The top places to be a mom are Norway, Australia, and Iceland. The worst places are Chad, Niger and then Afghanistan at the very bottom. Surprising (to me) was that the U.S. ranks 28th, which is actually down a spot from the previous year. Here’s why:

One in every 4,800 American women dies due to pregnancy. It’s one of the highest maternal-morbidity rates in the developed world. To put that number into perspective, in Bosnia, Herzegovina, Greece and Italy, the risk of maternal death is less than one in 25,000 — and in Ireland, it’s less than one in 47,600.

But it’s not just American moms who die due to pregnancy: American babies don’t fare so well, either. Our infant-mortality rate is pretty dismal for the developed world, with eight out of every 1,000 children dying before their fifth birthdays. A child born in the U.S. is more than twice as likely as a child born in Finland, Iceland, Sweden or Singapore to die before his fifth birthday. Also, the U.S. has the least-generous maternity-leave policy of any developed country, fewer women in elected government positions than other developed countries and fewer kids enrolled in preschool.

The list illustrates that access to education, economic opportunities and proper health care provide the best chance for mothers and children to survive and thrive. In the U.S., we should do a lot better. So, what’s the deal with the ranking?

First, let’s look at infant mortality.

“Infant mortality is defined as the number of children born alive who die after birth — but this differs state to state and country to country,” said Dr. Benjamin Sachs, a fellow of the American Congress of Obstetricians and Gynecologists.

For example, he says in the U.S., a baby born at 17 weeks who later died would be considered a miscarriage. But, a baby born at 23 weeks who later died would count towards the infant mortality rate, even though it only had a 20% chance of survival outside the womb. In some other countries, this would instead be considered a miscarriage.

Abortion politics in the U.S. also are thought to play a factor.

“About 20 percent of the children who die in the U.S. do so from birth defects,” said Sachs. “In a country that has a liberal abortion policy, those children will die in abortion — some countries even allow third-trimester abortions so their rates [of infant mortality] are going to be lower,” he said.

Next, let’s look at maternal mortality, which is shockingly high for a country so rich as ours. Only, that’s the difference. If you’re a rich American, you’re more likely to be better educated, with better health care. But, if you’re in a lower economic class, or an illegal immigrant, you’re at greater risk.

Powers said Save the Children’s research has also found that pregnant “minority” women who seek medical care do not end up getting the same quality of care as pregnant women “in the majority.”

That is appalling.

There are 40 million people in the U.S. without health insurance, a large population of which are illegal immigrants. The doctors interviewed agreed that the rates would improve if every pregnant woman were guaranteed access to health care.

Also, other factors at play may include the obesity epidemic here as well as the older age of some mothers.

The bottom line: Maternal and infant mortality rates are complicated issues where more than one factor may be at fault. Still, the U.S. has a long way to go–especially when it comes to maternity leave, flexible workplaces, and affordable health care. We can do better for our mothers.

Photo

From the article:

Since 2005, however, 3 randomized trials have evaluated male circumcision for prevention of sexually transmitted infections. The trials found that circumcision decreases human immunodeficiency virus acquisition by 53% to 60%, herpes simplex virus type 2 acquisition by 28% to 34%, and human papillomavirus prevalence by 32% to 35% in men. Among female partners of circumcised men, bacterial vaginosis was reduced by 40%, and Trichomonas vaginalis infection was reduced by 48%.

This certainly makes a strong case for circumcision. Yes, condoms should always be worn when having sex with a non-monogamous partner, but, in reality, they’re sometimes forgotten in the heat of the moment. Circumcision seems to add another layer of protection against STDs in such cases. But, is that enough to sway some people?

Circumcision can be a touchy subject. Before I learned the sex of my daughters, I really turned this one over in my mind. Could I allow someone to cut a piece of my child’s skin off? I cried in the hospital because I thought the nurses were “manhandling” my newborn daughter when changing her diaper. So, I’m pretty sure I would have been a basket case knowing my (fictional) son was having his foreskin removed. Just read the comment thread below the article at Science Based Medicine and you’ll see how passionate some people feel on this subject. There is quite a spirited debate there.

Family precedent is likely a big factor for a lot of parents in deciding what to do. While circumcision has been around for thousands of years,

most American males were not circumcised routinely until the post-World War II era. Today about 80 percent of American males are circumcised, though rates vary by region.

As of 1999, the latest figures available from the Centers for Disease Control and Prevention, 81.4 percent of all baby boys in the Midwest were being circumcised, compared to 36.7 percent of baby boys in the West. On the East Coast, 65.4 percent of baby boys were circumcised.

Since the 1980s, a growing anti-circumcision movement has been gathering steam. The arguments against cutting the foreskin include less sexual sensitivity as an adult and the cruelty of an unnecessary surgery on such a small baby. With regards to the sensitivity of the foreskin:

In an editorial accompanying the Pediatrics essay, Dr. Michael T. Brady of Ohio State University points out that studies on circumcision and sexual pleasure are all over the map, leaving parents once again without clear guidance on that point.

There are no right or wrong answers here, I believe. Only information to let each family decide what is best for their children. I am curious, however, to hear what other rational parents have to say on the topic. Would the information on STD prevention sway you to circumcise?

Some of the myths discussed include sitting too close to the television, eating carrots, and contact lenses. My favorite nugget of information:

“If a child is sitting too close to the TV or computer screen, it is probably because he needs glasses to see well. Sitting very close to the screen will not cause them to need glasses,” said Dr. Borchert.

To make your child’s computer station more comfortable, make sure the screen is at eye level. Reduce screen glare by using a desk lamp with a dimmer so there isn’t a big contrast between the brightness of the screen and the room. Make sure your child can’t see her own reflection on the screen.

To sum up the following pages, the vaccine is similar to the seasonal flu vaccine and yes, multi-dose vials do contain thimerosal.  There is a single dose vial available which does not contain thimerosal.  Thimerosal is a preservative that has been removed from most vaccines because of concerns about a link to autism, but no such link was ever proven.  Because the flu vaccine has to be manufactured quickly in large batches, it requires some kind of preservative in multi-dose vials so it doesn’t become contaminated with bacteria and fungi.  (Yech.)  Links:

General Questions and Answers on the H1N1 Vaccine from CDC

General Questions and Answers on Thimerosal from the CDC

And now let’s get to straightening out some of the lies.

Harriet Hall on Science Based Medicine does a great takedown of the fear mongering surrounding the H1N1 vaccine.

A favorite quote:

Claim: People should be allowed to “self-shield.” For self-shielding you go home lock the doors and stay there. Then you can try to further protect yourself with nano-silver, homeopathic remedies, cold packs, vitamins, flavonoids, zinc, astaxanthin, magnesium, and other stuff.

Fact: A self-imposed quarantine is better than nothing, but I question whether it would be effective in practice. The suggested (untested) remedies might conceivably keep people entertained so they are more willing to stay home.

Hee hee.

“More on flu woo” on Science Based Medicine explains some other misguided thinking about the flu.

And finally, an “Influenza Primer” on Science Based Medicine explains why this flu is different from normal seasonal flu.

If you just read or even skim these articles, you should be reassured that the benefits of the H1N1 vaccine outweigh the risks.  And you can make an educated decision about who in your household should get the vaccine.  We’re definitely getting our 15-month-old son vaccinated, and I will probably get vaccinated myself.  I am not among the groups listed as high priority, but I work in a public school, and I’d like to minimize the chance that I will get swine flu.

If I were pregnant or trying to get pregnant, I would not hesitate to vaccinate myself against H1N1. So far, the 2009 H1N1 virus has affected pregnant women more severely than the general population.

So that’s the real information.  Next post, I’ll muse about some of the misinformation I’m hearing in my neck of the woods.

So they explained the controversy, and they had some good takeaways for parents, but all in all, Dateline failed to spend enough time pounding home the multiple studies that have shown no link between vaccines and autism.  Sure, they mentioned the conflicting studies in passing a couple of times, but then they spent an entire segment on an 11-year-old getting a controversial treatment at Dr. Wakefield’s Thoughtful House.  If they truly wanted to have their show be science based, they would have spent a segment on those other studies.

Head on over there and read Rob’s entire review.

Lamaze Class at A Local Hospital 

My husband and I signed up for a four week Lamaze class taught through a local hospital. We barely made it through the first class and never went back. Our problem was really with the teacher and not the class, but oh what a big problem it was! 

Right off the bat, the instructor had an unfortunate voice. Loud, nasal… annoying. My willingness to ignore the voice and concentrate on the message may have been a mistake. It turns out that when a screechy harpy voice is mixed with condescension, unsubstantiated claims, anti-doctor paranoia and anti-vaccination messages, the voice quickly becomes intolerable. 

It started off poorly and only got worse. During our initial introductions, I mentioned I had received a voice mail from my doctor saying that I didn’t pass my first glucose test and that I’d need to take another. I could feel my “can we pleeeeeeze just get through this and leave” husband wince, but I wanted to have something more to say to the group than, “Hi I’m Jessie, I’ve had a very easy, uneventful pregnancy and I’m having a boy.” Big mistake: The instructor insinuated that my doctor was probably doing it to cover her ass and that they make the bar low so the doctors who are in cahoots with the drug companies and laboratories can get money by making women take the second test. Next came a list of gestational diabetes horror stories. I smiled, waited for her to stop screeching at me long enough to gently tell her that I was going to talk to my doctor and take the second test before I began worrying about gestational diabetes.  Luckily I had read about it and talked to friends so I knew that only 4% of women actually get gestational diabetes. Many women don’t pass the first test but do pass the second. I also knew that if I did have it, gestational diabetes is a very manageable condition. Otherwise she may have freaked me out. 

When I’ve mentioned the second glucose test to others, I’ve been told that a mid-wife would simply measure my belly and check my diet and shame on my doctor for treating me like I was sick. But, isn’t the only way to know for sure that your blood sugar levels are normal to draw blood and measure the amount of sugar? Why wouldn’t I want to know for sure? Making sure I’m healthy isn’t treating me like I’m sick, it’s called preventative medicine, people.

I’m here to tell you that the second glucose test is NO FUN! Mine was fifteen hours of fasting and four blood draws. I would happily go through that discomfort to make absolutely certain that my baby and I are healthy. After passing my second glucose test, I celebrated with a thick slice of chocolate cake. 

All through the class the instructor would tell us not to be scared about our pregnancy or the birth, after all, “It’s not a medical emergency.” Then, immediately screech examples of all the scary and horrible things that can happen during childbirth. Fascinating. Appalling. Funny.    

I knew when signing up that Lamaze advocates unmediated birth and the point is to help manage the pain without medication. Great. That’s fine until the instructor implies that interventions somehow harm the baby and the mother and doctors push for you to have en epidural because they get kickbacks from drug companies while offering no evidence to support these claims. Mainly, those who choose something like a c-section or epidural miss out on having an “authentic” childbirth and aren’t real women. 

There were two couples in the class who got pregnant using In Vitro Fertilization. I think this is a beautiful wonderful thing! The teacher seemed to think so too. I would call In Vitro Fertilization a pretty hard-core intervention. Apparently the teacher was fine with the use interventions to get pregnant but not to relieve pain during delivery. Highly illogical, Captain.  

Toward the end of class she said, “Doctors coming out of medical school now don’t even see unmediated births anymore.”  This was just too much for my husband. He felt that was an extraordinary claim and required some extraordinary evidence.  He asked her where she got her information. After some back and forth and evasion on her part, she admitted that she inferred that information from “articles”.  That just wasn’t good enough for us. We were done with her.

Like I said before, my problem was with the teacher not the class. I thought about trying to find a different class but decided that it just wasn’t for me. I’m not anti birthing class, it’s just not my thing.  

Infant CPR Class

This two and a half hour class was two hours too long. The class was informative and the instructors were knowledgeable. They handed out a pamphlet with a lot of good information and we saw an instructional video that was helpful. The instructors also answered questions, watched us practice on dummies and corrected us if we were doing something wrong, which I found comforting. The rest felt like filler. It would have been a perfect class if it lasted 30- 45 minutes.

Maternity Tour of Cedars-Sinai

This was a great. The tour of the Maternity facilities was given in a group and lasted about one hour. My husband described our tour guide as “The Winner of the Jewish Lady from New York Contest”. She was funny, informative and helpful. We got all sorts of useful information on: where to park, what rooms we will be in when in during early labor, where we will be during delivery, what happens to the baby right after delivery (they remain with the family at Cedars, by the way) contact information, what to bring with us and more.  This was an hour well spent.

Conclusion 

When I first got pregnant I was excited (I still am!), went a little nuts and signed up for a bunch of classes. I signed up for Lamaze, Infant CPR, a Maternity Tour of the Hospital, Breast Feeding and a Baby Care Class. Yes, a little excessive. Personally, I learn best through watching a demonstration or a lecture so I thought that the classes would be a good way for me to go. But maternity classes are different then having someone walk you through the advanced effects in Final Cut Pro, media management for the AVID or going through a video tutorial on doing motion graphics in After Effects. (I’m a Video/TV editor) The Maternity classes I’ve experienced have a little bit of great info mixed in with a lot of opinion and emotion and just aren’t for me. 

I canceled the Breast Feeding Class.  I will probably go the Baby Care class, because I can’t get my money back, but I told my husband that he shouldn’t go. He is happily going to a funeral instead. Seriously. 

I have a fantastic doctor who is happy to sit with us and answer all of our questions. I’ll get a visit from a lactation consultant when I’m in the hospital after delivery and I can ask the nurses about all the stuff that will be covered in the Baby Care Class during my two day stay at the hospital. I also have plenty of people to ask and books I can read if I have a problem with anything. I feel well taken care of and have full access to all the info I could ever possibly need.

My conclusion on classes is that they can offer some good information. That same information is readily available in books, from your doctor, at the hospital, or from other people who have had kids. How you choose to get the information is just a matter of personal preference.

Babies Know: A Little Dirt is Good for You

A quick excerpt:

One leading researcher, Dr. Joel V. Weinstock, the director of gastroenterology and hepatology at Tufts Medical Center in Boston, said in an interview that the immune system at birth “is like an unprogrammed computer. It needs instruction.”


He said that public health measures like cleaning up contaminated water and food have saved the lives of countless children, but they “also eliminated exposure to many organisms that are probably good for us.”


“Children raised in an ultraclean environment,” he added, “are not being exposed to organisms that help them develop appropriate immune regulatory circuits.”

So, don’t obsess and over sanitize for your kids. Their bodies need to be exposed to bacteria and germs now and again. And, maybe even the occasional mud pie.

For starters, catgirl asks “For comparison, how hazardous is a normal light bulb?”

Great question! I hadn’t really thought about it. I’d say the short answer is that while both types of bulbs have their drawbacks, I’d rather have an incandescent bulb break a foot from my face than a CFL (curly) bulb. But I don’t think either is going to kill me.

I found a few  material safety data sheets (MSDS) on the internet for incandescent bulbs: here,  here and here (all pdfs). They all stress that unbroken intact bulbs pose no real danger. However, if an incandescent bulb breaks, there may be some lead present in the solder or glass, which can be toxic if inhaled. I’m sure the amount present varies with different types and brands of bulbs.

Let’s compare and contrast the  Sylvania MSDS for incandescents to the Sylvania MSDS for CFLs, and we find that in both documents Section V. Health Hazards has the exact same statement:

“No adverse effects are expected from occasional exposure to broken lamps. As a matter of good practice, avoid prolonged or frequent exposure to broken lamps unless there is adequate ventilation. The major hazard from broken lamps is the possibility of sustaining glass cuts.”

But the MSDS of incandescents lists only lead as as a possible health hazard and recommends ventilating the area before cleaning, then placing the broken bulb in a closed container to prevent generating dust, whereas the MSDS for curly bulbs lists mercury, lead, phosphor, barium compounds, manganese, yttrium, aluminum oxide, and Krypton-85 as possible health hazards and then states, “Clean-up requires special care due to mercury droplet proliferation.”

So, be careful. Don’t break any bulbs if you can help it. If you do break a curly bulb, clean-up requires extra work, but you’ll probably live (as I did). Or, you can spend $23 or so per bulb and get shatter-resistant curly safety bulbs!

Back to the comments, Stacy McKenna and Arwen had questions about how “green” CFLs can be, if they contain toxic mercury. I found this Fox News article that mentions that incandescents use much more energy than CFLs, and the energy probably comes from burning coal, and burning coal releases mercury into the atmosphere.

“The EPA has estimated that the mercury in a CFL added to the mercury emitted from the electricity used to power it is still less than the mercury emitted from powering an incandescent bulb. So they’re still the better choice, the EPA’s Bergstein says.”

So, are CFLs going to save the planet? I dunno, but they do use less energy. If they are recycled properly, they might be a better bet than energy-hogging incandescents. Maybe in the near future we’ll have an affordable, mercury-free option, such as plasma bulbs or energy-efficient incandescents.

Poison?? CFLs are going to save the planet, right? You hear it all the time on TV: “Save about $30 or more in electricity costs over each bulb’s lifetime!”, each bulb uses “up to 75% less energy!”, CFLs will “help out the planet!” (Points with which I am not here to argue.) But did you know that curly bulbs, as well as all fluorescent bulbs, contain mercury, a neurotoxin that can cause brain, liver and kidney damage, and which, therefore, must be disposed of properly?

After breaking the bulb and scaring the kids, I got on the internet to refresh my memory as to how to clean up the mess I just made. According to the EPA’s website, the clean-up process for a broken fluorescent bulb is complicated. It contains multiple steps, including evacuating and airing out the room for at least 15 minutes, cleaning up the glass using stiff cardboard and packing tape, and, very importantly, not vacuuming if you can help it.

After reading all that, I am upset. Just how hazardous is this mess? There are no windows in that bathroom, so is turning on the exhaust fan (which vents outside) enough? Surely 15 minutes isn’t sufficient evacuation time. Gosh, this is the kids’ bathroom, maybe I should just lock the door and never let them in there ever again!

After two hours of fretting and research, I’ve got my gloves on, I have a good supply of ziplock bags, cardboard, paper towels, and packing tape, and I’m ready to go in there. Glass is everywhere. I mean everywhere! Tiny, tiny pieces of glass under the vanity, behind the toilet and even in the tub. Plus there is a fine powder on the vanity, which is the mercury itself. First thing I do is put all the stuff that can’t be cleaned into ziplocks, including the fancy guest soap, the paper cups, the roll of toilet paper, and the kids’ toothbrushes. Then I put the rugs, towels and hand towels in the washing machine. Then I use cardboard to scrape up all the big pieces of glass, and packing tape to pick up all the microscopic ones. Next I clean with paper towels. And I do mean clean. The whole room. Now don’t get me wrong, it’s a bathroom, it needed cleaning anyway, but not like that! Once I’m done, all the used cardboard, tape and paper towels go in ziplock bags, to be disposed of properly later. It takes an hour even though it is a small room. Then I shut the door, leave the exhaust fan on, and don’t let the kids in until the next day.

A quick search on the web reveals that there seems to be universal agreement that care must be taken to properly clean up a broken CFL. I found one study that backs up these claims. The Maine government conducted a study in which they broke bulbs and measured levels of mercury before and after clean-up. They dropped different kinds of bulbs, from different heights, onto different types of flooring. They cleaned up using different methods, including vacuuming. They found that vacuuming is a no-no, since it can disperse the mercury powder into the air. They made the scary discovery that “flooring surfaces, once visibly clean, can emit mercury.” They developed new recommendations on how to clean up broken bulbs, which the EPA used to modify their recommendations. The study makes the point that “it is unclear what the exact health risks are from exposure to low levels of elemental mercury, especially for sensitive populations, so advising for the careful handling and thoughtful placement of CFLs may be important.”

That last point from the Maine study was one that occured to me after my marathon bathroom-cleaning: Where you place CFLs is important. I was glad this bulb broke in a room with no carpeting, since carpeting is hard to clean, and might need to be replaced. Also, that bulb is in a fairly safe location, and if I hadn’t physically dropped the dumb thing, there was virtually no way it would have broken. But what about other bulbs in my house? Can they get broken accidentally? It turns out that all the bedrooms in my house have ceiling fans, with downward-facing, tulip-shaped lamps. A year ago I replaced all the burned-out bulbs in my 5-year-old son’s bedroom fan with CFLs. Well, they are now incandescent again, because that child constantly throws thing in his room, including toys and balls. I now have the nightmare image of him throwing a toy up, a CFL breaking right above him, and mercury powder raining down on his face. Yikes.

Before this incident, I happened to have already read that breaking a CFL could be a big deal, and knew to research the proper method before beginning clean-up. But what about the majority of CFL consumers? Does anyone else know about this? The package the bulbs came in doesn’t mention any of it. All the package says is, “dispose of properly.” No mention of bulbs being a hazard if broken, no mention of how to safely clean up, nothing. It doesn’t even point out that “dispose of properly” means don’t throw used bulbs away in the trash.

I broke one little curly bulb, and I personally was pretty diligent in my effort to clean up. Part of that was the mommy in me, since this was the kids’ bathroom, and I’ll happily go overboard to protect them. Did I overreact? Or should I have done more? Now that I think of it, I forgot to take down and wash the shower curtain. Damn, I better go do that now…

(Part 2)

Immediately, I thought, “Yea! Ice cream!” But my doctor nipped that in the bud. He said ice cream was no longer recommended for tonsillectomy patients because the milk fat generated phlegm. I was bummed, but thought I would power through anyhow.

Now, for those unfamiliar with the procedure on an adult, let me tell you first hand that the recovery is rough. Really rough. I’ve never, ever felt so awful. By comparison, first trimester “morning” (really all-day) sickness and labor/delivery were a breeze. While convalescing, my doctor told me to drink water all the time to keep the throat moist. Guess what, buddy? My throat hurts! Water didn’t feel good, but ice cream sure would have. It was a long two weeks before I felt marginally better.

A friend recently told me that her son was having his tonsils out. She said she’d already stocked up on a load of ice cream for him. I felt a Helpful Mommy urge I couldn’t suppress. “Did you check with his pediatrician on that? Because when I had my tonsils out, they told me to avoid ice cream because it makes mucus.” Then she laid a bomb on me. “Oh, our pediatrician said that’s a wives’ tale. Milk doesn’t make mucus.” What?! Even my husband, as hard a skeptic as they come, said, “Really? I’ve heard my whole life that milk creates phlegm.” My friend stuck to her story, and I had to investigate.

Turns out, she’s right. The cardinal rule of avoiding milk when you have a cold isn’t necessary. Milk does not create phelgm. However, milk thickens mucus that is already present. So, if you have a respiratory issue where phlegm is present, avoid dairy. But dairy does not generate mucus on its own.

So all ye tonsillectomy suffers, get thee some ice cream! I sure hope you recover easier than I did.