“The Weight of the Nation”: Watch it tonight!

There’s an excellent documentary tonight on obesity in the U.S.: The Weight of the Nation (8:00 pm, HBO). From the Robert Wood Johnson Foundation:

The documentary is part of a public service campaign that encourages action at the personal, community, and national levels to prevent obesity. To raise awareness of the obesity epidemic and support action to reverse it, HBO is providing free online access to the entire documentary, as well as topic-specific segments, action steps, discussion guides, and other materials at http://theweightofthenation.hbo.com/. The series also will be viewable on YouTube.

Check it out–it promises to be a remarkable show.

More on breastfeeding…

As if you needed more reasons to choose breastfeeding, this just in from the journal Genome Biology:

Babies who breastfeed have a wider variety of bowel bacteria than those who are formula-fed. Why is this important? Because the bacteria in the newborn bowel (also known as the gut microbiota) help direct the development of the newborn’s immune system, among the many other beneficial functions they perform. A more diverse gut microbiota is associated with a healthier immune system.

We already know that babies born by cesarean section have a less-diverse gut microbiota than vaginally-born babies, and that following a c-section the newborn gut microbiota is often dominated by bacteria picked up from the hospital environment. Some of those hospital bacteria–clostridium difficile in particular–are associated with a number of nasty diseases in humans. From the looks of this study (and others), formula feeding may exacerbate the problem.

Nature intended for us to have a diverse gut microbiota, dominated by the types of bacteria picked up in the course of a vaginal birth and breastfeeding. We’re only now learning of the long-term health consequences of tinkering with that plan…

PS: In no way am I criticizing women who, for whatever reason, formula feed their babies. Exclusive breastfeeding isn’t always an easy thing to do in this day and age. But however it happens that a baby isn’t breastfed, the potential health impacts are the same.

Things Kids Say: Heartbeat edition

“Rhumba, anyone?”

“It sounds like buffaloes dancing.”

Muriel, 5, on listening to her own heartbeat with my stethoscope.

Where some addicted moms get their start…

Tagging on to my last post…

According to a study in the new Archives of Pediatrics & Adolescent Medicine, one in eight (13%) American high school seniors admit to having used prescription pain medications–like codeine, vicodin, or oxycontin–that were either left over from a previous medical condition or not prescribed for them at all. Sadly, some of these teens go on to become drug-dependent mothers, with all the dangers to themselves and their babies that come with addiction.

From the article, summarized in Reuters Health:

“Most of the kids who used the drugs recreationally had previously been prescribed them for a medical condition. Teens may be using their own leftover medication for pain or recreational purposes, or may get painkillers from family members or friends who were prescribed the drugs, researchers said.”

Started in high school?

A popular place for teens to find prescription painkillers is in the medicine chest of a grandparent or other elderly person. I often speak to grandparents in my practice, and the discussion about properly disposing of old prescription drugs raises quite a few eyebrows. Narcotic abuse isn’t something most grandparents think about when the think of “childproofing” their homes.

Jailing addicted new moms: A slippery slope?

Two troubling articles about pregnant women, addiction, and the law came out this week.

1) The first, in the most recent New York Times Magazine, describes how Alabama is increasingly handing out long jail sentences to drug-addicted new mothers. The charge? “Chemical endangerment of a child,” a Class A felony in Alabama that carries a mandatory 10-year sentence.

Emma Ketteringham, the director of legal advocacy at the National Advocates for Pregnant Women (NAPW), is particularly rankled by the use of the “chemical endangerment” statute to prosecute addicted women. The law was originally drawn up to protect children from the dangers of parental meth labs and the like; it was never intended to be used against pregnant women struggling with the disease of addiction. From the Times article:

[Ketteringham] argues that applying Alabama’s chemical-endangerment law to pregnant women “violates constitutional guarantees of liberty, privacy, equality, due process and freedom from cruel and unusual punishment.” In effect, she says, under Alabama’s chemical-endangerment law, pregnant women have become “a special class of people that should be treated differently from every other citizen.” And, she says, the law violates pregnant women’s constitutional rights to equal protection under the law.

It also makes it much less likely that an addicted woman will seek help during her pregnancy, thus putting her child in even greater danger–a point which seems to have been lost on the state’s legislators.

The push to prosecute drug-addicted pregnant women is actually part of the larger effort to pass “fetal personhood” laws (which have been introduced as initiatives and measures in 22 states to date), which declare that a fully constitutional-rights-endowed person is created the moment sperm meets egg.  A major problem with this view, according to Lynn Paltrow, executive director of NAPW, is that:

“… there is no way to treat fertilized eggs, embryos and fetuses as separate constitutional persons without subtracting pregnant women from the community of constitutional persons.”

In other words, from the moment of conception a woman’s rights would be superseded by those of her fertilized egg.

2) Okay, so getting jailed on a PWA (pregnant-while-addicted) charge may seem like a distant concern for most Americans–the vast majority of pregnant women in the U.S. are not drug-addicted, after all.

But hold on a moment. As the second article (from the Washington Post) points out, the number of pregnant women addicted to prescription painkillers has tripled in the last decade, including many women who are being treated for very legitimate pain issues–not the “typical” drug addict so often reviled in the media.

The Alabama law makes no distinction between “medical” addiction to painkillers (prescribed after a car accident, say), and “recreational” addiction to heroin or crack, and in a way, they’ve got a point. From a baby’s standpoint it doesn’t matter why mom’s addicted, so why not prosecute them all? There hasn’t been a legal stampede to throw the book at moms on Vicodin as yet, but it shouldn’t take a politically ambitious Alabama attorney too long to figure that one out.

Spending a decade in jail for the “crime” of having a baby while addicted to a doctor-prescribed treatment may seem like a stretch today, but today’s stretch is often tomorrow’s norm. As Rush Limbaugh-esque politicians steadily chip away at women’s reproductive rights, it doesn’t sound so far-fetched to me.

Home birth geography quiz!

Quick! Name the country where:

• Maternity care is provided in hospitals by obstetricians, and at home by medically-trained midwives and traditional midwives.
• Obstetricians don’t trust midwives.
• Midwifery groups don’t trust each other, and none of them trust obstetricians.
• Midwives feel obstetricians are often insulting and disrespectful to them.
• Obstetricians, in fact, are often insulting and disrespectful to midwives.
• Timely transfer from home to hospital during labor is often hampered by delays in deciding to seek care, by slow transport to the hospital, and by delays in receiving care on arrival.
• Women seeking home births are afraid of hospitals, which they see as cesarean mills.
• Obstetricians are viewed primarily as surgeons, their motives mainly financial.
• Economic and ethnic disparities are rife; those with money get care when and where they want it.
• Despite years of progress, maternal mortality rates remain stubbornly high.

I know what you’re thinking: Hey! I live there, right?

Wrong. It’s Iran.

Specifically, it’s Zahedan, the capital of Sistan and Baluchestan province in eastern Iran, home to 600,000 people on the border with Pakistan.

A recent study of maternity care in Zahedan revealed a very fractured, and fractious, obstetrical world. What with battles over where and when midwives can legally practice, how best to deal with a flood of undocumented and uninsured immigrants, layers of professional suspicion, accusation, intrigue and infighting…you start to get the idea that maternity care is a mess the whole world ’round.

Granted, there are differences between Zahedan and the U.S. It’s unlikely, for example, that an American woman would have to have her eclamptic seizures exorcised by a faith healer before her family would allow her to go to the hospital (a not-uncommon practice in Zahedan). Too, an American family would probably not be required to drive their very angry midwife home before heading to the local maternity ward. And an Iranian midwife’s trump card–the threat to “go outside the home and shout and bring disgrace” on a woman and her family for seeking hospital care–probably doesn’t strike a lot of fear in American hearts.

Still…

Hospitals in Zahedan have begun a two-pronged outreach effort of sorts, aimed at convincing mothers and their relatives that a) traditional midwives may be lacking the kind of training needed in real emergencies, and b) hospitals aren’t simply scary cash-machines for doctors:

“Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central factors to increasing the use of available hospitals. The hospitals must be safe, comfortable and attractive environments for parturition and should give appropriate consideration to the ethical and cultural concerns of the women.”

Maybe we have more in common with Iran than we thought…

 

One family’s history

Gram Sloan in 1918. John Francis (left) died a month later in the Spanish flu epidemic.

Yesterday was my parent’s 65th wedding anniversary. I realized in talking with them over dinner that their family stories (and mine, too, of course) provide a pretty good snapshot of how children’s health has improved in the last century, at least on the infectious disease front.

Dad’s 93 now, born in 1919 during the waning days of the Woodrow Wilson administration. His mother (my Gram Sloan) experienced a lot of tragedy with her children. She gave birth to five babies, but only three survived to adulthood. My uncle John Francis died in the 1918 Spanish flu epidemic at the age of three, and Donald was 4 years old when he died of pneumonia in 1924. The striking thing about her experience is that it was basically the norm for families back then. In 1914, the year she married, about one in four children didn’t make it to their 5th birthdays. (I wrote an essay about John Francis for Notre Dame Magazine–link is here.)

Mom is 87 and, though she and her six siblings all survived to adulthood, her childhood was one long string of debilitating infections: whooping cough, diphtheria, scarlet fever, and polio (which left her with a weakened leg), to name a few. She even received the last rites of the Catholic Church once (for diphtheria), but defied her doctor’s dire predictions and pulled through.

Together Mom and Dad had seven babies. The first, my brother James, was born a few weeks early and died at two days of age from hyaline membrane disease (now called respiratory distress syndrome). The rest of us made it through childhood relatively unscathed–oh, we had measles, mumps, and chicken pox, like every other kid, but we were spared diphtheria, polio and the rest. (Mom dragged us to the pediatrician’s office, kicking and wailing no doubt, the day the polio vaccine arrived.)

And now my kids–they’re healthy and in their twenties. Both had chicken pox, the odd ear infection, and some wheezing, but basically had pretty healthy childhoods. The same is true for all of their cousins, a few of whom now have their own healthy children. If this were a century ago, I would probably be talking about a few of them in the past tense.

My career as a pediatrician is another indicator of how things have improved. I’ll just mention what I call the “spinal tap index.” When I started in the early 80s, I did about one spinal tap a week to diagnose or rule out meningitis. Then came the vaccines for Hib, pneumococcus, and meningococcus, and with them a huge decrease in cases of meningitis. It’s been more than a year since I did my last spinal tap.

Talk to your older relatives and friends–you’ll very likely find that they have similar stories. There is much to criticize in the current state of children’s health in the U.S., but on some fronts, particularly infectious diseases, the progress has been remarkable.