wellbery MD in the Lancet. She uses it to talk about the value of medical uncertainty.

Dr. Wellbery's article is worth reading, and so is the commentary that went with it in the May 15, 2010 issue.

My Father's Autopsy
by David Gewanter

The one he did, that is, and took me to
when I was 13. I turned as white as
the old woman lying naked there;

but as he clanked out tools I inspected her
quickly, the dead cinder of her nipples,
the stiff tuft at her crotch (“Still black?

Wouldn't it turn gray?”). Dad took stock
of her length, weight, muscle tone, telling me
or the microphone how she lived,

what made her sick. “Like being a detective,”
he said, “except I answer my own questions.
Here; touch this.” But I wouldn't, and

I wanted her body to resist interrogation,
prayed weirdly she never said “aah” for a doctor.
Then he slit and sawed her down the middle –

she opened as easily as a yam, or a duffel
bag; dipping delicately in, Dad scooped
out a handful of stuff, all jumbly

like underwear from Mom's dresser. He
read her guts like a priest: proving
the tubes, slicing wafers from her heart,

so thin they would glow under lens-light –
at last she yielded him a brown pebble
which I felt between his finger and thumb;

then he put it back. Death's story, deduced from
facts hard as bone – as he talked me through it,
I could hear the joyful lift in his voice….

He had little patience for his house,
its prattling unready anatomies,
his wife's “incompetent housekeeping”;

at night he sat over journals and drinks,
compact, severe, inward as a microscope.
Now he's home all day waiting for the mail,

hasn't cut a corpse for years. He calls
every weekend, his news familiar
as a backache, and we talk without fear.

Once I thought my pen would open him here
like the corpse on its single pan of judgment;
but as I cover this pan with pages

he is alive on another one.

David Gewanter, In the Belly, University of Chicago Press.

Often, the annual meeting of a medical group produces a flurry of scientific papers, but the meeting of the American College of Obstetricians and Gynecologists seems more like, say, a bunch of writers  getting together. (I attended the 2009 meeting in Chicago.) As a cohort, OB-GYNs seem to want to find out about the newest approaches, tools and techniques they might put to use in their practices, and perhaps exchange some stories from the trenches as well.

But here's something new for consumers from ACOG, which held its annual meeting in San Francisco this week. The fifth edition of Your Pregnancy and Childbirth: Month to Month was unveiled, along with a new companion website,  www.yourpregnancyandchildbirth.com.

While there are many pregnancy books, this one is "unique in the extent of the medical detail that it covers about all aspects of pregnancy, yet it is designed as an easy-to-read, helpful reference for all of those questions that inevitably pop up," said Hal Lawrence, MD, The College's vice president of practice activities in a press release on the ACOG website.

The latest edition of the book has a new chapter that addresses obesity and eating disorders, another devoted to diabetes during pregnancy, and a third covering other chronic diseases like hypertension, heart disease, celiac disease, lupus, and physical and mental disabilities.

"The majority of women do not experience severe complications, but we felt it was important to give a thorough overview so women will know if something's wrong and when to call a doctor," Dr. Lawrence said.

Another new chapter covers feeding the baby, and includes advice on both breastfeeding and the use of formula.

The American College of Obstetricians and Gynecologists was founded in Chicago in 1951, the latest in a line of associations that has sought to serve the organizational needs of specialists in medicine for women.

By the time the organization was founded, the controversy over whether the two specialties should be practiced separately or together had been largely resolved, which reflected an improvement of the status of obstetrics. (One 19th century proponent of keeping the two disciplines together had characterized obstetrics as "the portal to the temple of gynecology.")

Obstetricians are not the only doctors who deliver babies — family physicians attend about 20 percent of births nationally, and midwives, mostly nurse-midwives, handled about 8 percent of births in 2004. Still, obstetricians deliver the majority of American babies.

ACOG membership is voluntary. The group, now headquartered in Washington, D.C., has 52,000 members, more than 90 percent of board-certified OB-GYNs. Important ACOG activities include the annual meeting, continuing education and the publication of the monthly journal Obstetrics and Gynecology, the so-called Green Journal.

Some of  ACOG's members are specialists in maternal-fetal medicine, gynecologic oncology, reproductive endocrinology, and other areas.

The American College of Obstetricians and Gynecologists begins its annual clinical meeting today in San Francisco. And so, I guess, does the American Congress of Obstetricians and Gynecologists.

Where there was one organization, there now are two, and confusion abounds. I gather that even some ACOG members and staffers aren't sure exactly where the College leaves off and the Congress starts.

Here's "the basic explanation" I got from ACOG's press office when I inquired about the new name on the ACOG website:

The College and the Congress are two separate and distinct legal entities, although they are companion organizations.

The American College of Obstetricians and Gynecologists is a 501(c)(3) organization and its activities include producing the College's practice guidelines and other educational material.

The American Congress of Obstetricians and Gynecologists is a new 501(c)(6) organization that was formed December 31, 2008 and is operational as of January 1, 2010. The Congress focuses on socioeconomic, political, and grievance activities for its members.

Here's an old riddle. I am using the cognitive scientist and author Douglas Hofstadter's version, which appeared in Scientific American in 1982. If you find you can't solve it, contact me and I'll email you the answer.

A father and his son were driving to a ball game when their car stalled on the railroad tracks. In the distance a train whistle blew a warning. Frantically, the father tried to start the engine, but in his panic, he couldn’t turn the key, and the car was hit by the onrushing train. An ambulance sped to the scene and picked them up. On the way to the hospital, the father died. The son was still alive but his condition was very serious, and he needed immediate surgery. The moment they arrived at the hospital, he was wheeled into an emergency operating room, and the surgeon came in, expecting a routine case. However, on seeing the boy, the surgeon blanched and muttered, “I can’t operate on this boy — he’s my son.”

What's the explanation? As Hofstadter wrote, "You'll know when you've got it, don't worry."

We're halfway through National Women's Health Week, a time for women to remember that a mother's health is the linchpin for the whole family's health.

On Monday, National Women's Check-Up Day, we were all supposed to make all our necessary medical and dental appointments. If you missed it, you might consider making one or two of those appointments today.

If you're not sure what sort of maintenance you need to do, check out the Interactive Screening Chart and Immunization Tool on the U.S. Dept. of Health and Human Services website. It breaks down recommended exams, screenings and immunizations by age groups and classifications of health (mental health, reproductive health, oral health, to name a few).

The website notes that it's a good idea to talk with your health-care professional about the recommendations.

The basics of women's health are these, according to the HHR website:

*Get at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of both each week.

*Eat a nutritious diet.

*Visit a health care professional to receive regular checkups and preventive screenings.

*Avoid risky behaviors, such as smoking and not wearing a seatbelt.

*Pay attention to mental health, including getting enough sleep and managing stress.

"The Favorite" by Leon-Francois Comerre, courtesy of Wikimedia Commons

We're in the thick of the 50th anniversary rumination on "the Pill," which has been blamed for precipitating "the sexual revolution" -- it was hardly the only impetus -- and has probably played a role in lowering maternal mortality as well. In May 1960, the U.S. Food and Drug Adminstration began the process of allowing the pharmaceutical maker G.D. Searle & Company to market its drug Enovid as the first oral contraceptive.

A hundred million women worldwide use oral contraceptives now; where the average American women had 3.6 children in 1960, she now has 2. That's an important figure for our maternal mortality statistics, as the more children a woman has, the more likely she is to die in childbirth.

Margaret Sanger, who coined the term "birth control," was driven first to become a nurse and then to make disseminating birth-control information her life's work after watching her mother's 18 pregnancies contribute to her death at age 50.

When Sanger began her crusade, the Comstock Law of 1873, an anti-obscenity measure, made it illegal to publish information about birth control, and she was arrested more than once.

In 1936, ruling in U.S. vs. One Package of Japanese Pessaries, Judge Augustus Hand of the U.S. District Court of Appeals in New York exempted birth control devices from restriction under the Comstock Law, which had been absorbed into the Tariff Act of 1930. This was the first step toward making birth control legal. The case came out of Sanger's importation of a shipment of "pessaries," in this case essentially a diaphragm, for distribution through the birth control clinics she had fielded since 1916.

Working with the wealthy philanthropist Katharine Dexter McCormick, Sanger formed the organization that would become the Planned Parenthood Federation of America. (In the spring of 1960, Sanger was 80 and McCormick was 84.)

The researchers John Rock and Gregory Pincus, working first independently and then together, developed an oral contraceptive that they tested in Puerto Rico to get around laws that persisted against birth control on the American mainland.

There have been some great recent stories about the Pill at 50 in the press. I thought Time magazine did a nice job of summing up the pre-Pill atmosphere, the history and today's landscape, and PBS has a useful timeline on birth control from "The American Experience" on its website.

Flashing back to a time when people were arrested for sharing information on birth control is pretty chilling, especially given the fact that it wasn't very long ago.

As Sanger put it, “No woman can call herself free who does not own and control her own body.”

Image from Wikimedia Commons  http://creativecommons.org