“Pregnancy seemed to be a world of arbitrary rules”

This was my experience to a T. That’s why it was so refreshing to read this article posted by a friend on Facebook last week. Economist Emily Oster approached her pregnancy like, well, a scientist. She wanted to know the why behind the long list of seemingly arbitrary rules that a pregnant woman is given by her doctor and she had the tools of her trade at her disposal. She did a lot of research about the research- the actual peer-reviewed studies these rules are (supposedly) based on and, thankfully, wrote a book about what she found (which is now at the top of my reading list).

One of the most controversial issues surrounding pregnancy is alcohol consumption of any kind and Oster tackles this issue specifically here. Remember when the universe exploded because pregnant Gwenyth Paltrow drank a Guinness? And check out this comment on Oster’s Huffington Post article from NOFAS, the National Organization of Fetal Alcohol Syndrome:

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As Oster points out in this article, most women don’t need to be convinced that they shouldn’t go on a 24 hour booze bender or do cocaine off a toilet seat while pregnant. Most women are wondering about the safety of an occasional glass of wine or beer- a part of their lives they enjoyed before pregnancy, like a weekend road trip (which Oster points out is also “risky” behavior but somehow not controversial). NOFAS comment suggests that even questioning the “zero drinks is the only safe amount” policy during pregnancy is selfish and reckless.

Such criticism frames this issue as black and white, like the only options are selfishly drinking and likely harming your child or selflessly never touching a drop. They also reinforce this impossible ideal our society has placed on motherhood: 100% unquestioning sacrifice for our children to the point that we stress over Goldfish vs organic Bunny crackers.  Oster is simply challenging us to seek more information- where do these hard and fast rules come from and what does the science really say? And if provided with more information, don’t we have the capacity to weigh the pros and cons for ourselves to decide what’s best?

Oster’s work, in my opinion, goes beyond the debate over whether or not you can have sushi or a glass of champagne while you’re pregnant.  It is a good reminder for me of how important it is for women to take charge of their health- pregnant or not, it’s still YOUR body. She says: “pregnancy and childbirth (and child rearing) are among the most important and meaningful experiences most of us will ever have; probably the most important. Yet we are often not given the opportunity to think critically about the decisions we make. Instead, we are expected to follow a largely arbitrary script without question. It’s time to take control.”

I believe most doctors are well-trained experts who have their patient’s best interest in mind and I usually feel comfortable following their recommendations. But empowering yourself with knowledge about your health (whether pregnant or not, really) and your child’s health and feeling comfortable speaking your mind are important for multiple reasons, one of which being that sometimes health professionals have different recommendations. After little V was born, we had a bit of a rough road with nursing and he barely nursed at all for the first 36 hours of life. Our nurse thought this was a huge issue and wanted little V taking formula out of a bottle right away, but the hospital’s lactation consultant was less concerned and suggested we wait it out until we were at home and more relaxed. A few hours before we were set to go home, the nurse came over and started shoving a formula bottle nipple into little V’s mouth after I’d already expressed my apprehension about this (I was worried this might interfere with breast feeding down the road). In that moment, the mama bear came out and I tearfully demanded that she stop. I shakily reminded her that we’d decided to wait based on the recommendation of the lactation consultant. Fortunately, Little V started nursing shortly after we got home.

I don’t think she was a bad nurse; if anything, she was probably just having a bad day. What I find most disturbing is that I almost didn’t say anything because I was feeling emotionally fragile and intimidated (of course, I’d just given birth!!). But we’d talked about this very situation in my childbirthing class and had learned these tools: it’s ALWAYS ok to ask “why”. And if you know why, but still don’t feel comfortable, it’s always ok to ask “can we wait X amount of time and talk about it again then?” I think having this prompt in my head empowered me to speak up.

As Oster argues, we are continually weighing the pros and cons in our lives when deciding what house to buy or job offer to take. If only provided with more information, we might be better able to do the same in other important areas, like how we’d like to navigate our pregnancies and the birth of our child. Oster’s book looks like a great place to start.

 

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Hypnobirthing – what does science say?

http://www.hypnotism.co.uk/Cartoons/Self-hypnosis.jpg

In the previous post, I talked about how the year of 2012 has been the year of doing shit I never thought I would do. And signing up for a class called “hypnobirthing” would have been right at the top of the list had I even known such a thing existed pre-pregnancy. I mean,  I once had an anxiety attack DURING a yoga class. And Therapist M has tried to talk me through some meditation exercises a couple of times, but they’ve only made me more anxious. I don’t seem like I’d be the type of person who could achieve deep relaxation during childbirth.

So why bother? As many of my friends say, there’s no prize for having a drug-free labor. But one of my own recent medical experiences revealed to me that unnecessary medical interventions can cause more problems than they solve. In my case, one unnecessary drug created a cascade of issues that resulted in an emotionally and physically traumatic ER trip and what would have been about $10,000 in medical bills, if not for our glorious health insurance. And although I’m all for doing whatever it takes if my baby’s life is at risk, giving birth doesn’t usually involve a medical emergency. I mean, people give birth to perfectly healthy babies in caves, taxis, on airplanes, in fields… yet all kinds of seemingly unnecessary medical “things” come standard during in a hospital birth.

Anyhow, hypnobirthing came highly recommended by our midwives. The idea is that there is a culture of fear surrounding birth and that this contributes to a stressful environment during labor. Movies, TV shows, and even birth horror stories from strangers on the street all make childbirth seem scary and painful. Then all the standard poking and prodding laboring women experience further diminishes any hope for relaxation. And all this stressful input causes our fight or flight response to kick in during labor, which causes the cervix to clamp down (making the pain of contractions a hell of a lot worse) and the whole birth process to stretch out into eternity. So hypnobirthing uses principles of hypnosis (essentially, meditation) to promote relaxation and a calm environment to prevent stress, thus encouraging the body to open up and give birth on its own.

All this intuitively makes sense to me. From an evolutionary perspective,  it seems beneficial that our bodies would have a mechanism to stall labor in the event of a real or perceived life-threatening situation (like being chased by a rabid animal). And as J and I continue to practice hypnobirthing techniques, I do find myself able to be more and more relaxed each time. So whether or not hypnobirthing works for birthing, it has definitely helped minimize the take over of My Anxious Self in everyday life. But I’m still feeling skeptical. Will hypnobirthing actually help when shit hits the fan during labor? And here I’m looking for cold hard facts- do women who use hypnobirthing during labor have shorter, less painful, and simply easier labors then women who don’t use it? 

So lately I’ve been delving into the research- is there actually compelling scientific evidence that hypnobirthing works? Perhaps not surprisingly, I haven’t found loads of peer-reviewed studies about hypnobirthing. Here I’ll present the first study that popped up in google scholar and review some others next time. If you have a compelling study to recommend, let me know!

This first study is out of Australia (1) and sounds extremely promising from the abstract… they claim to have found shorter labor times, less drug-taking, and fewer c-sections in  hypnobirthing moms (based on surveys) compared to the general population. However, there are serious limitations to the study (most of which the author discloses herself). The sample size is small- around 80 for most of the stats. And instead of a proper control group (ideally, a similar subset of women who were not in the hypnobirthing program but took the same survey), they compare their results to stats from the general population. And one can think of all kinds of problems with this comparison. For example, the study suggests that hypnobirthing can play a role in minimizing c-sections: 22% of individuals in the study had c-sections compared to a general public rate of 38.4%. But what role does the actual hypnobirthing play here? Hypnobirthers are probably less likely to have a c-section even if the techniques themselves are useless. For example, a woman who already knows she’ll get a c-section (for whatever reason) probably wouldn’t bother signing up for a hypnobirthing class in the first place.

In general, this study contains a LOT of qualitative statements about the benefits of hypnobirthing but not a lot of numbers to back up the claims. And because there’s no control group, much of the information collected in the survey seems compelling but it’s hard to know what to make of it. For example, women were asked to address their discomfort level during labor and the author finds an average of 5.8 out of 10. This seems pretty good… except without a comparison to a non-hypnobirthing group, how can we know? And participants who opted for an epidural are excluded from this average.  I imagine their pre-epidural discomfort would increase this average substantially.

In the end, I didn’t find any rigorous scientific evidence in this study that women who use hypnobirthing during labor have shorter, less painful, and simply easier labors than women who don’t use it.

But… that doesn’t mean it’s not out there. And I’m willing to give it a go, sample size = 1.  

(1) Phillips-Moore, J. (2012). Birthing outcomes from an Australian Hypnobirthing Prgramme. British Journal of Midwifery, Vol. 20, Iss. 8, pp 558 – 564.