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Traditional Chinese Medicine and the Mystery of Preeclampsia

Preeclampsia is one of the leading causes of maternal and infant death. Globally, conservative estimates place the death toll at 76,000 maternal deaths and 500,000 infant deaths every year. In the United States, preeclampsia and other hypertensive syndromes account for about 18% of maternal deaths and about 15% of premature births every year. And while it is relatively common (affecting about 5-8% of pregnancies), a great deal of mystery surrounds hypertensive pregnancy. Western medicine has no known cause for these disorders and sometimes doesn’t diagnose them until it’s too late to save the baby or mother. Mysterious syndromes like this are where Traditional Chinese Medicine can offer some answers and treatments.

Over the past six months, I have seen my husband make dramatic progress using TCM herbs, diet recommendations and acupressure to address digestive inflammation and autoimmune conditions. Eating healthy paved the way for better health, but TCM has helped him finally resolve long standing issues that we had no answers to before. TCM has also been known to resolve many cases of “unexplained” or “hopeless” infertility and autoimmune conditions. So what is it about TCM that makes it so different than Western methods?

For starters, TCM has been around for longer. Much longer. Wait, let me rephrase that. Much, much, much longer. The Chinese have been using what we call TCM for around 2,500 years, whereas our current pharmaceutical based approach has been in use for about 100 years. So with TCM we’re talking about centuries of observation and practice, not years or even decades. The other difference is in approach. The Chinese used a pattern of inductive and deductive logic to understand how the body worked. Their understanding of anatomy and biology came from observing what strategies caused the disease (or disharmony as they would call it) to resolve itself. (This is why TCM terminology is different than that of Western medicine.)  In contrast, Western medicine studies anatomy and biology and then bases treatment on its current theories of how the body works. While this can have some efficacy, it is limited because we are always learning new things about how the body works.

Another difference is that TCM tends to see the body as a whole with many interrelated parts while Western medicine tends to view diseases and disorders in isolation. For example, if you were to go to a Western doctor for fertility treatments, you might get a prescription for a drug to induce ovulation or undergo procedures to mechanically fertilize and implant eggs. The reproductive system is viewed as having a problem isolated from anything else in the body.  But if you go to a Doctor of Oriental Medicine, she will feel your pulse, look at your tongue, ask you about your diet, and other symptoms like stools and urine, whether you tend to feel hot or cold, if you have headaches and when, if you are prone to certain kinds of infections like yeast infections or colds and flu, do you experience dizziness, changes in vision, etc. etc. (TCM is very thorough!) All of these are important to a TCM practitioner because the patterns of what is going on in the body as a whole can tell her what underlying disharmony is causing the infertility. Once she knows that, she can prescribe herbs, diet changes, and acupressure/acupuncture to help resolve that underlying disharmony and bring the body back into balance.

So back to preeclampsia. What can TCM tell us about preeclampsia? Well to start with, the patterns that are associated with high blood pressure are called Liver Yang Rising and Kidney Yin Deficiency. What symptoms are associated with these patterns? Liver Yang Rising is known to cause headaches, convulsions, seizures and hypertension, all symptoms of preeclampsia. In fact, bleeding from the liver is a serious complication that can result from preeclampsia. Liver Yang Rising is also associated with a phenomenon Western medicine calls a Transient Ishcemic Attack. A TIA is basically a mini-stroke and can often be a sign that there is risk for a major stroke. This is important because strokes are on the rise among pregnant women and preeclampsia is one of the main causes. Kidney Yin Deficiency presents with preeclampsia symptoms such as reduced dizziness, urine output and low backache.

One of the strengths of TCM is that it can address underlying problems rather than simply trying to perform damage control by using medications to stop symptoms. As we start to learn more about other kinds of medicines and open up to what they have to offer, we could potentially see some leaps forward in maternity care.

Tips On Transitioning To Healthy Eating

Diet has more of an impact on a baby’s health than most people think. I know from experience because I was folate deficient when I got pregnant and had baby with a birth defect as a result. And if you start your kids out eating healthy from an early age, they will love good food and health and weight will be less of an issue for them. Our kids have been known to throw tantrums in the produce aisle at the grocery store. I’m not exaggerating. I let my 18 month old push around a baby sized grocery cart when I go grocery shopping and every single time he heads straight for the bananas and starts piling them in his cart.

This is by no means meant to be any sort of comprehensive advice on how to start eating healthy. It’s more like what I wish I had known five years ago when we first started our journey towards healthy eating. This doesn’t have to be a grueling or extremely expensive process. There are a few relatively simple things that can really help in smoothing out the transition to a healthy diet. So here are a few ideas based on my family’s experiences with learning to eat for wellness.

Start with a green smoothie every day

Leafy greens have the highest nutrient density of any food on the planet. They are a powerhouse for all kinds of nutrients! Unfortunately, our modern stomaches and mouths are not very used to eating leafy greens (outside of nutrient deficient iceberg lettuce that you find at most restaurants). I remember hearing admonitions to eat more leafy greens and feeling like someone had asked me to eat add more cardboard to my diet. Ick.

This is why starting with smoothies is so great. Take a regular fruit smoothie and a few greens to it and voila- you have added some greens to your diet! If you are on the go, you can even find them at Jamba Juice now. Green smoothies start getting you used to the taste of greens. Slowly, you’ll find yourself transitioning towards liking the taste of leafy greens and vegetables. Pretty soon you’ll find yourself eating salads with dark leafy greens and enjoying it. Victoria Boutenko was the first to really advocate the idea of drinking green smoothies for health. She has great recipes on her site. Another great place to look for recipes is on Kris Carr’s site. (Kris was diagnosed with terminal cancer at 31. The doctors told her she had no chance to live so she decided to she had nothing to lose by trying nutritional therapies. She wrote a bestselling book called Crazy Sexy Cancer.) Eating Bird Food has some green smoothie recipes too.

Add some apple cider vinegar and blackstrap molasses

I started doing this halfway through my second pregnancy and noticed that I had more energy when I did. I find it helps with digestion too. I personally do raw apple cider vinegar.  Blackstrap molasses is a good source of iron, potassium and calcium, so a tablespoon gives you a good kick of vitamins and minerals too. Potassium has a lot of potassium as well. Make sure your molasses is blackstrap molasses. Other molasses can be refined and doesn’t have the high nutrient content that blackstrap does. Here is a great article from Dr. Christopher’s Herbal Legacy about ACV. I like to have a glass of this before every meal.

You don’t have to invest in a lot of expensive machinery.

Ever heard of the 80/20 rule? In 1906 an Italian economist named Vilfredo Pareto noted that 80% of the wealth was owned by 20% of the people and 80% of the people owned 20% of the wealth. Others took this principle and started applying to fields like management and business. There are a few things that are essential (20%) and a lot of things that are not essential (80%). And it tends to take 20% of the time, effort and resources to accomplish 80% of the job and 80% of the time, effort and resources to accomplish the last 20%. Wellness is no different. 80% of health comes down to eating right, exercising and good thinking. And it takes about 20% of your time, money and effort to reach that 80% of wellness. The other 20% can be accomplished with more expensive machines, but you don’t need those to get to the 80% mark.

When we were first transitioning our diet, we were big followers of a local health blogger. She was touting the benefits of a device called a water ionizer that costs thousands of dollars and would run “group buys” where people could get a bit of a discount on the device by buying though her site. She talked about how crucial water ionizers are to good health and how dramatic the improvements in your health would be if you had one. I thought  to myself, “If only we had enough money to buy one of that water ionizer! Then my husband would really be healthy! He would feel better and we would be happier!” Then she started doing group buys for a special infrared sauna that had special colored that would help in detoxifying the body and then I thought, “If only we had enough money to buy a sauna like that! We would be so much healthier and happier!” I’m really glad now that we didn’t have money to buy these devices. They could be great down the road. But having to change our diet on a budget focused us on what really matters: eating whole, unprocessed food, exercising and changing our mindset to be more positive and productive.

I will say that some devices can make your life easier with healthy eating. We had a Blendtec blender for a while and it really did give us smoother, better blended smoothies than a cheap blender. But we started with a cheap blender and started reaping the benefits immediately. My husband really wants a Norwalk juicer one day. They really are more efficient. They don’t leave you with a mound of fruit and vegetable pulp after making juice like most cheaper juicers. However, he got started juicing with a $99 Jack LaLanne juicer from Target and that carrot juice did a lot of good for him. Focus on making changes rather than getting equipment.

Don’t drink tap water

Speaking of water, what kind should you drink? Well, I’ve heard a lot of different opinions on the matter (distilled, alkalized, etc.). I really don’t know who is “right”. I will tell you what I believe. I believe that 80% of  good health with water comes from simply removing the impurities by filtering. We also add lemon essential oil drops to our water bottles to purify it further. I make my own kombucha and I can tell you that the multi-stage filtration water from the grocery store is clean enough to to grow a kombucha mushroom. According to the President’s Cancer Panel, filtered water will reduce your risk of cancer. So there you have it, don’t drink tap water.

Watch for “sensitive foods”

This was a huge turning point for my husband’s health. As we started monitoring how he felt after he ate certain things, we found that certain foods set off his digestive inflammation really badly, like tomatoes and dairy. Eliminating foods that cause you inflammation can go a long way towards helping you feel better.

Eat cold pressed oils 

Cold pressed oils are the purest and have the least risk of trans fats. With olive oil, make sure that it’s first cold pressed. Unrefined coconut oil is a great substitute for butter if you have to go dairy free.

Grind your own flour

This was a big one for me. I found that I got really anxious and irritable after having flour or bread from the store- even if it was organic and whole grain. We got a grain grinder a few years ago and every week or two I grind up some flour and put it in the fridge for storage. This keeps the flour from getting mold and fungus. We got a Blendted grain grinder, but I’ve heard people say they grind their own flour in Blendtec blenders too. We don’t eat very much flour (rice and beans is actually the staple of our diet), but we’ve found rye flour works best because of its higher protein content. We often use a blend of half rye and half chickpea flour to make desserts like brownies and lemon cake because it increases the protein content so you don’t have that “carb rush” afterwards.

Replace temptation with something better

We love to eat dessert! This can be a really hard thing if you’re trying to change to a healthy diet. If you feel deprived, you’re more likely to “cheat” and then end up back where you started. So we’ve moved towards eating desserts with healthier ingredients, all of the fun and none of the guilt! Using better sweeteners helps a lot. If you’re on a tight budget, try sucanat. It’s unrefined cane sugar and doesn’t “spike” the same way refined sugar does. Other options are coconut sugar (low glycemic), maple syrup, rapadura (this actually retains a lot of iron) and raw honey. I do use some stevia leaf extract too. I really love the blog Chocolate Covered Katie. She has so many awesome dessert recipes using healthier ingredients. She’s vegan, so her recipes are dairy free, but I think it’s well worth it for anyone who is trying to eat better.

Emotional eating? Try meditation

If you’re struggling with emotional eating I really recommend kundalini yoga and meditation. There is a specific meditation for addiction that is especially good. I did this meditation for several months to work through negative thought patterns and worry and it helped me immensely! I know a few people who have used it to kick emotional eating and computer game addictions as well. I did three minutes of this meditation a day, but if you are really struggling, you can do more. Here is a link for how to do it. You should tune in before you meditate and tune out afterwards. 

Don’t get hung up on supplements

When we were first married, my husband was into supplements for weight lifting, but he was still struggling with his workouts. It wasn’t until we started making all the changes to our diet that he really started to see improvements in his athletic performance. If you need to supplement a particular vitamin or mineral go ahead and find a high quality supplement, but on the whole our bodies were meant to get nutrients from food, not pills. If you’re eating a diet that is high is nutrient dense greens, vegetables, fruits whole grains and legumes, you will get most of what you need right there. There is no substitute for eating nourishing food.

Birth Apologetics: Homebirth Advocate Dies Giving Birth

Note: This post is part of a series called “Birth Apologetics”. “Apologetics” comes from the Greek and means “to speak in defense”. (Often used in relation to defense of a particular idea or viewpoint, such as “Christian Apologetics”.) In these posts, I will be taking blog posts and articles that are critical of home birth and natural birth and doing a critical analysis on the data and arguments. The idea is that if natural birth and home birth are safe for most women, arguments against them will have serious flaws.

Claims: Australian homebirth advocate Caroline Lovell suffered a cardiac arrest an hour after the birth of her second baby at home and subsequently died at a hospital. This is yet another proof of the dangers of homebirth and childbirth in general. A detailed news article is here, many of the facts cited in this post will come from this article.

Analysis: The first thing to understand in dealing with an individual case is what it can and can’t tell us. The death of Caroline Lovell is one incident and can not be used alone as proof of the safety of homebirth in all cases. What it can tell us is what happened in her specific case and possibly whether a homebirth was a bad decision for her individually, or if in this specific case the midwives were some how lacking in the care they gave to her. It could possibly highlight problems within the homebirth and medical communities within Australia specifically. It can not tell us about homebirth as a whole, especially when we consider that other countries like the Netherlands and the United Kingdom have a greater degree of cooperation between midwives and doctors than countries like Australia and the United States.

While this proved to be a very emotional topic in the media, we would all do well to remember that mothers also die in hospitals. For example, when a London mother died after an elective c-section at an upscale maternity clinic, there were no news reports about the dangers of elective c-sections or calls to outlaw elective c-sections, even though elective c-sections carry an increased risk of neonatal death and c-sections have an increased risk of maternal death as well. So I really feel that there is a double standard the media and the public have when it comes to maternity care.

However, examining the case of Caroline Lovell as an individual incident has definite merits. If something went wrong at the birth that could be prevented by better preparation on the part of the midwives or by giving birth in a hospital I think we need to know so that we can learn from it. As of a few months ago, the inquest had narrowed the cause of death down to what the  experts think are the three most likely causes of death: postpartum hemorrhage, pulmonary embolism or amniotic fluid embolism. So let’s take a look at each of these possibilities.

Postpartum hemorrhage: The news media has paid a great deal of attention to the possibility of postpartum hemorrhage and reports of Caroline Lovell having lost “litres of blood”. However, when understood from a clinical standpoint, the possibility of postpartum hemorrhage becomes less likely. The inquest found that the midwives knew that Caroline had a uterine fibroid, but did not know that she had a history of postpartum hemorrhage from her previous birth at a hospital. It seems the records they received about the previous birth may not have been complete. Uterine fibroids do carry an increased risk of postpartum hemorrhage, though most women with uterine fibroids have uncomplicated pregnancies. Much of this depends on where the fibroid has grown. Fibroids in the pelvic area can be especially problematic, where as those in the upper part of the uterus tend to cause fewer problems. For a great discussion from several UK midwives on fibroids during pregnancy and labor, check out this link here.

In areas of the United States where midwives are allowed to attend homebirths, it is typical for the midwife to be required by law to carry pitocin with her to the birth to stop postpartum hemorrhage. (If you’ve seen The Business of Being Born, you might remember the New York midwife who talked about having pitocin ready before hemorrhage becomes a problem.) So while it’s possible that Caroline Lovell was at an increased risk for postpartum hemorrhage, there are ways to handle it at home. Also problematic with this theory is the fact that the amount of blood she lost was 400 milliliters of blood and postpartum hemorrhage is generally defined as a loss of 500 milliliters or more. A minor postpartum hemorrhage is usually defined as between 500ml and 1000 ml, and a major hemorrhage is usually defined as a loss greater than 1000 ml of blood, so the amount of blood is not consistent with a severe hemorrhage.

Pulmonary embolism: A pulmonary embolism is when the pulmonary arteries of the lung become blocked, usually by a blood clot. A pulmonary embolism can cause cardiac arrest, which was the cause of death for Caroline Lovell.  Cardiac arrest from pulmonary embolism usually happens very fast and is typically fatal, and usually the cause of death is only discovered during autopsy. The symptoms of pulmonary embolism are consistent with the symptoms Caroline displayed after the birth such as fainting and loss of consciousness. In fact, pulmonary embolism is one of the leading causes of maternal death in the developed world. (As a side note, research has found that there has been a significant increase in pulmonary embolisms during pregnancy because of the increasing cesarean rate.) So there is a pretty strong case for death being due to a pulmonary embolism. If that is the case, a hospital may have been able to provide resuscitation if the staff figured out that a cardiac arrest was about to occur, however, this would be no guarantee. One study found that of patients who died suddenly and unexpectedly in hospitals, 80% had died from a massive pulmonary embolism.

Amniotic fluid embolism: This is a rare, but very serious complication where amniotic fluid enters the mother’s bloodstream. It is very hard to detect, even by doctors in hospitals and it kills the mother very quickly. In fact, there was a recent case of a mother dying in a hospital from an amniotic fluid embolism, even with a c-section. Amniotic fluid embolism presents with some of the symptoms that Caroline displayed, such as anxiety and circulatory failure. However, often the baby goes into distress as well and Caroline’s baby did fine during and after the birth.

Conclusion: Of the three causes of death listed as most likely by the inquest, postpartum hemorrhage is treatable at home with the right skill and preparation. This is probably the least likely cause of death considering that Caroline Lovell’s blood loss at autopsy was not within the range of a hemorrhage. A pulmonary embolism or amniotic fluid embolism is more likely, but even in hospitals, mothers die from these conditions. While this was a homebirth and the mother did die, there is strong evidence that even in a hospital she may still not have survived.

Birth Apologetics: Homebirth and Multiples

Note: This post is part of a series called “Birth Apologetics”. “Apologetics” comes from the Greek and means “to speak in defense”. (Often used in relation to defense of a particular idea or viewpoint, such as “Christian Apologetics”.) In these posts, I will be taking blog posts and articles that are critical of home birth and natural birth and doing a critical analysis on the data and arguments. The idea is that if natural birth and home birth are safe for most women, arguments against them will have serious flaws.

The Claims: A case of a woman and her triplets who all died when she gave birth at home has been cited as proof of the dangers of homebirth, especially with multiples. News article is here.

Analysis: The first thing to understand here is that there are homebirths and then there are births that happen at home. If we read this article one of the first red flags is that the woman was hiding her pregnancy and even her mother and close friends didn’t know that she was pregnant and no one really knows why. Even her long-time boyfriend didn’t seem to know that she was pregnant. She didn’t call for help during or after the birth, and made up a medical condition to explain her weight gain to family, friends and neighbors.  An article with more details , states that the cause of death was hemorrhage, very common but easily treatable, even at home. The babies were stillbirths. It does seem that for whatever reasons, the woman may have been in a certain amount of denial about the pregnancy and wasn’t really planning the birth, either in or out of the hospital. It is also very possible that she may not have received prenatal care either, since there seems to be no record of her seeing an OB-GYN or midwife.

So while this birth took place at home, the circumstances are very different than giving birth at home with an attendant who has medicine on hand to deal with hemorrhage, preparation for infant and adult CPR and is monitoring the labor and pregnancy for any possible problems. So while this case is tragic, it is not representative of a planned homebirth with twins or triplets.

In fact, there are a few accounts of triplet homebirths, though they are extremely rare. One happened in the mid ’80’s and the midwife has overall kept very quiet because she was not technically allowed to deliver multiples in her state. The mother had had a c-section previously and wanted to VBAC. The midwife palpated twins, but didn’t feel right about leaving the mother with another c-section. She consulted with several other midwives and they combined their experience and research to plan for a twin VBAC at home. Two babies turned out to be three and they were all born at home at 41 weeks with no complications, weighing between 7 and 8 lbs. each. The mother and midwife’s accounts can be found on the Brewer Pregnancy Diet Website.

Another more recent incident in 2006 involved a mother in North Dakota who had previously had very large babies and measured big with her previous two pregnancies. She and her husband decided to plan a homebirth with a midwife they felt comfortable with. Everything seemed normal as with the previous singleton pregnancies. Everyone got the surprise of their life when three babies were born! The first two did well, but the third was bluish. The midwife gave him oxygen, but called for an ambulance when the canister ran out. The third baby spent 17 days in the NICU as a precaution but was afterwards released with no problems. Despite the outcome, North Dakota legislators looked at the triplet homebirth not as a a chance to work with midwives in creating better resources for birthing, but rather as “proof” of the need to limit midwives and homebirth. Details from the birth can be found in this legal abstract about birthing rights in North Dakota.

Twins born at home are far more common. For a series of great twin homebirth accounts, please see  the Homebirth Reference site. This is an amazing resource for accounts of women who have homebirthed under all kinds of circumstances. Aside from twins and triplets, the first surviving set of quintuplets were born at home.

Conclusion: The case of a woman who hid her triplet pregnancy and then had a tragic outcome is not indicative of a planned homebirth with measures taken to prepare for emergencies. Many planned multiple births at home have had good outcomes. When examining information on homebirth outcomes, it is important to compare similar cases.

 

 

Positive Princess Stories

Every little girl is a princess- with all the good and bad connotations that entails. Some research shows that narcissism is on the rise in North America and the group that is showing the fastest gains in narcissistic behavior are women and girls. So while we’ve had a lot of focus on building strong women and helping girls have better self-esteem, we’re also dealing with the flip side of too much ego. Maybe we shouldn’t be too surprised. Culturally, we place a lot of emphasis on the special “princess”s status of girls. I once saw baby girl onesies at a store that said “It’s simple really, I’m a princess, Mommy’s a queen and Daddy’s around here somewhere…”  Apparently we as a society are starting girls out on this attitude very young.

You can blame the media and there are certain elements of truth to that argument. Yes, little girls are bombarded by princess messages and images everywhere, but I really don’t think that’s the problem. Frankly, the last couple of Disney movies with princesses have been part of the solution. Tangled and Frozen both depicted princesses exhibiting traits like compassion, sacrifice and loyalty. With heroines like Rapunzel and Anna, it wasn’t their position as princesses that made them great, it was how they chose to treat others. And they don’t fall in love with handsome princes, they fall in love with men who have their share of faults but are caring and devoted. I don’t know if this politically correct any more, but I remember seeing  Beauty and the Beast when I was 5 and being very impressed that Belle loved to read. I was learning to read at the time and seeing Belle made me think that being educated and free-thinking were good attributes to cultivate.

But here’s the thing, no matter what messages are out there (and there have always been bad messages for parents to deal with), we are the ones who really have the last say about what is and isn’t appropriate for behavior for our children. We are the gatekeepers and we can choose what to tell our children about the world. And it’s important for boys to see positive female role models too. I want my sons to marry young ladies who are good women, not just good-looking.

So if you are interested in introducing your kids to some positive princess role models here are a few suggestions:

A Little Princess by Frances Hodgson Burnett. (Frances Hodgson Burnett also wrote The Secret Garden.) Sarah believes she should always act like a princess, and to her this means being caring, compassionate, and loyal under all circumstances. When the book starts out, this is relatively easy for her. She is the daughter of a British soldier and was born in India. Her mother died when she was a baby. Sarah and her father are very close, but eventually Sarah is sent to England to go to school as was customary amongst the British aristocracy.

At first, Sarah is the favorite pupil of the school’s headmistress, Miss Minchin, especially because her father has investments tied up in his best friend’s diamond mine. But the friend finds out that the diamond mine is a bust. He sends word to Sarah’s father, who is already sick and the shock kills him. Suddenly Sarah is left a penniless orphan. She is put to work as scullery maid at the school where she was once a student. Through it all, Sarah stays true to her code of honor that she should always strive to act like a princess.

If you want to watch a movie version, the only one I have seen that I really recommend is the 1986 mini-series from the UK. It stays very close to the book and is the only version I’ve seen so far where Sarah’s father actually dies. The temptation with other versions I’ve seen is to bring the father back and rescue Sarah. This was never Frances Hodgson Burnett’s intention. The beauty of the original story is that it requires Sarah to put her life back together and move on after so much loss. This is a good one for kids about 8 and up.

Ever After– Set in Renaissance era France, this movie features a Cinderella character named Danielle who continues to educate herself even after being forced into servitude by her stepmother. She risks imprisonment to free one of the other servants who has been sold to pay off her stepmother’s debt and that is how she meets the prince. Despite the many dangers she faces, Danielle is determined to meet her challenges with her own resourcefulness and doesn’t wait to be rescued. She also doesn’t see being queen as a chance to be waited on and fawned over, but rather as a way to serve others. Another cool thing about this movie is that the writers did some research into 16th century Europe. You’ll catch references to Henry VIII, the Edict of Nantes and Leonardo da Vinci makes an appearance as a “fairy godmother”. This is a good movie for ages 12 and up. It’s rated PG-13.

Enchanted- When Michael Eisner was in charge at Disney, a Rapunzel movie was in development. It went through a number of iterations, including a version that Eisner came up with where the fairy tale would be set in modern day San Francisco. Nothing seemed to work and the idea was killed. After Eisner was booted off the board of Disney, Pixar’s John Lasseter was brought on as the head creative for all of Disney. He, Ed Catmull and some other folks found the Rapunzel movie idea and decided to revive it. Of course, the aforementioned Tangled was one of the resulting movies. The other was Enchanted, the movie that proved to be Amy Adams’ big break.

Enchanted is the story of a fairy tale princess named Giselle who through a curse ends up being transported into New York City where she befriends a divorce attorney and his daughter. Giselle cleans the apartment with the help of rats and pigeons, breaks into song at random, makes beautiful dresses out of the drapes and says her best friend is a (now mute) talking chipmunk. But she also believes in true love- which means fidelity and devotion and she is completely sincere in her desire to see others be happy. These are the really refreshing things about her character and this movie. This one is a great family movie. We’ve watched it with our four year old and when my nieces were preschoolers it was one of their favorites. It’s rated PG.

Ella Enchanted by Gail Carson Levine. Read the book. The movie was a big departure from the original story of a girl who is under a curse to do whatever she is told and overcomes it as she matures and exercises her own free will. This book is many ways a parable about growing up and learning to make your own decisions and be accountable. This is a relatively short novel and is probably good for ages 10 and up.

Catherine, Called Birdy by Karen Cushman. When we think about life in the Middle Ages, we imagine people going around bemoaning their misfortune at having been born in a time that would later be termed “The Dark Ages”, kind of like in Monty Python and the Holy Grail .(“Bring out your dead!”) This book tries to see life in Medieval England from the point of view of the people who lived it, not based on our own modern judgments of these peoples’ lives. Catherine is not actually a princess, but the daughter of a nobleman trying to deal with the possibility of marriage to a man she detests. This is another great read for ages 10 and up.

The Paper Bag Princess by Robert Munsch. Princess Elizabeth is going to marry Prince Ronald when  dragon comes and carries the prince away. Elizabeth is courageous and resourceful in rescuing him, but finds at the end, that some princes aren’t worth holding on to. This is a good one for kids as it is a picture book, but I actually remember hearing it in a lesson at church as a teenager and it still made an impression on me.

Cinder Edna by Ellen Jackson. What if instead of waiting for a fairy godmother, a girl who cleans the fireplaces simply made it to the ball on her own? What if the prince relied on things he learned about her at the ball to find her instead of looking for a girl with the right foot size? This is another great book to read with kids!

Fanny’s Dream by Caralyn Buehner. Fanny is a farm girl with a dream that one day her fairy godmother will come and she’ll go to a ball looking beautiful and meet a handsome stranger. When the mayor throws a ball in town, Fanny thinks her chance has come. But when her fairy godmother doesn’t show up, she decides to marry a good friend and they start their life together on a farm. Fanny’s life turns out different than she imagined, but she’s still happy. Another great picture book for kids.

 

 

 

Investigation: Mother Dies of Cardiac Failure After Cesarean At Upscale Clinic

This is part of a series of posts aimed at attempting to uncover possible causes behind maternal and neonatal mortality. Often, these deaths are said to be “unpreventable” or have “unknown causes”. The “Investigation” series of posts will delve into some of these cases and see what possible causes might be applicable so that greater awareness and education can hopefully lead to lower death rates for mothers and babies.

Case: A 36 year old mother with an uncomplicated pregnancy had a scheduled elective c-section at 39 weeks gestation for her third baby. The hospital is an upscale gynecological  clinic in London that caters especially to celebrities, but has previously had a death of a mother due to negligence of the staff. The c-section is performed under general anesthetic because the mother had a phobia of needles. The c-section itself went well and the baby was delivered safe and healthy, but during recovery, the mother became restless and very stressed. She pulled the breathing tube from her mouth, but was not re-intubated afterwards. She was still communicating and acknowledged things being said to her, but was moving her limbs erratically and breathing rapidly. Her pulse was racing and she was starting to turn blue. Almost two hour after the cesarean, doctors are unsure of what to do, but eventually decide to send the mother to another hospital.

They call for an ambulance. The ambulance arrives about an hour after being summoned. At this point, it has been about three hours since the c-section was performed. The mother dies after transfer to the second hospital and two inquests are performed. The coroner reports that the mother died of acute cardiac failure of unknown cause, though presumably related to the c-section. A news article here details the events and the results of the inquests. Another one here has a few more details right after the death and before the inquests were finished. An article here has information on the hearing for one of the doctors. (He was later cleared of any wrongdoing. The verdict ruled that his performance had not fallen far below the level of competence of other doctors in his field and the facts of the case were insufficient to support a ruling of misconduct on the doctor’s part.)

Analysis: While two inquests on the death and a hearing have been performed, I think there are still some things to investigate with this case. A lot of attention has gone to the breathing tube, but there are a couple of other factors that could have been problematic. The first thing to consider is the general anesthesia. Death and heart attack are very rare risks of general anesthesia, though these are usually much more likely to happen in older patients or those with pre-existing conditions, not a healthy woman, even during pregnancy.

What might be a more likely case here is hypovolemic shock, which can occur after traumatic injuries or from a loss  of fluids, including blood. In fact, the agitation that the mother was exhibiting could have been a sign of a class III hemorrhage, which causes hypovolemic shock. The mother’s rapid breathing and rapid heart rate are also indicative of hypovolemic shock. (The clinical terms are “tachypnea” and “tachycardia”, respectively.) Reports that she was starting to turn blue could also be indicative of hypovolemic shock. Untreated, hypovolemic shock can cause cardiac failure. Though little has been said about the possibility of hemorrhage here, I think it is worth considering that a hemorrhage could have gone undetected or untreated in this case.

We know the doctors were unsure about what was going on, as evidenced by statements that they needed to come up with a diagnosis and that they had never seen anything like it before. So it’s possible they may have overlooked signs of failure and hypovolemic shock. Failure to monitor a mother after a c-section has happened before and resulted in blood loss and death. This was the case of Joanne Hatton, who died at another hospital in the United Kingdom when staff failed to carry out a blood transfusion that had been ordered and did not connect up the signs of organ failure with loss of blood.  We do know that this particular clinic had been cited for failure to monitor another mother properly and that case resulted in death.  We also know that the doctor who accompanied the mother on transfer to another hospital was accused of failing to give full and proper information to the transfer hospital about the mother’s condition and what had taken place at the clinic. So it is not out of the realm of possibility that a hemorrhage could have gone undetected. Pregnant women also have an increased volume and often the clinical signs of hypovolemic shock don’t become evident until a large amount of blood has been lost.

Another contributing factor to hypovolemic shock could have been inadequate fluid intake. Most of the time, women are advised not to eat or drink anything for 8-12 hours before a c-section. Low intake of fluids and dehydration can cause hypovolemic shock on its own in extreme cases. If the mother was hemorrhaging, dehydration could have potentially complicated her condition.

Conclusion: The symptoms reported here are consistent with hypovolemic shock and this could be the cause of the cardiac failure. It is possible that better monitoring and education amongst the staff could have prevented the problems seen here.

Birth Apologetics: Waterbirth

Note: This post is part of a series called “Birth Apologetics”. “Apologetics” comes from the Greek and means “to speak in defense”. (Often used in relation to defense of a particular idea or viewpoint, such as “Christian Apologetics”.) In these posts, I will be taking blog posts and articles that are critical of home birth and natural birth and doing a critical analysis on the data and arguments. The idea is that if natural birth and home birth are safe for most women, arguments against them will have serious flaws.

Case: The American College of Obstetrics and Gynecology released a bulletin earlier this year saying that waterbirth has no known benefits for babies and many potential dangers and should be limited only to controlled studies for research purposes. Full text of the ACOG’s bulletin can be found here.

Analysis: The ACOG’s position is based on individual case reports and case series of complications, which they acknowledge are not uniformly reported and there fore make it impossible to assess the actual incidence of these complications. The ACOG also bases their position on concerns about possible complications like “…higher risk of maternal and neonatal infections, particularly with ruptured membranes; difficulties in neonatal thermoregulation; umbilical cord avulsion and umbilical cord rupture while the newborn infant is lifted or maneuvered through and from the underwater pool at delivery, which leads to serious hemorrhage and shock; respiratory distress and hyponatremia that results from tub-water aspiration (drowning or near drowning); and seizures and perinatal asphyxia.” They also state the they have believe that waterbirth could be potentially dangerous because of the possibility of the baby breathing in water: “Although it has been claimed that neonates delivered into the water do not breathe, gasp, or swallow water because of the protective “diving reflex,” studies in experimental animals and a vast body of literature from meconium aspiration syndrome demonstrate that, in compromised fetuses and neonates, the diving reflex is overridden, which leads potentially to gasping and aspiration of the surrounding fluid.”

So let’s take a look at these arguments in detail.

1. Incidence of serious complications: The ACOG states that the information they have is not enough to actually find what the incidence of complications would be on a large scale. However, The United Kingdom provides a nice counterpoint to this. As stated in the ACOG’s bulletin, approximately 1% of all birth in the UK have at least a period of water immersion. It should be noted that the United Kingdom has lower rates of neonatal mortality (3 deaths per 1,000 live births) than the United States does (4 deaths per 1,000 live births), so if waterbirth is as dangerous as the ACOG seems to be representing, then the UK would likely have higher rates of neonatal mortality than the United States, but this is not the case. Also, because the usage of waterbirth is not well regulated in the United States, the chance for problems to occur because of ill-informed and untrained attendants could be a significant (but very avoidable) risk factor for complications. Furthermore, the ACOG dismisses studies involving thousands of births which show that with a competent attendant water birth is very safe. One study from England showed that of 4,032 births in water that took place between 1994-1996, there was a mortality rate of 1.2 per 1,000 but none of those deaths were not attributed to waterbirth, but rather other causes. Out of the entire 4,032 births, two babies were admitted to the NICU for possible water aspiration, but recovered.
2. Concerns over certain conditions: The ACOG very rightly brings up that there are risk factors for waterbirth. However, in the 2006 joint statement from the UK’s Royal College of Obstetrics and Gynecology and the Royal College of Midwives, good practice of waterbirth requires taking measures to avoid these problems. For example, the Guidelines from the RCOG and RCM state that all birthing pools and equipment should be sterilized or disposed after use and that the water should be kept free from debris and fecal matter to prevent infection. They also state the need to watch for umbilical cord rupture and plan and prepare for it. Guidelines from Waterbirth International for waterbirth state that sterilization of all supplies and parts of the tub must take place and that no one should allowed in the tub if they have an infection. These guidelines also include recommendations for control of the baby’s body temperature by monitoring the temperature of the pool or tub water and keeping the baby in the water with head out and close to the mother initially. The UK’s policies for hospital waterbirth (similar to those of UK midwives) state that women who are at least 37 weeks along with an uncomplicated pregnancy and have well-established, spontaneous labor are candidates for water birth or water labor. This reduces many possible complications. One large study from Switzerland (which has a neonatal mortality rate lower than that of the United States at 3 per 1,000 live births) compared waterbirth to maia stool births and bed births for spontaneous, singleton babies in a head down position and found that there was no greater risk of infection with waterbirth. (In fact, out of the natural births, births in bed had a greater risk of infections, primarily in the eyes). They also found that waterbirths had far less complications with bleeding and hemorrhage than other birthing options.
3. Concerns over drowning: Take note of the language in ACOG’s comments on the possibility of drowning: “…in compromised fetuses and neonates, the diving reflex is overridden…” (emphasis mine). So the ACOG acknowledges that the diving reflex which keeps babies from gasping under water does work under normal circumstances. Their concern lies with babies who have been compromised, inhibiting the diving reflex. However, the RCOG and RCM’s guidelines state that “If the woman raises herself out of the water and exposes the fetal head to air, once the presenting part is visible, she should be advised to remain out of the water to avoid the risk of premature gasping under water.” Guidelines from Waterbirth International state: “The baby should be born completely underwater with no air contact until the head is brought to the surface, as air and temperature change may stimulate breathing and lead to water aspiration. If a change in position during delivery causes the baby to come in contact with air, the birth should be finished in the air.” Both organizations advise the monitoring the baby’s heart rate with a Doppler heart monitor to watch for problems. So those who are experienced, educated and competent in attending waterbirths acknowledge that the baby’s protective diving reflex could be overridden and have guidelines in place to handle such a situation. Also, once the baby has been fully born a competent waterbirth attendant will quickly and gently get the baby’s head out of the water and into the air while leaving the body in the warm water, held by the mother.

Conclusion: It is curious that American OB-GYN’s have a habit of criticizing the birthing options of countries that have lower rates of neonatal death than that of the United States! Waterbirth is successfully used in many other countries to deliver babies and with competent and educated attendants has a great track record. For the most part, the ACOG’s reasons against homebirth surround bad or incompetent usage of this tool. But we can’t write something off as dangerous just because it has been used improperly.

Let’s take for example, Cytotec (a.k.a. misoprostol). Cytotec is a drug for preventing stomach ulcers caused by non-steroidal anti-inflammatory drugs. However, doctors in America have been using it for about  20 years now to induce pregnant women because it works faster and causes stronger contractions than pitocin. This usage is in opposition to both the FDA and Cytotec’s manufacturer Searle. Cytotec is contraindicated for use in pregnant women and not approved by the FDA for labor induction and has been associated with a large number of uterine ruptures and the deaths of many babies and mothers. Cytotec has proven so problematic that its manufacturer Searle issued a letter in August of 2000 warning obstetricians not to use it for labor induction.

Now, just because some doctors have chosen to use Cytotec in a way that it was never designed to work with resulting injuries and deaths does not mean that Cytotec itself is dangerous. Cytotec may be very helpful for someone with stomach ulcers from NSAID’s. Cytotec is simply a tool. The results from its use depend upon the discretion of the practitioner. The same can be said of waterbirth. Waterbirth is a tool and while the improper use of it can result in injury or death, when used competently the evidence shows that it can have enormous benefits.

“But this might make other women not get a c-section when they really need one…”

What is this dangerous information that people are reacting so strongly to? It’s news reports like this one of a mother who developed placental abnormalities after five c-sections and died on the operating table during the sixth c-section. Or articles like this one about how Cephalopelvic Disproportion (CPD) is often over-diagnosed or when legitimately diagnosed is not necessarily a permanent condition from pregnancy to pregnancy.

It really is surprising how often this argument comes up when the subject of low-intervention birth is discussed. Now, there is sometimes a view of natural birth proponents that we are zealots who believe in natural birth at all costs and in our passion to share the benefits of natural birth, sometimes we can become a bit too pushy. We should always be respectful of other women’s choices in birth. Giving birth is extremely personal and each mother needs to make the decision for what is best for her and her baby. The more respect we have for each other, the more we can share and benefit and the less fear we will have about birth.

This doesn’t negate a search for the truth though. I think it’s worth it to take a good look at the argument that information discouraging excessive intervention is harmful.

1. How many c-sections are necessary? About 5% of c-sections are true emergencies. (Incidentally, another 3% are completely elective with no medical indication at all.) The rest fall into gray areas, such as failure to progress, doctors think the baby is too big, or the mother is past her due date, all of which can be very hazy areas. Sometimes mothers fail to progress because they feel too fearful of the birthing environment. When this happens, the body releases a chemical called catecholamine which stops labor so the mother can escape what is making her afraid and resume labor when she has moved some place where she feels safer. Inductions that take place before the mother’s body is ready to labor are typically very difficult and often end up with a c-section. Sometimes the baby’s size or position is too big for the mother’s pelvis, on the other hand many petite women have birth big babies naturally. And going past the due date doesn’t necessarily mean there is something wrong with the baby. It can simply mean that your cycles are irregular and this wan’t taken into account in calculating the due date. If it’s your first baby, it’s actually very common to go past your due date. Sometimes, the baby is just on the slow side! With a third of babies in America being born via c-section, statistically speaking there is a far greater chance that information on low-intervention birth will reach a mother who has had an unnecessary cesarean than a mother who actually needs a cesarean.
2. What prompts a necessary cesarean? Most of the time, if you need a c-section, you’ll know! If you’ve been pushing for a very long time and the baby isn’t coming, there really might be a problem with CPD. If you start experiencing excessive vaginal bleeding , this is often an indication that life-threatening preeclampsia or placenta previa is underway. If you have sudden abdominal or uterine pain or cramping, this can be an indication of placenta previa or placental abruption. Premature rupture of membranes before 37 weeks gestation often requires a cesarean and other specialized care to ensure the baby’s and mother’s safety. If you have a baby in transverse lie (where the baby is lying sideways in the womb) there is no possibility of a vaginal delivery (unless the baby can be turned into a more favorable position before labor begins). When a cesarean is necessary, the mother will experience serious symptoms or her doctor or midwife will tell her that a cesarean is the best choice for this birth. So in this hypothetical scenario where a mother needs a c-section and chooses not to get one because she zealously clings to the idea of natural birth requires that the woman resist intervention despite experiencing life-threatening symptoms or the counsel of birth professionals. While this sort of scenario is not impossible, it is highly unlikely as it requires a woman to basically take leave of her senses. I don’t any women who would sacrifice their life or the life of their baby just to attempt a natural birth.

Whenever we hear people saying that we need to cover up the truth to protect others, I think we really need to take a look at the motivations and implications of such advice. When we resist or ignore the truth, we are not dealing with reality and we are making decisions based on illusions; what we would like the truth to be rather than what it is. Illusions may seem comforting, but are ultimately more dangerous than the discomfort of the truth. Getting the truth out about birth options is the only way to make birth safer for mothers and babies.

 

 

Investigation: 20 Year Old Mother Dies Of Stroke

This is part of a series of posts aimed at attempting to uncover possible causes behind maternal and neonatal mortality. Often, these deaths are said to be “unpreventable” or have “unknown causes”. The “Investigation” series of posts will delve into some of these cases and see what possible causes might be applicable so that greater awareness and education can hopefully lead to lower death rates for mothers and babies.

Case: 20 year old previously healthy pregnant mother admitted to the hospital for placenta tear at seven months gestation. All vitals appear normal, but the mother complains of a migraine. She is given a narcotic for the pain of the headache and over the next hour starts to go numb. She then turns blue and suffers a fatal stroke. The baby is delivered via emergency c-section and survives. Doctors say the cause of the stroke is unknown. News article here.

Analysis: Pregnant women are at a higher risk of stroke, and in fact it is the leading cause of death in pregnant women in the United States and Canada. Most of these strokes are caused by preeclampsia/eclampsia (a disorder of pregnancy characterized by high protein in the urine and high blood pressure). The migraine and the placenta tear are telling here, since migraine-like headaches are one of the telltale signs of preeclampsia and preeclampsia can lead to placenta abruption or a lack of blood flow to the placenta.

The doctors state that the mother’s vital signs, including blood pressure were normal, but this may not have been the case. Typically, doctors won’t consider preeclampsia unless the mother’s blood pressure is greater than 140/90 on two separate readings more than six hours apart. The problem is that blood pressure rates can vary greatly from person to person (just like average basal body temperature). A woman whose blood pressure tends to be on the lower-than-average side may be technically within the guidelines of normal blood pressure numbers while her body is getting dangerously close to disaster.

A rise of 15 degrees or more in the lower number  (diastolic) or of 30 degrees or more in the higher number  (systolic) during pregnancy can also be a signal that preeclampsia is underway. But this sort of data requires multiple readings on separate occasions. A mother who shows up at the emergency room and gets a single reading may not get the help she needs because the number is taken out of context. For an account of a mother who experienced the nearly fatal situation of having a variation of preeclampsia called HELLP syndrome but was repeatedly told that her blood pressure was normal read here.

Preeclampsia is called the silent killer because often mothers don’t feel poorly until the condition has progressed to a serious stage and it often goes undetected by doctors because of variations in blood pressure readings and dismissal of the symptoms as “normal pregnancy complaints”. Preeclampsia can also progress to a dangerous point very quickly, another reason it sometimes escapes notice, even in women receiving full prenatal care. A urine test at the time of admission may have revealed dangerously high levels of protein in the urine and could have alerted doctors to possibility of preeclampsia, but it doesn’t sound as if a urine test was performed. These tests are typically very quick and easy to do.

Conclusion: While it is impossible to know for sure what happened without a complete set of data from blood pressure readings or tests for protein in the urine, there are many indications pointing to advanced preeclampsia as the cause of the stroke. It is very possible that this mother had developed preeclampsia that quickly progressed to a dangerous stage.

Prevention: Because it is so easy for preeclampsia to be overlooked, it’s important for mothers to know the signs and symptoms and also to know their blood pressure and even keep a log throughout their prenatal care visits. If you’re feeling sicker than usual, yet being told that nothing is wrong, you may have to become very assertive in getting the care you need. If preeclampsia progresses to a point where the mother’s and baby’s lives are in danger, a c-section will probably be necessary, even if the baby has not reached full-term gestation. For information on signs of preeclampsia and it variations, go to the Preeclampsia Foundation’s website here.