Birth Story

Annie Murphy Paul's new book, Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, is getting the star treatment. It is the subject of a Time magazine cover story (written by Paul), and an article by the New York Times' Motherlode blogger, Lisa Belkin.

And why not? Paul has written what looks to be a fascinating exploration of the explosion of research on the effects of the environment human beings encounter while developing in their mothers' wombs.

In a guest post for Motherlode (the link is above), Paul writes, "Startling as it may seem, qualities ranging from our intelligence to our temperament to our health, and our susceptibility to diseases as varied as cancer, asthma, obesity, diabetes and mental illness, are affected by our experiences as fetuses decades ago."

We have already considered one aspect of this research here at Birth Story, how a mother's weight gain during pregnancy can influence her infant's lifetime chances of being able to maintain a healthy weight. But Paul covers the waterfront in this "new chapter in the long-running nature-nurture debate," as she calls it.

In her Motherlode guest post, Paul raises and then downplays the likelihood that mothers will be blamed for anything that goes awry with their children, given the new understandings of the importance of what goes on in the womb.

Love Paul's optimism! And, I'm impressed she researched this book while she was pregnant. I'm looking forward to reading it.

Saving women's lives in the developing world can start very early, with the education of young girls. That's the message of the "The Girl Effect," an initiative of the Nike Foundation, which has been working to lift girls out of poverty since 2004.

"The Girl Effect," a collaboration with the NoVo Foundation, focuses attention on the importance of reaching pre-adolescent girls before they are carried off into marriage, pregnancy and, often, another revolution of the cycle of poverty.

“If there’s a time to act in the fight against poverty, it’s when a girl stands at the crossroads of adolescence – yet today less than half a cent of every dollar spent on international assistance programs is invested directly in girls. We believe the girl effect deserves more attention,” Maria Eitel, president of the Nike Foundation, has said.

"The Girl Effect" first made a splash with the following video.

Every ninety seconds, somewhere in the world, a mother dies in childbirth. For three days this week, in Times Square in New York City, Amnesty International, a global human rights group, placed a "maternal death clock" to note each minute-and-a-half marker.

The clock was hung in conjunction with the big meeting the United Nations was hosting, the subject of which was how the nations of the world are doing on eliminating poverty and other ills, including infant and maternal mortality.

So far, Goal 5 (of the eight Millennium Development Goals), cutting maternal mortality by 75 percent by 2015, is lagging the rest.

All told, nearly 1,000 women die in childbirth every day, according to estimates by the U.N. and the World Bank.

“It’s such a clear example of people dying who don’t need to,” Larry Cox, the executive director of Amnesty International USA. told the New York Times' Clyde Haberman this week.

World leaders gathered in New York this week for the so-called September Summit to beat the drums for the Millennium Development Goals of the United Nations, one of which is slashing the rate of maternal mortality in the developing world.

The official name of the meeting is "The High-Level Plenary Session of the General Assembly." This year, the spotlight is on the MDG. Only five years remain until the 2015 deadline for meeting the eight goals; however, only a couple of them are likely to be met by then.

Barring a breakthrough, Goal 5, reducing maternal deaths by 75 percent, will not be one of the successes.

The World Health Organization, an agency of the United Nations, recently issued an update on Goal 5. The goals were set in 1990. The update looked at the most recent figures, which are from 2008.

While 10 of the 87 countries targeted in the program have brought down their rates of maternal mortality by 5.5 percent, 30  other countries have made little or no progress.

Ninety-nine percent of maternal deaths in 2008 occurred in the developing world.

The Baby Friendly Hospital Initiative, an international program, has created a list of things birth facilities in the United States can do to optimize the chances that mothers will choose to breast-feed their babies.

Here are "The Ten Steps To Successful Breast-feeding," from BFHI USA:

1. Have a written breast-feeding policy that is routinely communicated to all health-care staff.

2. Train all health-care staff in skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of breast-feeding.

4. Help mothers initiate breast-feeding within one hour of birth.

5. Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infants.

6. Give newborn infants no food or drink other than breast milk, unless medically indicated.

7. Practice “rooming in” — allow mothers and infants to remain together 24 hours a day.

8. Encourage breast-feeding on demand.

9. Give no pacifiers or artificial nipples to breast-feeding infants.

10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

The BFHI is underwritten by the World Health Organization and the United Nations Children's Fund (UNICEF).

Fewer than 4 percent of births in the United States occur at facilities that are considered "baby friendly," according to the latest Breast-feeding Report Card, issued this week by the Centers for Disease Control and Prevention.

That's interesting, in light of the fact that birth is the one point at which the nation's breast-feeding practices actually meet the goals set by Healthy People 2010.

And, it raises some questions: Are American women determined to breast-feed even in the teeth of an unsupportive environment? Or does strong support from the hospital not matter much in their decision? Do problems caused by settings where breast-feeding is not actively promoted only show up later?

Or are environments that come after the birth facility, including families, other medical advisers, child-care centers and workplaces, even less sympathetic to breast-feeding?

Only two hospitals in Illinois, my home state, are among the 99 "baby friendly" facilities recognized by the Baby-Friendly Hospital Initiative as providing "an optimal level of care for infant feeding." These are Pekin Hospital in Pekin and St. John's Hospital in Springfield.

Thirty of the hospitals on the list are in California.

"Although the hospital is not and should not be the only place a mother receives support for breastfeeding, hospitals provide a unique and critical link between the breastfeeding support provided prior to and after delivery," the BFHI's website states.

The BFHI is a joint global effort of the World Health Organization and the United Nations Children's Fund (UNICEF).

Three-fourths of American babies start life on the breast, but moms are giving up on breast-feeding sooner than officials would like to see.

Healthy People 2010, a national statement of health goals, sets the bar for breast-feeding at birth at 74 percent. Fully 75 percent of American moms are breast-feeding at birth, so the country is (barely) meeting that objective.

However, the goals would have half of mothers breast-feeding at six months of life and a quarter continuing on at a year. In practice, 43 percent are breast-feeding at six months and 22 percent at one year.

"We need to direct even more effort toward making sure mothers have the support they need in hospitals, workplaces and communities to continue breastfeeding beyond the first few days of life, so they can make it to those six- and 12-month marks," said William Dietz, M.D., Ph.D., director of Nutrition, Physical Activity, and Obesity for the Centers for Disease Control and Prevention in Atlanta, Ga.

The CDC issues an annual report card of how "key community settings" like hospitals and child-care centers are supporting breast-feeding, which research has demonstrated can improve an individual's lifetime health outlook.

While the overall news is good for moms' getting a start on breast-feeding at birth, the swing among the various states ranges from 90 percent in Utah to to 53 percent in Mississipi.

Trepanning is the world's oldest surgery. A procedure in which a hole up to two inches in diameter is cut in the skull, trepanning is known to have been performed at least 8,500 years ago, and trepanned skulls have been found all over the world.

Why it was performed all those years ago is a mystery. Healing at many of the wounds tells us that at least some subjects survived — and in some places, there were many subjects.

Perhaps the ancients knew that trepanning, also known as trephination, could relieve pressure on a swollen brain. Perhaps they were hoping to rid one of their clan members of evil spirits, or cure mental illness, or clean up a head wound.

Trepanning has been performed throughout history. A modern trephination movement, founded in the Netherlands in the 1960s, holds that cutting a hole in adults' heads allows their consciousness to expand. That movement has its adherents in the United States as well.

Every pregnancy begins with a 3 percent chance that the resulting baby will have birth defects, and that is before individual genetic and environmental histories come into play. Some birth defects cannot be prevented or fixed. Medicine cannot work miracles.

That's the message in "The perils of the imperfect expectation of the perfect baby," an article in this month's American Journal of Obstetrics and Gynecology. Prospective parents need to understand that "perfection in pregnancy is not attainable now or even in the foreseeable future," according to the article's authors.

Doctors too can get drawn into "expecting more from medicine than its limited diagnostic and therapeutic capacities justify," say the article's authors, led by Frank A. Chervenak MD. Not only that, but "many pregnant patients are optimistic about the advances in medicine and are confident that their physicians will solve all problems that could occur with their pregnancy."

In fact, everyone needs to get in touch with "the inherent errors of human reproduction, the highly variable clinical outcomes of these errors, the limited capacity of medicine to detect these errors, and the even more limited capacity to correct them," the article states.

The expectation that a perfect baby can eventually be taken away from every pregnancy "assumes powers of medicine to control human reproduction that medicine does not possess," the article states.

September is Be Kind to Writers and Editors Month, and as both writer and editor here at Birth Story, I intend to take advantage of this important event. I've been writing some long posts, but I'm hoping to keep them a bit shorter this month.

September is also Baby Safety Month, as well as National Preparedness Month, two interrelated observances, you could say, as planning ahead could help keep that baby safe.

Jane E. Brody's Personal Health column in the New York Times Science section today, for example, suggests that moms should adopt a healthy regimen, and maintain a lean frame, even before they get pregnant, if they want to help their children avoid becoming overweight themselves.

Brody's piece is a survey of the present understandings of how a mother's weight while pregnant affects the health of her fetus.

Her chief reference is a recent Lancet article that sought to tease apart the influence of genetics from the effects of more-than-adequate weight gain during pregnancy.

A separate study in Circulation "found that a woman’s weight before pregnancy was even more important than excessive weight gain during pregnancy in predicting a number of risks for the baby" that included childhood obesity," Brody writes.

"The new findings suggest that Americans are now caught in a vicious cycle of increasing fatness, with prospective mothers starting out fatter, gaining more weight during pregnancy and giving birth to babies who are destined to become overweight adults," Brody writes.

The latest recommendations from the Institute of Medicine, a subsidiary of the National Academy of Sciences, call for these weight gains during pregnancy:

¶28 to 40 pounds for thin women, with a B.M.I. of 18.5 or lower.

¶25 to 35 pounds for normal-weight women, with a body mass index of 18.6 to 24.9.

¶15 to 25 pounds for overweight women, with a body mass index of 25 to 29.9.

¶11 to 20 pounds for obese women, with a body mass index of 30 or higher.

Image courtesy of Wikimedia Commons