I'm back. In so many ways, I feel like I'm coming up for air after a long, long time.
Posts from the ‘Pregnancy’ Category
I, for one, am not sad to see 2013 go. It’s been a rough year for me. I haven’t been blogging about it – haven’t been blogging about much of anything, actually – and I think it is time for an update. 2013 started with a miscarriage in progress, finally ending with a D&C on January 4. I grieved that lost pregnancy openly on this blog. It was therapeutic for me to blog about it and to feel support from women who had had similar experiences, or at least had empathy for the magnitude of love and hope that comes with a pregnancy. I started to feel better. I was confident that I would be pregnant again soon, and that was the obvious way to fill the gaping hole in my heart.
In the spring, I watched seedlings poke through wet dirt. Our neighborhood burst with color and new life, and I felt hopeful. But as the days grew longer and hotter, I felt sadder and sadder. I still wasn’t pregnant. My previous due date came and went, now just another day, but such a heavy one for me. Cee and I sorted through newborn clothes in our hot attic, not for a new baby for our family, but to lend to a friend. Cee asked to keep a few onesies for her baby doll. I showed her how to fasten the snaps and then sent her downstairs so I could cry.
In August, I had another miscarriage, this time very early. Then, another one in October, early again (and thankfully spontaneous) but far enough out that I let myself think ahead to another summer due date. That one really crushed me. I know miscarriage is common, and it’s easy to chalk the first up to bad luck. But by the third time around, I had really lost faith in my body. It has failed, repeatedly, to do one of the things I feel it was always meant to do. I’ve always wanted children, and the family that I have, for which I am exceedingly grateful every day, doesn’t feel complete. There’s still a gaping hole here, and it’s only gotten bigger.
Meanwhile, Cee turned three in November. I know my sadness has affected her, and it’s affected my parenting, because my emotional reserve is just plain depleted. I am working hard at being enough for her and at assuring her that she is enough for me. (And she is. She really is. I’ve come to terms with that, most days anyway.) Read more
I meant to do skin-to-skin with Cee after her birth, I swear. It was in my birth plan. But after a long labor, Cee was born blue and limp, and the understandable concern about her health trumped any ideas I’d had about optimizing our postpartum experience. Cee was whisked away to a warmer on the other side of the room and encircled by the NICU team. Thankfully, I heard her cry within a few moments, and she was in my arms soon after. But by then, she was wrapped in a pink and blue flannel blanket, and I was too overwhelmed and taken with her to think of unwrapping her. Instead, I held her, and we gazed into each other’s eyes. She started rooting and was nursing within a couple of minutes. It was a magical first meeting, and it wasn’t until later that I realized that I’d screwed up and forgotten to do skin-to-skin.
I’ve been researching this topic for a chapter in my book about the postpartum period. I’m writing about what we know and don’t know about getting to know our newborns, establishing breastfeeding, rooming in, and yes, skin-to-skin. When I started working on this chapter, I thought the skin-to-skin thing was a slam-dunk, maybe even too obvious to be of much interest to my readers.
Modern-day interest in skin-to-skin, also called kangaroo care, began in 1978 in the NICU at San Juan de Dios hospital in Bogotá, Columbia. For every 10 premature babies born there, only 3 survived. There weren’t enough incubators or nurses. Babies were tucked two to three at a time in incubators, and infections were rampant. Parents weren’t encouraged to be involved in the babies’ care, and having little emotional connection to them, many abandoned their sickly babies at the hospital. Kangaroo care was a desperate attempt to care for these vulnerable babies. Mothers were essentially asked to be their babies’ incubators, holding them skin-to-skin 24 hours per day and breastfeeding on demand.
The results were astounding. The kangaroo care babies in Bogotá grew well, were more likely to be breastfed, and were less likely to get severe infections or be abandoned. The power of kangaroo care for low birth weight babies has since been confirmed in multiple studies. A 2011 Cochrane review concluded that skin-to-skin helps stabilize premature newborns, reduces mortality, infections, hypothermia, and length of stay in the hospital. These benefits are particularly clear in developing countries, but many hold in industrialized nations as well.
With the impressive success of skin-to-skin care for preemies, it seemed natural to assume that full term babies would benefit from it as well. But the research in this area is disappointing. Read more
I wrote my last blog post before going in for a D&C last Friday. The procedure itself was simple and quick. I “fell asleep” with the warm hand of my OB holding mine and woke up from general anesthesia feeling an inevitable emptiness but some degree of peace. At home, I ate a piece of toast, crawled into my own bed and woke up four hours later. What greeted me were your comments and emails of sympathy, empathy, and heart. There were a lot of them, some from people I have known for decades and some from readers that I had never heard from before, but I read every single one before I got up to face the afternoon.
The resounding message was this: You are not alone.
I was nervous about writing about miscarriage, but once it was out there, I felt nothing but support. It made me wonder why we hesitate to share this kind of hurt. It is personal, and it does seem strange to tell the whole world that I’m grieving. But the world is full of hurt. What’s wonderful is that so many people are willing to share a bit of mine – even the smallest bit – and enough people doing that really does make me feel better. I didn’t anticipate that writing about miscarriage here would be so therapeutic. The writing itself is actually sort of painful, in a good way I guess, but sharing the experience has been healing. Read more
It has been a hard couple of weeks for me, even with all the warmth and joy of the holidays. On December 21, 10 weeks into pregnancy (as yet unannounced here), we watched as my OB scanned my uterus. We saw the dark gestational sac and a small clump of embryonic tissue. There was no heartbeat, and the embryo measured at about 5 weeks. It hadn’t developed beyond that. This pregnancy would not be ending with a baby.
I’m a very cautious person when it comes to celebrating pregnancy. I didn’t really relax into my pregnancy with Cee until I saw the normal fetus at our 20-week ultrasound. I have had several close friends suffer the loss of miscarriage (and go on to have beautiful, healthy babies, I will add). I know that among clinically recognizable pregnancies (not counting the 30-50% of conceptions that never implant), about 15-20% will not survive. Even as I shared our pregnancy news with our close family and friends, I reminded them of this fact.
Although a part of me was prepared for this outcome, there was really no way that I could prepare myself for how it would feel. I have a profound sense of losing something important. Tiny as it may have been, it was part of me and part of Husband, and it was growing inside of me, if only for a short time. The wonder of pregnancy has been replaced with the vision of that ultrasound: the gestational sac a gaping dark hole, what remains of the embryo little more than a smear. Empty, dead, inevitably transient.
This is the grief of pregnancy loss, something so many of us must face as we try to build our families. What it speaks to, more than anything, is the power of a parent’s love, even for an embryo whose heart never beats. For many parents, it is the struggle to conceive, and after that, it is the fragility of human life. And even as our healthy babies become children and our love grows beyond the bounds of what we thought was possible, we know we are vulnerable to loss. It is the reason that it felt unbearable to be a mother on the day of the Newtown school shooting. This is family. This miscarriage, it is a small loss, but it still sure hurts. Read more
I first heard about delayed cord clamping as a doctoral student in Nutrition at UC Davis. One of my professors, along with her graduate students, was conducting research on delayed cord clamping in Mexico. Their findings were exciting, and their research was eventually published in the Lancet . I remember being impressed that a simple change in protocol at the birth of a baby – effectively, a non-intervention – could have a profound effect on that baby’s health.
Fast-forward five years, when I was pregnant with Cee in 2010. My OB was an attending physician at an academic hospital and very knowledgeable. However, even she was skeptical when I told her that I was interested in delayed cord clamping. I emailed her a stack of journal articles showing that, at least in an uncomplicated delivery, the benefits outweigh the risks. She was convinced, and we agreed to delay clamping, providing everything went smoothly at the delivery. In the couple of years since Cee’s birth, I think delayed cord clamping has become more mainstream and in some cases, it has become standard protocol. Still, in many hospitals, you may need to advocate for delayed clamping or at least be prepared to discuss the risks and benefits with your OB or midwife.
What exactly do we mean by delayed cord clamping?
Delayed cord clamping means waiting 2 to 3 minutes after the delivery of an infant before clamping and cutting the umbilical cord. During this time, blood continues to pulse from the placenta to the baby until the pulses naturally stop around 3 minutes. The transfer of blood from the placenta to the baby is most effective if the baby is placed on the mother’s abdomen or lower.
What are the benefits of delayed cord clamping?
Research has found that delayed cord clamping allows 20 to 40 mL more blood to pulse from the placenta to the newborn, carrying with it an additional 30 to 35 mg of iron . As a result, babies have higher newborn hemoglobin, lower risk of anemia at birth and through 2-3 months, and higher iron status and storage through 6 months of age [2, 3].
Delayed cord clamping gives your baby more iron. Why is this important? The extra iron is stored and becomes your baby’s main source of iron until she starts eating solid foods, particularly if you breastfeed. Your baby will use that iron to form red blood cells and transport oxygen, to build muscle, and to develop her brain cells. Severe iron deficiency can cause anemia, but iron deficiency during infancy (even without anemia) also increases the risk of cognitive, motor, and behavioral deficits that can last into adolescence [4-6].
How much stored iron do babies have at birth? That depends. Because the final 8 weeks of pregnancy are most important for iron storage, babies born prematurely can really come up short in iron. Size also matters; big babies are born with more iron stores than their smaller peers. Finally, maternal iron deficiency seems to increase the risk that baby will become iron deficient later in infancy. Depending on these factors, most babies will use up their stored iron between 4 and 8 months of age, after which they’ll need to get iron from fortified formula, iron supplements, or solid foods .
This can pose a real problem for exclusively breastfed babies, especially since both the AAP and WHO recommend waiting until babies are 6 months old to begin introducing solid foods. Breastfed babies are at higher risk for iron deficiency than those fed formula, because formula is fortified with iron. Breast milk, on the other hand, is very low in iron. (Why is breast milk so low in iron? I ruminate about that in this post.) Although breastfed babies are very efficient at absorbing that little bit of iron, the quantity is still too small to meet their needs once their iron stores have been depleted. The AAP estimates that U.S. infants that are exclusively breastfed have a 20% risk of iron deficiency by 9-12 months of age .
Delayed cord clamping can give babies an extra 1-3 months of iron stores to help bridge their transition from exclusive breastfeeding to solid foods . This can be especially helpful for breastfed babies that are a little slow to start solid foods. Other mammals do not rush to clamp the cord immediately after birth and therefore also get that extra dose of iron to baby before cutting her off from mom’s supply. However, immediate cord clamping does not mean your baby is destined to be iron deficient – it just increases the likelihood that she will need a boost from iron supplements and/or iron-fortified foods.
An added benefit of delayed cord clamping is that it may protect your baby from lead poisoning. One study found that in breastfed infants at risk for lead exposure in Mexico, delayed cord clamping was associated with lower blood lead levels than immediate clamping . This effect is probably related to the improvement in baby’s iron stores, since iron deficiency increases lead absorption. The CDC estimates that 4 million U.S. households have children exposed to lead, so this benefit has the potential to be very relevant to these kids.
Delayed cord clamping is likely even more important for preterm infants, and in fact, is beginning to be adopted by hospitals as general protocol. Preemies are at higher risk for iron deficiency. Delayed cord clamping improves hematocrit and reduces anemia and the need for blood transfusions in these babies . In one trial, it also improved motor development in 7-month-old baby boys who were born prematurely . In another, it increased oxygenation of brain tissue in newborn preemies . Delayed cord clamping has also been shown to decrease the incidence of intraventricular hemorrhage and late-onset sepsis in preemies [10, 11]. Many of these studies used only a 30-45 second delay in cord clamping, but these benefits were observed even with this short delay.
Are there risks to delayed cord clamping?
To date, there is no evidence for significant risks to the mother or the baby associated with delaying cord clamping by 2-3 minutes. Until 2007, early cord clamping was part of the WHO protocol for preventing maternal postpartum hemorrhage, leading many practitioners to believe that late clamping might increase maternal bleeding. However, studies have found that this is not the case , and the WHO modified their protocol to reflect this evidence.
Delayed cord clamping does not increase an infant’s risk of jaundice, elevated bilirubin, or the need for light therapy [2, 3]. Some studies have found that delayed cord clamping increases the risk of polycythemia in newborns. Polycythemia occurs when infants have too many red blood cells in circulation – it is the opposite of anemia. However, infants with delayed cord clamping that were diagnosed with polycythemia had no symptoms and did not require treatment. Polycythemia may be a normal outcome of delayed cord clamping in some babies, and as far as we know, it does not appear to pose a health risk in these babies .
One other common objection to delayed cord clamping is that it is unnecessary in a developed country, because iron deficiency and anemia are only problems in developing countries. Quite simply, this is not the case. Approximately 10% of toddlers in the U.S. are thought to be iron-deficient . A study in Sweden, a country with a very low prevalence of anemia, still found benefits of delayed cord clamping in this advantaged population .
When is delayed cord clamping not appropriate?
If a baby is born in distress and in need of resuscitation to help her breath, delaying cord clamping takes a back seat. Babies in distress need immediate attention, and it may not be practical to care for them while the cord is still attached. To get an idea of how quickly pediatricians need to assess newborn health and take appropriate action, check out their guidelines for newborn resuscitation. As more is learned about the benefits of delayed cord clamping, pediatricians may adjust their protocols to do some procedures at the bedside, allowing the cord to remain attached. In the meantime, it is my opinion that we should let them do their jobs and not ask them to practice outside of their comfort zone when it comes to caring for newborn babies. If the cord is clamped immediately, you can make up for the lost iron by giving your baby an iron supplement or feeding her iron-rich foods when she is ready for solids.
The Academic OB/GYN blog, written by Dr. Nicholas Fogelson, has several articles on delayed cord clamping, as well as links to a 50-minute Grand Rounds video, which is very informative. Squintmom also has a nice, well-cited article on the topic. Links to cited studies are included in the reference list below.
1. Chaparro, C.M., L.M. Neufeld, G. Tena Alavez, R. Eguia-Liz Cedillo, and K.G. Dewey. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet. 367(9527): p. 1997-2004. 2006. Link (abstract)
2. Hutton, E.K. and E.S. Hassan. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 297(11): p. 1241-52. 2007. Link (full text available)
3. Andersson, O., L. Hellstrom-Westas, D. Andersson, and M. Domellof. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 343: p. d7157. 2011. Link (full text available)
4. Hurtado, E.K., A.H. Claussen, and K.G. Scott. Early childhood anemia and mild or moderate mental retardation. Am J Clin Nutr. 69(1): p. 115-9. 1999. Link (full text available)
5. Lozoff, B., E. Jimenez, J. Hagen, E. Mollen, and A.W. Wolf. Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics. 105(4): p. E51. 2000. Link (full text available)
6. Sherriff, A., A. Emond, J.C. Bell, and J. Golding. Should infants be screened for anaemia? A prospective study investigating the relation between haemoglobin at 8, 12, and 18 months and development at 18 months. Arch Dis Child. 84(6): p. 480-5. 2001. Link (full text available)
7. AAP. Pediatric Nutrition Handbook. 6th ed, ed. R.E. Kleinman. Elk Grove Village, IL: American Academy of Pediatrics. 2009.
8. Chaparro, C.M. Timing of umbilical cord clamping: effect on iron endowment of the newborn and later iron status. Nutr Rev. 69 Suppl 1: p. S30-6. 2011. Link (full text available)
9. Chaparro, C.M., R. Fornes, L.M. Neufeld, G. Tena Alavez, R. Eguia-Liz Cedillo, and K.G. Dewey. Early umbilical cord clamping contributes to elevated blood lead levels among infants with higher lead exposure. J Pediatr. 151(5): p. 506-12. 2007. Link (abstract)
10. Rabe, H., G. Reynolds, and J. Diaz-Rossello. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology. 93(2): p. 138-44. 2008. Link (abstract)
11. Mercer, J.S., B.R. Vohr, M.M. McGrath, J.F. Padbury, M. Wallach, and W. Oh. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics. 117(4): p. 1235-42. 2006. Link (full text available)
12. Mercer, J.S., B.R. Vohr, D.A. Erickson-Owens, J.F. Padbury, and W. Oh. Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. J Perinatol. 30(1): p. 11-6. 2010. Link (full text available)
13. Baenziger, O., F. Stolkin, M. Keel, K. von Siebenthal, J.C. Fauchere, S. Das Kundu, V. Dietz, H.U. Bucher, and M. Wolf. The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics. 119(3): p. 455-9. 2007. Link (full text available)
14. McDonald, S.J. and P. Middleton. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. (2): p. CD004074. 2008. Link (abstract)
15. Baker, R.D. and F.R. Greer. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 126(5): p. 1040-50. 2010. Link (full text available)
(An earlier version of this post was published here, where it was hardly noticed. Maybe I’m too conservative for that crowd. Regardless, I’m having a hard time keeping my head above the water with teaching this term, much less find time to research and write sciency posts. I miss it. A lot. Teaching is good, but not as much fun. I’ll be back soon, promise.)
You’ve heard the warning before: Don’t share saliva with your baby. No sharing utensils, food, or toothbrushes. No “cutting” grapes in half with your own teeth. No cleaning the crud off the corner of her mouth with a little spit on your finger. No blowing on your baby’s hot food or tasting it yourself first. All of these things can spread mama’s saliva to baby and infect her mouth with cavity-causing bacteria.
I’ve heard these warnings, but all I can say is, “Seriously?” In my mind, a little saliva-sharing between mom and baby is unavoidable. I have tried. It wasn’t too difficult for the first few months of BabyC’s life, but then she started fish-hooking my mouth with her finger while she nursed, and it’s been down hill over since.
So what’s the deal? Are cavities contagious? If so, what can we do about it?
Bacteria that colonize the mouth cause cavities, or dental caries. Mutans streptococci (MS) are the most common bacteria implicated, but several other species are also associated with caries. The bacteria consume food particles, particularly sugar and starch, and produce acid, which causes demineralization of the tooth.
We aren’t born with bacteria-infested mouths – we have to be infected. Cavities are contagious in the sense that MS can be passed from mom’s saliva to baby’s mouth, where they quickly set up shop. MS is detected in some infants within the first few months of life, even before their first teeth erupt, and studies conducted in the 1980’s identified mom as the primary source of bacterial colonization in an infant’s mouth . Of course, you’ve got to wonder if a bit of colonization blame has shifted towards fathers or other caregivers since the 80’s, since fathers are sharing more of the balance of childcare these days. Read more
Last week, I wrote about some of the unique challenges (and one potential solution) to breastfeeding a baby born prematurely. Another study recently published in BMJ Open provides more food for thought on breastfeeding preemies (1; full text available here).
A team of French researchers examined the relationship between breastfeeding, growth, and neurodevelopment in two observational cohorts of babies born very prematurely, at less than 32 or 33 weeks of gestation.
Between the two cohorts, a total of 2925 very preterm infants were included in the study. These babies were in the hospital for 50-60 days before they were allowed to go home. In the two cohorts, 19% and 16% of babies were breastfeeding at the time of discharge from the hospital. The study looked at associations between type of feeding at discharge (breast milk or formula), growth during hospitalization, and growth and neurodevelopment at 2 and 5 years of age.
What were the findings? In these cohorts, formula-fed babies had gained more weight by the time they were discharged from the hospital. However, at 2 and 5 years of age, the formula-fed babies scored lower on neurodevelopment assessments compared to the breastfed babies. Breastfed babies also had greater head circumferences by 2 and 5 years of age, suggesting improved brain development, and they appeared to catch up to formula-fed babies in height and weight. Read more
The breast pump is a fabulous invention. It is what gives modern moms the option to pursue a career and breastfeed. And for moms of babies born prematurely, it is everything. Their babies get a great start with breast milk, and moms can establish milk supply even if they are separated by prolonged stays in the NICU.
In a study published in Advances in Neonatal Care last week, Douglas Keith and colleagues reported on their attempt to increase production in moms pumping milk for their preemie babies . 162 moms of preemie (average 32 weeks) or critically ill newborns admitted to the NICU were given a hospital-grade breast pump and encouraged to pump 8 times per day. They were randomly assigned to one of 4 groups. A control group received standard support for breastfeeding, and the remaining 3 groups were given a recording to listen to during pumping. The second group received a recording with a spoken guided relaxation. The third received the same guided relaxation, but it was accompanied by soothing guitar lullabies. The fourth received the relaxation/guitar recording, plus a video player with images of their own babies. Milk production and milk fat content were measured over 14 days.
What effect did a little music and pictures have on milk production? The results were actually quite striking. Read more
I just finished reading the new book, Do Chocolate Lovers Have Sweeter Babies? by Jena Pincott. Before you jump to the conclusion that this is a completely fluffy book, consider the subtitle: “The Surprising Science of Pregnancy.” It turns out that this book is chock-full of science, some of it admittedly fluffy but some of it rock solid. I enjoyed the book and thought that you might, too. I tweeted Jena Pincott to see if she was interested in donating a copy for a giveaway, and she enthusiastically agreed.
(By the way – if you aren’t on Twitter and wonder what the point of it is, then this gives you a good example of why it is cool. I can take a break from the book I am reading and tweet the author a message. Within minutes, we’ve had a little conversation about her book, doing a giveaway, and remarked that our daughters were born just a few months apart and how much we are enjoying this age.)
So here we are – the first-ever giveaway on Science of Mom. I don’t know if I’ll make a habit of this, but I like the idea of reviewing books occasionally, and if I can put together a giveaway to share a book that I like with you, that seems like a win-win. Just to be perfectly clear, I purchased my own copy of Chocolate Lovers. The author is donating a copy of the book, but I haven’t received any compensation. I am not obligated in any way to write a positive review, but I also wouldn’t bother giving away a book or product that I didn’t like myself.
Formalities out-of-the-way, let me tell you what I think of Chocolate Lovers:
Chocolate Lovers is a book about the science of pregnancy, birth, parenting, and newborns. It focuses on understanding the magical transition to parenthood from a biological and evolutionary perspective. Pincott tackles old wives tales, quirky observations, and serious science. The book is by no means a comprehensive guide to pregnancy, but it is way more fun than any book I have read on the topic. It won’t explain every pregnancy symptom, but it will make you think about pregnancy as the product of millions of years of evolution. You will envision yourself as one of a long line of pregnant mothers, and Pincott will help you understand that your first trimester nausea probably happens for a reason. Read more