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21st Century Digital Moms

Yes, that’s a reference to Bad Religion’s “21st Century Digital Boy”, one of my husband’s favorite songs.

I’ve definitely been seeing a shift in my own profession of breastfeeding support as online social networking is taking off. I think at this point social media is kind of like The Force (or duct tape): it has a light side and a dark side and it holds the entire universe together. Social media is becoming a more and more crucial part of breastfeeding support. Facebook and other online communities serve many important purposes for us Millennial moms…

Easier Connection

I’m not talking about high speed internet here.

Many women have few friends or relatives who have breastfed, so Facebook groups and other online communities are a great way to feel more “normal” about breastfeeding and get advice from other mothers. Social media also has the advantage of offering support on a much more instant basis than many other types of support. For example, breastfeeding clinics are typically held at one particular hospital during business hours and La Leche League meetings happen once a month- if there’s a group in your area. Facebook and online communities offer much faster support since a mom with a question can log on from her home any time of the day or night and reach other people who may be able to offer advice or encouragement.

Geography

I’ve had some requests to start a local breastfeeding support group. Since the local community center doesn’t want to get involved, I may have to get a bit more guerilla marketing style and come up with some scrappy alternatives- one of which may be online support. We live in a rural area and people tend to be more spread out here. Living in a resort town also means that many residents work non-traditional schedules. Connecting digitally can allow mothers in rural areas to connect with help that may not be easily accessible otherwise.

The Downside…

On the other hand, we’ve seen more moms getting all kinds of inaccurate advice online. And there are some anatomical issues that absolutely need an in-person assessment of a qualified practitioner. Tongue-tie is one particularly troublesome issue and a frequent refrain among lactation consultants, breastfeeding educators and doctors and dentists who specialize in this issue is “You can’t get an accurate diagnosis on a Facebook group.”

We Like Texting As A Form of Communication

In the most recent meeting of my local Breastfeeding Coalition, the observation came up that many women prefer text message help rather than phone calls. In one area, they said that they had seen their Loving Support Hotline cut back- it’s just not being used as much. But everyone agreed that moms will text. I know I feel more comfortable writing out a text than having to talk to a stranger in a phone call. Because they can’t interrupt me, I feel like I can explain myself better.

Before the rise of smartphones hotlines may have been used more, but I think that is changing- a lot. One big review of breastfeeding support studies that covered 56,000 women from 21 countries showed that face-to-face support was the most effective at helping mothers to exclusively breastfeed longer and that methods that required the mother to actively find help- specifically telephone hotlines- were much less effective. I think in the next ten years breastfeeding support hotlines might go the way of dinosaurs and dodos- replaced by peer counselors with smartphones and unlimited text plans.

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I Love WIC- But We Need Some Changes To Food Packages

First of all: Happy World Breastfeeding Week!!! Along with that, this week is also the first ever National WIC Breastfeeding Week.

I love the concept of the WIC program. The Supplementary Food For Women, Infants and Children (WIC) program is supposed to increase access to healthy food for low-income pregnant and breastfeeding mothers, babies and children under 5. The problem is that some of the food options may actually be doing more harm than good…

Juice is actually a risk factor for diabetes

WIC gives $8.00 in cash vouchers for canned/frozen/fresh fruits and/or veggies for children and $11.00 for women. You can also get roughly 1 gallon of juice every month. But here’s the problem with juice:

“Conversely, those who consumed one or more servings of fruit juice each day increased their risk of developing type 2 diabetes by as much as 21 percent. The researchers found that swapping three servings of juice per week for whole fruits would result in a 7 percent reduction in diabetes risk.

The fruits’ glycemic index (a measure of how rapidly carbohydrates in a food boost blood sugar) did not prove to be a significant factor in determining a fruit’s association with type 2 diabetes risk. However, the high glycemic index of fruit juice — which passes through the digestive system more rapidly than fiber-rich fruit — may explain the positive link between juice consumption and increased diabetes risk.” – Harvard School of Public Health, about a 2013 study in the British Medical Journal

So the WIC program is probably contributing to the problem of type 2 diabetes among low-income women and children.

In my opinion, a better strategy would be to replace the juice with an extra $3-$5 of vouchers for fruits and vegetables. Preferably a separate one so that families can use the second another time during the month instead of all at once.

I’m Not Asking Much- I Just Want A 42 oz Cardboard Canister of Rolled Oats

You can only buy 16-32 oz. bags/boxes/cardboard canisters of oats on WIC. But one of the most common sizes for rolled oats are 42 oz. cardboard canisters. And that 42 oz. canister of rolled oats costs about as much as a box of Cheerios or Honey Bunches of Oats- which are WIC approved cereals. Seriously, just approve the 42 oz. cardboard canister of rolled oats already.

…And, Here It Comes: Allow Full-Fat Dairy Products

Yes, I actually said that.

Folks, the science behind the “low-fat diet for everyone” idea is actually pretty sketchy.

In 2006, the results came in from the large scale Women’s Health Initiative Dietary Modification trial came in. The WHI Dietary Modification trial tracked 49,000 women over 8 years. It showed that a low-fat diet hadno effect on heart disease, breast cancer, colorectal cancer, or weight.” 

That’s the right. The cornerstone of dietary advice from the 1990’s, was not exactly evidence-based.

But it’s actually not too surprising since no large scale dietary trials on the low-fat diet for everyone were ever conducted before it became accepted as “fact”. Trials had been conducted on individuals with heart disease. Researchers noticed that cutting down the fat intake of high-risk individuals reduced heart attacks, and the idea took hold that if everyone followed a low-fat diet then everyone would be healthy. (If you are into diet and health, I highly recommend taking a read through the above cited article because it is an eye-opening account of how cold pressed olive oil and raw nuts became “bad food” and Snackwell’s low-fat cakes became “healthy”.)

 

Unfortunately, the US government has not caught up with some of the more recent dietary research. But hopefully in the future women and children on WIC will have better access to healthy food.

 

Bioethics Is Not A Sequel To A Pauly Shore Movie

“Is your wife one of those people who will go along with it? Just sign him up for the surgery and you can go home and discuss it with her later.”

My husband had come to a prominent teaching hospital in Southern California affiliated with the Seventh Day Adventist faith seeking orthotic braces for our son. Instead, he was getting a hard sell for an experimental surgery. The surgeon was conducting a study on a procedure for certain hip problems and was looking for another subject in his study. My husband kept asking what the potential risks were with the procedure, but all the surgeon would say is that the procedure was “controversial”. (He was in full-blown authority mode too since he had medical students shadowing him.)

The surgeon kept pushing, but my husband didn’t feel good about the way the surgeon was refusing to disclose possible risks. We had worked so hard to get our son walking unassisted after being told that he never would and we knew that surgery is like getting a tattoo- you can never go back. (Sometimes that’s a good thing, like closing the lesion on the back of a spina bifida baby.) Ultimately, my husband left saying that he needed to do more research and talk to me before committing to anything.

That night we started researching medical journals and studies online and found out that while this surgery has shown some benefits for kids with cerebral palsy, it has no demonstrated benefits for kids with spina bifida and could potentially cause long-term damage to CJ’s ability to walk. We breathed a sigh of relief that we waited, did our research and got informed- even though the doctor neglected his responsibility to disclose the risks of the procedure.

Unfortunately, the orthopedic surgeon at said hospital refused to provide our son with the orthotics our son needed to maintain mobility. That started us on a nightmare of trying to get adequate orthotics for our son that we are still dealing with a year and a half later. But that’s another story.

I don’t think this surgeon (who would have made one helluva used car salesman) was thinking, ” Wow, I really want to screw this dad and his special needs kid over.” I think he was probably thinking something like “This kid isn’t going to have much mobility over the long-haul anyway. The surgery can’t be that damaging and I’ll get another subject to help further my research which will help other children.”

As parents, we chose our son’s mobility. Our son also wasn’t a good candidate and so we felt that including him in the trial wasn’t that beneficial to kids with CP anyway.  But we were disturbed by the actions of the surgeon. It was like he had never heard of the term “bioethics”. (Is that some kind of sequel to the 1996 comedy Bio-Dome?)bio-dome

Bio-what???

Bioethics is the practice of ethics within the field of medicine and healthcare. The Center for Practical Bioethics says that bioethics is about asking the following questions: What is the right thing to do and the good way to be? What is worthwhile? What are our obligations to one another? Who is responsible, to whom and for what? What is the fitting response to this moral dilemma given the context in which it arises? On what moral grounds are such claims made?



Medical and public health issues tend to bring up a lot of sticky ethical situations about things like responsibilities, informed consent  and conflicts of interest. And when you’re dealing with people’s lives- either in the immediate as a patient or loved one or on a broader scale in public health or an experimental procedure- it’s tempting to feel like the end justifies the means. For example:

A teenage boy died of organ failure from MRSA, but was also infected by influenza at the time. Is it ethical to present his case as an example of why people should get a flu shot when a flu shot would not have prevented the infection and spread of MRSA?

Parents who have received a diagnosis of spina bifida for their unborn child have a few weeks to enroll in a trial for prenatal surgery. The surgery may or may not improve their child’s function and carries a high risk of premature birth, but could add to the body of research on the procedure, potentially helping other children. The parents are in a state of shock, reeling from the diagnosis. Should the parents be encouraged to undergo the surgery?

How do we feel about Jonas Salk experimenting with flu vaccines on mental patients who could not consent to the experiments and could not give accurate feedback about the experiments? How about Joseph Goldberger causing pellagra in prison inmates to study the disease?

Do parents have a right to sue a care provider because their baby’s birth defect wasn’t detected until birth? Sonograms and prenatal testing are not guarantees of health.

Should we in the breastfeeding community tout gains in IQ as a primary benefit for breastfeeding when intelligence is actually a combination of many factors working together?

How reliable are studies that have been funded by a corporation or have been conducted by researchers who also receive consulting income from corporations?

A doctor is recommending a procedure or medication to a patient. The doctor thinks the procedure or medication will be highly beneficial. There are risks- but the doctor thinks the risks are very, very unlikely. Is it OK for a doctor to simply tell patient that the procedure is “safe” when there are risks? Driving a car and air travel are generally “safe”, but have risks.

Is it OK to allow pharmaceutical companies to advertise directly consumers? Pharmaceutical manufacturers stand to benefit from people asking their doctors for a particular medication- regardless of whether drug is useful or safe to consumers. This means that it’s in the pharmaceutical company’s interest not to focus on how a drug might not be effective or could have serious side effects. (Note, most developed countries do not allow this.)

The Charlie Gard case has (in my opinion) highlighted many different sides of bioethics. It shows the responsibilities and rights of parents, doctors and researchers. Who gets the last say about when to go off life support? When do experimental treatments create false hope? Should parents or doctors have more say in a child’s care? Who is a more reliable judge of what the child needs? Maybe that should be determined on a case-by-case basis?

Another recent case in ethics is USC’s former medical school dean Carmen Puliafito. Puliafito was only recently barred from seeing patients after the Los Angeles Times published an expose of his substance abuse and abusive behavior towards faculty and staff. However, USC had been receiving complaints for years about his heavy drinking- and still allowed him to see patients during that time. However, they have stated that they never had any complaints from patients.

Still, is it ethical to allow an intoxicated physician to care for patients? (Writing as a parent who has had to leave her hours old infant in the hands of surgeons and doctors and not knowing if they have had adequate sleep or are sober, I can tell you this kind of situation haunted my nightmares while my son was in the NICU.)

Inequities Exist

Sometimes there are inequities in knowledge between the care provider and the patient and/or parents. This is why we have informed consent:

Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment. (Appelbaum, 2007)1   It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

The surgeon who was pushing the experimental surgery had violated informed consent by refusing to disclose the risks to us. Though it was his responsibility to do that, we knew that as parents we had the responsibility to our son to make a decision that was informed. When we couldn’t get the information we needed from the surgeon, we went looking for it ourselves.

A conflict of interest, such as career advancement or funding should go into our decision about how reliable we gauge information to be. Doctors, scientists and everyone who works at a drug company are people. They have their own biases and they have their own agendas. This is why conflicts of interests have to be noted in a medical or science journal.

How Ethical Are We?

And bioethics should always be challenging. We humans have a tendency to think we are doing the right thing- especially if we think there will be a benefit for the greater good. But that altruistic bent can also lead us to do terrible things as well. The Nazi’s believed they were making the world a better place through ethnic cleansing. In the 1970’s doctors often refused care for infants with spina bifida because they felt that these children had so little possibility of any quality of life that letting them die quickly was the most merciful thing to do- despite the fact that treatment existed for the associated health problems with spina bifida.

Jonas Salk, Joseph Goldberg and their colleagues felt like testing vaccines and diets on inmates and mental patients was moral because they hoped to provide better disease prevention for the rest of society. And USC probably felt that the money Puliafito brought in for the medical school from fundraising outweighed the damage of his behavior. I personally believe it’s important to understand the belief system others are operating under- even if we don’t agree with it.

I think bioethics is everyone’s responsibility. Do your research, look for possible conflicts of interest. And always question yourself and others.

Pregnancy, Breastfeeding And That Little Legalized Leaf

Note: This post is only looking at marijuana use in women who are not taking other drugs. Mothers who are taking marijuana in addition to drugs like cocaine, meth, heroin, etc. have more complicated issues and probably somewhat different perceptions of marijuana use than women who are only using marijuana, especially under legalized circumstances. OK, onwards…

I had to write a paper for my MPH class on using an ecological framework to deal with a

Marijuana Yes - No , Marijuana leaf , cannabis , cannabis leaf

public health issue. I decided to write on marijuana use in pregnancy because legalization has created an interesting new landscape with marijuana use. But I was in for a couple of surprises. First of all, more women are using marijuana during pregnancy!

Marijuana use among pregnant women is still relatively rare, but it is increasing. In 2002 2.37% of pregnant women reported using marijuana within the last month. In 2014, that number had climbed to 3.85%. Also startling is that some data from Hawaii showed that women who are suffering with severe nausea in pregnancy are more likely to use marijuana during the first trimester than those who are not suffering from severe nausea and vomiting of pregnancy. The THC levels of both recreational and medicinal marijuana have increased from 4% in 1995 to 12% as of 2014 (Volkow, Compton, Wilson, et. al., 2016).

Perception is important

If people think something is harmful, it’s unlikely they’ll do it. On the other hand, if they believe something to be safe, they probably will continue. The catch is that our perceptions don’t always match with the actual risk level. Research indicates that many young adults who use marijuana perceive it to be “natural” and “safe”. Individuals who believe marijuana is natural and safe often believe that tobacco products are addictive and can cause long-term adverse health effects, so they are aware that smoking and tobacco products like cigarettes and e-cigarettes are harmful, they just don’t believe that marijuana carries the same kind of negative effects (Popova McDonald, Sidhu, et. al., 2017.)

But marijuana use can be harmful to a baby! 

bigstock--132650111Marijuana smoke contains the same chemicals as tobacco smoke with the same risks to lung health for both the mother and baby. (American Lung Association, 2015).  Any chemicals that the mother takes in through smoking marijuana are passed to the baby, just like smoking tobacco products. Marijuana has been shown to decrease milk supply in animals and smoking tobacco products is known to decrease milk supply for human mothers. If you’re trying to make a good supply of milk for your baby, marijuana might not be a good choice.

Marijuana use in pregnancy has also been linked to cognitive impairments such as impulse control, attention and visual memory in children whose mothers smoked marijuana during pregnancy (Volkow, Compton, Wilson, et. al., 2016). Some studies have associated marijuana use in pregnancy with pre-term birth, low birthweight and intrauterine growth restriction, but these studies haven’t always controlled for other drug use. Because the mothers in these studies were using other drugs, it’s difficult to say whether marijuana alone would cause these pregnancy complications. (That’s why I’m leaving them out of the discussion.) Based on my research, the most reliable findings for marijuana use are the dangers of smoking in pregnancy and the possibility of long-term cognitive impairments. THC also passes to the baby during breastfeeding. But all of these reasons should be enough to avoid using marijuana during pregnancy and breastfeeding!!!

Marijuana is a medicine- treat it like one  

“Weed out of all these, to me, is not as harmful … because they suggest it to cancer patients. It’s medicinal.” – 19 year old respondent to survey about perceived harms and benefits of alcohol, tobacco and marijuana.

Medicinal and legal and even “safe” are not the same thing as risk-free. There are plenty of substances that are safe under other circumstances but not during pregnancy and/or breastfeeding. Moderate consumption of alcohol outside of pregnancy is relatively safe and thalidomide is a pharmaceutical that can treat leprosy and myeloma. But during pregnancy, alcohol can cause fetal alcohol syndrome and thalidomide causes birth defects. (In an eerie parallel, thalidomide was prescribed to mothers in the 1950’s and 1960’s to treat morning sickness and caused tens of thousands of babies to born with severe birth defects. It remains one of the great cautionary tales of medications and pregnancy.)

Competent herbalists will tell you that certain herbs and essential oils should not be used during pregnancy or breastfeeding because they can have harmful effects on the baby. Even a relaxing trance state can be harmful when used improperly. My Kundalini yoga teacher is also a certified hypnotherapist and all of her imagery journeys begin with the warning that you should not drive while listening to an imagery journey track because it can put you in a profoundly relaxed state and affect your ability to drive safely. Marijuana is like any other medicinal substance and needs to be used with caution.

But the morning sickness is killing me!!!

Believe me, I feel your pain. When I was pregnant with my oldest, I lost 15 pounds in 6 weeks because I was either too nauseated to eat or throwing up almost everything I did eat. But please, please, please, don’t use marijuana to relieve the misery. Here are some other things you can try:

  • Unisom and vitamin B6– Unisom is a safe-for-pregnancy OTC sleep aid. When taken with vitamin B6 it can help with nausea. I have heard a lot of women with severe morning sickness swear by this. The American Congress of Obstetricians and Gynecologists recommends Unisom with vitamin B6 for relieving morning sickness. Check with your doctor or midwife before you start taking it.
  • Essential oil candies– sour and ginger flavored candies are another recommendation, but I feel like the ones flavored with essential oils really work best. I’ve used Preggie Pops and Preggie Pop Drops during my pregnancies and they have really helped. They helped take the edge off the nausea in my first pregnancy so I was able to eat. (I really liked the sour flavors. But the herbal ones were good too.)
  • Essential oils– Peppermint, orange, lemon, lavender, ginger can all be helpful. Use with caution, consult your care provider. You don’t even have to apply these to the skin, you can sniff them.
  • Sea Bands– Some moms swear by these. Sea bands are a little band that you can wear that applies continuous pressure to an acupressure point called Pericardium 6 (the Chinese name for this point is Nei Guan).
  • Cut out dairy products for a little while– I tried this during my first pregnancy and it helped a lot! Add in other sources of protein to help keep your blood sugar level.
  • Add in a green smoothie- This also helped during my first pregnancy. Drink slowly and take little sips. Dark leafy greens are extremely nutrient dense and can help replenish your stores of calcium and iron.

6 Reasons Why Breastfeeding Problems Are Not Your Fault

Yes, I don’t believe it’s entirely your fault that you are struggling with breastfeeding. (That’s not to say that you can’t breastfeed or don’t have any control over it.) I think most of our public health and private programs that aim to help with breastfeeding forget that we live in a very different situation than ever before in human history when it comes to breastfeeding and childbearing.  So here are the six reasons why it’s not your fault that you are struggling with breastfeeding…

Reason #1: Anatomical issues

Tongue-tie, lip-tie, hypoplastic breasts… these can all cause difficulties with breastfeeding. In these cases, you or your baby were the unfortunate winners of a genetic lottery. However, you can still breastfeed even with these issues. In the case of hypoplastic breasts, you may not be able to give a full milk supply (or maybe you can), but you can partially breastfeed and use a supplementary nursing system to get your baby at the breast when you give supplementary feedings with formula.

With tongue-tie and lip-tie, it’s super important that you have a competent professional who knows how to effectively care for these conditions. Unfortunately, you can’t just walk into the average pediatrician or dentist’s office and get informed advice on tongue-tie and lip-tie, which is why I included an entire detailed section of it in my curriculum.

Please, please, please do your research and learn before you get your baby evaluated or treated for tongue-tie! That way you can do it right instead of getting an ineffective frenotomy that has to be revised later on!!!

Reason #2: Most women around you don’t breastfeed

The first infant formulas were introduced around 150 years ago and breastfeeding rates started dropping. Think about it. For most of human history, the vast majority of women breastfed their babies. Never before in human history have we lived in a time where so many women did not participate in this biological function. If most of the women around you didn’t breastfeed or breastfed only a short time before moving to formula, it’s difficult to establish a baseline of what’s even normal.

Reason #3: Hospitals aren’t always breastfeeding friendly

UNICEF has spear-headed the Baby Friendly Hospital initiative, though some hospitals are still not on board. And even those that are certified as Baby Friendly may not always follow guidelines for encouraging breastfeeding.

Also, gentle/natural/family-centered cesareans that allow the mother skin-to-skin contact with her baby are still pretty rare here in the US. (Though they totally rock for moms and babies who need them!!!) And of course there is the elephant in the room that most births do not require cesarean delivery thought 1/3 of all births in the US are c-sections. C-sections can make it more difficult to breastfeed- though not impossible. (I have known plenty of c-section moms who have breastfed successfully.)

Reason #4: The medical and health professions haven’t caught up

It wasn’t about the late 1970’s that scientific research started coming out with all theformula ad 1950 benefits of breastfeeding over formula feeding. So it wasn’t that long ago that doctors were recommending formula. By that time, breastfeeding had become more or less a dying art.

On top of that, the climate of maternity and neonatal care has changed dramatically since that time. We have more mothers delivering by c-section. We also have more premies and babies with birth defects in the NICU who would not have survived before because technology or medical practice was not in place to preserve their lives. A micro-premie may not have survived 40 years ago and a baby with spina bifida may have been denied care, but we now have better care for premature babies and medical ethics now dictates that babies with spina bifida receive care. So we have a whole lot of special cases with a more limited base of knowledge among medical and lactation professionals.

Reason #5: No one told you that some kind of complication would come up.

Did you go through pregnancy thinking that breastfeeding is normal and therefore easy and then get blindsided by some complication you could not have anticipated in your wildest dreams? Welcome to the club. When I was pregnant with my oldest, I was going to be the perfect breastfeeding mom. I read up on all those breastfeeding positions, determined that I was going to get it right. Then I ended up having a baby who needed back surgery at 36 hours old and all those breastfeeding positions went out the window. during my observation, I heard one mother remark, “It’s like they don’t want to tell us something could go wrong because they’re afraid we might not breastfeed.”

Reason #6: Breastfeeding has been presented to you as an all-or-nothing endeavor.

If you have hypoplastic breasts or had certain types of breast surgery, exclusive breastfeeding may not be in the cards for you. Biologically speaking, there are some cases where it won’t work out. But any degree of breastfeeding is still beneficial for both moms and babies. This isn’t a zero-sum game. Breastfeeding may be different for you than your neighbor, friend, sister or cousin, but you and your baby can still get many of the benefits!

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Kombucha: The Good, the Bad, the Ugly and the Neutral

Most labels describe kombucha as a tea, but that’s actually only true in the loosest sense. Kombucha is a fermented drink, very similar to raw apple cider vinegar.

How is kombucha made? Well, you make some black, green or oolong tea and add some sugar. When the tea is sufficiently cooled off, you dump in some starter kombucha and a SCOBY. (SCOBY stands for Symbiotic Colony of Bacteria and Yeast. Basically, a big blob of good bacteria and yeast. Sometimes called the “mother”.) Over a period of approximately 2-4 weeks, the SCOBY eats the tea and sugar from the liquid and excretes out probiotics which soon permeate the liquid. The result is what we call kombucha.

Calling kombucha a tea is popular way of positioning it for businesses that sell it. Calling it a tea vinegar or bacteria and yeast juice does not sound appealing to most Americans.

How Healthy Is It?

This depends a lot on the particular brand of kombucha and how it’s made. A traditionally brewed kombucha will have trace amounts of caffeine and alcohol. However, the alcohol and caffeine content can be controlled with the right fermentation conditions.

Kombucha that has been fermented between two and four weeks will have a relatively low alcohol and caffeine content because at this point the SCOBY will have eaten up most of the tea and sugar, but won’t start fermenting to the point of high alcohol content yet. This usually considered the ideal for kombucha. If you want to flavor kombucha, you put it in bottles with flavoring like juice or herbs and let it sit for a few days, a week at the most. After about a week, it will start developing higher alcohol content because the sugars from the additional flavoring (especially fruit juice) will quickly be converted to alcohol.

Federal law requires that all beverages that are marketed as non-alcoholic have 0.5% or less alcohol content, so the kombuchas that you find in the store have to meet this standard. In 2010, a public health official in Portland, Maine noticed some bottles of kombucha leaking and thought that the beverages might have high alcohol content. Four brands were taken from the store and tested at the University of Maine and found to have alcohol content ranging from slightly over 0.5% to 2.5%. In the United States, a drink with over 0.5% alchol content has to be regulated by the Alcohol and Tobacco Tax Trade Bureau. So many kombucha brands did a voluntary recall while they reformulated to strictly comply with the 0.5% standard.

Reformulation has meant different things for different brands, and herein lies the central issue with the kombucha vs. soda question. Most brands of commercial kombucha now use a short fermenation process, so the SCOBY doesn’t eat up much of the sugar and tea. This makes the kombucha sweeter. It also makes it much easier for manufacturers to get under .5% because the kombucha isn’t as active. Long brew kombucha can meet the 0.5% standard, but it requires more care. You have to make sure that your fermentation time and conditions are balanced to get to that happy medium.

Because short brewing doesn’t give as much time for the fermentation process, this kind of kombucha ends up being on the flat side. Most short brew brands use forced carbon dioxide to make their kombucha effervescent, just like a soda. The downside to forced CO2 is that it can make the kombucha more acidic.

So long story short, most commercial kombuchas are short brewed with forced CO2 making them more like a sweet tea soda with a little bit of probiotics. There are a few traditionally brewed brands that do a long brew and have very probiotic rich kombucha. Of course whether you do a long brew or short brew, the probiotic benefits will be negligible if the kombucha has been pasteurized.

Most brands of kombucha that use forced CO2 don’t list it on their label, so it is hard to tell from the label alone. Reed’s Culture Club uses forced CO2 as does Kosmic Kombucha. Nationally distributed Kombucha Wonder Drink is pasteurized as well.

From an article in the journal Comprehensive Review of Food Science and Food Safety, the following benefits have been found from kombucha:

  •  High levels of probiotics
  • Antimicrobial effects against both Gram positive and Gram negative pathogens
  • Inhibits the growth of some types of cancer cells
  • hepatoprotective against various environmental pollutants (i.e. protects the liver from nasty pollutants)
  • High antioxidant content
  • B vitamins- including vitamin 12

What about alcohol and caffeine content (especially for pregnant and breastfeeding women)?

 An average kombucha is usually listed as having approximately 24 mg of caffeine per 8 oz. GT’s brand kombucha says that theirs has about 8-14 mg of caffeine per 8 oz. serving. For a point of reference:

  • Starbucks 16 oz. coffee has 330 mg of caffeine
  • 2 Tbsp of Maxwell House ground coffee has about 100-160 mg of caffeine
  • 8 oz. of black tea brewed for 3 minutes has 30-80 mg of caffeine
  • 8 oz. of Lipton black or green decaf tea has 5 mg of caffeine
  • 16 oz. Starbucks decaf coffee has around 15-25 mg of caffeine
  • 2 Tbsp. of Maxwell House ground decaf coffee has 2-10 mg
  • 12 oz. diet Coke has 47 mg of caffeine
  • 12 oz. Sunkist soft drink has 41 mg of caffeine
  • 12 oz. of Barq’s regular root beer has 23 mg of caffeine
  • A Rockstar Citrus Punched energy drink has 240 mg of caffeine
  • A 1 oz. package of Jelly Belly Extreme Sport Beans has 50 mg.
  • 16 oz. Starbuck’s hot chocolate has 25 mg. of caffeine
  • 1 Tbsp. of Hershey’s cocoa has 8 mg of caffeine
  • A 1.5 oz serving of Hershey’s Special Dark chocolate has 20 mg of caffeine.

So a store-bought kombucha will have about as much caffeine in it as a soft drink like Barq’s root beer or Sunkist or 3 oz. of dark chocolate.

Alcohol has been a much publicized issue with kombucha. However, seeing as how any kombucha being sold as a non-alcoholic beverage has .5% or less alcohol the alcohol content is very low. A regular beer is 5% alcohol, so you would have to drink 10 kombuchas to even start approaching the alcohol content of one can of beer. Wines usually have 12% alcohol content in a 5 oz. serving and hard drinks like whiskey and gin are at around 40% alcohol content for a 1.5 oz serving. How does it compare to other non-alcoholic foods/beverages?

The Washington State Toxicology Lab conducted a study on the alcohol content of foods and drinks that are considered non-alcoholic and found that many breads actually have alcohol content greater than 0.5%. The apples in a Great Harvest Apple Walnut Roll actually have an alcohol content of 1.066% and the roll itself has a total alcohol content 0.956%. Rosemary onion bread has an alcohol content of 0.98%. Home Pride brand wheat bread has 0.48% alcohol content.

Fruit juices also have naturally occurring alcohol in them. In fact, the United Arab Emirates has pulled juices from stores for exceeding 0.03% alcohol content  (their legal limit for non-alcoholic beverages). In August 2013, Snapple’s fruit punch drink and peach flavored tea were pulled from the UAE because they were found to have alcohol contents of .48% and .05% respectively. So a carefully long-brewed non-alcoholic kombucha has about the same alcohol content as a fruit juice drink. 

The article fromComprehensive Review of Food Science and Food Safety also noted that some cases of toxicity had been reported, such as dizziness and nausea after consuming certain kombucha products. Lead poisoning has been known to occur in home brewed kombucha that is brewed in containers with lead content. According to this article, kombucha is contraindicated in pregnant and lactating women. I do know several women who have drunk kombucha through pregnancy and breastfeeding and seen no ill effects. Of course, you should always consult your doctor before consuming a substance when you are pregnant or breastfeeding.

 

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Measles, Dying in Childbirth, VBAC’s, Hospitals and Why Bambi Is Deadlier Than An Alligator

The odds of measles complications are high at 1/1000…

The CDC says that 1 in 1,000 people with measles will develop encephalitis and that 1 in 1,000 people with measles will die. 1 in 1,000 is pretty high.

…But the odds of maternal death from blood clots are low at 1/1,000

On the other hand, the risk of maternal death is concerning but relatively low. Here’s what Dr. Shilpi Mehta-Lee, MD Assistant Professor of Maternal Fetal Medicine at NYU Medical Center says about maternal death from blood clots: “We actually know the risks are between 1:500 and 1:2000, which makes 1:1000 about average. When you put the statistic that way, it sounds pretty bad, but what that really breaks down to is about a 0.25 to 0.1 percent risk. That means more than 99.5 percent of women won’t have this problem.”

Amniocentesis is safe, VBAC’s aren’t?

Amniocentesis has a 0.6% risk of miscarriage- a slight risk according to the Mayo Clinic. But a VBAC is pretty risky. Which is why many doctors and hospitals don’t do them. No one wants to mess around with a 0.07% uterine rupture rate.*

Which is more likely to kill you, an alligator or a deer?

There were 9 alligator and crocodile related deaths during 1999-2007Nine. Isn’t that crazy? Better cancel your trip to Florida. You’ll be much safer driving on the interstate in October where vehicle collisions with deer cause only 200 deaths a year. (And an estimated $4 billion in damage annually.)

But you can’t any get safer than going to the doctor…

Except that 1.7 million Americans develop nosocomial (healthcare-acquired) infections each year, and 99,000 die from them every year. And 3/4ths of these infections start in places like nursing homes and doctor’s offices- the other 25% mostly come from hospitals. The total economic burden of nosocomial infections may be as high $45 billion per year. That’s billion, with a “b“. (For a point of comparison, consider that a measles outbreak can cost state and local health departments about $2 million to $3 million.)

What kills more people than emphysema, HIV/AIDS, Parkinson’s disease, and homicide combined?

Antibiotic resistant methicillin staphyoloccocus aureus infections (MRSA).

How we perceive risk

What if I tell you that vitamin A reduces the risk of measles death and complications? What if I tell you that c-sections increase the risk of deadly blood clots? Do you feel differently about measles? About c-sections? Should you be less concerned about measles or more concerned about maternal death? Both? Neither? Equally concerned?

We like to think of ourselves as rational human beings, but the truth is that we make decisions based on emotion. Sometimes we listen to the loudest screams rather than what is most likely. But on the other hand, being that one in a thousand isn’t fun.

The bottom line is that every decision we make has some kind of risk associated with it. When you make a choice about your health or your child’s health, there is no such thing as risk free. You will always be choosing a set of risks and benefits. The question will always be which benefits and which risks are worth committing to for you?

*Yeah, I had to do a double take on this too because I had heard the 0.4-0.7% statistic most often quoted. Apparently the risk of rupture is even lower than previously described. This is from newer research: “From 1976-2012, 25 peer-reviewed publications described the incidence of uterine rupture, and these reported 2,084 cases among 2,951,297 pregnant women, yielding an overall uterine rupture rate of 1 in 1,146 pregnancies (0.07%).”

Making the Decision About Prenatal Surgery For Spina Bifida

Disclaimer: I did not undergo in-utero surgery for my son’s spina bifida. I have studied this report on the MOMS trial extensively and used it as an example in my biostatistics and public health policy courses during my MPH studies.

Parents who receive a prenatal diagnosis for spina bifida are in a unique situation. They have the option of a relatively new procedure for performing in-utero surgery to correct the defect. But since the surgery can only be performed within a narrow window of time, they have to make a decision about a major medical procedure in the course of a few weeks. Bioethics textbooks have thrown this scenario around a lot because of the competing interests in research and the vulnerable emotional state of parents make it very difficult make an informed decision.

People don’t usually think of the diagnosis of a special needs child as a grieving process, but it is. You expected a healthy baby like any other. When you find out your baby has spina bifida (or another birth defect), you begin the process of mourning the child you thought you were going to have. Your grief is OK though. By grieving, you will be able to open up yourself to accepting the beautiful child you have.

The third stage of grief is bargaining. This is when we attempt to regain control over the situation when we feel so helpless. Emotionally, getting a new procedure that promises the possibility of better function appeals to this. Further complicating the situation are news media reports that hail in-utero surgery as a cure for spina bifida.

I have seen some centers that offer the surgery focus their initial information on a few success stories or just listing off the possible positive benefits, glossing over the possible risks and the unknowns. It’s in their interest to have parents choose in-utero surgery, which gives these centers a conflict of interest in advising parents. (Others are forthright with parents warning that the surgery has potential benefits, but is not a guarantee and does entail risks.)

And so, I’m writing this post with the hope that it will provide parents of a newly diagnosed spina bifida baby with some information that will make the process a little easier.

What is the actual impact of spina bifida when treated with conventional (post-birth) surgery on the baby’s back?

To really understand this, we need to back up a bit. Spina bifida has been identified as a birth defect for hundreds of years, but without any treatment, babies died. Before 1960 when surgery to close the lesion was well-established, the survival rate for all forms of spina bifida was 10% to 12%. Surgeons typically postponed treatment until age 2, believing that only the strongest babies would survive that long. Before the introduction of antibiotics in the 1940s, most infants with myelomeningocele died from meningitis. Hydrocephalus was another cause of death until the development of shunts in the late 1950s revolutionized the treatment of hydrocephalus.

Those who survived meningitis and hydrocephalus faced kidney complications until the 1960s when clean intermittent catheterization was developed to preserve kidney function and allow children to gain social continence. In the 1950’s, Dr. Robert Zachary pioneered the practice of performing surgery on newborns rather than waiting until the age of two. His trial showed no improvements by postponing surgery and he was the first to recommend that babies with spina bifida receive surgery right after birth.

However, many doctors felt that even with treatment available, children with myelomeningocele were too burdensome to care for. Dr. John Lorber said: ” the majority of children with myelomeningocele have very few or no friends; most are left without jobs, they have no chance of love or marriage, and when their exhausted parents can no longer cope, they will end their days in an institution.”

Lorber’s colleague, Dr. Robert Zachary took the opposite view saying that our discomfort with children who have spina bifida has more to do with our own anxieties about quality of life and less to do with their condition. He believed that children with spina bifida could lead happy and productive lives with good treatment and a good attitude.

Unfortunately, his view was largely rejected until about 30-40 years ago. Until the 1980’s, doctors usually advised parents that even with treatment, children with spina bifida would have no quality of life and that withholding treatment and allowing death to happen sooner was best-despite the fact that medical technology and care existed to save the lives of infants with spina bifida and give them a better life. In fact, the team that performed a large study on the outcomes of a multidisciplinary approach for treating children with spina bifida was roundly criticized at first and accused of ethical violations.

So it’s in this context that many doctors and specialists look at spina bifida. There is still a bias against babies with spina bifida and the expectation that they will be “vegetables” or “too burdensome”. However, with conventional treatment of myelomeningocele, a baby can be expected to live well into adulthood and do many things like work and play sports with some adaptations. I have known adults with spina bifida who have gone on to get married and have children of their own.

The exact “combination” and severity of issues will vary from child to child. My son walks with orthotics and a walker and we have rarely used a wheelchair with him. He does not require catheterization , but has issues with bowel and bladder control. He has a VP shunt, but has had no revisions in his seven years of life. My childhood next door neighbor has a daughter with myelomengocele and her daughter walks well without assistance, does not use catheterization, but has had multiple shunt revisions.

This degree of variability is what makes it difficult to say whether in-utero surgery will be beneficial for an individual child.

Will the surgery improve my child’s function?

Maybe, maybe not. Since it’s hard to say exactly what function your individual child would have if he grew up without the surgery, no one can say definitively whether the surgery will improve your individual child’s function. This is why the 2013 study on prenatal surgery for spina bifida compared averages.

On average, children who had the prenatal surgery had a reduced need for VP shunts at 12 months of age, higher scores on the Bayley Mental Development Index at 30 months of age, and a greater likelihood of walking without orthotics at 30 months of age.

Also, this study reported results from between 12-30 months of age. We don’t know what the majority of kids who undergo prenatal surgery will experience as they get older. Many kids with spina bifida lose the ability to walk as they get older. Children who undergo the prenatal surgery may be less likely to lose the ability to walk, but we just don’t know. We also don’t know the likelihood of receiving a shunt later in their childhood years or as adults.

What are the risks?

Most of the babies who were in the study who received the prenatal surgery were born prematurely. Care for premature babies is pretty good here in the US, but there’s still the risk of disability. According to the March of Dimes, complications associated with premature birth include neurological disorders like cerebral palsy, autism spectrum disorder, asthma, bronchopulmonary dysplasia, hearing impairment, vision impairment and learning disabilities.

Many babies who are born prematurely grow up to be healthy, but premature babies are at a greater risk for issues like the ones above. As follow-up continues, we’ll know more about how prematurity might affect these babies long-term and if the risks of prematurity outweigh the benefits of the prenatal surgery- or vice versa.

In the prenatal surgery group, two babies were stillborn on day five after the surgery. In the postnatal surgery group, two babies died from severe hydrocephalus after receiving shunts.

Also, all babies the mother has after the prenatal surgery will have to be c-sections because the scarring on the uterus will be even more extensive than that of a regular c-section scar.

A few final thoughts…

MSDWIHE EC002

Sonora and Al after Sonora’s  first blind dive in the movie Wild Hearts Can’t Be Broken.

Have you ever seen the movie Wild Hearts Can’t Be Broken? It was a 1991 movie based on the life of a woman named Sonora Webster Carver. She was in a horse diving act during the 1930’s. She later became blind after an accident and learned to ride and dive afterwards continuing the show with her husband. The audience never knew she was blind.

It didn’t happen in real life, but there’s a scene in the movie where Sonora argues with her fiance Al that her sight will return and she’ll wait for that to happen. Al sits with her and says that the blindness is permanent,  that she can continue to deny it, but it is permanent. Once the character of Sonora accepts that her sight won’t return (the acceptance stage of grief), she is able to move on and train herself to ride and dive without her sight.

I can say from my experience that my son is not a burden. He has a few challenges that are different from other kids, but everyone has challenges. He has lots of friends (he’s a social butterfly who charms everyone) and he helps around the house, exercises and participates in a ton of fun things.

Spina bifida is permanent. It won’t go away. The surgery may improve your child’s function or it might not. But whatever the outcome, if you’re prepared to embrace having a child with spina bifida, you can choose how to frame spina bifida for you and your kid.

How Potatoes Shaped Our Views on SIDS

Did you know that many of our current views on Sudden Infant Death Syndrome have connections to a fear of potatoes?

Pieter_Bruegel

During the period between 1300 and 1870, Europe and North America experienced colder winters than they had during the 1100’s and 1200’s or during the 20th century. The years between 1600 and 1800 were the height of what has been called the “Little Ice Age” when temperatures dipped substantially. The harsh temperatures made it extremely difficult to grow cereal grains- a staple of most European peasants’ diets.  This was bad news for peasants because the difficulty in growing grains meant high prices for cereal grains. Famine, riots and the French Revolution followed. But another sad result was infanticide.

Suffocation of young babies because an older child had not yet been weaned was rampant in England, France and Germany in the 16th, 17th and 18th centuries– the height of the Little Ice Age and its accompanying famine. But to avoid being charged with murder most parents claimed that the baby had died when a parent accidentally rolled over on the baby during sleep and failed to wake up. And the idea caught on- so much so that laws were passed in many parts of Europe mandating jail time for a parent found sleeping in the same bed as a baby.  And the connection has persisted in the minds of most Americans and Europeans today, despite the fact that SIDS cases typically present with intrathoracic petechiae (broken capillaries in the chest cavity) indicating a centrally mediated airway failure consistent with apnea and gasping rather than an obstruction of the airway. In other words, the baby stopped breathing because the baby’s central airway collapsed, not because of suffocation.

However, history could have been different for the French if they had embraced the potato. The potato was a hardy, easy to grow food crop that was a good alternative to grains which were struggling in the cold weather. It  soon became the staple of other European peasants’ diets- like the Irish. (At least until the Irish started growing mostly one type of potato which was wiped out by a fungus in the Great Famine of 1845-1849. But that’s another story.)

The French peasants, however, resisted the potato as part of their diet for a number of reasons. Rumors abounded that the humble starch was evil or unhealthy.  The French aristocracy soon began eating potatoes and wearing potato blossoms in an effort to popularize them among the lower classes and mitigate the famine, but to no avail. And as the famine persisted, so did the idea that overlaying was the cause of sudden and unexplained death of an infant.

 

 

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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…

Myth #1- 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…

Myth #2- 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.

Myth #3- Someone needs to tell you to push during a natural labor

Nine 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.”)

Myth #4- 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).

Myth #4- 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.

Myth #5- 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.

Myth #6- You’ll get pain medication right away

Waitress, 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 sex

Look 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.

Update: We can add World of Warcraft to the list of birth myth promoting media…

I’ve been informed that World of Warcraft shows a Tauren character dying in childbirth on her back after giving birth to human-cow hybrid babies who have horns at birth. No species with horns/antlers gives birth to young with horns/antlers. The horns/antlers show up later on. Even animals like porcupines with spines have adapted. Newborn porcupines have soft spines that harden hours after birth.