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Things Movies Get Wrong About Birth

Azeem

An obstetrics Chuck Norris

Fact: Movies are not a realistic reflection of real life.

Another fact: This is especially true when it comes to childbirth.

According to a recent survey by Childbirth Connection, 68% of moms say they get their information about birth from TV.

This is very troubling because TV and movies have so little accurate information about childbirth.

This is probably one of the most frequently mishandled subjects in all of TV and film. So here’s the real story behind birth cliches in the movies and TV…

Your labor will start off when your water breaks– Oh my goodness, I can’t believe how many times I have seen this: Nine Months, Juno, Baby Mama… In about 1 in 10 labors the bag of waters will break hours before labor starts. That’s right, hours. And sometimes even a few days. That means that if you rush to the hospital because your water broke you may be going to the hospital when labor is hours off. Now if you are more than three weeks ahead of your due date and your water breaks, you should go to the hospital to seek medical care because you have premature rupture of the membranes (a.k.a. PROM). But if you’re 37 weeks or later, it’s probably better to wait until you’re actually in labor.(Just don’t have sex, take a bath, use a tampon or put anything in your vagina.) And concurrent with this myth is the next one…

You should leave for the hospital right away– Ah, the episode of The Office where Pam goes into labor. Jim is convinced that they need to leave right away, after all the timing of the contractions is right? The late Dr. Bradley recommended that couples stay home and work through labor together until labor was very well-established, otherwise the mother goes to the hospital, gets poked and prodded and miserable and everyone is in for a very long ride.

Dr. Bradley recommended that in normal labor couples wait until the mother hits the emotional signpost of seriousness before leaving for the hospital. When she gets snappish about things, can’t focus or concentrate on anything else going on and can’t smile or joke, then it’s time to go. (Melissa Joan Hart described this in her interview for More Business of Being Born. She had her family around her in labor at home and they were laughing and joking and when she started crying and saying things weren’t funny, then they knew it was time to go to the hospital.)

If Pam can come out and say that she changed her clothes because her water broke, talk with her coworkers, sit in a conference room for a meeting about slowing down her labor, she’s not at the emotional signpost of seriousness yet.

Someone needs to tell you to push during a natural laborNine Months, J.J. Abrams’ Star Trek reboot, Star Trek: The Next Generation. OK, here’s the thing about pushing a human being out of your vagina without pain medication: YOU’LL FEEL IT COMING!!! For women who have epidural pain medication, the sensation of contractions may be hard to feel. This is where the doctor or nurse telling them to push comes in. However, if

worf delivers molly

Dr. Bradley, he is not.

you are not on pain medication, I promise you, you will know when it’s time to push. Though I thought Worf delivering a baby in TNG was hilarious. (“My computer simulation was not like this. That delivery was very orderly.”)

The woman will be hurling insults for hours on end– Labor is divided into three stages: First stage (onset of labor until dilated 10 cm), Second stage (10 cm dilation to delivery of the baby) and Third stage (delivery of the placenta). First stage labor is divided into three phases: Early labor, Active labor and transition. Early labor is when you feel energized and excited or nervous. Active labor is when you start feeling serious and focused on the birth. And then there’s transition. Transition is when you start to lose it. It’s almost time to push and this phase gets very intense. Dr. Bradley characterized this phase with the emotional signpost of self-doubt. (I have told my husband that I can’t do it every single time I have given birth when I hit transition.) “You did this to me,” “I can’t do this” are all things that a woman feels like in transition. But transition is actually a relatively small part of labor (about 2 hours to 30 minutes).

You’ll get a c-section (or birth by beaming) and it will be totally easy!- Robin Hood Prince of Thieves, Star Trek: Voyager… The World Health Organization recommends that the c-section rate for a country not exceed 10-15%. So c-sections are definitely necessary and life-saving sometimes, but it’s major surgery and not some walk in the park.

In an obstetrical Chuck Norris move, Morgan Freeman’s character performs a c-section for a breech baby in Robin Hood: Prince of Thieves. C-section moms, don’t you love how he does this without a sterile operating room and with no pain medication and the mother is up and walking around just fine the next day? That’s Hollywood!

As a note, while breech births are typically performed by cesarean in the United States, a breech birth does not require a cesarean surgery like a transverse lie does. (Transverse lie is where the baby is lying sideways in the uterus. Ain’t no way that’s coming out.) In fact many breech babies have been delivered safely by the side of the road on the way to the hospital and a growing body of obstetrical and midwifery research is questioning the assumption that the breech positioning itself is always the problem and that maybe it’s the techniques associated with traditional breech delivery such as laboring in a reclining position and the use forceps that are more problematic.

As for Voyager, I think the writers just liked the novelty of beaming the baby out. They don’t really discuss the implications pf beaming a baby out of the mother’s womb, which would probably be a little different than transporting an exploration party to another planet.

Woman should be on her back during labor– The only movie I can recall seeing a woman in an upright position during labor was some made-for-TV movie about something in the Bible that my mom watched at Easter when I was a kid. (I think it may have been about Moses.) I was terrified of labor and baffled at the idea that a woman would be upright in labor. Since it was based on the Bible and the Bible states that women gave birth on stools during the Old Testament period, they probably went for accuracy instead of appealing to 20th century sensibilities.

You’ll get pain medication right awayWaitress, Junior. You scream for drugs and the nurses will come and give you an epidural immediately. Not so. You have to be far enough along in labor to get an epidural. (But Juno gets this one right.)

You’re going to die, even in a highly advanced civilization capable of interplanetary travel, and even with a genius vampire doctor father-in-law– Wow, even a long time ago in a galaxy far, far away in a civilization with light sabers and faster than light interplanetary travel, people are still freaking out about childbirth. (Or maybe that’s just George Lucas.) There are definite complications that can occur with childbirth, however, from an evolutionary standpoint the process had to evolve in such a way that even without any medical care, most (not all, but most) mothers and babies would live through the process. Otherwise, the human race would have died out a long time ago (in a galaxy far, far away- and everywhere else).

Seriously, in a civilization that advanced, I’m sure they could have safe and comfortable natural births- even for twin pregnancies. I’m imagining safe, sterile emergency c-sections at home and effective screening for blood clots and deep vein thrombosis in pregnancy. Now, I realize that Anakin grew up on Tattooine, a backwater, outlaw world that doesn’t seem to be a poster child for developments in infant and maternal health. For a slave in such an environment childbirth but seem frightening. But at no point in Revenge of the Sith does Padme point out that as a member of the Republic Senate on a developed world she would have access to the very best maternity care. What might have happened if Padme had simply opted for woman-centered care when her husband expressed his terror about the impending birth? Well, we may not have had Star Wars…but on the other hand maybe Padme would use her experience to advocate for less advantaged women in the galaxy. You know, start something like the Republic Maternal and Infant Health Coalition that would make safe maternity care available to women of all worlds. But you can’t make a sci-fi action franchise out of that. (Alternate universe fan fiction anyone?)

Breaking Dawn makes the case that pregnancy by a vampire will result in a horrifically complicated birth, though one has to ask the question that if Edward’s “father” is a doctor and so knowledgeable, why didn’t he just schedule a c-section for Bella since he should have known how high-risk her pregnancy was? Yes, a vampire human hybrid pregnancy might be little documented, but Bella would still show signs of impending labor. Seriously, he could be watching for Braxton-Hicks contractions, blood pressure readings, dilation. Labor doesn’t just come out of nowhere- even in a half vampire pregnancy.

And we’re on the subject of things that movies get wrong about human reproduction…

Conception happens right after sexLook Who’s Talking, Look Who’s Talking Two, Nine Months. Remember your sex ed and/or health class? They didn’t tell you how conception really works. A woman is fertile during about 2-5 days during her cycle, at some point she will release an egg often during the middle to end of her fertile phase. So here’s the catch: sperm can survive for about 3-5 days during a woman’s fertile phase. That means that conception does not take place minutes later. More likely a day or two later. So no matter how romantic the night was, conception probably happens in a much more mundane moment like standing in line at the post office, cooking dinner, around the water cooler at work, running errands, vacuuming the floor… That’s why Hugh Grant’s character could be away at a psychology conference and still get his girlfriend pregnant.

You can take a pregnancy test any time of the day- Well, you can take a pregnancy test any time of the day, but if you want to have an accurate reading, it’s best to do it first thing in the morning right after you get out of bed. That’s when the concentration of HCG is the highest for the most accurate reading.

 

 

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Now Open For Enrollment! Happier, Healthier, Easier: Breastfeeding In The Real World!

Happier, Healthier, Easier: Breastfeeding In The Real World is now open for enrollment! I am so excited about this class!!! Putting the curriculum together was an adventure. This is the first breastfeeding class to address the many experiences that mothers have breastfeeding in the real world. Rather than being based in theory and assuming that you will have a flawless experience breastfeeding, this class is about giving women actual strategies to navigate some of the questions and challenges that can arise during this special time on your baby’s life.

There are seven sections, each about a different aspect of breastfeeding:

  • Section 1: The Real Benefits of Breastfeeding
  • Section 2: The Biology of Breastfeeding
  • Section 3: Breastfeeding Your Baby
  • Section 4: Pumping
  • Section 5: Troubleshooting Problems On Mom’s Side
  • Section 6: Troubleshooting Problems On Baby’s Side
  • Section 7: The Toddler Years

Happier, Healthier, Easier: Breastfeeding In The Real World is available on Birth Multiverse’s Teachable site. You can see the course outline here.

This class is 100% online! You can learn any time and anywhere as long as there’s a good internet connection. Each section has presentations on different subjects along with digital handouts that go in-depth on specialized topics. You can pick which presentations and handouts you want to study.

There are almost 3 hours of video based instruction along with 28 handouts. You can enroll on the Teachable page for Happier, Healthier, Easier: Breastfeeding In The Real World. Once you enroll, you have lifetime access. The cost is $75. (Approximately the cost of 3 cans of formula.)

This class is great for pregnant moms, but also for moms who have tried breastfeeding before, struggled and want to try again. (You can successfully breastfeed after a difficult experience! I have seen it done!) There’s also information for mothers who are considering breastfeeding for an adopted baby. Whatever, your situation, Happier, Healthier, Easier will give you the tools you need to have a better breastfeeding experience!

Breastfeeding Article: Utilizing the Breastfeeding Pathway Model to Help NICU Mothers and Babies Breastfeed

For my Breastfeeding Educator Certification I had to write an article on a topic related to breastfeeding. I chose to write about breastfeeding in the NICU because of the pressure I felt as I was breastfeeding my oldest during his stay in a Level IV NICU. 

Breastfeeding in a Neonatal Intensive Care Unit (NICU) can be extremely challenging. Not only does the baby have a serious condition that requires specialized medical care, but the practices of NICU’s may not be conducive to establishing breastfeeding. Strict schedules for feeding, medications for the baby and the baby being attached to several monitors can all make it difficult for the mother and baby to work out a breastfeeding relationship that can work effectively during hospitalization and after the baby is released.

Mothers are often under pressure to get breastfeeding perfect right away and that pressure often increases for the mother of a baby in the NICU since her baby must meet certain weight gain requirements before he can be released from the NICU. Doctors in NICU’s are often supportive of breastmilk as a medicine, but actual feeding from the breast are often not perceived as a high priority for the baby’s care, especially long term (Lieberman).

Because of the difficulties with breastfeeding, the rates of breastfeeding for NICU babies are often lower than the national average- which is far lower than ideal to begin with. The rates for infants receiving any breast milk at some point range from about 50% to 83%. However, those rates drop as the babies are released from the hospital. Studies have found that the rates of breast milk feeds at discharge are 64%, with the rate of breastfeeding being 38%. One study found that at 4 months of age, only 24% of infants born at less than 33 weeks gestation continue to receive some breast milk feedings. (Pineda, 8). Without a strategy to plan for long term breastfeeding, many mothers end up providing breastmilk through pumping during their baby’s hospital stay and struggling to breastfeed afterwards- if they breastfeed at all.

However, University of California San Diego Medical Center has instituted a Breastfeeding Pathway program to help mothers not only provide breastmilk in the NICU, but also establish long term breastfeeding for mothers and infants. The approach is somewhat novel. Instead of viewing breastfeeding as an event that may or may not happen, the Breastfeeding Pathway focuses on establishing breastfeeding in a step-by-step fashion while the mother is pumping.

The first step is to encourage skin-to-skin contact as much as possible as soon as the baby is stable. The next step is to establish non-nutritive sucking by getting the baby to suck as much as possible even if he is receiving little or no milk. Step three moves to nutritive breastfeeding where the baby starts taking feedings at the breast. Step four is bottle and breastfeeding where the mother provides feedings whenever she is at the baby’s bed side, and bottle feeding is utilized when she is not present.

Step five involves planning for breastfeeding after discharge. The mother is advised about ongoing pumping needs and how to transition towards breastfeeding as much as possible. The hospital also maintains a Premature Infant Nutrition Clinic to help mother continue the transition to breastfeeding.

The results for the Breastfeeding Pathway have been excellent. 82 percent of UCSD’s NICU babies are receiving breastmilk either at the breast or from a bottle at discharge. Of their infants under 1500 grams, 75 percent are receiving some amount of breastmilk at discharge. With the Breastfeeding Pathway program in place, the hospital has seen an increasing number of mothers getting their babies to the breast several times a day instead of several times a week (Stellwagen). Unfortunately, not every mother who has a baby in the NICU has so much support from the hospital.

Doulas and lactation consultants can utilize the principles of the Breastfeeding Pathway model with NICU mothers and babies to help. Most NICU’s permit or encourage Kangaroo Care to some degree and encouraging mothers to hold their babies skin-to-skin as much as possible under their particular circumstances is one of the best ways to start breastfeeding a baby in NICU. While the mother is pumping milk for her baby, she can still put him to the breast, first for non-nutritive sucking and then for nutritive sucking. As the mother and the baby fall into a pattern of successful breastfeeding, working with the mother and the hospital staff to encourage more feedings at the breast will help build both the mother and baby’s confidence and set the stage for breastfeeding after discharge.

Typically, the parents and baby are often under a great deal of stress making the move from NICU to home. The baby may require special care or may be on medications. Unfortunately, most hospitals do not have the kind of post-discharge support that UC San Diego provides for it’s NICU mothers and babies. Again, this is where doulas and other birth and breastfeeding helpers can step in with the Breastfeeding Pathways model. As discharge nears, the parents and their doula or lactation consultant can request to work out a plan for breastfeeding post discharge in consultation with the baby’s team of specialists and doctors.

The parents should receive contact information with local breastfeeding support services including WIC, the La Leche League, breastfeeding hotline numbers, lactation consultants, doulas who specialize in breastfeeding and any other resources available. Making sure that the parents don’t feel abandoned after discharge and know they have help available to them will go a long way towards helping ease the transition from the NICU into breastfeeding at home.

Works Cited

Liberman, Tanya. “Booby Traps Series: Booby Traps in the NICU.” Best For Babes. Retrieved from http://www.bestforbabes.org/booby-traps-series-booby-traps-in-the-nicu/Accessed 16 August 2016.

Pineda, Gittens Roberta. “Breastfeeding Practices In The Neonatal Intensive Care Unit Before And After An Intervention Plan.” University of Florida Department of Rehabilitation Science. August 2006, p. 8. Retrieved from ufdcimages.uflib.ufl.edu/UF/E0/01/56/59/00001/pineda_r.pdf. Accessed 15 August 2016.

University of California San Diego Medical Center. “Breastfeeding Pathway for All Mothers and Infants.” Accessed 17 August 2016 health.ucsd.edu/specialties/obgyn/maternity/newborn/nicu/spin/staff/Documents/Riley%2520BF%2520Pathway%2520NICU.docx+&cd=1&hl=en&ct=clnk&gl=us

Stellwagen, Lisa. “Re: Statistics on Breastfeeding Pathway?” Received by Nicholette Lambert, 18 August 2016.

Rethinking How We Approach The Abortion Debate

My views on the abortion debate- not so much the procedure itself- changed forever when I found out that a friend of mine had an abortion. She had been engaged and was pregnant when she found out that her boyfriend was cheating on her, using drugs and had a criminal history. She wanted to place the baby for adoption, but the slimeball said he wouldn’t give up parental rights and would get custody of the child.

She didn’t know that his claim to custody and/or visitation would have been on shaky grounds since he had a criminal record and history of drug use. She felt that she had only two options: end the pregnancy or leave a child in the hands of a dangerous person. She chose abortion, but it grieved her deeply. Later on, her friends, not knowing of her experience, would share things on Facebook condemning women who had an abortion as murderers who cared only for their own convenience and it would open up the wound all over again.

The abortion debate is an extremely heated one and I think it’s very common for people from different sides to characterize things in an extremely narrow way. I guess what I would like to propose is that as deep as our feelings run on this issue, that we all try to look at the issue with more understanding of different points of view. In short, I think we need more compassion from everyone. I would like to suggest the following shifts in the way we approach the issue of abortion:

Move beyond the issue of legality– Laws only prevent things from happening to a limited extent. We have laws against a lot of things- speeding, sexual abuse, child pornography, murder, insider trading, etc. and those things still happen. The same is true of abortion.

Before Roe vs. Wade, women still had abortions. In the 18th century, recipes for herbal preparations that could act as abortifacients were known and used. The medical profession’s relationship with the procedure has been complicated. While the AMA took an anti-abortion stance publicly during the 19th century, many doctors continued to offer the procedure- often competing with midwives. Some estimates place the per capita number of abortions in the Victorian era to be seven or eight times as high as it is today. In the 20th century, abortions were still harder to obtain since many doctors didn’t want to be prosecuted under abortion laws, but many women did- sometimes at their own risk. Illegal abortions were often performed in unsafe conditions leading to 5,000 deaths a year. If Roe vs. Wade was appealed, it would not stop women from seeking abortions or being pressured into them. If we’re looking to preserve life and prevent abortion it is going to happen through choices on an individual level, not through legislation.

Understand why women have abortions– The motives for abortion often seem to get reduced down to soundbites about “rights” and “murder”. This isn’t getting anyone anywhere because these two concepts vastly oversimplify the dynamic and don’t address the reasons why women often feel an abortion is a better choice than carrying a pregnancy to term. One of the more detailed studies from 2005 on the subject found some interesting results. This was especially intriguing because it compared the reasons for abortion in 1987 vs. 2005. One of the interesting things that this study found was that “timing is wrong/ not ready to be a parent yet” was still the most common reason cited for having an abortion, but one reason had increased dramatically was “Had completed childbearing/ had grown children”.

Since 1987, fewer women were having abortions because they felt it would interfere with their careers, but slightly more were having an abortion because they felt that it would interfere with school. (This is ironic because more schooling has been moving online since the widespread use of the internet.) Finances was another frequently cited reason. Interestingly, about 40% of women  in this study said they had considered adoption, but felt it was morally wrong to give a baby away.

Stop catastrophizing pregnancy– I remember when I was a teenager, it seemed like all of the stuff in my child development class focused on how having a baby young would be a disaster. It would be expensive and would condemn a girl to a life of poverty. It would also be horribly uncomfortable and difficult. I even saw religious groups get in on the act, talking about how terrible it would be to have sex and then get pregnant. Now personally, if my daughter were to get pregnant as a teenager, I wouldn’t exactly be thrilled, but there are far worse things your kid could become (sex predator, terrorist, gang member, scam artist, white collar criminal…). I don’t have any concrete data on this, but I think if we were to stop telling our children that unplanned pregnancy is the worst thing that could happen, we might find that women feel like there are options available to them if they do get pregnant. I don’t think that being honest about the realities and options associated with single motherhood like job opportunities and education options is glorifying young single motherhood, but it is one option. I think that women need an honest view of pregnancy and motherhood that doesn’t reduce it to either easy or a travesty.

Stop castrophizing labor– Again, I don’t have any hard labor here, but I’m trying to put myself into the shoes of the average woman who doesn’t know that labor isn’t an automatic trauma. If you believe that labor is going to be this horribly frightening, painful thing and even life-threatening thing that you have to go through to get a baby, you’re not going to feel very inclined to go through it unless you really want that baby and are going to have it be yours. Labor is hard work-hard work. But it can have dignity, peace and love. The subject of labor and birth support for biological mothers is something rarely discussed, but I think more doulas and midwives should offer their services to women who plan to place a child for adoption and share their experiences about attending these kinds of births.

Have a more open dialogue about adoption– Families and adult adopted children  who feel positively about adoption should feel free to share their stories as a way of reducing the stigma associated with choosing adoption for a baby. I think there should be more resources explaining the options for different kinds of adoptions (varying degrees of open to closed) and the rights of birth parents. More information can help people make more informed decisions.

 

 

 

 

Public Health Mythbusters Edition: Raw Milk, Friend or Foe?

The last twenty years have not been kind to Louis Pasteur. He ordered that his laboratory notebooks be withheld from outsiders, but in the 1970’s one of his heirs left them to the Bibilotheque Nationale in Paris. In the mid-1990’s a researcher from Princeton went through the notebooks and then wrote a book on what he found. Since then embarrassing revelation after embarrassing revelation have come to light. In the race for an anthrax vaccine, Pasteur took his rival’s technique, misrepresented it to the public as his own, lied to get published and subsequently obtained a monopoly on the manufacture of all anthrax vaccine at the time. (The rival, a veterinarian named Toussaint, was so devastated by the theft of his work that he suffered a nervous breakdown and died shortly thereafter.) In the famous story of Pasteur administering a rabies vaccine to a boy who had supposedly been bitten by a rabid dog, Pasteur claimed that his vaccine had been tested on 50 dogs without a single failure. And that was true- but not for the vaccine he administered to the boy. That one was prepared in a different way and Pasteur had no conclusive evidence to show that it would work. Now, a small but growing group of people are questioning how effective and beneficial the treasured process of heating drinks and food to kill bacteria that bears Pasteur’s name really is.

Since my husband is Superman and milk of any kind has  proven to be his kryptonite, we don’t drink any animal milk at all any more. However, the question of pasteurized versus raw milk has intrigued me. I had heard since I was child that pasteurization was one of the greatest innovations in public health. All the milk I drank as a kid was pasteurized. On the other hand, my grandparents and great-grandparents were raised in small farm communities in Southern Canada . The kind of place where fifty years ago you could walk around the neighborhood and see a housewife out plucking a chicken for dinner that evening. The kind of town where cows outnumber people and the horizon is broken only by a lonely grain elevator.  And the people who lived in these small farming towns drank raw cow’s milk all. the. time. My dad lived in one of these towns for a few years  as a kid and recalled picking up buckets of fresh cow’s milk from his grandfather in the bone-chilling prairie winter nights.

My dad never got sick from drinking raw milk. My grandparents never got sick from drinking raw milk. My great-grandparents never got sick from drinking raw milk. But history tell us that a lot of people did get sick from drinking raw milk. And the news media continues to tell us today of incidents of people (including pregnant women and children) getting really, really sick from drinking raw milk. So what gives? What is it about raw cow’s milk that makes people (sometimes) sick?

Cow’s milk itself is generally not the problem. In fact, some sources say that milk straight from a healthy cow is sterile. This is most likely why my great-grandparents never got sick from drinking raw milk. They owned a few cows which grazed on their land, milked them and used it right away. When your milk distribution process is picking up a bucket from the barn where only a few cows have been, you have much greater control over the sanitation of the cows and milking. It’s the process of milk distribution and dairy farming that create the contamination problems most of the time. The soil, manure, feed, insects  and workers on the dairy farm can all cause pathogens to get into the milk and cause contamination. If an animal has mastitis, the bacteria that caused the infection can shed into the milk as well.

For large-scale dairy farms, pasteurization is a necessity because monitoring the health and sanitation of so many animals and their environment is extremely difficult. Another reason pasteurization is necessary for large scale dairy farms is that the milk from these farms is typically shipped out across the country to large grocery stores, and thus needs to have a longer shelf-life. In the 1940’s, reports indicate that milk had a shelf-life of 3-7 days, now it has an average shelf-life of 14-21 days, often longer. Part of this long shelf-life is due to a reduction in the number of pathogens by pasteurization. But the other place that contamination can occur is in the processing plant. And in fact, this is where things can get scary with pasteurized milk.

Post pasteurization contamination (commonly abbreviated PPC) remains a significant concern for the dairy industry. There are types of contaminants called psychrotolerant sporeformers that can survive the high temperatures of pasteurization and then flourish in refrigeration. These nasty organisms can cluster in groups on the processing equipment and create a biofilm that protects the spores from heat and chemical sanitization agents. In fact, the largest outbreak of salmonella in American history occurred in the mid 1980’s and involved pasteurized milk from a single dairy plant. The number of people affected was estimated to be between 168,791 and 197, 581. The salmonella strain was found to be antimicrobial resistant. And cases of food poisoning involving pasteurized milk products are still frequently reported. So in all reality, any of those cartons of pasteurized milk you see in the grocery store can be crawling with disease causing microbes.

That being said, raw dairy products caused 42 of the 56 dairy related outbreaks between 2000 and 2007, most of which were caused by campylobacter pathogens.  (See pages 18-19 of cited pdf for the following statistics.) There were two large outbreaks of campylobacter outbreaks with pasteurized milk, but these occurred at prisons with on-site dairies that had PPC problems, not milk sold to the general public. For the other pathogens (e. coli, listeria and salmonella) the results were more mixed. Between 2000 and 2007, there were 5 raw milk e. coli outbreaks and 1 related to queso fresco soft cheeses with none related to pasteurized milk. For listeria, there were 3 outbreaks related to soft cheeses and 2 related to pasteurized milk with none related to raw milk. For salmonella, there were actually 4 pasteurized milk related outbreaks, 3 raw milk related outbreaks and 1 case related to soft cheeses. Some sources say that consuming raw milk increases levels of “good” bacteria in the body, which could potentially fight bad bacteria.

However, dairy products both raw and pasteurized account for the smallest number of the foodborne illnesses for any  category of food (page 10). This chart from the CDC (which unfortunately groups eggs and dairy together) shows that produce, meat and poultry cause far more cases of foodborne illness and death than any type of dairy products. So statistics seem to show that you are much, much more likely to develop a serious foodborne illness from melons, spinach, chicken or beef than any kind of milk.

Whether raw or pasteurized, sanitation issues remain the biggest issue with the safety of dairy products. Raw dairies that have been sources of outbreaks typically have issues with sanitation, but pasteurized milk dairies and processing plants that have been sources of disease often have the same problem. Another problem with raw dairies is outsourcing, as was the case of a California dairy farmer who started buying and then selling colostrum from surrounding dairies that were not licensed to sell raw milk. The unlicensed colostrum ended up causing an outbreak of e. coli. But no matter where you get your milk (raw or pasteurized) you want it to come from a sanitary dairy and plant.

Are there benefits to raw milk? When my oldest was in the NICU recovering from surgery, I found out that NICU nurses used to warm breast milk in the microwave, until it was found that the babies didn’t thrive on microwaved milk. Similarly, heating milk to high temperatures does alter its composition. It kills off beneficial microorganisms and enzymes. But that is the idea behind pasteurization is to kill off all microorganisms. Research from Europe shows that raw milk consumption may lead to decreased levels of allergies and asthma. Raw milk also typically comes from small, local dairies that use more traditional farming practices such as allowing animals to graze in pastures for most of their time. The conditions on these farms can be healthier for animals than the crowded conditions of corn-fed dairy cows. (If you want to find out more about this, watch Food Inc.)

So if you want to drink raw milk, having a cow might be best- if you have the pasture to graze it in! However, if you’re thinking about getting milk from a local raw milk dairy, it would be extremely wise to find out as much as you can about the sanitation practices of the dairy and find out if they outsource any of their products. And if you drink pasteurized milk, hope that you didn’t get one of those gallons that was in contact with bio-film covered equipment.

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Breastfeeding Is a Weed, Not an Orchid

Sometimes I get the impression that people think breastfeeding is like a rare orchid that can only bloom under the most precise conditions. Like in order to successfully breastfeed you have to be a middle-class white woman who doesn’t work outside the home with a full-term, singleton pregnancy and uncomplicated natural birth of a baby who has no problems.

This is, in fact, false. Breastfeeding is like a dandelion. It’s misunderstood but actually incredibly useful and it’s everywhere. (Dandelions are edible, the greens are highly nutritious and you can even make a tea from the roots.)

18th century mother breastfeedingFrom Inuit to Australian Aboriginal, mothers all over the world have been breastfeeding southeastern asian mother breastfeedingtheir babies for millennia. Aristocrats, nomads, farmers, and hunter-gatherer mothers have all breastfed their babies.

ccac-med-zoom

Throughout history, women breastfed their babies under all kinds of circumstances. If you look at the background of this painting of Mormon handcart pioneers, you can see a mother nursing her infant.

Breastfeeding has saved the lives of babies in some of the most dire circumstances like a few of the babies who were born in Auschwitz. Barbara Puc‘s mother was unable to breastfeed her after being sick and malnourished, but another woman at Auschwitz who had just lost a baby was lactating and nursed the little baby girl- saving the baby’s life in a place where infant formula was an impossibility.

Women have been breastfeeding twins, siblings and even premature babies all before formula was widely available. mother breastfeeding twins

From a biological perspective, it’s actually abnormal for only 22.3% of babies to be exclusively breastfed for six months. But because it’s so rare for a baby to be breastfed according to biological norms, it gives the illusion that breastfeeding is like that rare orchid that blooms only in a climate-controlled greenhouse. Don’t be fooled. Breastfeeding is like those hearty dandelions that are edible and nutritious and can be extraordinarily prolific.

 

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Making Peace With Your Diet Through Traditional Chinese Medicine

We’ve all been through different diets to try and eat healthy. Vegan, vegetarian, raw, gluten-free, paleo and the list goes on… Some people see phenomenal results with one way of eating while others see little to no change. It used to be a big mystery to me. But the more I’ve studied the Traditional Chinese Medicine (TCM) perspective on diet, the more I understand. Certain foods are good for certain imbalances. Correcting these imbalances is crucial not only to general health, but also women’s health and decreases the chances of things like menstrual discomfort and infertility.

Why TCM? For starters, TCM has been around for longer than the Western model of medicine. 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 and surgery based approach has been in use for about 100-ish years. So with TCM we’re talking about centuries of observation and practice, not years or even decades. Western medicine is the best option for emergency care. In an emergency, no one can do better than a sterile ER with well-trained doctors and nurses. But for things like chronic diseases and hormonal imbalances, TCM has the potential to be much more effective while being gentler on the body.  

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

There are several different patterns of imbalance that TCM can identify and many people will have more than one at a time. But here’s a very brief intro to some of the more common patterns and a few of the dietary recommendations for them.

Kidney Yin or Yang Deficiency

In Traditional Chinese Medicine, the Kidney meridian governs fluid and acid balance, metabolism, waste elimination and growth and development. Stress and fear are the emotions that are associated with imbalances in this meridian. Conditions associated with this imbalance:

  • Lower back and knee pain
  • Feeling cold frequently
  • Stiff joints
  • Tinnitus (ringing in the ears)
  • Anxiety
  • Adrenal fatigue

TCM Diet recommendations:

  • wheat germ, bulgur, some tofu, millet barley, brown rice, amaranth
  • asparagus, beans of all varieties, peas, chickpeas, bean sprouts, eggplant, beets
  • seaweed, chlorella, spirulina, kelp
  • fruits like apples bananas, berries, melons and pineapple
  • shellfish
  • eggs
  • duck and organ meats
  • pork, venison and other hormone and antibiotic free meats
  • walnuts, black sesame seeds, yams, gelatin, corn
  • flaxseed oil
  • For Kidney Yin Deficiency avoid dry, pungent and acrid spices like horseradish, peppermint or curry.
  • For Kidney Yang Deficiency use warming spices like anise, ginger, cinnamon, cloves, fennel, basil, caraway and dill.
  • For Kidney Yang Deficiency eat more Yang vegetables like parsnips, parsley, mustard greens winter squash, cabbage, kale, onions, leeks, chives, garlic and scallions

Spleen Qi Deficiency

In Traditional Chinese Medicine, the Spleen meridian governs immune function, digestion, circulation and production of certain hormones like progesterone and thyroid hormone. Excessive sugar and refined carbohydrate consumption, greasy foods and excessive worry and over-thinking all stress the Spleen meridian. Conditions associated with this imbalance:

  • Thyroid abnormalities (hypothyroidism, hyperthyroidism, etc.)
  • A number of autoimmune conditions, especially with severe fatigue
  • Allergies
  • Irritable Bowel Syndrome
  • Anemia
  • Low blood pressure

TCM Diet Recommendations:

  • Eat organic vegetables lightly cooked or sauteed.
  • Avoid raw or cold foods, especially ice cream, popsicles and ice-cold drinks.
  • Avoid energetically “cold” fruits and vegetables like mangoes, watermelon, pears, persimmons, cucumbers, lettuce, celery and spinach.
  • Do not eat refined carbs. No white bread, pasta or refined sugar.
  • Eat whole grains like rice and oats.
  • Eat yams, pumpkin and pumpkin seeds (except if you have certain conditions like polycystic ovary syndrome).
  • Eat meat of many kinds (beef, rabbit, poultry, and fish).
  • Cherries, coconut, dates, figs, cherries, grapes, molasses, potatoes and shiitake mushrooms are especially recommended.
  • Avoid sugar, sugar substitutes and concentrated sweeteners like maple syrup, honey and agave.
  • Fruits should be eaten in whole form not as juices.
  • Avoid all dairy products as these have a dampening effect, which further harms the Spleen meridian.

Blood Deficiency

In TCM, blood deficiency doesn’t necessarily mean anemia. Blood depletion in the sense of Blood as a vital substance in its TCM definition can happen through a really crazy overly active lifestyle, too much stress, lack of rest and self-care and, of course, blood loss.

  • Dry, flaky skin
  • Brittle nails
  • Hair loss (all over, not in patches)
  • Diminished night vision

TCM Diet Recommendations:

  • Eat apricots, berries and grapes
  • Eat eggs and meat
  • Eat spirulina
  • Eat dark leafy greens
  • Eat liver and bone marrow broth

Blood Stasis

Blood stasis refers to conditions where the blood isn’t moving properly.

  • Varicose veins
  • Endometriosis
  • Chronic hemorrhoids
  • Blood clotting disorders

TCM Diet Recommendations

  • Eat soy, but in moderation
  • Use oils that are cold-pressed and unrefined and high in linoleic and alpha-linoleic fatty acids like flaxseed, pumpkin seed and chia seed oils.
  • Add spirulina to your diet.
  • Avoid foods containing arachidonic acids like meat, dairy, eggs, and peanuts. Fish is OK.
  • Eat walnuts, chestnuts, chives, crabs, peaches, mustard leaves, onions, scallions, dark leafy greens, cabbage, broccoli, Brussel sprouts, beets, turnips, cauliflower and carrots.
  • Lemons, limes and certain types of seaweed like kelp, Irish moss and bladder wrack are especially recommended.
  • Don’t eat foods straight out of the refrigerator or freezer.
  • Don’t put ice in your drinks.
  • Add grapes, raspberries, tomatoes, cucumbers, celery, beets, watercress, vinegar and unrefined salt to your diet to purify the blood.

Liver Qi Stagnation

Oh, Liver Qi stagnation. A good portion of America suffers from Liver Qi stagnation and at least one of its accompanying conditions. Liver Qi stagnation is often associated with stress, anger and unfulfilled desires.

  • Depression
  • Insomnia (trouble getting to sleep as opposed to night waking)
  • Heartburn
  • PMS
  • Irritable Bowel Syndrome

TCM Diet Recommendations

  • Incorporate Spleen Qi deficiency guidelines.
  • Don’t overeat.
  • Avoid heavy or hard-to-digest foods like nuts and nut butters, butter and other animal fats, and excessive bread or meat.
  • Don’t eat foods with chemicals or preservatives.
  • Sit down when you eat.
  • Eat small, frequent meals.
  • Chew thoroughly.
  • Eat spices like peppermint, rosemary, spearmint, turmeric and thyme.
  • Supplement with zinc.

Heart Deficiency

In TCM, the Heart Meridian encompasses the mind and the spirit as well as the cardiovascular system. Imbalances in this meridian are associated shattered emotions and spirit. If you have experienced severe trauma, there is a good chance you have an imbalance in this meridian. Take note that many of the symptoms are associated with Post-Traumatic Stress Disorder. If you want my opinion (and I’m assuming you do if you’re here), I think PTSD is associated with imbalances in the Heart meridian.

  • Insomnia (waking early and having trouble falling back to sleep)
  • Heart palpitations
  • Restlessness
  • Nightmares

TCM Diet Recommendations

  • Cut out coffee, caffeine and any other kinds of natural or artificial stimulants
  • Mung beans, beets and corn are especially recommended.

Excess Heat

In TCM, imbalances in the meridians can be associated with “coldness” or “heat”. Excess heat needs to be treated differently than excess cold.

  • Dry mouth and throat
  • Hot flashes or feeling warmer than those around you
  • Red acne

TCM Diet Recommendations

  • Don’t drink alcohol.
  • Avoid spicy and greasy foods.
  • Don’t take very hot baths or sit in hot tubs or saunas.
  • Include cooling foods like burdock root, plums, pears, tomatoes and pomegranates in your diet.

Dampness

Too much dampness in the system can be another imbalance. Some conditions associated with Dampness:

  • Fibrocystic breasts
  • Cystic or pustular acne
  • Joint aches with movement
  • Some types of overweight conditions
  • Certain types of rashes

TCM Diet Recommendations

  • Do not eat greasy, fried foods.
  • Avoid sugar, fruit juices, sweets and refined carbohydrates.
  • Do not consume dairy products.
  • Eat soy products sparingly if at all.
  • Avoid wheat (it’s a damp food). Barley, rye and brown rice are grains that help combat dampness.
  • Don’t eat bananas, chocolate or nuts.
  • Don’t drink alcohol.
  • Add in diuretic foods like alfalfa, parsley, radishes, summer melons, celery, carrots, cabbage, cranberries, cucumbers, lettuce and kelp.

I owe a debt of gratitude to the book The Infertility Cure by Randine Lewis Ph D and the website http://www.sacredlotus.com for much of the information in this post. I highly recommend both if you are curious about Traditional Chinese Medicine.

The Butlerian Jihad and Maternal Health

Butler_Pregnancy-e1437031975886

Interestingly enough, the backstory to the Butlerian Jihad in the Dune books involves a pregnant woman trying to protect  unborn children from overly technologized childbirth.

Frank Herbert’s epic sci-fi novel Dune chronicles humanity’s interstellar civilization thousands of years into the future. (If you read it, you’ll notice more than a few similarities between Dune  and Star Wars: A New Hope. George Lucas was very inspired by Dune and his initial versions of Star Wars were more of a reworking of it. Once he used a little more Force and a little less spice, the whole thing really took off.)

Anyway, in Herbert’s imagined human history of the future, there is at one point something called the Butlerian Jihad. Humans developed robots to do lots of things for them and became so cognitively lazy that the robots made the humans slaves for 900 years. Eventually, the humans got smart enough to realize that they didn’t need robots for everything, rose up and did away with the them. After that, specially trained humans called Mentats did all the computing. I think we’ve hit a similar problem with maternal health.

We have interventions of all kinds for giving birth- inductions, pain medication, cesareans, forceps, vacuum extraction. Formula feeding has changed the landscape of infant feeding in a single century. And I think we have become (in general) too dependent on them.

For example, I’ve encountered women who say, “I could never give birth without an epidural”. Well, if you were stranded by the side of the road en route to the hospital in late stage labor, your baby would come with or without an epidural! Women have been going into spontaneous labor for thousands of years and human biology has not changed to need the use of inductions on a regular basis. Ditto for c-sections. The vast majority our ancestors breastfed their babies, because babies who weren’t breastfed had a very slim chance of survival up until recently in human history.

Frank Herbert envisioned a universe without robots, but I don’t see a world without medical interventions for birth. When they are truly necessary, medical interventions can save lives. But like the inhabitants of the Dune universe, there is danger in becoming so overly reliant on technology that we give up our part. Medical interventions have side effects and when used on mothers and babies who don’t need them, they don’t do any good and can do harm.

And so, I propose that it is time that we institute our own personal maternal and child health Butlerian Jihad. It’s time to put medical intervention in its place as a measure for real emergencies and understand that our bodies are generally capable. For the vast majority of pregnancies, it is completely normal for a woman to go into spontaneous labor, deliver a baby vaginally (even without pain medication) and breastfeed the baby thereafter. Millions of years of biology are on our side.

Shaken Baby Syndrome: A Public Health Issue Looking For Evidence

Have you ever noticed that parents get an awful lot of education about Shaken Baby Syndrome? We’re told all the time never to shake our babies- though any other form of abuse is rarely talked about. Have you ever stopped to ask why shaking is such an issue rather than just child abuse in general? It’s actually a rather strange story.

220px-Macaca_mulatta_in_Guiyang

Rhesus macaque- Believe it or not, this was the starting point for Shaken Baby Syndrome

Shaken Baby Syndrome as an accepted pathology and its accompanying prevention campaigns were not the result of several repeatable studies on a large number of human infants displaying the “triad” of SBS symptoms (subdural and retinal hemorrhage with brain swelling) after confirmed child abuse. Instead, it began with monkeys and simulated motor vehicle collisions.

These experiments were conducted in 1968 on rhesus monkeys subjected to simulated motor vehicle collisions at speeds of 40 miles per hour. 15 of the 19 monkeys were found to have a “triad” of symptoms (subdural and retinal hemorrhage and brain swelling) after the experiments. From these observations (and without any further independent investigation), American radiologist John Caffey and British neurosurgeon Norman Guthkelcher theorized that human infants could develop a similar condition if deliberately and violently shaken.

Since infants displaying subdural hematoma with retinal hemorrhage  (bleeding in the brain and behind the eyes) frequently did not show any signs of head injury or abuse, Caffey and Guthkelcher proposed that the shaking must have occurred in secret with no other witnesses. This theory was not consistent with a significant and well-established body of literature which showed that subdural hematoma, retinal hemorrhage and brain swelling could occur without impact to the head or shaking, but it was published and subsequently became very popular at many conferences aimed at law enforcement, social services and physicians. Actually, a review of the literature on child abuse from 1966 through 1998 showed significant weaknesses in SBS literature. There are no published controlled prospective trials with replicated studies on the condition (Gabaeff, 2011). In other words, people started believing SBS was real simply because they heard about it so much from sources they thought were trustworthy.

Current research has shown the theories behind SBS to be highly questionable. An experiment with dummies that mimicked the size and weight of human infants with sensors attached throughout showed that shaking would not cause the type of acceleration which would produce a subdural hematoma in a human infant. Other inconsistencies with SBS are that experts admit that bruises on the baby’s arms and torso that would normally be expected in a baby subjected to excessive force are mostly absent from SBS cases. Which begs the question, how can a baby be shaken so hard that it induces brain damage, but not bruising?

Shaken Baby Syndrome was once unchallenged in the medical community. But lately it has been under greater scrutiny- especially with more parents and caretakers being tried for murder and attempted murder with an SBS diagnosis though they maintain their innocence. And with this greater scrutiny a more complicated picture is emerging.

For example, certain vitamin deficiencies and encephalopathy are known to cause the triad of SBS symptoms. Because  of this, more physicians are testifying for the defense on behalf of parents and caretakers that shaking is not the only cause of the symptoms seen in the baby. (Many defense experts for SBS will charge on a sliding scale because they know that a public defender won’t have the expertise to provide an adequate and informed defense.)

Another problems comes from a behavioral perspective. Some people accused of shaking a baby have no history of violent behavior. In one case highlighted in the New York Times, the daycare worker convicted of shaking a two month old baby had cared for her own children and several others including an autistic boy and a girl with one arm without any history of violent behavior. The other daycare workers described her as a very patient and gentle person. Many cases of SBS ask us to assume that people without any history of abusive or violent behavior and who have frequently raised their own children without any abuse suddenly shake a baby to death or brain damage out of the blue. And then other cases involve clear cut abuse where shaking wasn’t the only form of abuse involved.

SBS proponents frequently point out that the diagnosis still holds up because they have confessions from parents and caretakers as  evidence. However, these confessions are not very clear representations of the situation. Some parents said they had shaken the baby in a non-aggressive way to try to revive it after finding the infant unconscious and not breathing.  Others admitted to shaking, but only in a more generalized way as one of many abusive actions against the baby, so it may not have been shaking that actually caused the death.

Others have been told point blank by law enforcement and medical experts that the police and doctors know the accused is guilty and that he or she will no chance at acquittal in a trial since doctors and scientists will testify that there is no other way the baby could have died than at the hands of the accused. Sometimes they’re are offered a plea bargain and told it is the only way they will escape a lifetime in prison, so they confess. The New York Times highlights the case of a daycare worker from Peru for whom English was a second language who was interrogated in English, not Spanish, another thing that could “muddy the waters”.

For me, I believe in the power of public health as a field of study and as a tool for making the world a better place. Many of the things we’re doing to promote public health have solid evidence like eating a healthy diet, exercise, smoking cessation, seat belts and the list can go on and on. But Shaken Baby Syndrome simply doesn’t have the evidence the back it up as a public health problem.

Worse, in my opinion, is the possibility that because we’re focusing so much on Shaken Baby Syndrome as the definitive form of child abuse that we’re missing out on helping families where abuse is a real problem. You can’t stop child abuse simply by telling people not shake a baby.  To me, this is a reminder of how we need more than good intentions in the field of public health, we need to be brutally honest with ourselves about how we are allocating our resources and what we are supporting so that we can be more effective.

 

Measles Facts and Fiction

Fact: the news media is not trained in epidemiology.

Another fact: TV shows (like, say, Law and Order) are not scholarly sources of information on anything.

There are a lot of misconceptions circulating about measles and the state of measles here in the United States. Personally, I feel like the media bears some responsibility as journalists and TV shows present a series of half-truths or outright wrong information to the public under the guise of telling the public the facts. So I’d like to take a moment and clarify a few things on measles with information from the CDC, WHO and some medical and science journals…

Measles is coming back at rates never seen since the introduction of the measles vaccineFalseMeasles has always been cyclical in nature with more cases in some years than others. If you look at the CDC’s data on reported cases of measles and deaths from measles from 1950 to 2013, you’ll see that some years have been higher and others lower for measles, but reported cases of measles have been on a continual decline since 1967. (1968 was when the Edmonsten-Enders strain vaccine that is currently in use was introduced. An earlier version was developed in 1963, but not as widely adopted.)

Between 1950 and 1963, reported cases of measles ranged from a low of 319,124 in 1950 to a high of 763,094 in 1958. The death rate usually averaged about 1 in 1,000, but fluctuated some. For example in 1958, there were 763,094 measles cases reported with 552 deaths, a rate of 7 deaths per every 10,000 cases or .7 deaths for every 1,000 cases.

The most dramatic drop-off happened between 1966-1967 (204,136 to 62,705). The next big drop occurred between 1992 and 1993 (2,237 to 312). But even after the MMR vaccine was widely adopted, there were still ups and downs. For example in 1970 there were 47,351 reported cases of measles and there were 75,290 reported cases of measles in 1971. In 1993 there were 312 reported cases of measles and 963 reported cases of measles in 1994. In 1995, it dropped back down to 309 reported cases of measles.

Rates of reported measles cases between 2007 to 2013 are as follows: 2007-43, 2008-140, 2009-71, 2010- 63, 2011- 220, 2012-55, 2013-187, For 2014 through 2016: 2014- 667, 2015-188 (that includes the Disneyland measles outbreak), 2016- 70. (Note- the 2016 data is as of December 31, 2016. This number could be subject to change if new information comes in, though it hasn’t changed yet.)

I freely acknowledge that I am not a doctor, and the highest level of math I have taken is only Trigonometry, but it’s pretty clear that there is a big difference between 763,094 and 70 (or even 667). Reported rates of measles are nowhere near what they were in the pre-vaccine era.

People are dying of measles for the first time since the pre-vaccine era.- False. Again, refer to the chart from the CDC’s Pink Book on reported cases of measles. Measles deaths, though much rarer, continued through the 20th century with a few into the 21st century. According to the CDC’s numbers reported, the last measles death occurred in 2003.

Vaccine refusal is on the rise.- True and False. Yes, this is kind of a trick question. The all time high for vaccination coverage for school age children (ages 5-6 years) appears to be 95% as a national average between the years of 1980 and 1998, based on the CDC’s Weekly Morbidity and Mortality Report dated April 2, 1999.  In 2016, the national average for MMR coverage for children ages 5-6 years was 94.6% according to the October 7, 2016 Morbidity and Mortality Weekly Report. In 1997, the coverage rate of MMR for children ages 19-35 months was 90%. In 2015, the rate of coverage for MMR was 91.9% for one or more doses. So yes, coverage is on the decline by a small amount for school age children, but it’s actually slightly on the rise for younger children. Now if the charts posted by Harvard and PBS are accurate, the threshold for herd immunity for measles is between 83% and 94%, so based on current numbers for school age children at least, we haven’t fallen below the level of herd immunity. At these levels, even Colorado is still within herd immunity limits. (The above cited MMWR says that Colorado has the lowest coverage in the nation for MMR at 87.1% for the 2015-2016 school year. But that’s actually up from 86.9% in the 2014-2015 school year ).  The overwhelming majority of Americans still vaccinate.

Unvaccinated people spread measles at Disneyland. False- based on the information currently available According to the CDC, no source was identified for the Disneyland measles outbreak.

You can be sure you don’t have measles if you’re vaccinatedFalse. According to the CDC, two doses of measles vaccine is 97% effective at preventing measles. Considering that the average primary school enrollment in the US is 450.8 students, there is a chance that someone could still carry measles from vaccine failure even at a fully vaccinated school. Another issue is waning immunity. A 2008 study from Finland published in the Journal of Infectious Diseases found that efficacy was still high for individuals who had received a second dose of MMR after 20 years, but that measles immunity was no longer present in 5% of the individuals in the study. There is also modified measles- a form of measles that doesn’t carry the classical rash and affects vaccinated individuals. Data is scarce on this phenomenon. A few cases have been studied, including two physicians as described in the 2011 Journal of Infectious Diseases. The tricky thing about modified measles is that it presents with very generalized symptoms like coughing and a runny nose, which is why some researchers suspect it may be very underreported.  The risk of transmission seems to be low, but again actual data is scarce. What happens if a doctor with modified measles treats a patient with HIV or who is undergoing chemotherapy? If you get modified measles, how long will the immunity last? If you are a woman and you get modified measles, can you pass the antibodies to your baby through breastfeeding for passive immunity and how long would that last, hypothetically speaking? We don’t have any data on these scenarios at the moment, though hopefully we will soon as health officials become more aware of modified measles.

Vaccinated people don’t spread measles.- False. It is possible for a vaccinated individual to be part of the chain of transmission. In 2011, the first documented case of measles transmission from a twice-vaccinated individual with documented secondary vaccine failure occurred and was subsequently published in Clinical Infectious Diseases in 2014.

Mississippi and West Virginia don’t allow religious or philosophical exemptions. They are models of public health and an example for other states.- False. This is probably one of my biggest public health pet peeves with the media these days. Yes, Mississippi has low measles rates, but that’s about it. Mississippi has some of the highest rates of diabetes, heart disease, infant mortality and tobacco use of any state in the nation. Mortality is very high there. Poverty is rampant and (plug for breastfeeding coming): breastfeeding rates are extremely low. (And mandatory health insurance hasn’t changed anything, but that’s another soapbox for another day.) Ditto for West Virginia. In Mississippi, 4,700 people die from the effects of tobacco use every year, that’s 8.5 times the deaths from measles in the entire country in 1958, which was a high year for measles deaths.

West Virginia is facing a drug problem that has literally been called an epidemic with overdoses accounting for a jaw-dropping  41.5 deaths per 100,000– the highest in the nation. Public health records from 1956 say of the death rate from measles: “The death rate for measles has been below 1 per 100,000 population in the last decade as compared with rates between 7 and 13 per 100,000 in the early part of the century.” That means if we were to take the high rates of measles deaths from the early twentieth-century and triple it, the death rate from overdoses in West Virginia would still be slightly higher; that’s how out-of-control the drug use problem has gotten in West Virginia.

Good grief, Mississippi and  West Virginia frequently swap for 49th and 50th place in health rankings. The media coverage of Mississippi’s and West Virginia’s vaccine exemption policies ignores the astounding health problems the residents of these states face. The focus on vaccine exemptions in schools is also deceptive because West Virginia has some of the lowest rates of coverage for children ages 19-35 months with only 67% receiving the full vaccination schedule in 2011. “Medical exemptions only” policies are not some sort of magic pill to make morbidity and mortality go away and people need to be aware of the bigger picture.

Breastfeeding won’t protect your baby from measles.- True and False. Maternal measles antibodies do grant protection from measles to breastfeeding babies, but that immunity does wane over a period of months. One study from Belgium found that by nine months measles antibodies were no longer at a threshold of immunity in both mothers who had immunity from vaccination and those who had natural immunity. (Though mothers with natural immunity had higher levels of antibodies that they passed to their babies for longer than those with vaccine acquired immunity.)

There were no measles cases in the US because it was eradicated and now it’s back. False. Take a look at the CDC’s data sheet on reported cases of measles and measles deaths and you’ll see that there have been cases of measles every year. Measles was declared eliminated from the United States in 2000. From the Journal of the American Medical Association: “Elimination does not imply zero cases because some cases will continue to occur owing to international importation and limited local transmission.” Measles elimination is defined by the CDC as “the absence of continuous disease transmission for 12 months or more in a specific geographic area. Measles is no longer endemic (constantly present) in the United States.” (Confused about elimination vs. eradication? This is an awesome article from NPR that explains the difference really well.)

The measles vaccine ensures that your child won’t develop encephalitis or pneumonia. –False. Pneumonia from measles was the most common cause of death from the disease. (Pneumonia can result from several different infections.) Encephalitis can also result from many different kinds of infections. In fact, a recent study from the UK found that while encephalitis from measles and mumps have decreased, encephalitis from other sources (both known and unknown) have increased. Pneumonia still accounts for 15.9 deaths per 100,000 in the United States. We still need to be vigilant about these conditions.

A rash and high fever are dead giveaways that it’s measles.- False. There are clinical cases and laboratory confirmed cases. Clinical cases meet the criteria of symptoms history of fever, rash for three or more days, and either cough, coryza (runny nose) or conjunctivitis (pink eye) and (within the US) a history of recent international travel. Laboratory confirmed cases show confirmation from laboratory cases like IgM antibodies against the disease. But clinical diagnosis has its limits. For example, a study on 105 children in Zimbabwe showed that while 91% met the clinical criteria, only 75% had antibody levels consistent with a current measles infection based on laboratory testing. This is an older study, but interesting nonetheless as it found that (at least in 1995) only 11% of measles cases in the UK were validated by laboratory testing and that when laboratory testing was used many cases of measles were actually a condition called roseola infantum- a form of human herpesvirus-6.  A little more recent study (2003) from Brazil confirmed that human herpesvirus-6 can be mistaken for measles when diagnosis focuses too much on the rash as a symptom instead of using laboratory testing.

If you get measles, there is nothing you can do to prevent complications except hope for the best.- False. The role of Vitamin A in preventing serious measles complications (especially pneumonia) has been well-documented in health literature. The World Health Organization recommends greater access to vitamin A rich foods, especially in areas with malnutrition for this reason. An outbreak in India showed that an astounding 32.76% of measles cases in an outbreak had been vaccinated for measles, but the highest rates occurred among children with vitamin A deficiency. Vitamin A deficiency could possibly be a contributing factor to the death toll in the recent Romania outbreak as malnutrition continues to plague Romania.

Measles is a deadly disease for children. True and False. Measles can cause death in children, but children under 5 and adults have a higher rate of complications. Adults are especially at risk for a condition called subacute sclerosing panencephalitis, which may be why fatality rates have increased. (For example 2 deaths out of 100 measles cases in 1999, other years had similar rates.) As rates of vaccination have increased in school age children, the disease has more opportunity to infect adults, especially since fewer people have natural immunity. Interestingly, this was a concern voiced by some during the 1960’s when the measles vaccine schedule was being discussed, but many officials felt that it would be best to vaccinate children. (This is a fascinating read. It’s from the Netherlands and used archived public health documents to understand what issues were at play as Dutch health officials were deciding on the vaccine schedule, but it discusses what was going on in the US and UK as well and how their policies influenced other countries. I highly recommend it.)