Monthly Archives: May 2013

Memorial Day Weekend

Apologies for the radio silence.  A lot of (good) stuff has been going on.  Travel, birthdays, talks, work, etc.  I have a bunch of drafts in various stages, but no time to polish and post.  Despite being a short week, it has been crazy, and we’re off to New Hampshire for a wedding early in the morning.

Thus, here are some photos from our Memorial Day Weekend.  We spent it in the Catskills.  Even though the weather didn’t really cooperate, we still enjoyed being up there.  It was our first trip up of the season, so we did our best to enjoy being away from it all (there’s no cell phone reception or electricity up there!).

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Note Mabel pouting in the bottom left photo. She was upset because she could not find any large puddles to jump in.

We did manage to get into the woods, catch creepy crawlies, see lots of deer, and marvel at how lush and green everything is.

Even in the rain and the cold, it’s my favorite place.

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Wordless Wednesday: Cultured

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Pros and Cons of Coffee

I’ve written before about how scientists consume the most coffee of all professions, here.  I’ve also written about my own descent to coffee-dependence, here.

So, when this popped up in my FB feed from IFLS, I was intrigued.

As is my way, I couldn’t share without vetting at least some of the info.  For some more actual data and links to primary literature from which the factoids on the above infographic are drawn, see here.

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Moms can recognize their newborn by touch alone

While I was working on last week’s Transition to New Motherhood post, I came across this study:

Parturient women can recognize their infants by touch.  Kaitz M et al, Developmental Psychology, 1992

Unfortunately the full text is behind a paywall I don’t have access to, but you can read the first page here and a very brief summary here.

It turns out, brand new mothers can identify their newborns by touch alone, after only spending an hour with them after giving birth.

From what I can glean from the abstract and descriptions online, women were allowed to spend time with their infants, unaware of what the researchers were going to ask of them. It turns out that the majority of women were able to identify their own baby if they had spent a minimum of 1 hour with it since giving birth.  (And this paper would suggest fathers are similarly capable)

I can’t say I was that surprised.  When I delivered Mable, Mac accompanied her to the nursery while the surgeon completed my C-section.  Afterwards, I was in the recovery room with a nurse, and I hear a baby cry in the hallway.  I was a total mess- 36 hours of labor, a C-section, epidural, vomiting, etc.  However, when I heard the cry I said (to the nurse?  to myself?), “That’s my baby.”  The nurse replied, “Oh, honey.  All the babies sound the same.”

Moments later, this guy and this little gal appeared in the doorway.

mabelcry mcphd

My guy.  My gal.

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Transition to New Parenthood/Evidence Based Parenting Discussion Storified

Earlier this week I posted my contribution to this month’s Evidence-Based Parenting Blog Carnival about the transition to motherhood.

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Today, several of the contributors, all evidence-based parents (many scientists, science communicators, and researchers- all parents), got together on Twitter for a live discussion of some of the issues brought up in the Carnival.  We used the hashtag #parentscience and discussed issues ranging from sleep to swaddling to pain management and bonding.

If you missed the live discussion, don’t worry.  My fellow Carnival of Evidence-Based Parenting (CEBP) contributor, Matt Shipman Storified it!

You can catch up on what you missed here.  And you can contribute to the ongoing discussion on the CEBP Facebook page here (recent topics include the debatable happiness of new parents and the difficulties facing doctors and parents when caring for interest infants).

If you are ready to trade the parenting hype for the some legit, evidence-based parenting, read up!

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You might be a #scimom if… ROY G. BIV

You might be a #scimom if you notice when rainbow colored toys (or clothes) don’t conform to ROY G. BIV.

For whatever anal-retentive reason, it irks me when colors are arranged so as to be a ‘rainbow’ yet they are not in the order in which they appear in an actual rainbow.

For example- who designed this?

Roy G. Biv does not approve.

Roy G. Biv approved. Red then orange then yellow then green then blue.

They obviously knew what they were doing and adhered to the spectrum?

But what about this dress?  Would it be so hard to have switched the green and light blue ruffles to it would go in wavelength order?

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This tunic has the colored ruffles in the wrong order.

Seriously children’s fashion designers and toy makers!  Get with the spectrum.

So, am I alone?  Do you see a rainbow and think ROY G. BIV?

 

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Sex-assignment surgery in infants/young children- when will we learn?

I read this story today and my heart broke a little bit:  Couple sues over adopted son’s early sex-assignment surgery.

A South Carolina couple sued doctors and state social workers on Tuesday for subjecting a 16-month-old child born with both male and female genitalia to what they say was medically unnecessary and irreversible sex-assignment surgery while the toddler was in foster care.  The state and federal lawsuits — believed by the couple’s lawyers to be the first of their kind in the United States — argue that doctors should not have performed surgery to make the child’s body appear to be female when they knew they could not predict how gender would develop.  The child, now 8, has shown strong signs of identifying as male and recently began living as a boy, according to Pam and Mark Crawford, who adopted him after the surgery. Source.

The child in the above story had ambiguous genetalia and was “‘intersex’ / had a ‘disorder of sex development (DSD)’ which is “defined as any congenital condition in which development of chromosomal, gonadal or anatomic sex is atypical” (Source).  The child was treated with surgery to make the genitals appear female in February 2005.  In August 2006, the American Academy of Pediatrics released a revised Consensus Statement on Management of Intersex Disorders.

While the AAPs recommendations vary based on the exact medical diagnosis, the take-home message is: do what’s best in the long run, not what makes everyone feel most comfortable in the short run, maintain function as much as possible, don’t do anything irreversible that is not required for physical health early on.  Some quotes to give you an idea of what they are recommending:

-“Emphasis is on functional outcome rather than a strictly cosmetic appearance. It is generally felt that surgery that is performed for cosmetic reasons in the first year of life relieves parental distress and improves attachment between the child and the parents; the systematic evidence for this belief is lacking.”

-Certain procedures should be delayed until “adolescence when the patient is psychologically motivated and a full partner in the procedure.”

-“Surgical management in DSD should also consider options that will facilitate the chances of fertility.” (Source)

I wonder what would have happened if this recommendation had been made prior to that child’s surgery- would the outcome have been different? Would he not be facing another surgery to undo the damage?
I may be unusual in this regard, but the possibility of having a child with a disorder of sexual determination/intersex was something I considered when I was pregnant.  From news reports, studies, documentaries, I knew that if I had a child with such a condition, I would opt to delay surgery until the child could decide for him/herself what was the appropriate course of action.  The story of the tragic and troubled life of David Reimer particularly touched me.

Surgery is a permanent change, is irreversible.  What was the young child in that news story robbed of?  We cannot tell from the information being released, but at the very least, this child was robbed of a penis.

We may not discuss it much, but these types of conditions are not as rare as you might think.  Estimates of the frequency of surgeries to “normalize” genital appearance are as high as 1 in 500 (Source).

The types of conditions are varied and numerous- from chromosomal abnormalities (XXY) to enzyme deficiencies (click here for more info).

Scoring External Genitalia. A. The external genitalia can be objectively scored using the Prader staging system which provides an overall score for the appearance of the external genitalia. B. Alternatively, each individual feature of the genitalia (phallus size, labioscrotal fusion, site of the gonads and location of urethral meatus) can be individually scored to obtain the External Masculinisation Score (EMS). Adapted from Ahmed et al., BJU Int. 2000;85:120–4. (Source)

Scoring External Genitalia. A. The external genitalia can be objectively scored using the Prader staging system which provides an overall score for the appearance of the external genitalia. B. Alternatively, each individual feature of the genitalia (phallus size, labioscrotal fusion, site of the gonads and location of urethral meatus) can be individually scored to obtain the External Masculinisation Score (EMS). Adapted from Ahmed et al., BJU Int. 2000;85:120–4. (Source)

The dilemma in how to treat these children is what happens if you choose the wrong gender.  What if you get it wrong?

Numerous experts in the field have remarked on the lack of long-term data on how accurate doctors and parents are at choosing the correct gender.

More than 90% of 46XX CAH patients and all 46XY CAIS assigned female in infancy identify as females. … Approximately 60% of 5α-reductase (5αRD2)-deficient patients assigned as female in infancy and virilising at puberty (and all assigned male) live as males… Amongst patients with PAIS, androgen biosynthetic defects, and incomplete gonadal dysgenesis, there is dissatisfaction with the sex of rearing in ∼25% of individuals whether raised as male or female... In the case of mixed gonadal dysgenesis (MGD), factors to consider include prenatal androgen exposure, testicular function at and after puberty, phallic development and gonadal location. Individuals with cloacal exstrophy reared as female show variability in gender-identity outcome, but >65% appear to live as women. Source.

Look at those numbers.  In the first case, 10% of patients were assigned the ‘wrong’ gender (i.e. they did not identify themselves as the gender that was chosen for them).  In the second, 60% of patients were assigned as female in infancy went on the live as males.  The third statistic, 25% of individuals were ‘dissatisfied with the sex of rearing.’ And the last stat, around 35% of individuals reared as females live as males.

If I was a betting individual, I wouldn’t bet on those odds.  As a scientist, I see those percentages as indicating that not enough is known about the system to make an accurate prediction of the outcome.  As a human being, I mourn for those who lost a part of themselves to surgery that they cannot get back- a part that makes it harder for doctors and surgery to match their outsides with their self-image.  As a parent, I imagine how dangerous it would be to make such a decision at the risk of choosing incorrectly.

As I was researching this topic, I came across the following statement that struck me as odd:

Gender reassignment surgery is not carried out prior to adulthood in young gender dysphorics without DSD. There is international clinical consensus that the risks of early surgical intervention far outweigh the potential benefits in virtually all cases. (Source)

Gender dysphoria is when a person feels their biological sex is mismatched relative to the gender they identify as being.  The quote above indicates that surgery to bring biological sex in line with gender identity should be delayed until adulthood.  Perhaps the same caution should be applied when deciding for infants and young children with disorders of sex determination.

My heart goes out to MC (the child from the story) and his family.  May the grownups looking out for him- doctors, parents, lawyers- all do their best, and do what is best for him.  May they not fail him twice.

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Wordless Wednesday: I prefer realist

Sleep has been hard to come by lately.  I’ve been relying heavily on coffee.

My "Pessimist's Mug"

My “Pessimist’s Mug“- I consider myself more of a realist, actually.

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The Transition to New Motherhood

This month’s Evidence-Based Parenting Blog Carnival is discussing the transition to motherhood/fatherhood, inspired by Mother’s Day.  Our host this month is evidence-based parent Jessica Smock whose blog, School of Smock, looks at parenting from the perspective of a mom with a young child and a research background.  Our topics in this month’s carnival are as varied as you might expect.  You can find them all here.  You can also follow the discussion on Twitter with the hashtag #parentscience and on our Facebook page.  Also, tune in on Twitter this Friday (5/17/13) from 1 to 2pm for a Twitter party with all of our bloggers for a live discussion with the hashtag #parentscience.

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Last Mother’s Day was my due date with Nemo, my second offspring.  I was somewhat impatiently awaiting his arrival.  I must say, the transition from one kid to two was a lot easier than the transition to being a new mom.  Some of that was due to a more difficult delivery with my first and some of it was due to the amount of help I had with my second (Mac was home with me).  However, I think largely it was due to the fact that childcare was already routine.  I was used to being woken up in the night.  I was used to breast feeding.  I was used to diapers and swaddling and baby monitors and naps and sleep deprivation.  I’d been there, done that (or in some cases like diapers was still doing it with Mabel) when Nemo came along.  Caring for a baby wasn’t new, it was familiar.  It was habit.

What we were doing while Mabel's cord blood was being collected:  "Meet" for the first time in the OR.

Meeting Mabel face to face for the first time.

My practical advice to new moms, based on empirical evidence of having been one myself, consists of two things:

1.  Keep your expectations low.  (That includes expectations of yourself, your baby, and your partner.)

2.  Give it about a month before anything feels normal again.

I’ve written about #1 before, here.  In all truth, in the early days of parenting, it’s completely necessary and sufficient to just get by.  Your house doesn’t have to be clean.  Your clothes don’t have to be clean.  Your hair doesn’t have to be clean.  This study would indicate that you are not alone- 40% of women reported at 1 month postpartum that there were days they did not get dressed.  This was my experience too.  You can extrapolate from there.

At first, you just get by.  When it’s a struggle to just get all living beings in your household fed and clothed, you need to keep your priorities in order.  Now having had baby #2, I look back to how I did things with Mabel (#1) and feel like I need to apologize for my ineptitude.  We really were just getting by.  Learning as we bumbled along.

Why are these early days so hard?  I know my fellow EBBs (Evidence-based bloggers) are covering some of that.  There’s the sleep deprivation.  There might be postpartum depression.  You may be learning to breastfeed or struggling to breastfeed.  Bonding with the new baby.

I’ve written before about my recoveries (I had a C-section with both kids) in the past.  It’s definitely a transition physically, emotionally, and psychologically.

Meeting Nemo face to face for the first time.

Meeting Nemo face to face for the first time.

When I had my first child, Mabel, I didn’t feel myself for weeks.  I felt kind of out of place and on edge.  Crawling into bed at night wasn’t a welcome rest, merely a short reprieve.  I couldn’t relax and enjoy the rest because I knew, at any moment, it would be interrupted by a crying baby.  That getting into/out of bed or rolling over was still painful and I was waking up drenched in sweat each night didn’t add to any sense of rest or relaxation.

My experience is pretty typical if you look at the data.  Maloni et al looked at the postpartum symptoms reported by 106 postpartum women who had a singleton high-risk pregnancy and were treated with antepartum (before giving birth) bed rest.  At 6 weeks postpartum, at least 40% of the women were still reporting symptoms like fatigue, mood changes, tenseness, and difficulty concentrating.  In this particular study, the authors didn’t include any kind of “control” group of women (i.e. those who had not been on bed rest, those that had low risk pregnancies, etc.).  If they had included such a group, I would not be surprised if the results were similar. My own anecdotal evidence would indicate that fatigue, mood changes, tenseness, and difficulty concentrating are pretty universal for women after giving birth.

I kind of trudged through the days (and nights) like a zombie- lack of sleep, lack of food (it was hard to find time to eat while caring for a newborn solo), C-section pain, pain medication- the combo wasn’t conducive to coherent thought.  Watching the 2010 Winter Olympics is how I kept from slumping over while nursing in the dead of night (perk- I actually got to watch some of it live).

It also didn’t really help that during that time Mabel was lacking in the personality department.  It was kind of like caring for a slobbery, leaky, screaming sack of sugar.  Her first smile- right around the one month mark was kind of a turning point.  She was interactive and that helped with nurturing and caring for her.  Also, I think we kind of found our groove.  After a month of muddling along, I figured out how to live as a mom, and she figured out how to live outside of my womb.

First family photo on the day Nemo was born.

First family photo a few hours after Nemo was born.

Have you ever heard somebody say it takes 30 days to make a new behavior into a habit? Well, it turns out that there is some science to back up that notion- that it takes time for new behaviors to become habits, to become acclimated to new situations.

So is 30 days some kind of magic threshold?  I don’t think so.

By that one month mark, I was able to feel more relaxed at bed time, it no longer felt like there was a stranger in my house, I felt much less tense and on edge.  I still wasn’t ‘normal’- the house was still messy, I still spent days in my PJs, but they felt more like a lazy Saturday than futile struggle for self-care.

A few years ago, a group at the University College London, led by Phillipippa Lally studied 96 people who wanted to form a new habit (the article is behind a paywall, but you can find the abstract here).  Lally et al looked at how long it took individuals to report that the new behavior had become automatic- basically, had become habit.  They found a wide range (from 18 to 254 days) with an average of 66 days.

Source.

“When the researchers examined the different habits, many of the participants showed a curved relationship between practice and automaticity of the form depicted below (solid line). On average a plateau in automaticity was reached after 66 days. In other words it had become as much of a habit as it was ever going to become.” Source.

In a lot of ways, parenting becomes a habit.  Mac and I take turns getting up in the night, and a lot of times, in the morning, we can’t remember how often or what time or for which kid.  We’re on autopilot.  On the rare occasion we are childless, we still go to open the rear car door to extract a small child or still tiptoe up the stairs at nap time.

I think this force of habit is what made the transition to motherhood so challenging with my first child, and much less so when adding a second.  When transitioning to a new mom, I had to learn A LOT, adopt a whole new way of living, new skills, new routines, new patterns.  When transitioning to a mom of two, all of that was old hat, there was just one extra kid to juggle.

So, to those expectant and new parents, hang in there.  You can do it.  Give it time.  Cut yourself and each other lots of slack.  This too shall pass.  You’ll find your new normal.

What were your experiences becoming a new parent?  Adding another child to your family?  If you are expecting, what are you anticipating?

Read about the experiences of other evidence-based parents on School of Smock and follow our discussion on Twitter with the hashtag #parentscience and on our Facebook page.

Other posts I’ve done that might be useful for new and expecting parents:

My best parenting advice:  Keep you expectations low

The Science of Breastfeeding (already a little out of date)

My experience with a C-section birth

Recovering from a repeat C-section (and some info on my recovery from the first) and here

Recovering from late onset, pregnancy-induced hypertension

Introducing potentially allergenic solids

Baby-led weaning, and here

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Adverse Effects of Pitocin in Newborns

OMG!  “Pitocin Side Effects:  Harm to Newborns Found in Child Labor Drug Study Triggers mommy-Blog Firestorm!

I wasn’t really sure what the problem was from the headline.  Were mommy-bloggers upset over child labor?  Were newborns put to work on a drug study?  What’s going on?!

Apparently the moms at Babble and The Stir have their granny-panties in a knot reporting, sensationally*, on a press release from the American College of Obstetricians and Gynecologists. (*meaning they are sensationalizing the results for clicks, not that they are doing a sensational job reporting on the study)

All the hubbub is over Poster #74 at ACOG’s Annual Meeting.  Title:  “Oxytocin Usage for Labor Augmentation and Adverse Neonatal Outcomes” by Dr. Michael S. Tsimis et al.

What the study looked at?

…a  retrospective analysis of deliveries that were induced or augmented with oxytocin. The study included more than 3,000 women delivering full-term infants from 2009 to 2011. The researchers used the Adverse Outcome Index, one of several tools used to measure unexpected outcomes in the perinatal setting and to track obstetric illness and death rates. (Source)

What the data showed?

Researchers found that induction and augmentation of labor with oxytocin was an independent risk factor for unexpected admission to the NICU lasting more than 24 hours for full-term infants. Augmentation also correlated with Apgar scores of fewer than seven at five minutes. The Apgar is a test that evaluates a newborn’s physical condition at one and five minutes after birth based on appearance (skin coloration), pulse (heart rate), grimace response (medically known as “reflex irritability”), activity and muscle tone, and respiration (breathing rate and effort). A baby who scores eight and above is generally considered to be in good health. (Source)

What the authors concluded?

The analysis suggests that oxytocin use may not be as safe as once thought and that proper indications for its use should be documented for further study. “However, we don’t want to discourage the use of Pitocin, but simply want a more systematic and conscientious approach to the indications for its use.” (Source)

The take home message?  The study (as far as I can ascertain from the ACOG press release) did not establish a causal link between pitocin use and adverse effects in newborns, it showed a correlation.  Like any drug, pitocin isn’t without side effects.  Doctors and patients must exercise their judgement in using it- adverse effects from pitocin may be preferable to outcomes of NOT using it and complications of delayed delivery of a baby.

Keep in mind, since this is a poster and not a published paper, the data hasn’t been peer reviewed, actually, unless you are actually AT that meeting, you can’t see the data, because it’s on a poster. My search for the abstract was fruitless, leading me in circles back to the press release.

So, as always, talk to your doctor, ask questions, make informed choices.  Don’t just listen to some random mommy-blogger (or in this case, #scimom blogger/Evidence Based Parenting blogger) on the internet.

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