Promoting healthy behaviour in expectant mums / Current news / The University of Newcastle, Australia

Tuesday 16 February 2010
From the University of Newcastle website:

"Researchers at the University of Newcastle say many pregnant Australian women have difficulty exercising enough and consuming the recommended levels of nutrients.
A report on women's reproductive health — released by the Minister for Health and Ageing, the Hon Nicola Roxon MP — is the latest from the Australian Longitudinal Study on Women's Health (ALSWH). Now in its 16th year, the ALSWH has surveyed more than 40,000 women across three age groups.
"While women generally improve their diets when pregnant, many consume less than the recommended levels of folate and iron," report contributor, Jennifer Powers, said. “Many women quit smoking and stop drinking alcohol during pregnancy, but a small percentage of women continue to smoke and drink alcohol at levels considered unwise for pregnant women.
"Our research suggests there is an ongoing need for targeted public health messages that promote healthy behaviours during and after pregnancy."
The survey also showed that around 10 per cent of women who had given birth within a three-year period reported a diagnosis of post-natal depression.
"This diagnosis was less likely in mothers who had good social support networks," report contributor, Catherine Chojenta, said.
Ms Powers said the health and wellbeing of mothers could also be influenced by their attachment to the paid workforce.
"Women who took 12 or more weeks maternity leave reported higher energy levels than women who took less time off work.
"These findings support the Australian Government's initiative for a minimum amount of maternity leave for all women."
The ALSWH is funded by the Australian Government through the Department of Health and Ageing.
The report Reproductive Health: Findings from the Australian Longitudinal Study on Women's Health is available at the Women's Health Australia website and the Department of Health and Ageing website.
Jennifer Powers and Catherine Chojenta are members of the Hunter Medical Research Institute (HMRI) Public Health Research Program".
HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.



Promoting healthy behaviour in expectant mums / Current news / The University of Newcastle, Australia"

Founders of British obstetrics 'were callous murderers' | UK news | The Observer

Founders of British obstetrics 'were callous murderers' | UK news | The Observer

"They are giants of medicine, pioneers of the care that women receive during childbirth and were the founding fathers of obstetrics. The names of William Hunter and William Smellie still inspire respect among today's doctors, more than 250 years since they made their contributions to healthcare. Such were the duo's reputations as outstanding physicians that the clienteles of their private practices included the rich and famous of mid-18th-century London.
But were they also serial killers? New research published in the Journal of the Royal Society of Medicine (JRSM) claims that they were. A detailed historical study accuses the doctors of soliciting the killing of dozens of women, many in the latter stages of pregnancy, to dissect their corpses.
"Smellie and Hunter were responsible for a series of 18th-century 'burking' murders of pregnant women, with a death total greater than the combined murders committed by Burke and Hare and Jack the Ripper," writes Don Shelton, a historian. "Burking" involved murdering people to order, usually for medical research."
"Motivated by ego, personal rivalry and a shared desire to benefit from being acclaimed as the foremost childbirth doctors of their time, Hunter and Smellie sacrificed life after life in their quests to study pregnancy's physical effects and to develop new techniques, the author says. "Although it sounds absolutely incredible, the circumstantial literary evidence suggests they were most likely competing with each other in experimenting with secret caesarean sections on unconscious, or freshly murdered, victims, with a view to extracting and reviving the babies," Shelton told the Observer".
Another founder of obstetrics, Dr Marion Sims, who has the Sim's speculum named after him, was also callous about women and their bodies and performed hundreds of operations on black women slaves without anaesthetic.

          Sims contended that ‘Black women don’t feel pain'

Modern obstetrics evolved from this era.

When you consider the foundations of anything, the foundations do influence the structure of what comes after. Modern obstetrics imposes an impersonal, efficiency model onto women's organic, dynamic birthing processes. There are, of course, doctors who treat women individually and take into account what women want - they are however, not in the majority.

I'm not talking about those women-centred doctors here.

I'm talking about the 'cookie cutter' approach to labour and birth adopted by obstetrics generally. The process that women are subjected to has been linked to the industrial age Taylorist ideas of factory processing - speed, efficiency and cost containing - supposedly.

Many women emerge bruised and shattered from their birth experience having been 'done to' by the 'machine'.

Meanwhile, midwifery emerged from millions of years of women helping women during their life cycle events such as the birth of children. Midwifery remains woman focused and has sought and is seeking to keep birth normal, keep maternity care woman focused, accommodating women's individual needs, desires and dreams for her baby and her experience.

That is where the 'rip' is - the two tides of beliefs, attitudes, values, historical underpinnings, philosophy (etc) come together and create a field of dissension and distress for both women and midwives.

Many theorists are saying how invasion, genocide, penal colony origins, drunkenness, murder and mayhem were the foundations of contemporary Australia and underpin the rules, regulations and behaviours of 'mateship' - football culture, 'tall poppy' syndrome and other rather distasteful aspects of our culture.

In terms of modern maternity care and the 'turf wars' together with rising rates of surgical birth and maternal depression, as we look through the lenses of the foundations of medicine and midwifery - makes us think doesn't it.

          What do you make of all this?

          Update 25 August 2017 

          In the USA  Black Women are protesting Sims' statue

Medical News: Depression During Pregnancy Linked to Kids' Behavior Problems - in Psychiatry, Depression from MedPage Today

A study of the children of 120 disadvantaged mothers from South London, reported in the January/February issues of Child Development, provided more evidence of the compelling need to take care of childbearing women and in particular, to provide support for disadvantaged and marginalised women, who were more likely to be depressed and have experienced conduct problems themselves as children. Researchers found that children whose mothers were depressed were twice as likely to display antisocial behaviour than those whose mothers weren't depressed.

Medical News: Depression During Pregnancy Linked to Kids' Behavior Problems - in Psychiatry, Depression from MedPage Today

The researchers "explored several potential mechanisms for the link between maternal depression and a child's behavior problems:

• Direct effects on the fetus from biological correlates of the mothers' depressive symptoms
• Depression in pregnancy as a sign of environmental adversity
• Re-exposure to maternal depression after birth
• Indirect effects of depression on the developing fetus driven by mothers' smoking, drinking, and drug taking during pregnancy
• A genetic explanation whereby women who experience depression in pregnancy may also have a greater genetic risk for antisocial behavior, which they pass on to their offspring

Hay and her colleagues noted that these explanations are not necessarily mutually exclusive".

As the effect of the social environment upon the individual becomes more widely recognised and the way the building of a healthy sense of self in a baby/child is inextricably linked to the presence of a moment by moment, congruent, consistent, warm, responsive interactive relationship with the mother, it is no longer possible to ignore the responsibility of society to help childbearing women in every way possible. Apart from addressing basic economic necessities, a fundamental and important capacity building initiative is to provide one to one midwifery care. The provision of a trusting relationship with a known midwife in a continuity of care model, supports pregnant women's growth and development, providing the opportunity for early identification of potential problems and instituting remedial action and targetted solutions before the problems begin.  Authentic midwifery care, education, good nutrition, exercise and as already  noted, acupuncture all work together to alleviate and minimise depression and the associated problems with depression for childbearing women and their children.  Providing adequate resources for intervention in the beginning of life is an excellent public health strategy as it avoids the huge financial and societal cost of antisocial behaviour later on.

Cognition in pregnancy and motherhood: prospective cohort study -- Christensen et al. 196 (2): 126 -- The British Journal of Psychiatry

Cognition in pregnancy and motherhood: prospective cohort study -- Christensen et al. 196 (2): 126 -- The British Journal of Psychiatry

Background
Research has reported that pregnant women and mothers become forgetful. However, in these studies, women are not recruited prior to pregnancy, samples are not representative and studies are underpowered.
Aims
The current study sought to determine whether pregnancy and motherhood are associated with brief or long-term cognitive deterioration using a representative sample and measuring cognition during and before the onset of pregnancy and motherhood.
Method
Women aged 20–24 years were recruited prospectively and assessed in 1999, 2003 and 2007. Seventy-six women were pregnant at follow-up assessments, 188 became mothers between study waves and 542 remained nulliparous.
Results
No significant differences in cognitive change were found as a function of pregnancy or motherhood, although late pregnancy was associated with deterioration on one of four tests of memory and cognition.
Conclusions
The hypothesis that pregnancy and motherhood are associated with persistent cognitive deterioration was not supported. Previous negative findings may be a result of biased sampling.


This study is interesting on many points. One interesting point is the way the researchers concluded their paper by stating:

"Obstetricians, general family doctors and midwives may need to use the findings from this study to promote the view that ‘placenta brain’ is not inevitable, and that perceptions of impairment may reflect emotional or other unknown factors. Not so long ago pregnancy was ‘confinement’ and motherhood meant the end of career aspirations. Our results challenge the view that mothers are anything other than the intellectual peers of their contemporaries".

 An important point to make!

 The researchers state that:

"one of the weaknesses of our study was our inability to link cognitive change with biological changes associated with pregnancy"

What would have been really interesting is to see the neurological changes that were taking place in women's brains as they were questioned by the researchers.  Emerging insights from neuroscience indicate that different attentional networks are operating, depending upon the task at hand.  Different attentional networks trigger different autonomic nervous system 'states' with correspondingly different biochemical responses and levels.

Pregnant women do not suffer cognitive 'impairment' that much the research has demonstrated, however, the researchers dismisses the fact that many women do forget things in pregnancy, relegating the 'forgetting phenomenon' to the basket of emotionally related factors.  Dismissing women's experience as merely emotionally driven is, in my view, dangerous thinking.

Emotions are powerful chemicals for one thing and have a great deal to do with day to day health and long term wellbeing for both mother and baby.

A far better conclusion is that the pregnant woman's body and subconscious processes are very busy building a baby.  Our innate intelligence has a way of rerouting attention from less important to more important activities. Nothing, in terms of nature's agenda (healthy reproduction) is more important than building a healthy baby.

With an understanding of neuroscience and attentional networks, the fact that a pregnant woman becomes forgetful about 'boring' tasks and 'work' related activities is perfectly understandable and has nothing to do with her intellectual ability and cognition. When a woman's attentional networks are triggered to pay attention, she will, demonstrating, as this study shows that her intellectual ability is 'normal'.

Pregnant women can be assured that forgetting mundane, wordly things is actually very normal and very understandable. Their body intelligence is very consumed in growing a baby and is not bothered or very interested in outside worldly pursuits.

YouTube - matronas

Midwives and Matronas


YouTube - matronas

Delightful!

What to do about the top 15 chemical additives in your food and other hazards

I found the article  Top 15 chemical additives in your food informative and concerning. We are the product of what we eat and we are affected by all the chemicals in our environment.  For pregnant women, what they eat today, walks and talks tomorrow - to borrow and adapt the advertising tagline of a bread manufacturer.

Some additives are said to enhance the nutritive value of the food. More information about what is safe and what is unsafe is available here http://www.cspinet.org/reports/chemcuisine.htm

Over 86,000 man made chemicals are now found in our environment, the number of synthetic chemicals has grown exponentially in 100 years. There were a little over 100 at the beginning of the 1900's. Our bodies are truly amazing that we maintain our health as well as we do, given the number of synthetic substances that our bodies process. Here's a report by the CDC on the measurements of 212 of these chemicals in human blood or urine

http://www.cdc.gov/exposurereport/

Many of the synthetic chemicals are hazardous to human health. One of the ways our bodies cope with toxic chemicals is to sequester them within fat cells. Chemical toxicity is said to be one of the components of the obesity epidemic. Obesity itself is associated with a burgeoning disease rate in the population. More worrying still is that up to 232 toxic chemicals have been detected in newborn cord blood (please see link below for report on umbilical cord blood report)

EWG Minority Cord Blood Report Executive Summary | Environmental Working Group

Even 'healthy' processed foods are suspect. Bonsoy, a popular soy milk drink was recalled in late December 2009 because of unsafe levels of iodine which caused illness in a cluster of people in NSW. Although iodine is necessary for optimal health, too much or too little is dangerous. Ironically , the Australian government was concerned with the drop in the use of iodised salt and has recently legislated for bread makers to add iodine to bread! Only organic bread is exempt.

http://www.recalls.gov.au/content/index.phtml/itemId/971373

What can we do to minimise the effects of these synthetic and natural chemicals?

For a start, eliminate and avoid the synthetic ones and ensure the right intake of naturally occurring vitamins and minerals. To do so makes sense from a biological and ecological perspective.

Some suggestions include:

1. If you smoke, stop!

2. Drink lots of purified water - get a good purifier one that also removes 'bugs' - if you want to know a good one, contact me for a recommendation

3. Avoid processed food

4. take high quality, natural, organic supplements, including Omega 3's and antioxidants. Contact me if you want the best brand

5. Eat whole foods - buy locally grown

  Recipes

6. Avoid out of season whole foods - transportation involves time and chemical preservatives

7. Eat fresh foods - lots of salads

  Recipes

8. When you cook, cook slowly - avoid microwaves - keep veges crisp - do not use bicarb to keep greens 'green' - cook for a short time only

9. Reduce calories

10. Reduce salt intake

11. Reduce sugar intake

12. Drink green tea - antioxidant

13. Avoid transfats

14. Reduce your dependence on plastics of all kinds - bisphenol A is proving to be a real menace

15. Reduce pesticide use - go for the natural ways as much as possible

16. Grow your own veges and companion plant them

Sustainable Gardening Australia

Companion planting guide

 
17. When you grow your own veges, use natural fertilisers, not chemicals.


18. Don't use talcum powder - irritates mucous membranes and is associated with lung and ovarian cancer

19. Don't burn incense - the smoke is an irritant, as menacing as tobacco smoke

20. Get regular, brisk exercise every day for at least 30 minutes - helps the lymph system move toxins along and out - along with all the other benefits of walking

Norweigan Scientist says breastmilk is no better for babies than formula - mirror.co.uk

Interesting report on research from Norway, where breastfeeding support is high and most women breastfeed? What's going on?

Scientist says breastmilk is no better for babies than formula - mirror.co.uk

Statue in front of hospital on Margarita Island Venezuela

UNICEF has refuted the study

http://www.babyfriendly.org.uk/items/item_detail.asp?item=620

Ben Goldacre from Bad Science fame posts the press release that lead to the BIG STORY which has been subsequently plastered all over the media

http://bengoldacre.posterous.com/

These articles and responses to them are well worth reading to get the full story behind the 'story'.

Essentially, what the researchers are saying is that women who have high testosterone levels in pregnancy, have trouble breastfeeding.

There is a very thoughtful informed response by Australia's Karleen Gribble PhD School of Nursing and Midwifery, UWS, reproduced below.
Karleen's post was in response to a query about the study on en-net, " a free and open resource to help field practitioners have access to prompt technical advice for operational challenges for which answers are not readily accessible" The Emergency Nutrition Network is a UK registered international charity, set up by humanitarian agencies to improve effectiveness of emergency food and nutrition interventions through rapid identification and dissemination of lessons learnt in the course of operational practice, and through research and evaluation.

The en-net forum is made possible by the support of the American People through the United States Agency for International Development/Office of Foreign Disaster Assistance (USAID/OFDA) and the support of the Irish People through Irish Aid.

http://www.en-net.org.uk/

Karleen wrote on the above list:

"There's a few things that you need to understand about this study (which I have read) and the context in which it was carried out. This research is from Norway, the country with the best breastfeeding rates in the Western world- 99% initiation of breastfeeding and 80% of women still breastfeeding at 6 months. Societial support for breastfeeding women in Norway is very good. The very small number of women who cease breastfeeding in the early weeks of their infant's life would include those whose have a genuine physiological problem with making sufficient milk for their babies. It was found that these women were more likely to have higher levels of androgens during pregnancy. This is not a huge surprise, it's been something that others have been suggesting for some time (see the book for mothers "Making more Milk" by West and Maracso). The researchers seem to think that androgen levels can account for pretty much every factor associated with early weaning....they are endocrinologists....it's a case of if your only tool is a hammer, everything looks like a nail. It's a bit simplistic but there's no doubt that they have found a useful priece of the puzzle.
As to the idea that formula is as good as breastmilk. Well, the references cited in the study as providing evidence for this idea are 4 from the PROBIT study (the huge RCT of the implementation of BFHI in Belarus). The 4 studies cited looked at the impact of BFHI implementation (and lower of higher artificial feeding rates) on child behaviour, growth, dental caries, allergies/asthma- that's it. You'll get few people getting all het up saying you must breastfeed otherwise you're child will have behaviour problems or holes in their teeth. And to be perfectly frank any results from the PROBIT study on allergy and asthma is going to be questionable because the issue with allergic disease is exposure to allergens- and the only way to do this properly is a longitudinal study which records the time of the infant's first exposure to anything other than breastmilk- the only study I am aware of that has done this is one by Wendy Oddy in W Australia (and indeed, the critical factor was the timing of the first exposure to cows milk protein). There was nothing in the study that addressed the most common morbidities and mortalities due to artifical feeding, that is: diarrhoeal disease and respiratory infection.
Shall I be cynical and say that the researchers wanted to get media interest in their study?? (This was just a single small paragraph in the paper) Perhaps. Or maybe they just don't see the adverse effects of formula feeding since they are in Norway, where as I mentioned, just about every woman breastfeeds for a substantial period of time and where they have one of the best public health systems in the world.
And just a note about language when we talk about infant feeding. Breastfeeding is the normal way of feeding babies. It is extremely important and in fact it is vital, essential, indispensible to the wellbeing of infants and young children. It has NO BENEFITS. It is NOT best. Rather, artificial feeding is risky and dangerous. It actively and passively harms the immune system and the health of infants. Breastfeeding does not decrease disease, artificial feeding increases it. Breastfeeding is not best, infant formula is deficient.
This may seem pedantic but we actually have a growing body of evidence that if we talk about breastfeeding as best and the benefits of breastfeeding that we fail to effectively communicate the importance of breastfeeding and the risks of formula feeding- we actually assist in the promotion of formula feeding.
I can provide more evidence on this if there is interest".

Preterm babies grow better with Mozart's music

Gone are the days when babies were thought to be 'blank slates' requiring only sleep, clean nappies, warmth and food.


Advances in neuroscience demonstrate that babies need much more than cursory attention to their basic physical needs. Babies from birth, whatever their gestation, require love, sensory stimulation including movement, skin to skin experience with their mothers and the opportunity to engage eye to eye with their mothers. Babies are sensitive, social and interactive; constantly seeking to engage; adjusting, learning and developing according to environmental cues, feedback and experiences.

The environmental needs of babies who are born prematurely require thoughtful consideration as they are often in nurseries, handled by strangers even though they are generally kind and well meaning and subject to painful and unpleasant stimuli.

Exciting work, exploring the needs of premature babies is leading to brilliant discoveries by pioneers such as Dr Nils Bergman, who was the first to highlight the tactile needs of premature babies and developed kangaroo mothercare, or skin to skin baby wearing for premature infants and their mothers.

Dr Bergman demonstrated that premature babies who had 'kangaroo care' stabilise better and faster, cry less, fuss less, grow better and have enhanced brain development. Mother/baby bonding is improved too.

http://www.kangaroomothercare.com/


The recognition that babies are people too and thrive in an enriched environment has had another boost.

A new study carried out by Dr. Dror Mandel and Dr. Ronit Lubetzky of the Tel Aviv Medical Center affiliated with Tel Aviv University's Sackler School of Medicine has found that pre-term infants exposed to thirty minutes of Mozart's music in one session, once per day expend less energy -- and therefore need fewer calories to grow rapidly -- than when they are not "listening" to the music.
"It's not exactly clear how the music is affecting them, but it makes them calmer and less likely to be agitated," says Dr. Mendel, a lecturer at Tel Aviv University.
In the study, Dr. Mandel and Dr. Lubetzky and their team measured the physiological effects of music by Mozart played to pre-term newborns for 30 minutes. After the music was played, the researchers measured infants' energy expenditure again, and compared it to the amount of energy expended when the baby was at rest. After "hearing" the music, the infant expended less energy, a process that can lead to faster weight gain.
A "musical environment" for preemies
When it comes to preemies, one of the main priorities for doctors is to get the baby up to an acceptable body weight so he or she can be sent home. At the hospital, preterm babies may be exposed to infections and other illnesses, and a healthy body weight keeps them immune to other problems in the future.
While the scientists are not sure what occasioned the response, Dr. Mandel offers one hypothesis. "The repetitive melodies in Mozart's music may be affecting the organizational centers of the brain's cortex," he says. "Unlike Beethoven, Bach or Bartok, Mozart's music is composed with a melody that is highly repetitive. This might be the musical explanation. For the scientific one, more investigation is needed."
The study came about through an international project led by the U.S.-based consortium NIDCAP, whose goal is to create a set of standard practices to optimize the health and well-being of neonates. A number of environmental effects, such as tactile stimulation and room lighting, are already known to affect the survival and health of these very susceptible babies.

A sonata a day keeps the doctor away

Wonderful to see this work steadily improving the lot of premature babies and their mothers. However, we need to also focus on preventing prematurity as premature babies have extra risks and potential burdens to deal with as they grow outside the womb. One to one midwifery care with a midwife who respects, listens and cares for the individual woman provides a space place for the woman to explore becoming a mother; process her stressful feelings and develop self confidence. In such a capacity building environment, stress hormones are diminished because women feel valued and in control; inflammatory processes are not triggered and babies grow better and to term.

EWG Minority Cord Blood Report Executive Summary | Environmental Working Group

A two-year study involving five independent research laboratories in the United States, Canada and the Netherlands has found up to 232 toxic chemicals in the umbilical cord blood of 10 babies from racial and ethnic minority groups. The findings constitute hard evidence that each child was exposed to a host of dangerous substances while still in its mother’s womb.

Government, academic and independent biomonitoring studies, including those by EWG, have detected up to 358 industrial chemicals, pesticides and pollutants in the cord blood of American infants. Exploring the so-called “additive” effects of possible carcinogens, hormone disrupters and neurotoxins is a new and urgent priority for environmental health scientists. EWG supports this very important work.

But as this science moves forward, we need to act now to reduce exposures that present the greatest health threats based on what we know today, even as scientists struggle to understand how the cocktail of chemicals in the womb could harm current and future generations.

Many of the up to 232 compounds detected in this study have been the target of regulatory action and government controls. As a rule, however, these actions came far too late, well after the environment and the human race were polluted to a degree that has raised serious health concerns. Our failure to act quickly has ensured that these chemicals will continue to pollute future generations for decades, even centuries to come.

EWG Minority Cord Blood Report Executive Summary | Environmental Working Group

Medical News: Listeriosis Risk to Fetuses Higher than Thought - in Infectious Disease, General Infectious Disease from MedPage Today

The risk of listeriosis in pregnant women and their fetuses is greater than previously thought, researchers said.

Listeria monocytogenes -- one of the most dangerous foodborne pathogens in the U.S. -- can cause miscarriages and stillbirths, according to Mary Alice Smith, PhD, and colleagues at the University of Georgia in Athens.

Medical News: Listeriosis Risk to Fetuses Higher than Thought - in Infectious Disease, General Infectious Disease from MedPage Today

Folic acid in pregnancy linked to asthma

Evidence that more is not necessarily better.

Folic acid in pregnancy linked to asthma

Why immune cells count in early pregnancy

"This research identifies immune system cells as critical determinants of normal ovarian activity and the maintenance of early pregnancy. This might be a key to helping prevent early pregnancy loss, such as recurrent miscarriage."

Ms Care says a number of factors - such as smoking, obesity, poor nutrition and stress - could all alter the way macrophages behave and may provide reasons for infertility or miscarriage in some women.

Why immune cells count in early pregnancy

Shared via AddThis

How Diet Affects Fertility | Newsweek Health for Life | Newsweek.com

This is a great article. A must read for anyone who wants to get pregnant and anyone else who wants to stay healthy and live well.

Health, wellness and fertility all comes down to 'what you eat today, walks and talks tomorrow'. The overall message is
1. Eat whole foods
2. Avoid processed and modified products (which masquerade as food)
3. Eat quality protein
4. Include natural fats
5. Eat fresh foods

and of course, drink lots of fresh, filtered water, stop smoking, limit alcohol, move and enjoy your life!

The authors wrote:

"In a nutshell, results from the Nurses' Health Study indicate that the amount of carbohydrates in the diet doesn't affect fertility, but the quality of those carbohydrates does. Eating a lot of rapidly digested carbohydrates that continually boost your blood-sugar and insulin levels higher can lower your chances of getting pregnant. This is especially true if you are eating carbohydrates in place of healthful unsaturated fats. On the other hand, eating whole grains, beans, vegetables and whole fruits" all of which are good sources of slowly digested carbohydrates”can improve ovulation and your chances of getting pregnant."

The authors also talk about transfats. This article is excellent.

How Diet Affects Fertility | Newsweek Health for Life | Newsweek.com

Shared via AddThis

Bioethics for clinicians: 12. Ethical dilemmas that arise in the care of pregnant women: rethinking

Bioethics for clinicians: 12. Ethical dilemmas that arise in the care of pregnant women: rethinking "maternal?fetal conflicts"

This article was written in 1997. The ideas about ethics that are expressed here need to be reaffirmed today. 

Sexual Abuse Linked to Somatic Disorders

From Medpage


By Chris Emery, Contributing Writer, MedPage Today
Published: August 19, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Sexual abuse is associated with an increased risk of somatic disorders, in which patients report physical symptoms or complaints with no clear underlying cause, a review of nearly two dozen studies concluded.

Patients with a history of sexual abuse, as children or adults, were more likely to experience gastrointestinal disorders (OR 2.43; 95% CI 1.36 to 4.31), nonspecific chronic pain (OR 2.20; 95% CI 1.54 to 3.15), psychogenic seizures (OR 2.96; 95% CI 1.12 to 4.69) and chronic pelvic pain (OR 2.73; 95% CI 1.73 to 4.30), according the report in the August 5 Journal of the American Medical Association.

"Building greater awareness of the association between sexual abuse and somatic disorders may lead to improved health care delivery and outcomes for sexual abuse survivors," Ali Zirakzadeh, MD, of the Mayo Clinic, and colleagues wrote. "As a group, survivors of abuse have higher medical care use and incur greater costs compared with the general patient population."

Surveys have determined that the incidence of sexual violence in the United States is 2.5% for women and 0.9% for men, according to the review, and researchers have estimated that one in 15 adults has experience forced sexual intercourse. Studies have also estimated that 16% of men and 25% of women in the United States are survivors of childhood sexual abuse.

"To date, research on the long-term effects of sexual abuse has primarily focused on mental health outcomes," wrote Zirakzadeh and his coauthors. "Strong evidence supports a link between childhood sexual abuse and multiple psychiatric sequelae. However, studies investigating the association between sexual abuse and somatic outcomes have been less definitive."

The authors conducted a systematic literature search of electronic databases from January 1980 to December 2008, identifying 23 longitudinal studies that reported somatic outcomes in 4,640 people with and without history of sexual abuse.

The researchers categorized sexual abuse into two major groups. "Rape" was defined as penetration with a body part or foreign object, while "All forms of sexual abuse" captured the wide variety of definitions used to characterize sexual violence.

While analysis from the data in the studies indicated a relationship between sexual abuse and some somatic disorders, the researchers found no significant association between sexual abuse and a lifetime diagnosis of fibromyalgia, obesity or headache.

However, when they restricted the analysis to rape victims, they found a higher risk of fibromyalgia diagnosis (OR 3.35; 95% CI, 1.51 to 7.46). Like those classified under "all forms of sexual abuse," rape victims were also more prone to chronic pelvic pain (OR 3.27; 95% CI 1.02 to 1.53) and functional gastrointestinal disorders (OR 4.01; 95% CI 1.88 to 8.57).

The principal limitation of the study, according to the authors, was the inclusion of data susceptible to bias. Only two of 23 studies met at least 8 of the 10 maximum points of the Newcastle-Ottawa criteria for study quality. They also noted that their findings may not apply to men, since sixteen of the 23 studies in the review included only female subjects.

However, they also noted that the review used an exhaustive and reproducible search strategy and attempted to avoid bias by careful selection and extraction of data.

They also pointed out that sexual abuse remains prevalent and that doctors commonly encounter survivors in general medical practice.

They speculated that sexual abuse may be an early inciting environmental factor in a multistep process that culminates in physical dysfunction, and that the neuroendocrine system may mediate the connection between sexual abuse and the development of somatic dysfunction.

"Increasingly, it has been shown that survivors of sexual abuse face a spectrum of often challenging health concerns, resulting in greater health care use and cost and significant morbidity," they wrote. "Recognition of this association may have important clinical implications for patients coping with these disorders and their clinicians."

The authors reported no financial conflicts of interest.

No funding source for the study was reported.

Primary source: Journal of the American Medical Association
Source reference:
Zirakzadeh A, et al. "Sexual Abuse and Lifetime Diagnosis of Somatic Disorders" JAMA 2009; 5: 550-61.

The application of this information to pregnancy and birth for women who have been abused in childhood is well known to midwives. This information underscores the importance for women to feel in control and autonomous in their pregnancies and births.

Great to see this information becoming 'mainstream'.

Fish oil in pregnancy linked with reduced allergy risk fo children

A new study from Sweden published in the journal Acta Paediatrica [Acta Paediatr. 2009 Jun 1 ePub ahead of print] found at http://www.ncbi.nlm.nih.gov/pubmed/19489765 has found that Omega 3–rich fish oil supplementation during pregnancy and lactation may reduce the risk of food allergy and eczema in children.

The randomized, placebo-controlled, double-blind study, followed 145 pregnant women who had allergies or had partners or other children with allergies [which makes this group at high risk for having children with allergies.

From the 25th week of pregnancy until between 3 and 4 months breastfeeding, the women were randomly assigned to receive either:

1. daily fish oil supplements providing 1.6 g of eicosapentaenoic acid
(EPA)and 1.1 g of docosahexaenoic acid (DHA)
2. or placebo.

Children born to the group of mothers who were given Omega 3's had a 2% incidence of allergy, compared to a 15% rate for the babies in the control/placebo group.

Another finding was that the incidence of allergic eczema was reduced by 2/3rds (8% in the omega-3 infant group, compared to 24% in the placebo group).

How this works is because Omega-3 fatty acids compete with the Omega-6s therefore lessening the release of arachidonic acid (AA) and inflammatory prostaglandins, which create havoc in our cells.

Another example of how important nutrition is and how nutrition must be the first line of primary health care!

Health related behaviours found to be lacking in pregnant women

A study of the health related behaviours of 262 pregnant women for factors such as fruit and vegetable intake, physical activity and smoking levels was recently undertaken by the University of Queensland researchers.

The researchers found that:

"Few women met the guidelines for sufficient fruit (9.2%) or sufficient vegetable (2.7%) intake. On average, women consumed half the recommended serves of fruit (mean 2.2, SD 1.1; median 2.0, IQR1.0-2.0) and little more than one third of the recommended serves of vegetables (mean 2.0, SD 0.6; median 2.0, IQR 1.0-3.0) per day. Approximately one third (32.8%) of the population was undertaking sufficient physical activity (see Figure 1). Women undertook a median of 112.5 minutes of physical activity per week (IQR 43.8-240.0). A large proportion of women smoked prior to pregnancy (37.8%) and more than one quarter continued to smoke during pregnancy. Approximately 10% of women quit smoking when they became pregnant. On average, women smoked 15.9 cigarettes a day (SD 1.2, n=103) before becoming pregnant and smoked 13.4 cigarettes a day (SD 2.6, n=26) once becoming pregnant. Twenty-one per cent of women were overweight and 20.0% were obese before becoming pregnant"

This is where one to one midwifery care is so beneficial. When women and midwives work together in a primary health care way, issues such as the health related behaviours noted above can be explored and discussed in a safe and effective way. My guess is that the busy antenatal clinics where women wait for hours and see whoever is free, isn't the place where sensitive subjects such as eating habits, exercise activities and smoking are explored in effective ways, if at all.

The Australian and New Zealand Journal of Public Health (2009) 33(3): 228-33
The full text of the study can be read online at: http://www3.interscience.wiley.com/cgi-bin/fulltext/122423650/HTMLSTART

'Seeing the baby': pleasures and dilemmas of ultrasound technologies for primiparous Australian women

'Seeing the baby': pleasures and dilemmas of ultrasound technologies for primiparous Australian women

An interesting report of a study into the pleasures and dilemmas associated with the way that ultrasound has become a part of the embodied experiences of pregnant women. The paper reminds us that women are increasingly taking responsibility for a successful outcome for their pregnancies in a gendered experience which has been socially constructed as inherently 'risky' in contemporary Australian society.

http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:1913

My personal view is that women are under enormous pressure to produce the 'perfect' baby.

The tension that women feel as they wait to 'pass' the various tests, including ultrasound, has made pregnancy into an increasingly stress filled time.

The burgeoning list of 'tests' provide a series of challenges for women, the essence of which remind me of the trials and tribulations the heroes of ancient Greek and Roman mythology had to endure, to 'prove' they were capable and worthy of living. For childbearing women, the successful negotiation of the labyrinth or the attainment of the golden fleece means worthy for motherhood.

Pregnancy

This thread is for anyone who wishes to ask questions about pregnancy. Please drop me a line and I'll answer to the best of my ability. If I don't know, I'll find out. love, Carolyn