The length of human pregnancies can naturally vary up to 5 weeks

Science Daily covers a recently published study from journal Human Reproduction, investigating the variability in the length of human pregnancy:

Normally, women are given a date for the likely delivery of their baby that is calculated as 280 days after the onset of their last menstrual period. Yet only four percent of women deliver at 280 days and only 70% deliver within 10 days of their estimated due date, even when the date is calculated with the help of ultrasound.

Already 40 weeks pregnant? Not to worry, that’s within the range of normal! Researchers found that the average length of pregnancy was 328 days, which is 38 weeks and two days, though the length of pregnancies can vary by as much as 37 days.

“We know that length of gestation varies among women, but some part of that variation has always been attributed to errors in the assignment of gestational age. Our measure of length of gestation does not include these sources of error, and yet there is still five weeks of variability. It’s fascinating.”



Pregnancy” by Robert Pecino Martinez is licensed under CC BY 2.0

In addition to variation in gestation length:

Embryos that took longer to implant also took longer from implantation to delivery, and that pregnancies that showed a late progesterone rise were significantly shorter by an average of 12 days than pregnancies with an early rise.

Dr Jukic said: “I am intrigued by the observation that events that occur very early in pregnancy, weeks before a woman even knows she is pregnant, are related to the timing of birth, which occurs months later. I think this suggests that events in early pregnancy may provide a novel pathway for investigating birth outcomes.”

Read the whole story here.


Maternal mental illness comes in all shapes and sizes

Pam Belluck of the New York Times published a two-part piece (see part 1, part 2) on the common and varied onset of maternal mental illness. The articles feature a compilation of stories that chillingly portrays the experience and perspective of mothers who encounter diverse manifestations of maternal perinatal depression: depression, anxiety, obsessive-compulsive disorder, and bipolar disorder. Of course, the prevalence of postpartum depression has been well-recognized: the effects of perinatal depression, or depression during the pregnancy or the first year postpartum, is “impressively common and can have devastating consequences” for women, children, and families. However, recent studies challenge the common understanding that symptoms present only in the weeks following delivery. Rather, researchers say that many women begin experiencing depression during pregnancy, and can develop throughout the first year postpartum:

Postpartum depression isn’t always postpartum. It isn’t even always depression. […] 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.

Sometimes cases are mild, resolving themselves without treatment. But a large analysis of 30 studies estimated that about a fifth of women had an episode of depression in the year after giving birth, about half of them with serious symptoms.

Depression in 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.


Holding Hands With a Newborn Baby” by Bridget Coila is licensed under CC BY 2.0

The second NYT article focuses on the story of one mother, Cindy Wachenheim, who, despite repeated assurances from her doctors, became obsessed with the notion that she caused her son irrevocable brain damage. Read the whole story, it is worth it.

Experts say such breaks from reality are likely symptoms of postpartum psychosis, which affects only one or two in 1,000 mothers. About 4 percent of those hurt their children; about 5 percent kill themselves. Flagrant cases usually emerge soon after birth; women may hear voices or feel compelled to inflict harm, like Andrea Yates, who drowned her five children in a bathtub in 2001, or Dena Schlosser, who in 2004 cut off her infant’s arms. Both women were ultimately found not guilty by reason of insanity.

Most other maternal mood disorders do not involve such unshakably unrealistic convictions; most women know something is wrong, and although they fear they will harm their children, they rarely do.

Support for mothers experiencing perinatal depression can be found here, here, here, and here.


via NYT

What is a doula?

Let’s start with what a doula is not.

Doula ≠ midwife. Unlike a doula, a midwife is a licensed health care provider who attends births and performs clinical tasks such as vaginal exams, perineal massage, and fetal heart rate and blood pressure monitoring. A woman’s midwife, nurse, or physician is responsible for assessing the health and well-being of mom and baby, as well as ensuring the safe delivery of the baby.

A doula does not perform any clinical or medical tasks.

A doula does not diagnose medical conditions or give medical advice to the mother. Under DONA’s code of ethics, a doula encourages the mother to speak with her provider or other nurses, midwives, or doctors when she has questions regarding her health or is looking for recommendations. If a doula gives a recommendation to the mother, it is under the condition that the mother check with her caregiver before acting on the suggestion.

A doula does not make decisions for her client. She doesn’t project her own hopes and values onto the laboring mother, and support the mother regardless of any choice.

A doula does not administer any pharmaceutical or homeopathy medications to the mother.

Rather, a doula provides emotional support for the mother in her labor and delivery. A doula works to cultivate the mother’s breath, focus her energy, find comfortable positions, and relax her through massage, words, and other comfort measures. Throughout history, women have been nourished, cared for, and supported in their deliveries by other women. In artistic representations of laboring women, she is depicted next to two women: the first is a midwife, responsible for the safe passage of the baby, as well as the health of the mother. The second woman by her side comforts the mother, addresses her fears and anxieties, and provides emotional support. Today’s doula is the embodiment of the second woman. She soothes, she mothers the mother.

Today, it is common for women to deliver among strangers. Compared to historic birthing practices where women deliver in the presence of familiar faces, this can produce anxiety and stress for the women which complicates or delays her labor’s progress (see here for more information). Furthermore, many of the birth practices in the West cater to the convenience of the physician, yet make birth more difficult and painful for mothers. Reports addressing the dehumanization of this birthing model have found that the role of a doula – someone who’s only role is to support and nourish the mother – provides numerous benefits to the mother and baby.

This doesn’t mean that partners and other caregivers are less effective in providing continuous emotional support. Unlike the partner or other caregiver, a doula doesn’t have the same intimate knowledge and unique awareness of the mother. A doula is able to relieve some of the pressure often felt by the partner, and allow the partner and other caregiver to support the mother according to their own comfort level. Ideally, a doula and partner use their complementing strengths to support the mother in a richer, more complete way than if either were to support her individually.

The benefits of a doula are supported by research. One Cochrane study by Hodnett et al. (2011) found that women who received continuous emotional support from a doula were:

  • (28%) less likely to have a cesarean section
  • 31% less likely to use synthetic oxytocin to induce or speed up labor
  • 9% less likely to ask for pain medication
  • 34% less likely to rate their birth experience negatively

The same study by Hodnett et al. (2011) found that women who were supported by their social network, without a doula, rated their birth experiences more positively, yet did not impact her use of obstetric intervention.

So, what does a doula do? She provides unique, positive benefits for the care of the laboring woman. Doula work focuses on the art of labor support, and she cultivates skills to comfort, soothe, nourish, and empower the mother. By attending to a woman’s emotional needs, the mother’s obstetric outcomes are improved. When a mother receives continuous emotional support, she is less tense, stressed, and experiences less pain in her labor. Women report more positive birth experiences when supported by a doula, and early mother-infant relationships as well as breastfeeding are enhanced. A doula’s continuous emotional support throughout labor has clinically meaningful benefits for the mother and baby.

Helpful references:

Hodnett ED, Gates S, Hofmeyr G J, Sakala C, Weston J. Continuous support for women during childbirthCochrane Database Syst Rev 2011, Issue 2.

Ina May’s Sphincter Theory

Childbirth Connection’s Best Evidence: Labor Support