States using midwife-led maternity care have improved birth outcomes

A new study by explores the association between states with midwifery-led care, access to midwife-attended births, and childbirth-related procedures and outcomes. Some states have autonomous Midwifery laws, and do not require Certified Nurse Midwives (CNMs) to have physician supervision. In contrast, many states in the U.S have regulations requiring physician supervision or contractual practice agreements for CNMs.

Midwifery-led care is related to health, cost, and quality of care outcomes comparable or preferable to outcomes with physician-led care. Despite these findings, many U.S. states continue to rely on physician led care.* States that rely on midwife-led maternity care see improved birth outcomes:

“At a population level, women giving birth in states with regulations allowing [midwifery-led maternity care] had 13% lower odds of cesarean delivery, 13% lower odds of preterm birth, and 11% lower odds of delivering a low birth weight baby compared with women giving birth in states with more restrictive policies on midwifery practice. Although these effects were modest in magnitude, they could have important implications at the population level because there are approximately 4 million births in the U.S. each year.”

Previous studies have found that midwives are less likely than obstetricians to use interventions like labor induction and cesarean delivery that may have higher risks for women and infants when performed without definitive medical need.

What does maternity care look like in your state? Check it out here:Screen Shot 2016-03-08 at 9.56.42 AM

When midwifery-led care is available, patients tend to opt for midwifery services as an alternative to physician-led care, and are more likely to use midwifery services in their births.

The authors suggest:

it may be in states’ interests to consider or study efforts to reduce restrictions on midwifery practice to increase use of CNM services for prenatal, intranatal, and postnatal care.

Read the full study here.

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Pregnancy How-to’s from the Middle Ages: Dung Diapers, Barley, and Rabbit’s Blood Cocktails

Get Me Out, by Randi Hutter Epstein, MD, is an insightful history of childbirth exploring the evolution of advice and wisdom in childbirth. The book presents the lineage of childbirth, and helps contextualize the current state of obstetrics. Thomas Forbes once said that the history of obstetrics is “in large part a history of superstition.” Childbirth, then and now, is a “wonderful blend of custom and science.” Perhaps because of the time and space between current day and the Middle Ages, I found Get Me Out‘s chapters on medieval childbirth advice to be, at the very least, captivating. Thus, today we’ll explore advice surrounding birth in the early years in our history: the Medieval Period.

15 pieces of advice for childbirth during the Medieval Period

394px-Eucharius_Rößlin_Rosgarten_Childbirth1. Birth Control: According to the Greek physician, Soranus, who authored the leading text on gynecology for over a thousand years: you could have sex without conceiving if, after your partner ejaculates inside of you, you hold your breath, squeeze forcefully, and then drink ice-cold water. If that fails to work, try the Hippocrates’ abortion method: jump and kick your heels to your bum until the seed simply drops out of you.

2. Looking to get pregnant? France’s 16th century Catherine de Medici had the money and hutzpah to seek out all kids of advice and treatment to get pregnant. After ten years of marriage to the king, she had produced no heir. Her healer told her to drink mare’s urine and to soak her “source of life” (I presume this means her vagina) in a sack of cow manure mixed with ground stag’s antlers. Her husband was never sexually attracted to his wife – no doubt the dung diaper hindered his attraction further. The King was eventually diagnosed with physically defective reproductive organs (aka hypospadias), and recommended specific sexual positions for reproduction. Catherine, so the story goes, had her carpenter drill a hole into the floor to observe her husband having sex with mistress – for educational purposes. Maybe this did the trick, because she went on to have nine children.

3. How conception works: According to Aristotle, a man’s seed shaped menstrual blood into an embryo. Doctors later reconsidered that during pregnancy, menstrual blood flowed upwards and turned into breast milk. In this vein, men produced the life source of what became human. Women were “mere baby-making vessels.” As one sixteenth-century expert eloquently put it, the vagina was an “antechamber to lodge a Man’s Yard.

4. Penis size and getting pregnant: According to Jane Short, a British midwife in the seventeenth century, penis size affects fertility. Too big is just as bad as too small. If the penis is too big (longer than 11 inches), it sprays the womb with seed, thereby rendering conception incredibly difficult. A penis too short (shorter than 1 inch) would not touch the opening of the womb, so male and female seeds would never mix. In cases with an average-sized penis (greater than 1″, smaller than 11″), the vagina acts like spandex. It stretches and shrinks to suit the partner. Or, according to the experts: “the vagina would dilate, contract, extend or abbreviate itself according as it is necessary to bear exact proportion with the bigness or length of the man’s yard.” The clitoris was considered the female equivalent of the penis. Doctors worried about the size of the clitoris – not for fertility – but because women with oversized clitorises were prone to lesbianism.

5. Virginal Conception: According to the monks who wrote Woman’s Secrets, the vagina had powers that lured sperm into it, even without penetration. This explains how virgins become pregnant. The “vagina sucks up sperm like a vacuum”, so a woman could become pregnant if she bathed in a tub where there a man has ejaculated – this “has been attested to by experience.” Woman’s Secrets goes on to assert that, “along the same lines, if a cat ejaculated on sage and then a man ate the sperm-tainted herb, he would grow a cat in his stomach and vomit it out.” So, there’s that.

6. Home pregnancy tests: here’s a do-it-yourself method suggested by Soranus. Women should pee on a bouquet of barley, wheat, dates, and sand. If barley sprouted, you were pregnant. If wheat grew, it’s a boy; if barley, a girl.

7. If you wanted a happy baby, pregnant women were instructed to think happy thoughts. Don’t stare at ugly things, because you’ll get an ugly baby.

8. Most men and women believed that childbirth is a heavenly duty, and women deserved painful labor. This view, of course, stems from the story of Eve. Enticed by that proverbial apple, Eve was cursed with the excruciating pain of childbirth. In 1591, Eufame Maclayne was burned at the stake for asking for pain relief during the birth of her twins.

Sixteenth-century illustrations of fetuses in the womb by Eucharius Rösslin

Sixteenth-century illustrations of fetuses in the womb by Eucharius Rösslin

9. Sex: Sex in moderation is key to successful babymaking. Women were told to have “enough” sex because a “splash of sperm moistens the womb,” but not to have too much sex because “it wears out the baby-making machinery.” Perhaps this is why “whores have so seldom children”: because “satiety gluts that womb.” Too much sex during pregnancy was considered dangerous to the growing fetus, as it drained the vital juices that should flow to the baby. Too much intercourse created children who were “defective in vital and other qualities, ill tempered, sickly, and short-lived.” Smart parents = smart babies, but only if parents didn’t have too much sex. Too little or too much sex would produce smart little ones, but they would die before the age of 10. Too bad nobody ever defined what a moderate amount of sex was.

10. Women have to enjoy sex to get pregnant: Babies are born as a result of a woman’s “voluptuous itch” to copulate. When a woman is in the mood for sex, her womb opens and allows the male seed to enter, which facilitates baby making. Pleasure in sex is explained by four “carruncles” (bumps?) lining the opening of the womb that close more pleasantly around the Man’s Yard, so that the woman is also more delighted. But, if you’re enjoying it, your womb stays closed.

11. If you look at the moon, your child would become either a lunatic or a sleepwalker.

12. Hoping for a baby boy? One guidebook suggests his and hers cocktails to up the odds of having a boy”: red wine tainted with pulverized rabbit’s womb for him; red wine with desiccated rabbit’s testicles for her.” Yes, this seems weird. But when you consider the numerous hormones we shoot ourselves up with today, perhaps dried testicles isn’t as strange as it seems.

13. Bowels: Constipation suffocates the fetus, while diarrhea washes it away. Also from the texts of Soranus, women with chronic bowel issues would never be able to “lay hold of the seed injected into them.”

14. Birth through the Middle Ages was for women only: It was considered obscene for a man to be in the delivery room. While they wrote guidebooks and issued advice, their wisdom drew from “a man-made concoction of myth, herbs, astrology, and superstition.” In 1522, a German doctor – Dr. Wert – was sentenced to death when he was caught dressed up as a woman and sneaking into the delivery room.

15. Forceps: the best kept secret of the 1600’s: The Chamberlen family came to England from France in the 1500s with forceps. Forceps, a medical instrument used to extract babies, were kept secret for over 200 years to preserve steady work and financial success. Nobody saw their instrument, not even the doctors’ closest friends or relatives, not even the women who were receiving their services. Forceps transformed birth from a natural, social event attended by a female midwife to a medical event attended by men. Pre-forceps, midwives would use oils and herbs for the perineum and a birthing stool that allowed gravity to help the baby move down. Post-forceps, doctors didn’t like to use stools, and preferred the patient lying in bed where they could use their tools with ease. Of course, “forceps isn’t the only explanation for why everything changed, but they certainly opened the door for other birthing gadgets.


Randi Hutter Epstein‘s book Get Me Out is not an advice book. Her depiction of the history of childbirth encourages readers to be inquisitive in their health decisions, and portrays the field gynecology as a marriage of medicine and culture.

Read it, and then come talk to me about it.

Doulas Look for Greater Acceptance in Maternal Healthcare System

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Marisa Pizarro’s birth, as described by Anemona Hartocollis of the New York Times, starts out on a busy day in her apartment in Lower Manhattan’s financial district. As Marisa labored alongside her doula, her contractions 10 minutes apart, her husband (a music producer) was able to work on an upcoming release, tend to their young daughter, and catch up on the news on his iPad. With the presence of their doula, Marisa labored until it was time to go to the hospital.

The story of Marisa’s birth highlights the role of doulas in the United States:

Doulas are a growing force in the ever-changing culture of maternity, at once a manifestation of the growing demand for personal service (the doorman, the yoga teacher, Amazon Prime) and a backlash against the perceived overmedicalization of birth, with its high rates of cesarean sections.

Medical professionals can express resistance to doulas, and there is no insurance reimbursement for birth doula services. Despite the growing demand of doulas, they are a small part of the system of maternal healthcare. A recent report estimated that “there are as many as 400 doulas working in New York City who attend about 5,600 births a year, or about 5 percent of all births.”

doula (an antiquated Greek word for a female servant) offers support that complements the support from other birth partners (if others are involved). For many women, the support from their doula is

less-fraught emotional support than do sisters, mothers or husbands. They offer tactics to help women manage the pain of labor, as Lamaze breathing classes did to a previous generation. They are familiar faces and patient advocates in a situation where the patient may be meeting the nurses or the obstetrician on call for the first time during the birth. They also consult on prenatal subjects like nutrition and postpartum challenges like breast-feeding.

“We’re not there to change what the parents get,” said Adele Loux-Turner, a doula based in Brooklyn. “We’re there to help get what they want. If there’s a conversation to be had, we do and can let it be known that we’re there to kind of eliminate the hidden menu items.”

Some providers recognize how doulas support mothers in an otherwise impersonal hospital setting. They may recommend doulas, or – at the very least – feel obliged to allow them to honor their presence at the labor. Other providers work closely alongside doulas, and some hospital programs offer volunteer doula services.

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Doulas continue to seek out more recognition from insurance companies, but “insurance coverage is still rare, according to Choices in Childbirth, a maternal advocacy group that released a report promoting doula care last year.”

“Having a baby in New York City is a very lonely thing,” Dr. Jacques Moritz, an obstetrician at Mount Sinai Roosevelt hospital in Manhattan, said.

Yet the benefits of doula care are significant.

In New York, the By My Side Birth Support Program, which has provided free doula services to more than 400 low-income women in Brooklyn, has found that doulas led to a “definite improvement” in breast-feeding, but only a slight reduction in C-sections, perhaps because doulas could not influence hospital policy, said Mary-Powel Thomas, director of the program, a federal and city partnership.

According to Dr. Jacques Moritz, an obstetrician at Mount Sinai Roosevelt hospital in Manhattan, “a doula is like a personal trainer. Not that you can’t do it yourself; it’s just nicer if you have a personal coach for it.” 


For more information about the role of a birth doula, the growing interest in having doula support in labor, and the current state of recognition of doula care, you can read the entire article here, or check out an earlier post discussing the role of a doula.

From Zygote to Baby: How to Build a Human

Here is an amazing infographic on embryogenesis from Tabletop Whale‘s Eleanor Lutz.

How to Build a Human: Human embryo and fetus development from fertilization to birth. Eleanor Lutz, 2014.

In this stunning data visualization, Lutz illustrates the process of fetal development, including what the baby looks like in each of the three trimesters, when the eyelids form (~12 weeks), when the fingers and toes separate (9 weeks), to when the taste pores develop (~16 weeks), to name a few.

Imagine how helpful this would be for students, or even in a childbirth education class? I’ll start bringing this around with me to each of my prenatal visits.

Printouts of this visualization can be found here. This post and more can be found on Lutz’s website: TabletopWhale.

First hour of life for newborns: a timeline

Photo by Mikaela Wapman

Photo by Mikaela Wapman

Laura Sanders of Science News recently published a post on a Timeline of a Baby’s First Hour.

In the post, she stumbles upon a 2011 study from Sweden regarding observations of 28 of “the most mysterious creatures on the planet: brand-spanking-new humans.”

Sanders goes on,

Videos of babies in their first hour of life gave the researchers an unprecedented view of how newborns instinctually behave, when left to their own devices and nestled skin-to-skin on their mothers’ chests. I found the results, published in January 2011 in Acta Paediatrica, just as fascinating as the Drosophila courtship ritual.

Having supported a fair number of births in the hospital, I have witnessed many of the instincts of the newborn to cry, nurse, and sleep. Sometimes, routine tests or complications in birth interrupt the newborn’s instinctive inclinations and the maternal / infant initiation, as the hospital team performs the necessary evaluations, perfunctory tests (birth weight, length, head measurements, immunizations… the list goes on and on).

In uncomplicated, low-intervention births, new mothers are able to rest with their newborns on their chest and relish in the unique, indescribable joy of skin-to-skin. It is during these moments that the researchers from Sweden noted some key milestones in the first hour and 10 minutes of a newborn’s life, presented in median minutes:

Minute 0: Babies wail a robust, angry birth cry that helps wake up the lungs.

Minute 2: After all that wailing, babies spend less than a minute relaxing, holding perfectly still on their mothers’ chests. The authors speculate that this silent, still break might have evolved to keep babies hidden from predators.

Minute 2.5: As they start to wake up, newborns open their eyes for the first time. Babies gradually start moving their heads and mouths.

Minute 8: Babies become even more active, keeping their eyes open for five minutes or longer at a time. During this active phase, newborns seem to grow interested in eating, looking at their mothers’ faces and breasts, making sweet little “hungry” noises and moving their hands toward their mouths.

Minute 18: That was exhausting. Time for another rest.

Minute 36: Recharged newborns really kick it into high gear and begin scooting toward their mothers’ breasts, relying heavily on a sense of smell to navigate.

Minute 62: Babies nurse, most likely getting small amounts of colostrum, a pre-milk substance packed with protein and immune molecules. This early suckling stimulates the breasts to make milk and also helps mom’s uterus contract back to its pre-pregnancy size.

Minute 70: Babies fall asleep for a well-deserved break.

There you have it: the first seventy minutes of a newborn’s life, as described by science. Of course, these minute markers are median numbers drawn from a small number of newborns (n=28), and even the time tables of the babies included in the study varied substantially. Any single baby’s behavior might fall well outside of these time points.

These quantitative observations are helpful with respect to the introduction and recent emphasis that most hospitals are placing on “baby friendly” practices, designed to encourage breastfeeding and also happen to support the bond between mom and baby.

Photo by Mikaela Wapman

Photo by Mikaela Wapman

“Baby friendly” practices, as outlined by Baby-Friendly USA, state that “health care systems should ensure that maternity care practices provide education and counseling on breastfeeding. Hospitals should become more “baby-friendly,” by taking steps like those recommended by the UNICEF/WHO’s Baby-Friendly Hospital Initiative.” Initiatives to improve breastfeeding rates include forgoing formula and pacifiers, allow the mom and baby to stay together (rather than baby in nursery), and provide hospital staff to instruct and support new moms with breastfeeding.

Sanders refers to another observational study:

In the first hour of birth, babies whose chins touched the underside of their mothers’ breasts were more likely to successfully suckle than babies who didn’t do a chin-brush. These sorts of studies, which rely on carefully watching a newborn, are beginning to paint a more complete picture of what newborns might need in the moments after birth. And that understanding might ultimately be useful to the adults who want to ease the introduction of this new little person to the world.

Observations from these studies regarding the instinctive newborn behaviors – without interference from anyone – might help healthcare providers come up with better ways to encourage breastfeeding, and cut down on some of the routine tests that might be best delayed until the third (or fourth, fifth, or sixth) hour of the baby’s life.

You can read the whole article here. Via Science News.


Questions? Feedback?

Please feel free to comment, or contact me at mikaelawapman@gmail.com, or by filling out the form below:

Birth Videos

So many of us are filled with imagery of births as medical emergencies or otherwise painful, screaming, or distressing visions. These videos of various hospital and home births offer a new perspective and help us imagine that there are many, many possibilities for what birth “looks like”.

French Woman Giving Birth With Joy

A couple of things about this powerful birth:

  1. Notice her perineum. That stretch! The body is made to do this. It will stretch out, and stretch back. We’ve talked about Perineal Massage on the site, but here’s a visual aid for how a vaginal birth without lots of interventions can reduce perineal trauma and pelvic floor damage. For more information, see here.
  2. Consider how little movement and action there is in this film. The mom is free to take on any position that is comfortable to her, and she is calm. The birthing assistants (the doctor or partner, and the second doctor / midwife / nurse) are supporting her, but otherwise not doing much at all. After mom has delivered the shoulders, the male birth partner places the baby on mom’s chest. But there’s no pulling the head, suctioning, episiotomy… mom delivers baby without much assistance!

Natural Unassisted Homebirth

Birth of Sloane

A gentle film of a home birth from Natasha Hance.

Welcoming Theodore

A gorgeous depiction of sibling support during birth. “Waiting, birthing and welcoming Theodore into his new family of five. A homebirth in Tennessee. 9lbs 9oz” via Documentingdelight.org

Arden’s Labor

The calm birth of Arden, or “Sugarbaby” as some of the commenters have asserted, is via the TheLeakyBoob.

Happy watching!!


Please feel free to contact me at mikaelawapman@gmail.com, or in the form below:

13 Things You Probably Didn’t Know About Human Birth

Robbie Gonzalez of io9 published a fantastic super list on the 13 Things You Probably Didn’t Know About Human Birth. Posted with permission, please enjoy reading the full article!

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13 Things You Probably Didn’t Know About Human Birth

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Everyone on Earth has been through it, but there’s a lot about birth that you’re probably unfamiliar with. Here’s thirteen facts about the human birthing process you may not have picked up in biology class.

13. In An Alternate Timeline, Birth Might Have Been Aided By Centrifugal Force

In the 1960s, inventors Charlotte and George Blonksy devised an “apparatus for facilitating the birth of a child by centrifugal force.” The device, which is picture at the top of the post anddescribed in further detail here, was designed to “assist and supplement” the natural efforts of the mom, who is strapped into the apparatus, “so that such centrifugal force and her efforts act in concert to overcome the action of resisting forces and facilitate the delivery of the child. Blessedly, the “Blonksy Device” never really caught on.

12. Postpartum Depression Isn’t Always Postpartum, or Depression

The New York Times reported on the growing body of research that suggests mental illness in new mothers and moms-to-be is not only more common than once believed, but more varied. Recent findings challenge the view that symptoms begin in the weeks immediately following childbirth, and that those symptoms are limited to ones of depression:

In fact, depression often begins during pregnancy… and can develop any time in the first year after a baby is born… In the year after giving birth, studies suggest, at least one in eight and as many as one in five women develop symptoms of depression, anxiety, bipolar disorder, obsessive-compulsive disorder or a combination. In addition, predicting who might develop these illnesses is difficult, scientists say. While studies are revealing clues as to who is most vulnerable, there are often cases that appear to come out of nowhere.

…Depression [during] pregnancy can be missed because symptoms like trouble sleeping and moodiness also occur in pregnant women who are not depressed. And doctors have historically been taught in medical school that “women don’t get depressed during pregnancy because they are happy,” said Dr. Katherine L. Wisner, a professor of psychiatry and obstetrics at Northwestern University.

11. Babies Born In Space Would Likely Have Problems

Pregnant rats that are sent to space give birth to pups on Earth with an impaired sense of direction. They struggle with basic orientation, and have difficulty righting themselves when thrown into water. The pups do, however, tend to be better at processing orientations common during weightlessness, suggesting that a baby gestated and born in space might actually have an easier time navigating their zero-G environment than one born here on Earth.

That being said, there’s reason to believe that children raised in space would face considerable developmental challenges. That’s assuming, of course, that it’s even possible to become pregnant in space. Sperm do weird things in aberrant gravitational environments.

10. Part of Your Microbiome Is Planted During Birth

Image by Lauren Davis, sources via Shutterstock

Every one of our bodies is an ecosystem, home to an estimated 100-trillion bacteria called, collectively, our “microbiome.” Many of the microbes found in a baby’s gut are believed to be acquired during birth, when an infant is exposed to the microbe-rich environments of their mothers’ vagina and intestines.

9. But Your Microbiome May Also Begin Taking Shape Before You’re Born

It was long assumed that fetuses developed in a sterile womb and took on their first bacterial tenants during birth, upon exposure to the microbial communities mentioned above. But in the last decade or so, several studies have called the concept of the sterile womb into question. Increasingly, scientists are beginning to suspect that women actually “seed” their fetuses’ microbiomes with bacterial populations prior to birth, during pregnancy. The means of bacterial transmission, the makeup of these foundational populations, and the degree to which an unborn baby’s nascent microbiome can be targeted for manipulation remains less clear.

8. The Placenta Is a Lot Like Your Mouth

One piece of evidence that fetuses may acquire bacteria in the womb was the discovery,published in May, that DNA from a variety of microbes can be found in the placentas of healthy pregnant women. More intriguing still: when researchers compared the placental microbiomes of pregnant women to the skin, oral, nasal, vaginal, and gut microbiomes from nonpregnant controls, they found that the microorganismal makeup of the placenta most closely resembled that of the mouth. (A fascinating, if widely overhyped, observation.)

7. Bringing a Child to Term Costs More in America Than Anywhere Else

According to a survey conducted by Truven Health Analytics on behalf of the New York Times,charges for delivery have about tripled in the U.S. since 1996.`

6. The U.S. Also Has The Highest First-Day Infant Death Rate In the Industrialized World

Via Save the Children’s State of the World’s Mothers 2013 Report:

Only 1 percent of the world’s newborn deaths occur in industrialized countries, but the newborn period is still the riskiest time, no matter where a baby is born, with the first day being the riskiest time of all in most, if not all, countries. The United States has the highest first-day death rate in the industrialized world. An estimated 11,300 newborn babies die each year in the United States on the day they are born. This is 50 percent more first-day deaths than all other industrialized countries combined.

5. America’s Stats: Bad For Moms, Too

Research published in the May issue of The Lancet illustrates how the surprising disparity in birthing safety applies to mothers, as well. Tracy Cassel summarizes The Lancet’s review in a recent post at Evolutionary Parenting, where she notes that a mother is more likely to die from childbirth-related problems in America than Albania:

In 1990, the USA was ranked 22 in maternal health and mortality. This year, the USA ranks 60th after dropping from 50th in the last assessment. In fact, the US is one of only 8 countries to have seen a rise in maternal morality, up from 17.6 in 2003 to 18.5 deaths/100,000 in 2013 (the other 7 were Afghanistan, Belize, El Salvador, Guinea-Bissau, Greece, Seychelles, and the South Sudan). In 1987 that number was 7.2/100,00.

…Canada and New Zealand have maternal mortality rates that are half of the USA. The UK has one that is a third. Australia’s is a quarter of the USA’s. Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Romania, Kuwait, Lebanon, Iran, and Serbia all have rates that are lower than that of the USA.

4. Birth Is Surprisingly Risky

Birth is a high-risk affair for mammals, in general, but it’s especially so for humans. The constraints of the narrow human pelvis, thought to be an evolutionary tradeoff of walking on two legs, combined with the exceptionally large heads of human babies, makes human birth especially difficult, and therefore dangerous, compared to other animals.

3. So Where Are Moms Least Likely To Face Birth Risks?

13 Things You Probably Didn't Know About Human Birth

Photo Credit: Moyan Brenn | CC BY 2.0

That would be Iceland – home to gorgeous vistas, crazy-maned ponies and maternal mortality rates of just 2.4/100,000 (roughly 1/8th that of the U.S.).

2. Human Labor Is Also Exceptionally Long (And Painful)

13 Things You Probably Didn't Know About Human Birth

Image Credit: Dr. Cheryll Knott via

To accommodate big-headed babies, a human’s cervix has to dilate a lot – about three times wider than it does in apes. Not only does greater cervical dilation require more time, these later stages of dilation are also more painful. As the Mayo Clinic notes, the beginning stages cervical dilation are so mild that many women report feeling perfectly content to continue going about their daily lives. It’s further along in childbirth, as the body prepares for active labor by dilating the cervix to 8, 9, or more than 10 centimeters across, that humans experience the most pain.

1. At One Point In Life, We All Looked Like Admiral Ackbar

In 2011, researchers were first able to acquire scans of a baby’s face, taken between the second and third months of fetal development, and combine them into the morphing animation you see here. Ever wonder where the dimple above your lip comes from? Wonder no more.

Check out the post here, as well as the endless stream of content on io9 posted daily! 

“Morning Sickness” vs. Hyperemesis Gravidarum

Photo by Mikaela Wapman

Photo by Mikaela Wapman

Pregnancy-related Nausea or “Morning Sickness”

Pregnancy-related nausea is a common enough concept for most of us: nausea and vomiting during the first trimester, food aversions, and beyond.

Morning sickness – a misnomer, as it’s symptoms strike throughout the day for most women –  usually begins around the 6th week of pregnancy and tends to last for the duration of the first trimester (or until around the 14th week), but many women don’t experience relief from the symptoms for another month or so. And some women don’t feel a lessening of symptoms until they give birth, or somewhere around 40 weeks.

Pregnancy-related nausea affects over 70% of all pregnant womenAccording to Baby Center, more than half of pregnant women experience both nausea and vomiting, a quarter experience only nausea, and the remaining quarter are don’t experience any form of “morning sickness”.

Hyperemesis Gravidarum

Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting during pregnancy that is characterized by “unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids”. If HG is severe enough, or untreated, it can be associated with:

  • loss of greater than 5% of pre-pregnancy body weight (usually over 10%)
  • dehydration and production of ketones
  • nutritional deficiencies
  • metabolic imbalances
  • difficulty with daily activities

While the majority of women experience some form of morning sickness, around 1-3% of women are hospitalized for HG. That may seem pretty low, but these statistics offer very limited information, as many of the women who suffer from HG are treated as outpatients with mild to severe symptoms. Helpher.org – a website devoted to raising awareness about HG – goes on to say,

There are reports from hundreds, if not thousands, of women who terminated out of desperation when given the diagnosis of morning sickness and given inadequate treatment. One study by Zhang, et al of 1867 women found a 10.8% incidence of severe vomiting. Many women are not represented in current statistics which only report the number of women hospitalized as inpatients. HG is not a rare disorder.

Like more moderate forms of pregnancy-related nausea and vomiting, symptoms from HG can resolve around 21 weeks, though – for less than half of these women – can last for the duration of the pregnancy. The effects of all forms of HG are severe: considering the cost of additional doctor’s visits, outpatient care, consultations, and treatments for consultations, the annual cost could reach to one billion dollars.

Beyond the financial effects of HG are the emotional and psychological impacts: family relationships are disrupted, women could be “misdiagnosed by a disease erroneously presumed to be psychological”, and women could lose their jobs because of the debility. 

While there is no known prevention of HG, there are many ways to alleviate and manage the symptoms. These include: bed rest, acupressure, herbs (ginger or peppermint), IV fluids to restore lost hydration, electrolytes, vitamins and nutrients, tube feeding, and medications.

Distinguishing between Pregnancy-Related Nausea and HG:

Pregnancy-related nausea is what is commonly referred to as morning sickness. Symptoms of those suffering from Hyperemesis Gravidarum are generally more severe, as is depicted in the chart below (source: www.helpher.orgAmerican Pregnancy).

Why do we have pregnancy-related nausea, anyways?

Theories regarding the etiology of pregnancy-related nausea and HG are inconclusive. This is partially because pregnancy-related nausea and HG are influenced by a number of factors, and may vary among women depending on their biological makeup (genetics), body chemistry, and general health.

Theories regarding the cause of  pregnancy-related nausea and HG center on hormonal changes (increase in estrogen during pregnancy) and physical changes (relaxed esophageal sphincter) during pregnancy, since the time period is restricted to pregnancy.

Other half-witted theories include: one’s psychological state may be related to the development of pregnancy-related nausea and HG. In this vein, women who are frustrated, depressed, isolated, and / or have feelings of helplessness are more likely to experience pregnancy-related nausea or HG. Understandably, others respond by pointing to the fact that most, if not all women experience psychological effects (frustration, anger, depression, isolation, and feelings of helplessness) secondarily to  pregnancy-related nausea and HG.

At present moment, there are no conclusive theories as to the etiology of pregnancy-related nausea and HG. Click here to learn more about the many theories of pregnancy-related nausea and HG’s etiology.

Narratives from HG

To get a sense of what Hyperemesis Gravidarum (HG) can look like, check out Huffington Post ‘s post What It Really Feels Like to Have Hyperemesis Gravidarum”. An account of a third time mom who experienced HG so severe that she was hospitalized for 11 days, and spent the remaining duration of her pregnancy receiving IV fluids and medications for HG through a PICC line and stomach pump. Alexa continues,

One of the worst things about HG is how isolating it is. I cannot go out, cannot even talk on the phone for a long time because it makes me feel sick. I cannot cook, everything smells terrible to me, and even walking to the bathroom makes me vomit most days. I also have ptyalism, which is hyper-salivation, and swallowing it makes me vomit too, so I am constantly spitting into a cup. I feel disgusting.

Her account ends happily, with her giving birth to a 9 pound, 11 oz son (described by her OB as “the world’s most effective parasite”). For her, her HG improved after about 22 weeks of pregnancy, though she is the first to remind us that “far too many sufferers are severely ill until they give birth”. Read the whole thing here

For more information on Hyperemesis Gravidarum, visit www.helpher.org and beyondmorningsickness.com.

The Best of Breastfeeding Awareness Week

It’s August, National Immunization Awareness Month, and the first week of August is the World Breastfeeding Week! People all over the world – from Tennessee to Singapore – are taking action to raise awareness and promote the powerful importance of breastfeeding.

Here’s a roundup of some compelling information on the call for Breastfeeding Awareness:

  • Red Wine and Applesauce covers Breastfeeding and Immunizations: Yay for Breastfeeding and Immunizations! Tara Haelle raises awareness of the importance of breastfeeding and immunizations and the benefits of both.
  • Celebrating the Very Ordinary – Chrissy Chittenden of The Huffington Post asks why something so ordinary and natural as breastfeeding has become taboo in the eyes of the public.
  • Looking Beyond 2015: Ellen Piwoz, writing for the Bill and Melinda Gates Foundation, presents the gains and challenges in promoting immediate and continued breastfeeding around the world. She calls for an indicator to increase the rate of exclusive breastfeeding from birth to six months to 60% by the year 2030, urging the goal to be included in the Sustainable Development Goals for the UN General Assembly.
  • Most under two-year Tanzanian children suffer from malnutritionMothers of in Tanzania are reminded that exclusive breastfeeding for their infant from birth to six months is the best nutritional option their babies. Breastfeeding assures 100% food security for Tanzanian mothers, and improving exclusive breastfeeding rates could potentially reduce the mortality rate of children under five years old by up to 13 percent.
  • I fed my newborns formula to keep them alive. Still, I felt guilty about itvia the Washington Post‘s Darlena Cunha – A heartbreaking essay by a woman who fed her newborn premies formula and her experience of shame and judgement from the public.
  • The Millennium Development Goals: What’s Breastfeeding Got to do with it? – 1000 Days considers how promotion of breastfeeding alleviates global poverty and interacts with the UN’s Millennium Development Goals (MDG).
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Image from the Cincinnati Zoo & Botanical Garden

Nursing is something we share with every mammal – it is a normal, natural thing to do.. everywhere! Breastfeeding Awareness Week is a perfect time to demonstrate the importance and benefits of breastfeeding! From the words of Tara Haelle:

Exclusively breastfeeding offers wonderful health benefits and should be encouraged as the default norm. Yet World Breastfeeding Week is actually a good time to also remind folks that as long as a baby is well fed, a mother’s choice should be respected in how she feeds her child, and no mother should be made to feel guilty or ashamed if she is feeding her child some or all formula.