Come join me on Preg U!

preg U seal clear back@2x

If you’re wondering where I’ve been… Here! I’ve been here! Click on the image to come hang out with me.

Hi friends!

As you can probably tell from my lack of recent posts, my writing/posting/bloggin’ time has been shifted over to other things. Two littles, a full time job, blah blah blah….

BUT luckily, my full time job involves writing about pregnancy! Woohooo!

With my team over at Bloomlife we’re launching a new publication called preg U to provide a better resource – a smart girls’ guide to pregnancy and parenting. Fact-based articles ranging from the Biology of pregnancy to current research and myth busting  to historical breakdowns of silly pregnancy terminology.

We aim to provide the information you need in the context of your own, personal and unique pregnancy journey. Or just satisfy that fascination with the amazingness that is pregnancy.

Basically it’s The Pregnant Scientist and Friends! (Friends include Amy from Expecting Science and she is AHHHHMAZING)

And it is awesome (well, I might be biased.) We’ll be pumping out cool stuff on a regular basis so sign up for our newsletter, follow the Preg U publication, or comment below with questions/topics you want to see tackled and I’ll link to them when we publish.

Join me!

9 ways to give your overdue baby the boot (supposedly)

Back when I was trying my damndest to evict little E (can’t believe that was over five months ago!) I decided to dig into the literature on natural induction.

Check out my post over on Medium – https://medium.com/40-weeks/9-ways-to-give-your-overdue-baby-the-boot-supposedly-9119ff1cab96#.4i01pfrdt

Spoiler alert – you may have to get extreme with this one.

9 ways to give your overdue baby the boot (supposedly) – 40 weeks

What science says about natural induction techniques. Today marks 40 weeks + 5 days pregnant. Not cool, baby, not cool. While I have no trust in due dates, it is still incredibly frustrating to watch yours come and go. Needless to say, natural induction techniques are high on my to-do list these days.

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No sleeping on your back! Wait, what?!

Of all the “no no’s” thrown at your growing pregnant body, the one that I found ridiculously frustrating was the “No sleeping on your back” rule.

Sleep is a precious precious commodity when carting around a huge pregnant belly. Why would you dictate how I sleep with this thing?!

The reasoning for the sleep position policing stems from the idea that back sleeping can choke off your baby’s oxygen supply.

Here is the “logic”:

Your uterus is heavy. So heavy, in fact, that it puts weight on the vena cava, the vein that runs blood back to your heart. A compressed vena cava means decreased blood back to the heart and therefore, decreased blood coming out from the heart. Less oxygenated blood for you, less oxygenated blood for the baby. Not good.

I really wanted to call bullshit on this one during my last pregnancy (yet dutifully buoyed myself on my side with pillows each night). I mean, if oxygenated blood is getting cut off, it would affect how that blood gets to the brain and you would feel dizzy. Right? So, isn’t that a simple test to see if your heavy uterus cuts off your blood supply? Lay down, feel woozy, heavy uterus!

Drs Farine and Seaward at the University of Toronto seem to agree with me.

“Women should be told that a small minority of pregnant women feel faint when lying flat” – Dan Farine, MD, FRCSC, P. Gareth Seaward, MD, FRCSC

Of course, my experimental nature was cut short when a friend sent me this article.

Medical student, Allan Kember is fighting stillbirth with a belt that prevents pregnant moms from sleeping on their backs.

Stillbirth!? Back sleeping!? Holy shit. Maybe this deserves a second look.

I called up Allan.

Allan’s research stemmed from studies like this one and this one. Most inspiring though was a study coming out of Ghana in which the authors showed that a quarter of stillbirths might be prevented by changing mom’s sleep position. Allan wanted to answer the call for a simple, inexpensive solution to solve stillbirth in the developing world. His thought process: encourage expecting moms to not sleep on their back, save a few babies.

Cool.

Of course, I had to bug him about the whole vena cava scenario. He admitted that this might not be the full picture.

Another culprit? Gestational sleep apnea (sleep disordered breathing).

Here’s the problem though: we really do not understand gestational sleep apnea well enough to point a finger quite yet and we have no idea how sleep apnea might affect a growing baby. Oxygen flow disturbances? Stress responses? Mom snoring too loudly?

Ok, probably not the last one.

At the end of the day, it seems that stillbirth may follow a similar rule as what has recently been shown in SIDS research. It isn’t any one thing that causes it. It’s the perfect storm of complications that can result in stillbirth.

The triple risk:

(1) maternal risk factors, (2) fetal risk factors (low growth rate, placental insufficiency), and (3) a stressor (such as back sleeping).

Don’t tick off all three boxes, you’re in the clear. At risk already? Do whatever you need to do to prevent that third tick and you’re in the clear.

SIDS research has figured out a way to prevent that third tick in as many babies as possible, regardless of preexisting vulnerabilities – the giant, border crossing “Back to Sleep” campaign where parents are reminded to never put a baby to sleep on her tummy. The result? A decrease in SIDS with an increase in flat heads. But flat heads are fine if it means babies keep breathing into adulthood.

Of the 4 possible sleep positions, pregnant women end up on their backs over 25% of the time, with over 80% of women hitting this position some time during the night. It’s normal. It’s common. It’s an epidemic?

Researchers in the UK are now trying to determine if a national campaign, similar to the SIDS “Back to Sleep”, should be launched to tell moms not to sleep on their backs.

This is where I draw the line.

Going to sleep with a homework assignment (“do not sleep on your back!), is enough to keep us pregnant moms up worrying about what all the damage we can do to our unborn child while we toss and turn. One study showed exactly this – asking women to make sure they slept on their left sides results in decreased overall sleep time.

When quality sleep is so freaking important during pregnancy and so freaking difficult to achieve, why mess with it more?

Here’s another gem of a quote from Drs. Farine and Seaward:

“If lying prone had been detrimental to a normal pregnancy, the species would long ago have ceased to exist” – Dan Farine, MD, FRCSC, P. Gareth Seaward, MD, FRCSC

Back to the stillbirth thing. Maybe the first thing to tackle is figuring out how to define which women and babies are at risk and come up with solutions for this small subset. Maybe it’s a CPAP to treat sleep apnea, maybe it’s a belt with balls to encourage side sleeping, maybe it’s a mound of body pillows.

For now, it’s time for me and my big, heavy, vein crushing uterus to hit the hay.

My birth story vs. science

vintage nursery2

I’ve been diving back into the world of pregnancy since starting to work with Bloom Technologies.

My first challenge – analyze my birth story against all scientific and medical definitions at my disposal and decide if my labor progression classified as “normal”.

(Spoiler alert: it’s really freaking hard to tell.)

Here’s the story:

https://medium.com/40-weeks/my-birth-story-vs-science-d0baebdfd72c

Get your baby on board the probiotic bandwagon?

baby's belly

Ah, probiotics. The supplement du jour.

It was only a matter of time. Just as we started wrapping our heads around the concept of consuming “live cultures” for gut health, the market spilled into the realm of baby products.

Would you deny your baby something that promises eternal tummy happiness?

WHAT ARE PROBIOTICS?

Is it me, or are probiotics one of those things that we nod our head in conversation and go “oh, sure, totally, it’s soooo important” without having a freaking clue what we are talking about?

Here’s a super quick summary of our belly bugs —

We eat stuff… let’s say kale. Our measly human machinery cannot break down the tough bits in kale. We simply do not have the tools.

You know who does have the tools? Bacteria. Specialized little worker bugs that hang out in our intestine with their tools all ready for the kale chunks that escape our ill-equipped stomach.

In exchange for room and board, those little worker bugs break down that kale and kick back some nutrients we would have missed. Kale-eatin’ bugs are only the start. Along with a range of other little bug friends, our gut is host to a beautiful little ecosystem that, when kept happy and in balance, can confer all kinds of health benefits.

Probiotics? Anything that you might ingest containing live microorganisms (bacteria) that pass through the digestive system to confer “benefits” once they reach the intestines. For example, a whole range of yogurt products have “live cultures” on board and are promoted as probiotics.
Here’s the problem — our gut is already jam packed with resident bacteria. After those “live cultures” brave the digestive passage to end up in your gut, they drop off the good stuff they already made while waiting out in the yogurt, and pass on through. The real estate landscape is already too crowded and the residents are not likely to make room for the new guys.

But you know whose gut does have a lot of open real estate?

Babies.

COLONIZING THE BABY GUT

In order to establish residency, the microbes have to get there.

When they’re born, babies are rubbed all over by bacteria that may be important for gut colonization. The gut of a C-section babies compared to a vaginal birth babies shows profound differences. Babies that come out on their own have higher quantities of helpful microbes. Presumably, this is a result of spending time in the birth canal. But, this study cannot rule out another possible influence — C-section mamas went through major surgery and weren’t able to nurse immediately or effectively for the days before the test (samples taken on day 3 post-birth) [1].

Which brings us to that mama milk.

We all know that breast milk passes along important antibodies, but here’s another thing that breast milk may provide— gut bacteria.

Yes, helpful microbes may also be passed along in the milk [2].

More importantly, human breast milk contains a critical prebiotic to sustain the helpful bacteria.

PREBIOTICS ARE MORE IMPORTANT THAN PROBIOTICS

Ok, prebiotics, what are those?

Think of prebiotics as the food for the good bacteria. Without a prebiotic, the probiotic bacteria reaching the intestine realize that there is nothing for them to do and nothing for them to eat, and they wave goodbye to the other bacteria setting up shop and head on out the other end. They are probably not around long enough to confer any kind of benefit to that baby.

No food? No bugs.

Human breast milk has special complex sugars, called Human Milk Oligosaccharides. The human body cannot digest these sugars. Only specialized bacteria can digest them. By introducing this prebiotic, the bacteria that feast on this specific sugar flourish. They set up shop and multiply. They also kick back amazing benefits — immune system building, preparing a happy gut for adulthood, and the list goes on.

But these bacteria will only set up shop if they have those special mama sugars available. No sugars? No food. No bugs.

You can have a prebiotic without a probiotic, but a probiotic without a prebiotic is useless.

Adult side note:
One funny thing about this all is that a common probiotic on the market is a little posse of bacteria called Bifidobacteria. These bacteria were first isolated from baby poo and now they are the main health bug in a whole range of probiotic products aimed at adults.

The problem? Bifido prefers Human Milk Oligosaccharides as a prebiotic. Since I’m pretty sure no adult is taking a healthy swig of breast milk on a daily basis, it’s hard to say how much benefit our adult gut is getting from adding these fellas to our daily diet.

BACK TO THE BABIES!  THE VERDICT?

Hmmm…

First, here are my general concerns —

One, you are essentially feeding your baby bacteria. Where is this bacteria coming from? How is it controlled, isolated, tested?

Two, the baby gut is trying to do it’s thing. It is set up to do it’s thing. Do we need to play puppet master to a community that has evolved for beautiful symbiotic balance?

So, at first I would have said “NO, crazy!” but upon greater reflection I have softened my stance.

A few scenarios:

Natural birth, breastfeeding mama — why mess with nature? This is my category, and, personally, I will not be giving the wee one probiotics.

C-section, breastfeeding mama — Tough one. We still do not know how important the exit strategy is for setting up the important bacteria. Maybe they could use a boost?

Super early baby, breastfeeding mama — Ok, for this one there are some data. A recent study in a NICU, doctors gave babies born pre-term (< 32 weeks), daily doses of a carefully screened probiotic. There was a significant reduction in necrotizing enterocolitis (a super scary intestinal disease in preemies). Sure, the numbers went from 10% to 5% but when you are talking about babies, every baby counts. The authors conclusion was to adopt daily probiotic administration into the protocol of pre-term care [3].

See a pattern? Breastfeeding is key. The boobs make the prebiotic.

Even in the NICU study, 93% of the mothers were nursing.

FORMULA + PROBIOTICS?

Only human milk has the one true prebiotic to encourage the happy bugs to grow and establish their community.

To get around this, formula companies have tried to mimic Human Milk Oligosaccharides with a combination of complex, but not as complex, sugars: Galacto-oligosaccharides and Fructo-oligosaccharide (GOS/FOS). Some research suggests that having this GOS/FOS prebiotic is enough to get the happy bacteria established in the baby gut similar to the breast-fed baby (no probiotic necessary) [4]. Other research warns that we don’t know enough about GOS/FOS to be messing around with it [5].

Research on everything involving the baby gut is still in its infancy (pun intended).

We haven’t mapped out every inch of bacterial real estate in the ever changing baby intestine. We don’t know the job description for every occupant. We don’t know the long-term effects of manipulating the landscape.

I say, leave ‘em be for now.

The baby will figure out how to walk.

The microbes will figure out how to flourish.

1. Jost, T., Lacroix, C., Braegger, C., Chassard, C., 2013. Assessment of bacterial diversity in breast milk using culture-dependent and culture-independent approaches. Br J Nutr 110, 1253–1262span>

2. Biasucci, G., Rubini, M., Riboni, S., Morelli, L., Bessi, E., Retetangos, C., 2010. Mode of delivery affects the bacterial community in the newborn gut. Early Human Development 86, 13–15.

3. Janvier, A., Malo, J., Barrington, K., 2014. Cohort Study of Probiotics in a North American Neonatal Intensive Care Unit. The Journal of Pediatrics 164, 980–985.

4. Bakker-Zierikzee, A.M., Alles, M.S., Knol, J., Kok, F.J., Tolboom, J.J.M., Bindels, J.G., 2005. Effects of infant formula containing a mixture of galacto- and fructo-oligosaccharides or viable Bifidobacterium animalis on the intestinal microflora during the first 4 months of life. Br J Nutr 94, 783–790.

5. Ninonuevo, M.R., Bode, L., 2008. Infant Formula Oligosaccharides Opening the Gates (for Speculation) 1–3.

Mommy brain

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My husband and I had little — meaning no — baby experience before bringing our daughter home. We would jokingly ask questions like “how much do we have to feed this thing?” and then nervously laugh, look at each other with concern, and consult the “owner’s manual” (our affectionate name for the American Academy of Pediatrics tome).

And then, she was born. An insane flurry of eat, poop, soothe, repeat.

After those first few weeks, when the dust settled, I had a profound revelation — I might actually know what I’m doing! Could I now have maternal instincts that were not there before?

By its very definition, “instinct” is a response that is inherent, basic, not requiring thought or careful consideration. Unlearned. Unconscious. Instinct. [Note: maternal instinct makes sense given that we have yet to see a National Geographic film of a baboon parenting class gathering every third Tuesday on the savannah.]

Turns out, there is quite a bit of evidence demonstrating that our brain does, in fact, change when we transition from clueless pregnant woman to caregiver. 

As pointed out in a 2012 review in Physiology and Behavior, this transition marks an important point at which our brains have to shift from a world revolving around self-care to one oriented around the care of a tiny helpless being. With a little bit of parenting experience, the mammalian brain shows changes in cognition (e.g. spatial memory, attention), emotional responsiveness (e.g. boldness in new settings, focus), and social awareness (e.g. attention to those helpless little beings). Put a pregnant rat in a cage with pups strewn about, and she doesn’t give a shit. Put a mama rat in a cage with pups strewn about, and she goes right to work, gathering up those babies, protecting and nurturing them.

Now, it probably helps that the mama brain is also altered to respond to baby with a spurt of sweet sweet dopamine right in the reward centers of the brain, similar to a hit of cocaine.

Yup, our babies are addictive. 

As demonstrated in a 2005 paper in The Journal of Neuroscience, a mama rat with a suckling rat pup feels the same dopamine reward signal as a virgin rat does when given cocaine. Interestingly, though, in the mama rats, a dose of cocaine does not have this same effect and actually suppresses activity in the reward center. Nature’s way of focusing mom’s attention — You want to get high? Feed your baby.

But wait, a similar high does not require baby at the teat. In a 2008 study in Pediatrics, researchers using human subjects showed moms pictures of their own baby, or someone else’s, along a spectrum from smiley to distressed (see figure on left). Those same dopamine pathways were activated in these human mothers, BUT only when they were shown pictures of their own babies, and only when the babies were smiling.

But, c’mon, did you need a scientist to tell you that your baby’s smiles are like crack?

At the end of the day, though, the joke is on us. Evolution has crafted tiny manipulation machines. All those cute baby features — chubby cheeks, big eyes, tiny noses, large foreheads — drive our most basic urge to cuddle and protect. Our brains instinctively respond to “baby schema,” a term coined by Konrad Lorenz, a Nobel Prize-winning zoologist famous for studying imprinting and having adorable photos of baby geese following him around and preening his beard. Even the guy’s guy can’t ignore a cute baby face. Go watch Three Men and a Baby for the not-so-scientific evidence. 

If you do want scientific evidence, a 2009 study in the Proceedings of the National Academy of Sciences documented which areas of the brain are activated when non-mothers were shown pictures of babies with enhanced or downplayed “baby schema”-typical features. Using manipulated pictures of babies either made “cuter” or, well, not so cute, the researchers were able to demonstrate that the cuter the baby, the more activated the area of the brain associated with anticipation of reward. The motivational drive to become caregivers to cute little critters runs deep in our animal instincts.

There you have it, humans. We all have a little bit of mommy brain! 

Happy Mother’s Day!

 

Lambert, K. G. The parental brain: Transformations and adaptations. Physiology and Behavior 107, 792–800 (2012).

Strathearn, L., Li, J., Fonagy, P. & Montague, P. R. What’s in a Smile? Maternal Brain Responses to Infant Facial Cues. PEDIATRICS 122, 40–51 (2008).

Ferris, Craig F., et al. Pup suckling is more rewarding than cocaine: evidence from functional magnetic resonance imaging and three-dimensional computational analysis. The Journal of Neuroscience 25.1, 149-156 (2005).

Glocker, M. L. et al. Baby schema modulates the brain reward system in nulliparous women. Proceedings of the National Academy of Sciences 106, 9115–9119 (2009).

On maternity leave… kinda

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It’s been almost three months from my last post.

Not so coincidentally, the babe (formerly known as “womb baby”) is approaching her three month birthday. 

While busy with the madness that is having a new (and very dependent) human in my life, tackling a new post for The Pregnant Scientist has been a bit tricky.  Instead, I decided to revisit and summarize seven of my favorite findings during this pregnancy. 

https://medium.com/science-and-its-communication/fca48a718d9f

I still have a lot of questions to ask and hope to start tackling new posts soon.  In the meantime, if you have any ideas/questions for upcoming posts, please leave a comment below!

My due date, by the numbers

Today is my due date.

But the hours are ticking down and the likelihood of a punctual baby is just about zero at this point.

I realized this might happen as soon as I found out I was pregnant.  My mom had three of us.  We were all late.  Very late.  I was three weeks late, my older sister was as well, and my little brother was induced after two weeks post date.

My husband likes to remind me that he was four weeks early, so maybe we will just cancel each other out and this baby will come right on time.  But I am convinced that it has nothing to do with him and that I am doomed to follow in my mother’s footsteps and carry this baby around for another three weeks (or until the doctor induces me).

So what is a “due date” and does our genetic make up have anything to do with it? 

An article that was published this summer in Human Reproduction entitled “Length of human pregnancy and contributors to its natural variation” by Jukic and colleagues highlighted the importance of not putting too much weight on set due dates.  By analyzing 125 pregnancies and calculating gestation age based on ovulation date rather than the less reliable date of last menstrual period, the researchers found that gestation length can vary quite a bit.  Over a 37 day span, to be more specific.  That puts the due date range for normal gestation length at five weeks!  The median gestation length was 38 weeks and 2 days (keep in mind that due dates calculated by the last menstrual period would tack on about 14 days – so this would be around 40 weeks for those with true 28 day cycles).  Basically, it wouldn’t be crazy if this baby came in two weeks, rather than, say, tomorrow.  UGH.

They also tried to figure out what exactly was leading to shortened or lengthened gestation time.  Although they were quite limited with their sample size, from the data they were able to mine, they did find that events in the first two weeks affected timing of delivery.  This related to the time it takes for the little ball of cells to implant itself into the uterine wall and also how fast the hormone progesterone increases in the circulation after conception.

Again, this study was quite limited with its sampling.  Of the 125 pregnant women included, 95% were high school educated white women. There were very few smokers and the average age was 29.  So, someone like me, a 32 year old, educated white non-smoker might be able to glean information from this study, but it is hard to predict what other factors could contribute to gestation length unless you fit this profile.

With that said, in this study, the mother’s own birth weight did show some correlation with the gestation length.  Since this was not true of the mother’s adult weight, it can be inferred that there is something going on with inheritance from the mother – whether it be on the fetal side (e.g. growth rate) or maternal side (e.g. uterus size, pelvic size).

What about the father?  Will the hubs’ jump-the-womb-ship-early genes cancel out my late bloomer genes?

A 2006 paper “Maternal and Paternal Influences on Length of Pregnancy” published in Obstetrics and Gynecology by Lie, Wilcox and Skjeorven considered the input from both parents.  Here the researchers combed the Medical Birth Registry in Norway to gather birth data for two generations.  From this massive data set, they found that several aspects of delivery date could be correlated with heritable traits from both the mother and the father.  For fathers, a higher birth weight correlated with a decreased gestation length for their babies but this did not hold true for the mother’s birth weight (in contrast with the Jukic et al. study). The authors suggest that fathers may pass down their fast growing baby genes and thus influence the timing of birth. However, comparing parental birth weight with baby birth weight, both parents showed a positive correlation. In addition, the gestation length for both mothers and fathers correlated with the gestation length of their babies.

Although these two correlating factors, parental birth weight vs. offspring birth weight and parental gestation length vs. offspring gestation length, were evident for both parents, the effect was twice as strong for the mothers.  Therefore, the mother’s genes appear to have twice the influence over birth weight and gestation length than the father’s.  The authors predict this uneven influence from the maternal side suggests that the delivery decision is split between the baby’s input and the baby maker’s input.  Here is their logic – the baby is half dad genes, half mom genes.  If it was solely fetal input setting the date, that baby would follow exactly in the parents footsteps with no maternal leaning. But this is not the case, the maternal side is more predictive of the outcome (nearly two-fold), therefore, there must be some additional input from the maternal side. And similar to what was suggested by Jukic et al., this could have to do with the inner workings of the maternal body as it carries and grows a tiny human.

So, can we predict when this baby is going to make her debut?

Here is the basic baby prediction math –
1/3 = super early baby genes from the hubs (4 weeks early)
1/3 = super late baby genes come from me (3 weeks late)
1/3 = super late baby maker machine (again, 3 weeks late)

While this might seem like I should expect this baby to arrive a little more than a week past my due date, to complicate this math even more, the correlations between mother/father/baby gestation length and birth weight are not one to one.  According to the Norwegian study, an extra week in parental time is not the equivalent of an extra week in baby time.  Rather an extra week for mother’s gestation length = 1.22 days; for the fathers, one extra week = 0.58 days.

Revised baby prediction math – (keeping in mind that maternal input and baby input from mom’s genes are indistinguishable for the week:day ratio)
super early baby genes                          – 4 (weeks) x 0.58 (days) = -2.32 days
super late baby/baby maker genes          3 (weeks) x 1.22 (days) =  3.66 days
———————————————————— ————————————————————
average                                                                                     =  0.67 days

Ok, so even if I give myself a bit more credit, this math suggests that the baby should arrive… tomorrow.

But, then again, these are averages, based on correlations, and I am not Norwegian.

And, really, this baby will probably just come out whenever she damn well feels like it.

I want my N2O! (or at least the option)

Fellow American preggos, we are being deprived and we didn’t even know it!

In that inevitable conversation of whether or not we are going to want pain medication during our labor and delivery, the only option that really comes to mind is the epidural.

But for most women across the world, the epidural is not the only analgesic pain relief option.  WHAT!?

Our fun times Saturday activity a few weeks ago was an all-day birth class.  Pretty typical stuff, lots of vaginas and babies trying to fit through spaces that seem impossible to navigate.  But one issue that came up, almost in passing, really stood out to me.  A fellow student asked the instructor about the “gas option” for pain relief.  Pretty sure every woman in the room leaned in with a very confused look on her face – thinking, what the hell is “the gas option”?

As explained by our instructor, the question referred to nitrous oxide.  And, no, the gas option was not available at our hospital nor was it available at >99.99% of the hospitals in this country.  Fortunately for us, here in the Bay Area, if this is something we really wanted, we could just go across the bridge to UCSF, one of the FIVE hospitals in the US that offers this option to laboring mothers.  Going across the Bay Bridge while in labor is not my idea of fun so I’ll forgo this opportunity, but I was intrigued.

Apparently, nitrous oxide (N2O, also known as “laughing gas”) is the most commonly used labor analgesic in the world – used by more than 60% of laboring women in the UK, 70% in Sweden!

First, how does it work?  It seems that the best “dose” of N2O is a 50:50 mix of nitrogen and oxygen, mixed immediately prior to inhalation.  It is self-administered – the woman holds up the mask and takes a puff any time she wants.  How it works, physiologically, is a bit murkier but the overall gist is that it effects the way pain is perceived in the brain. It is very temporary – it takes about 30 seconds to have an effect and it is cleared from the system within minutes.  It does not accumulate, it only goes through the lungs and never involves the liver so there are no bits left over from metabolism.

So how good is nitrous oxide for pain relief during labor and why is it not available to most of us here in the US?

A 2002 review by Dr. Mark Rosen, an obstetrician at UCSF, pointed out the basics of the benefits and the absurdity of the concerns [1].  In the review, he evaluated every scrap of scientific and clinical evidence he could find about the use and the study of nitrous oxide in labor pain management. Overall, what he found was that the literature was lacking.
(A more recent review demonstrates that this lack of information and sound, well-controlled studies is still a problem [2].  But I can imagine it is pretty difficult to ethically give a woman in labor a placebo pain medication, so designing that perfectly controlled experiment can be a bit tricky.)

With that said, there were some key points that Rosen could assert.  First, the concerns are stupid (my words, not his).  For the actual labor component, there is far less to worry about than pretty much any other medical option – N2O does not affect uterine contractions and it does not affect the newborn.  It can cause drowsiness – but the beauty of the self-administered system is that if the woman gets drowsy or starts to pass out, she drops the masks, inhales fresh air and, voila! drowsiness from the N2O is gone.  The main concerns really center around the gas getting out into the room and into the world.  Escape into the room exposes the health care workers BUT most of our hospitals these days have pretty damn good ventilation systems and the units for administering the N2O have scavenging systems in place to grab the escaped gas before it accumulates.  Plus, the mask only releases N2O when the patient takes a pull.  The second escape concern is that N2O is a potent greenhouse gas.  But as Judith Rooks points out in her 2007 article in the Journal of Midwifery & Women’s Health [3] “…it is clear that medical uses of N2O are a very small part of the problem. In summary, the global warming risks are valid but low relative to many less vital uses of N2O, including NASCAR races, the followers of which, however, have a more effective political voice than pregnant women in the United States, who might want to use N2O but who don’t even know about it as an option”.  Sing it, Judith!

Second, for the pain, well, let’s just say it’s no epidural.  According to Rosen, it has not been shown to be a potent labor analgesic, it does not eliminate pain, but it can provide “a sense of relief”.  And there are ways to improve the effectiveness of the pain relief; for example, learning how to time inhalation with contractions since it can take up to 30 seconds to kick in and does not last long after the mask is removed.  But, it is safe and it is adequate and most women who labor with access to N2O do not end up going for the stronger stuff.

As someone who studies stress, I am reminded of a classic stress experiment involving two rats, two tethered cages, two electrified floors, and one off lever to push. The electrified floor switches on unexpectedly, give both rats a little shock, and one of the rats has the ability to stop this pain by hitting the lever in its cage.  Same shock, same timing, same pain, but one rat has a sense of control over this pain and the other does not.  It is this sense of control that appears to be what saves this rat from the stress of the situation while the other rat turns into a stressed out mess (non-scientific terminology, of course).

By giving a laboring woman the option, the mask to hold in her hand to self-administer a little hit of possible pain relief, we are giving her control. We are lowering the stress of the situation. Why? WHY? Is this option not widely available or even known about in the US? The birth class instructor seems to think that it has something to do with money – no one makes money from an off-patent, inexpensive, old school gas option so who is going to promote it?  If this is actually the case, it would be another incredibly sad and f-ed up thing about the American Health Care System.

Personally, I am going to try to get through as much of labor as physically possible without medication.  I’m honestly curious about what it all feels like (all the mamas out there have one eyebrow raised with deep insight and skepticism).  But, man, I do wish I had the option of hitting some laughing gas rather than only having the option that involves a tube feeding nerve knockout juice past my spinal column.

1. Rosen MA. (2002) Nitrous oxide for relief of labor pain: A systematic review. Am J Obstet Gynecol;186(Suppl 5):S131–59.

2. Likis FE, Andrews JA, Collins MR, et al. (2012) Nitrous oxide for the management of labor pain. Comparative effectiveness review no. 67. AHRQ publication no. 12- EHC071-EF. Rockville (MD): Agency for Healthcare Research and Quality.

3. Rooks, J. P. (2007) Use of Nitrous oxide in Midwifery Practice – Complementary, Synergistic, and Needed in the United States. Journal of Midwifery & Women’s Health; 52 (3): 186-189.

Beyond the baby monitor

baby monitoring

Did I mention that I am currently part of a science experiment?

Sure, there is a sample size of one so I can’t promise a powerful data set coming out that would revolutionize how we think about pregnancy but maybe…

Anyway, as soon as I announced my pregnancy to the world last spring, a fellow postdoc, who is interested in biological rhythms in humans and other furry creatures, immediately jumped at the chance to make me a lab rat.  “Can I wire you up?”, he asked.

My first thought was that I was going to have electrodes attached all over my body for the next six months.  So, of course, I responded “Hell yeah!”

How could I resist?

Luckily, I do not have to wear multiple electrodes on my increasingly uncomfortable body, but I have been wearing an armband with a little data collector attached to it.  It is actually marketed for the much more lucrative fitness and weight loss industry (technically an “on-body monitoring system”) and it monitors aspects of everyday life from steps taken (your standard pedometer) to calories burned (changes in body temperature) to sleep patterns (are you laying still or moving around a lot).

So far, we have only peeked at the output with plans to really get into the data once the womb baby has joined the world. My predictions – my sleep will get progressively crappier (I can see that 3am wake up, toss and turn, and every additional midnight trip to the bathroom), the number of steps I will take will decrease and calories burned will …. well, that one will be interesting (Can we see if I’m actually “eating for two”?)

While I’m quite interested to see what information my friend can actually mine from this data set, I don’t have my hopes up too high.  It feels very limited.

But is there a way to glean even more information from our pregnant bodies?  A way to glean more information about this tiny stranger that we are building and carrying around inside our body for 9+ months? 

Looking around for this kind of technology it appears that there are quite a few things out there for understanding our own bodies… to some degree.  For example, fitness buffs and not-so-buffs looking to get into shape are using things like BodyMedia (what I currently have strapped to my arm), FitBit, and Jawbone UP.  Again, think fitness, these guys are really out for quantifying your physical output and come with handy apps to also keep track of your eating patterns, weight, etc.  They also claim to measure sleep “efficiency” but really they just rely on an accelerometer to say “ooh, movement! fitful sleep!” or “no movement, must be cruisin’ in deep sleep”.  Interesting, but not completely insightful (and maybe not even that accurate!)

In addition, there has been a burst of technology coming out to monitor babies’ bodies as well. Mimo, comes with a cute little “turtle” that attaches to a special electrode equipped onesie and tracks sleep trends and development and can also alert the parents about changes in breathing, sleep position, temperature, and waking patterns. Owlet, is a little foot cuff thing that tracks baby heart rate and oxygen levels.  Sproutling is another wearable for the baby’s ankle that monitors heart rate and breathing along with a base station that measure temperature and humidity in the room. Teddy the Guardian by iDerma is a special teddy bear that will take the kid’s temperature and oxygen saturation.  This one requires the kid to actually grab onto the bear’s paw for a reading.  With a name like Teddy the Guardian, I would actually be a little frightened that the thing might grab back, Poltergeist-style, so I don’t know about this one.

It is hard to escape the fact that we live in a world revolving around technology.  Through our keyboard, we literally have information at our fingertips (although, I must say, I am not impressed with much of the pregnancy “advice” coming up on Google).  Is monitoring our own bodies and our babies’ bodies the next step in the fully informed patient generation?

Is having access to this level of knowledge about your baby empowering or neuroses enabling?

What do we need to know?  What do we want to know?  Where is the line?

What can we learn about pregnancy if devices are available or adapted for pregnant women to track biological rhythms, changes in womb baby’s movement, heart rate, sleep cycles?

What can we learn about babies when more parents opt to go beyond the baby monitor and keep track of biological details of daily and nightly patterns?

Is this a pediatrician’s worst nightmare or previously unattainable dream?

As I prepare to make this transition from pregnant scientist to mommy scientist, I have just a few more questions for those of you who have gone through all of these stages already.  From what is available and what might become available, what is one thing you wish you could have monitored at any point during pregnancy or infancy?  What kept you up at night, checking on the baby (besides the screaming, feeding, changing part)? Would a little bit of tech have brought you peace of mind?  Or made you crazy?

And what the hell is the point of TweetPee?

Please leave comments below!