Category Archives: Birth Day

Epidurals: Do they prevent postpartum depression?

Leonardo da Vinci

Leonardo da Vinci

Do epidurals prevent postpartum depression? That’s the intriguing conclusion some people are drawing from a study published in this month’s issue of Anesthesia and Analgesia. But is that conclusion correct?

In a study of 214 women at Peking First University Hospital in Beijing, researchers found that 14% of women who received epidural analgesia during labor reported symptoms of postpartum depression (PPD) six weeks later, compared with 34.6% of women who refused epidurals. The authors point out that their findings don’t necessarily prove that epidurals can prevent PPD, but the language in the discussion sure sounds like that’s what they believe.

But…the premise of this study is flawed from the start, because the investigators compared epidural analgesia to, well, nothing:

“Each parturient made a decision by herself to have epidural labor analgesia or no pain relief at all. Other forms of analgesia are not available at our hospital.”

What does “no pain relief at all” mean at Peking First University Hospital?  Were spouses/doulas/other support people allowed in the room? Did the mothers labor alone? Does “no pain relief at all” mean no freedom to move about, no bath/massage/music/visualization exercises/birth balls, none of the myriad other comfort measures that can reduce pain during labor? It obviously means no nitrous oxide, and I presume no tylenol or ibuprofen, either. In this particular hospital it seems, the choice is pretty stark: you get an epidural or you tough it out.

Which means we’re left with a study of unaddressed labor pain and postpartum depression, not the benefits of epidurals.

Karl Gauss, inventor of Twilight Sleep

Not exactly “new news”: Dr. Karl Gauss, inventor of Twilight Sleep

It’s hardly news that uncontrolled pain can lead to postpartum depression. One of the main drivers in the “painless childbirth” movement of the mid-19th century and the development of Twilight Sleep in the early 20th century was the prevention of neurasthenia—a debilitating combination of anxiety and depression that haunted many postpartum women.* 

This study would be more compelling if the authors had compared epidurals with other pain relief modalities in the setting of a well-supported labor. Otherwise we’re left with the conclusion that uncontrolled labor pain can make women miserable, and medically obliterated pain makes them less so. 

I can’t think of any other form of human pain that would be studied in such an all-or-none way.

* * *

* Department of Shameless Self-Promotion: You can read more about the history of painless childbirth, as well as what a lousy labor coach I was, in my book, Birth Day: A Pediatrician Explores the Science, the History, and the Wonders of Childbirth.  

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Filed under Birth Day, Labor pain, Maternal-child health, Natural childbirth

“Birth Day” is out in paperback!

Better than Hemingway

Better than Hemingway

And now, time for some shameless self-promotion…

At long last, Birth Day is out in paperback! What a great gift for you, your partner, your pregnant friends, your non-pregnant friends, your friends with ten kids, your friends who swear they’ll never have kids…basically, Birth Day is a great gift for anyone who has ever been born. (Am I forgetting anybody?)

Birth Day is available from Amazon and other online booksellers, or you can get a signed-by-me copy by ordering directly from my website. It’ll set you back $12.99 plus shipping, but hey, it’s a darned good book:

From the Washington Post:

“Sloan is a graceful writer, and his narrative, like the works of Jerome Groopman, flows easily between memoir, anecdotal reporting and hard science. Birth Day has a natural audience in curious, new and expectant parents. But anyone interested in the complex and, yes, miraculous way we all make it into this world will find lots to wonder over and ponder here, too.”

Aw, shucks…

Okay, commercial’s over! Back to blogging.

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A great book about living with polio

Anne Finger

Anne Finger

I had the pleasure of meeting the author Anne Finger in 2010, when we were both nominees for the Northern California Book Awards. (Anne was a Fiction nominee for her short story collection, “Call Me Ahab.” Me? I lost to Dave Eggers–does he have to win every award?–in the Creative Nonfiction category.)

Anne’s legs were paralyzed by polio when she was a toddler. Her book, “Elegy for a Disease: A Personal and Cultural History of Polio” (2006) brings all the theoretical discussions of polio and vaccines down to a very personal level. “Elegy” is a remarkable read for anyone who wants to know what it’s really like to live with the damage, both physical and emotional, that polio once wreaked on thousands of American children and adults every year.

Here’s an excerpt from Publishers Weekly’s review of “Elegy for a Disease”:

In skillful prose, Finger merges memoir with historical narrative about how polio was viewed and dealt with in the years before the Salk vaccine was invented 50 years ago. Evocative and often poetic, the memoir is also a litany of the miserable, useless, even harmful treatments imposed by helpless doctors on suffering children. She offers a nuanced history, for instance, of the painful and unorthodox heat treatments espoused by Elizabeth Kenny. Finger… describes the traumatic operations, beginning when she was six, that led in turn to complications when she was in her 40s. Taught to believe that she could overcome her disability, Finger overexercised and, while living in England, attended antiwar demonstrations that were physically dangerous…

“Elegy for a Disease” is a vividly-written reminder of why we should still worry about polio in Pakistan.

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A tale of two feet

Claire’s feet: 1990

Those of you who have read Birth Day will recall this image of my daughter Claire’s feet from her birth record.

Here’s their owner, all grown up at her graduation from UC Davis yesterday…

That went way too fast…

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Filed under About the photos, Birth Day, etc., Fathers

Call me Eli

Elihu Yale: Fabulous hair.

I’m in New Haven this week, attending the Yale Writers Conference. The attendees are mainly fiction writers, with a medium number of us nonfiction types, and even fewer screenwriters. (The poets either weren’t invited or they boycotted the proceedings. You never know with poets.)

It’s been a fascinating few days, sharing notes and ideas with other writers. There are novelists working on murders and zombies and crooked corporate CEOs and dysfunctional families (sometimes all four), and there are memoir writers working on real versions of the same things, minus the zombies. Nobody but me is writing about babies, except as cute little fictional props squeezed in between scenes of mayhem.

I’m here because I’m working on book two, code named “Son (or Daughter) of Birth Day.” I would tell you what it’s about, but my instructor here at the conference, who is a well-known, literary-battle-hardened L.A. writer and editor, tells me that only someone who wants their book idea stolen tells people what it’s really about.

So I’ll tell you this: There are no zombies. There will be babies. And I hope to bring back Queen Victoria for an encore.

What more could you want?

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Hey, teachers! How about a BiblioBattle at your school?

Book fight in Tokyo!

I got this email a while back from Yumiko Kaigawa of Ritsumeikan University in Japan, where the BiblioBattle concept was developed. (Refresher: My book, Birth Day, finished third in the 2011 BiblioBattle in Tokyo. More on that here.)

“Thank you for introducing BiblioBattle! I hope there will be an opportunity in the US to have and enjoy BiblioBattle, anyone, anywhere. It’s a good for a reading and cultural exchange.”

I think that would be a great idea! BiblioBattle is a straightforward book-vs-book contest, in which contestants have five minutes to talk up the merits of a book they particularly love. A three-minute audience discussion of each book follows, and at the end everyone votes for the “champ-bon,” or champion book. There’s a concise, one minute YouTube video that describes the process. As an example of how the presentations look in Japan, you can view Mina Mizuhara’s Birth Day presentation at the Tokyo finals here. (It helps if you can speak Japanese, but you’ll get the gist of it regardless.)

I think this could be a great way to drum up reading interest in our sometimes book-averse U.S. students. The Japanese BiblioBattle has the feel of a polite poetry slam, and it could be developed along those lines in the U.S.

So, any teachers out there? Does this kind of program already exist in the U.S.? Want to give it a try at your school? Please let me know what you think.

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Tokyo update: Birth Day and the Biblio Battle

"Baby Science" takes the bronze!

I can hear you out there (all five or so of you): “Hey Mark, what ever happened to that book contest in Japan last October? You know, the one where Birth Day (translated into Japanese as Baby Science) triumphed in the preliminaries over a 63 year-old Dale Carnegie self-help book and that Pokemon-like novel about satellites? How did the finals go?”

Well, thank you for asking! It went very well, and the Biblio Battle turned out to be a bigger deal than I thought. Hosted by Naoki Inose, Vice-Governor of Tokyo and a well-known author, the Battle is a national phenomenon and growing quickly in popularity. Organizers expected 400 attendees for the 2011 finals in Tokyo, and more than 1,400 showed up. (And many thanks to Yumiko Kaigawa, a reader from Ritsumeikan University in Japan, for filling me in on the details. Her boss, Dr. Tadahiro Taniguchi, designed the Biblio Battle concept.)

A Tokyo nail-biter!

Here’s how the Biblio Battle worked: more than 200 Japanese university students entered, each picking a book they were passionate about. Then, through a tournament-style series of book-on-book debates held at a number of universities, the titles were winnowed down by audience vote to 33 semi-final contenders. The final five duked it out on the big stage in Tokyo. Thanks to the hard work of Osaka University student Mina Mizuhara (you can watch Mina in action on YouTube), Birth Day/Baby Science finished third.

Although there were no medals or new cars awarded (none have arrived on my doorstep, at any rate), this is an honor I very much appreciate.

Oh, and the winner? A mystery novel titled “She Is No More,” by Yasuhiko Nishizawa. The plot synopsis, as mangled by Google Translate: “Kidnapping, abduction and killing of taking a look. Faint thoughts of youth are turned into grotesque and irreversible runaway love.”

I can’t compete with that…

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