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.

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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.

Homebirth increases the risk of neonatal death to double or triple the neonatal death rate at hospital birth.

And then go read the comments.  Amy holds her own.  I have to had it to her.  I would probably wither in the face of such meanness.  If you want to get the full impact, go back and take a look at the old Homebirth Debate blog, where there are often hundreds of comments per post, and people will just let the name calling fly.

Aside from the visceral thrill of reading so much vitriolic discourse, I enjoy Amy’s blog because she is such a staunch defender of hospital births, which is refreshing if you are surrounded by homebirth and water birth advocates, as I am here in LA.  Amy cuts through the repeated lines of the birth cult folks and offers up real numbers to prove her points.  In another post, she dissects a WHO paper examining C-section rates.  I’m sure we have all heard that in the US the C-section rate is “too high,” but Amy argues that the “ideal” C-section rate is actually higher than we might think.

She also does a good job revealing the mythology and marketing behind organic food.

But whatever you read over there, make sure to read the comments, and if you’re in a fighting mood, maybe even make some of your own.

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.

The scientists had two groups of expectant parents who were all in their third trimester. One group received information and training only on natural childbirth, focusing on breathing and relaxation techniques. The other group learned about pain relief available during labor as well as how to care for a newborn baby. But, they did not practice any breathing or relaxation techniques.

The result was no difference at all.

When asked to rate their pain and experience of childbirth, both groups gave similar answers. Both groups had similar levels of stress when it came to being new parents. There was also no difference in the proportion of women who had an epidural, which was 52 percent in both groups.

So, don’t take anyone else’s advice on which method to use. There is no scientific evidence that one method of preparation is better than another. Do what makes sense for you and your family.

Kari from Mythbusters debunks a few popular (and one just weird) pregnancy myth.

Favorite quote:

You may hate being pregnant. Even if you feel great physically. You may not bond with your baby. You may not feel overjoyed and amazed whenever your baby kicks. You may find it annoying. You may feel gross having a person inside you. This is not a sign that you will be a terrible mother. Once your baby is here, you will love it.

If you are, or a lady you love is, currently building a human, check it out!

This is a great example of a post-hoc ergo propter hoc fallacy. Obviously, women who are past their due date are going to give birth any day. So they eat The Salad, go into labor, and attribute the onset of labor to The Salad.

One day, in a prenatal yoga class, a couple came by to show off their new baby. “By the way,” said the husband, “The Salad doesn’t work!” He detailed his and his wife’s efforts to induce labor. I was thinking that he had possibly learned that the whole myth of The Salad was a post-hoc fallacy, until he said, “What finally worked was Thai food! We ate it, and she went into labor that night!”

So there you have it. Whatever you eat the day you give birth gets the credit for bringing your child into the world. It couldn’t possibly be that you were nine months pregnant, after all!

As it happened, my son was not only late but seemed to have no intention of making an appearance. The days after my due date crept slowly by. My husband and I would wake up every day, both off from work, with no idea of how to occupy ourselves. Invariably, we would somehow end up at Target or Babies R Us, buying more stuff for the child we hoped would come soon. The eleven days of waiting were beneficial for the economy of baby goods, thanks to us.

I thought for sure my doctor would want to induce labor, but I did not dilate or efface or in any other way progress. He proclaimed me “not even close to induceable.” And as we waited for anything at all to happen, my son grew inside me to record levels. Even now, he is quite literally “off the charts,” and he was a very big baby when he was born. Had I ever started labor, I would have argued to try to do things the old fashioned way, but I didn’t have a leg to stand on. I simply never began to labor at all, and a final late ultrasound revealed that our baby was like a ship in a bottle inside me.

My doctor scheduled a c-section.

I was disappointed with this outcome, and as a lark to cheer me up, my husband and I went to Caioti Café and ordered The Salad. We grabbed the journals, and I wrote something to the effect that The Salad would definitely work for me, since I knew for sure I was giving birth the next day! If I actually went into labor, I joked, I would chuck out my beliefs in science.

The waitress saw us laughing and said, “No, you’ve got to believe it! You have to have faith.” If it worked, we told her, we might. But we knew it wouldn’t work, and she was too busy with other tables for us to explain that no one should believe in The Salad.

My water broke the next afternoon, six hours before my scheduled c-section.

Okay, no, I didn’t give up my skeptic outlook and become a salad follower. I just thought the whole thing was kind of funny. But my success with the salad inspired a friend of mine, who was six weeks behind me in her pregnancy. She ate The Salad several times after her 39th week, hoping to bring on an early birth. Nothing happened at all, except that she had a delicious and healthy lunch. She finally was induced into labor about a week after her due date.

Los Angeles is a huge place, and I like that there’s a quaint local custom like this nearby. It makes life a little more fun. It gives pregnant women something to talk about. It alarms me just a little that The Salad is part of a larger issue I have with the world—that people believe silly things. But at least it tastes good.