Time to wake up…

Well, it’s been almost exactly one year since my last post. Unlike my friend in the photo here, though, I haven’t exactly been sleeping. I smacked head-first into grad school last summer (getting my Masters in Public Health from the University of Minnesota), and between homework, term papers, and managing school deadlines for the first time in a few decades, my writing energy got all used up. But I’m proud to say I survived biostatistics, which was a bit hair-raising. (I swore when I finished college that I would never take another math course, but what are you gonna do? Stuff happens.)

Image

Your Blogger, hard at study…

There’s quite a bit of interesting research on pregnancy, labor, and the newborn these days, and that’s what’s got me interested in blogging again. So, here I go…

2 Comments

Filed under Uncategorized

How mama ‘roos do it…

Busy mother, wildlife park outside Perth

Busy mother, wildlife park outside Perth

Here’s a lactation trick humans can only marvel at:

A kangaroo mama often nurses two babies (“joeys”) of different ages, meeting the individual nutritional needs of both simultaneously. She does this by producing milk of very different composition from each of her two breasts–one milk designed for the newborn and the other for the “toddler.” Protein and fat content differ considerably between the breasts.

Kangaroo lactation consultants certainly have their work cut out for them…

1 Comment

Filed under Animals, Breastfeeding

Here’s to Peg and Barney…

What hath polio wrought? Ma and Pa, April 19, 1947

Peg (Dalton) and Barney Sloan–April 19, 1947

Today is my parents’ 66th wedding anniversary…

  • 7 children
  • 16 grandchildren
  • 5 great-grand-kids…and counting!

5 Comments

Filed under Uncategorized

Australia

Neighbors, north of Sydney

Neighbors, north of Sydney

Just back from three weeks Down Under, where I was invited to address the Rural Health West Annual Conference in Perth. The theme this year was “Children of All Ages: Health Across the Continuum in Rural Communities.” It was a wonderful experience, and I’m grateful to Belinda Bailey and the organizing committee for their warmth and hospitality.

I gave the keynote address (“Unintended consequences: How mode of delivery impacts long-term child health”) on the mounting evidence that cesarean birth increases the risk of a number of chronic illnesses later in childhood. (For previous posts on the subject, see here and here.) Lots of discussion followed–the cesarean saga in Australia has paralleled that in the U.S., and in sparsely populated Western Australia, where hours-long air transport to a tertiary care hospital is common, decisions about when to intervene in a woman’s labor are particularly challenging. As here in the U.S., a popular movement is pushing back at unnecessary cesareans, or “caesars” as they’re known in Australia.

Later that day I spoke on the history of neonatal resuscitation, a talk loaded with odd historical tidbits, as is my habit… (Did you know that newborn babies in ancient Greece were salted and coated in honey (scroll link to page 82) to protect them from infection? Or that midwives were performing

Perth, From King's Park

Perth, from King’s Park

mouth-to-mouth resuscitation on sick newborns as early as 3,000 years ago? Or that in Germany, the accepted means of reviving a sick newborn until well into the 20th century was to simply swing them up and down?) That talk always gives an audience an appreciation for modern resuscitation equipment.

Perth is a beautiful city, more or less the San Diego of Australia. The weather was gorgeous, and my wife Elisabeth and I did quite a bit of touring around. Became fairly familiar with a number of marsupials, including a few we’d never even heard of. (Numbats, anyone? Quokkas?) We spent a week in and around Sydney, too (over on the east coast, for those of you not up-to-date on your geography)–another fascinating city. We finished up with four days in a cottage in a national park, which is where my kangaroos-in-the-field photo at the top was taken.

Talking cesareans with new friends

Talking “caesars” with new friends.

Oh, and I actually drove over 400 miles on the “wrong” side of the road without so much as a scratch on our rental car, let alone the fiery chain-reaction pile-up (my fault, of course) that I’d been expecting…

3 Comments

Filed under Cesareans, Travel

The Brazilian preference?

4753658072_3816f74c0d_nWhat happens when a woman emigrates to a foreign country and then gives birth? Is her birth experience more likely to conform to the country she comes from, or the one she moves to?

For example, is an immigrant woman more likely to have a cesarean birth than a native-born woman, or less? How big a role do the cultural norms and expectations she brings with her from her home country play in determining mode of delivery?

Studies of immigrant birth experiences have been mixed to date. Immigrants do tend to have higher cesarean rates than natives, but interpretations of such findings are often complicated by things like language barriers and the difficulties new arrivals may have in accessing timely maternity care. Teasing out the effects of culture can be tricky.

A Portuguese article just published in the journal PLOS ONE helps to clarify this issue. The study compares cesarean rates between native-born and immigrant Brazilian women in northern Portugal. Two major potential confounders are quickly dealt with: the two groups of women both spoke Portuguese, which eliminates language barrier as a source of cesarean-inducing miscommunication, and all the women were drawn from five public hospitals, so that the care they received was more or less uniform.

The authors found that Brazilian immigrant women had a 50% higher cesarean rate than did native-born Portuguese women (48.4% vs. 32.1%), a difference that persisted even after controlling for such things as demographic, medical and obstetric risk factors. In fact, the cesarean rate for Brazilian immigrants was nearly identical to the overall cesarean rate in Brazil itself.

What explains the native-immigrant difference? The authors speculate it has much to do with attitudes about childbirth that the women brought with them from Brazil:

“This extremely high prevalence [of cesarean birth] seems to be a cultural consequence of attitudes towards labor and the perception of obstetric care among Brazilian women. The majority of Brazilian women perceive cesarean as the most adequate mode of delivery and as a symbol of high social status.”

In other words, culture strongly influences mode of delivery, even far from home. A woman raised to see cesarean birth as a desirable norm is much more likely to end up having one.

Leave a comment

Filed under Cesareans

Things Kids Say: Australian art critic edition

"What the...?"

“What the…?”

“Why would anyone think to draw that?”

Small child in Sydney’s Museum of Contemporary Art, viewing painting that looks a lot like, well…guts.

 

 

 

(Photo credit: jenny818)

Leave a comment

Filed under Uncategorized

Vaccination: The bad old days

IMG_4898

Have you ever met anyone who had diphtheria? How about tetanus? You may know an older person who had polio as a child, and most people my age can remember measles and mumps, but how about congenital rubella? Hemophilus influenza meningitis? Smallpox?

As vaccines become more effective, and global vaccine campaigns more successful, fewer and fewer people (let alone their doctors) have any direct experience with the infections we vaccinate against.

That’s why vaccine-preventable infections can be a low priority for some young parents: They’ve never seen any of them. As one dad put it not long ago, when we got onto the subject of polio risks for his two month old daughter: “What’s the point of  getting shots for non-existent diseases? It’s like you’re warning us about the dangers of buggy whips.”

That’s how my days go, sometimes…

I really like the illustration that accompanies this post (and thanks to my daughter Claire for sending it to me). The left hand column of red-tinged syringes shows how many cases of a given infection occurred each year in the pre-vaccine era. The mostly red-free column on the right lists the annual totals we see today.

The differences are dramatic, but it’s important to take note of the little slivers of red still visible next to infections like measles, mumps, and congenital rubella. These diseases and the others on the list aren’t extinct, they’re just held at bay by vaccines (and other public health improvements like clean drinking water and improved hygiene).

So keep this chart in mind when thinking about vaccinations for your child. Oh, and those bad old days? In the case of Hemophilus influenza, they weren’t so long ago: the vaccine didn’t come out until I’d been in practice for several years. I (and my patients) lived those 20,000 cases a year…

4 Comments

Filed under Infectious diseases, Vaccines

Flu shots help prevent preterm birth

5278448067_f76b92377cA research team in Georgia recently published a study that shows the protective effect of flu vaccine for pregnant women.

Led by Dr. Saad Omer of Emory University, the team examined the records of more than 3,300 pregnant women between April 2009 and 2010. They found that those women who received influenza vaccine overall had a 40% lower likelihood of giving birth before 37 weeks of pregnancy than women who were not vaccinated. That protection increased to 72% during the peak of the flu season.

The protection extended to birthweight as well. Vaccinated women were 69% less likely to have a small for gestational age baby than were the unvaccinated women.

Dr. Omer’s study underscores the importance of flu shots for pregnant women. Keep that in mind come next October, when the 2013-2014 vaccine  comes out!

(Photo credit: International Ladies Garment Workers Union Photographs, 1885-1985)

1 Comment

Filed under Infectious diseases, Maternal-child health, Vaccines

Pollution and birth weight

Beijing in January

Beijing in January

What with continuing air pollution woes in such diverse locales as Beijing and Salt Lake City,  a study released last week in Environmental Health Perspectives–which found a direct relationship between particulate air pollution and low birth weight in term babies–couldn’t be more timely.

The study’s authors compiled data on more than 3 million births in nine countries and found a 10-15% increased risk of low birth weight in the most polluted locations.

This isn’t just about turning out slightly less pudgy newborns. The consequences of low birth weight are far-reaching, even multi-generational. Low birth weight babies are more likely to develop chronic health conditions as they grow up, like heart disease, hypertension, and diabetes–just the sort of health problems that make for high-risk pregnancies a generation down the road.

In other words, today’s low birth weight baby girl is more likely to one day produce an unhealthy baby of her own. It’s a cycle that’s tough to break once it starts, and this study is more food for thought as world leaders (hopefully) get serious about addressing climate issues.

(Photo credit: jaaron)

Leave a comment

Filed under Environment/Toxins, Maternal-child health, Newborns

Things I Learned En Route to Looking Up Other Things: Baby Kitty edition

What's next? "Minnie's Maternity Mansion"?

Coming soon: “Minnie’s Maternity Mansion”

I kid you not…

There is a Hello Kitty Maternity Hospital in Taiwan. (No word as yet on HKMH’s “Hello Cesarean!” rates…)

Leave a comment

Filed under Things I learned en route to looking up other things