SCIENTIFIC AMERICAN REPORT: The U.S. Needs More Midwives for Better Maternity Care

For better birth outcomes, the U.S. should rethink maternity care

By THE EDITORS | Scientific American February 2019 Issue

(Please read full article at Scientific American:

Art by Ramona Ring for Scientific American. Go to

Art by Ramona Ring for Scientific American. Go to

Despite the astronomical sums that the U.S. spends on maternity care, mortality rates for women and infants are significantly higher in America than in other wealthy countries. And because of a shortage of hospitals and ob-gyns, especially in rural areas, many women struggle to access proper care during pregnancy. Moreover, the rate of cesarean sections is exceedingly high at 32 percent—the World Health Organization considers the ideal rate to be around 10 percent—and 13 percent of women report feeling pressured by their providers to have the procedure

Widespread adoption of midwife-directed care could alleviate all these problems. In many other developed countries, such as the U.K., France and Australia, midwifery is at least as common as care by obstetricians. In the U.S., certified midwives and nurse-midwives must hold a graduate degree from an institution accredited by the American College of Nurse-Midwives, and certified professional midwives must undergo at least two years of intensive training. This is designed to make midwives experts in normal physiological pregnancy and birth. Thus, for women with low-risk pregnancies who wish to deliver vaginally, it often makes sense to employ a midwife rather than a more costly surgeon. Yet only about 8 percent of U.S. births are attended by midwives.

The roots of America's aversion to midwifery go back to the late 1800s, when the advent of germ theory and anesthesia reduced much of the danger and discomfort associated with childbirth. The benefits of these technologies brought doctors to the forefront of maternity care and pushed midwives aside. Obstetricians helped to bar midwives from practicing in hospitals, which were now considered the safest birth settings. By the early 1960s midwifery was virtually obsolete.

It has made a comeback since then, with practitioners just as well trained as doctors to supervise uncomplicated deliveries. Studies show that midwife-attended births are as safe as physician-attended ones, and they are associated with lower rates of C-sections and other interventions that can be costly, risky and disruptive to the labor process. But midwifery still remains on the margins of maternity care in the U.S.

To bring it back into the mainstream, midwives must be fully integrated into the medical system. Some states currently refuse to recognize them as legitimate practitioners, and some severely limit what midwives are allowed to do, despite evidence that states with the most restrictive policies also have some of the highest rates of adverse birth outcomes, such as deaths of newborns. If midwives were allowed to work alongside other providers, patients would get the care advantages, and if difficulties arose, a woman whose home birth suddenly became complicated could be seamlessly transferred to a hospital. . . .

Please read full article at Scientific American:

TIME Magazine: First U.S. Baby Born After a Uterus Transplant


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For the first time in the United States, a woman who was born without a uterus gave birth to a baby. The landmark birth took place at Baylor University Medical Center at Dallas, a part of Baylor Scott & White, TIME reports exclusively.

Go to article at

“We’ve been preparing for this moment for a very long time,” says Dr. Liza Johannesson, an ob-gyn and uterus transplant surgeon at Baylor. “I think everyone had tears in their eyes when the baby came out. I did for sure.” The woman and her husband asked that their identity not be revealed in order to protect their privacy

The birth took place at Baylor — the first birth in the hospital’s ongoing uterus transplant clinical trial. Women who participate in the trial have what’s called absolute uterine factor infertility (AUI), which means their uterus is nonfunctioning or nonexistent. Most of the women in the trial have a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome — and have lived their entire lives under the assumption that they would never be able to be pregnant or give birth to a baby. The procedure could also work for women with other medical issues, such as certain cancers.

“We do transplants all day long,” says Dr. Giuliano Testa, the leader of the uterus transplant clinical trial at Baylor, and surgical chief of abdominal transplant for Baylor Annette C. and Harold C. Simmons Transplant Institute. “This is not the same thing. I totally underestimated what this type of transplant does for these women. What I’ve learned emotionally, I do not have the words to describe.”

The birth was a scheduled Caesarean section, and most members of the multidisciplinary clinical trial team were present. The baby was delivered healthy and screaming. “I’ve delivered a lot of babies, but this one was special,” says Dr. Robert T. Gunby Jr., the obstetrician and gynecologist who delivered the baby. “When I started my career we didn’t even have sonograms. Now we are putting in uteruses from someone else and getting a baby.”

The moment Dr. Gunby first held up the baby was emotional for many members of the medical team. “Outside my own children, this is the most excited I’ve ever been about any baby being born,” says Dr. Gregory J. McKenna, a transplant surgeon at Baylor. “I just started to cry.”

A donor’s gift

Taylor Siler, 36, a registered nurse in the Dallas area, donated her uterus to the woman who recently gave birth. Siler wasn’t always certain she wanted to have children, but she says deciding to get pregnant was one of her best decisions. “Once they lay that baby in your arms,” Siler says. “Your life changes forever.”

Siler, who has two boys aged 6 and 4, came across a news segment about Baylor’s uterus transplant program. She and her husband had already decided they were not going to have any more children, and she wanted to offer someone else a shot at motherhood. “I have family members who struggled to have babies, and it’s not fair,” says Siler. “I just think that if we can give more people that option, that’s an awesome thing.”

Siler went through extensive screening about both her physical and mental health before getting approval for the trial. Participating required surgery and about 12 weeks of recovery. Baylor says it typically takes about five hours for the wombs to be removed from the living donors, and another five to transplant.

Though she did not know the woman who received her uterus, Siler and the recipient exchanged letters on the day of the surgery, and the recipient sent Siler another letter to let her know when she was pregnant. Baylor informed Siler this week that the woman had given birth. “I’ve just been crying and getting teary thinking about it, “ says Siler, who had not yet met the new mother when she spoke to TIME. “I think about her every day and I probably will for the rest of my life.”

How a uterus transplant works

The women in the clinical trial are transplanted with a uterus from either a living or deceased donor. The woman who gave birth received her transplant from Siler, who was a so-called “altruistic” living donor: a stranger who volunteered to donate her uterus to a woman without one. So far, Baylor says they’ve had over 70 women express interest in donating their uterus.

Baylor will complete a total of 10 uterus transplants as part of its first trial. So far the hospital has completed eight. At least three have failed. The hospital has confirmed to Time that there is another woman in the trial who is pregnant, using a living donor uterus.

The baby's father rests his hand on the child.

Baylor University Medical Center at Dallas.

Baylor’s uterus transplant program is one of a handful to launch in the United States in recent years, and it’s the first to use both living and deceased donors. Successful uterus transplants from live donors have taken place in Sweden — a medical team at Sahlgrenska University Hospital in Gothenburg pioneered the first uterus transplant trial that resulted in eight births. This first birth at Baylor is the first to replicate that success.

Dr. Johannesson was part of the original uterus transplant team and has since moved to Texas in order to work on the Baylor program. “We were very proud of the first birth in Sweden,” she says. “But this birth is what’s going to make the field grow, because this is the first time this has been replicated anywhere else. This step is equally, if not even more, important.”

The recipients in the clinical trial are between the ages of 20 to 35, and the donors must be between ages 30 to 60. “When you donate a kidney, you do it to help someone live longer and get off dialysis,” says Dr. Testa. “For these women, they are donating an experience.”

Most of the women in the trial have moved to the Dallas area in order to undergo the procedures and the many follow up visits and tests. Once the women in the trial are transplanted with the uterus, they wait to recover and achieve menstruation, usually about four weeks from transplant. Women whose transplant is successful can then attempt in vitro fertilization (IVF). (The women in the trial have functioning ovaries that are not attached to their wombs, which is why IVF is required to get pregnant.)

Uterus transplants are expensive, with some estimates putting the cost at up to $500,000. Like other infertility treatments, it’s very rare that an insurance company would cover the procedure, which is largely viewed as elective. Baylor covered the cost of the first 10 transplants in the clinical trial, but the medical team is now seeking funding—largely through donations from institutions and private donors—in order to continue. The team says many more transplants need to be done before it could be provided as a standard treatment. “The reality is that it’s going to be very difficult for many women to afford this,” says Testa.

Go to article at

Newborn Guts Need Micro-Organisms!

By Paul Rogers / NYT

By Paul Rogers / NYT

There are a gazillion (OK I exaggerage) mico-organisms that live and breathe in the human body, making sure it stays on healthy track and influencing heavily not only each unique child'd future but the future of nations and the world.

Unfortunately, high rates cesarean deliveries in the United States and less than 100 percent breast-feeding rates have impacted the gut biome of a significant number of baby’s -- a scenario that research shows has lead to long-term health issues in children and adults, including asthma, allergies, celiac disease, Type 1 diabetes and obesity. Check out thei fascinating -- and scary -- article publishing in the New York Times this month by wrtier Jane E. Brody. Definitely gives us something to think about. Not all babies can breastfeed or be arrival via the vaginal canal. But are we doing all we can to protect the precious gut biome that determines a baby's future heath? Click on the article title below to read more!

The Importance of Infants' Exposure to Micro-Organisms / by Jane E. Brody



YES! Acupuncture REALLY DOES Relieve Pelvic & Low Back Pain in Late Pregnancy


It is always reassuring to read studies that show with confidence what your friends, midwife and other providers have been telling you: acupuncture works. Especially if you have lower back and pelvic pain, which are common in late pregnancy.  Take a look at what researchers who published in the journal of obestetrics in Scandanaia. To purchas the full article click here.


Researcher: Nina Kvorning Ternov
Department of Anesthesia and Intensive Care
Hospital of Helsingborg
Helsingborg, Sweden


Background.  The study was designed to evaluate the analgesic effect and possible adverse effects of acupuncture for pelvic and low-back pain during the last trimester of pregnancy.

Methods.  Following individual informed consent, 72 pregnant women reporting pelvic or low-back pain were randomized during pregnancy weeks 24–37 to an acupuncture group (n = 37) or to a control group (n = 35) at three maternity wards in southern Sweden. Traditional acupuncture points and local tender points (TP) were chosen according to individual pain patterns and stimulated once or twice a week until delivery or complete recovery in acupuncture patients. Control patients were given no sham stimulation. Throughout the study period each patient made weekly visual analog scale (VAS) evaluations of maximal and minimal pain intensity as well as three-point assessments of pain intensity during various activities.

Results.  During the study period, VAS scorings of pain intensity decreased over time in 60% of patients in the acupuncture group and in 14% of those in the control group (p < 0.01). At the end of the study period, 43% of the acupuncture patients were less bothered than initially by pain during activity compared with 9% of control patients (p < 0.01). No serious adverse effects of acupuncture were found in the patients, and there were no adverse effects at all in the infants.

Conclusion.  Acupuncture relieves low-back and pelvic pain without serious adverse effects in late pregnancy.

7 Tips for Great Smart Phone Photos of Your Baby


So you just bought a new fancy schmancy smart phone and you can’t wait to see how smart it really is -- especially given those billboards you see all over town promising that it will take the BEST photos EVER of your favorite restaurant dishes, your dog, and your brand new baby.

Take it from a professional -- you need more than a smart phone for smart (meaning beautiful) photos of your precious one(s). Here are some simple ways to help the camera in your new phone take photos you'll treasure forever:

#1 Take Photos During the Day -- Especially Indoors.

Yes, your new phone has a flash. And you could use the flash. People Do. But the truth is, they always hate those photos. That's because taking pictures in the dark, even with a flash, often results in ugly red-eye, harsh, unwanted shadows, garish skin tones and tons of grain. Not to mention, cranky, startled babies!

So instead of sub-par night shots, look for the the daytime sun spots around the house -- they will change throughout the day as the light moves around your abode though windows or other light sources. Indirect light is best -- through a window for example or one of those IKEA lamps that directs light upward to bounce off of the walls or ceiling to light the room. Be sure to face your baby toward the light. For example if lush light is wafting through the window in the living room, face your baby toward the window to get the best lit shot.

Follow the light in your house. Usually face the baby toward the window or light source. In this case we have shot the photo with the baby in front of the window to create a silouette and halo.

Follow the light in your house. Usually face the baby toward the window or light source. In this case we have shot the photo with the baby in front of the window to create a silouette and halo.

#2 The Best Outfits Are Simple and Comfortable.

Every new baby receives ugly, itchy outfits from their loving relatives and you may feel obliged to have your sweet baby wear them in your smart phone fashion shoot. Toss that guilt out the window -- that same window you're going to be taking gorgeous photos of your baby in front of. Remember, photos are forever! Babies are happier if they are comfortable, so skip grandma's hand-knit wool matinee jacket and scratchy caps and pull out the soft comfy clothes your baby can move around in. While you are at it, avoid plaids, small dots, stripes and brand labels (those are just tacky!)

Dress that baby in SIMPLE clothes and colors -- no strips, dots, logos!

Dress that baby in SIMPLE clothes and colors -- no strips, dots, logos!

#3 Go Horizontal

Unless you are trying to capture your baby climbing a palm tree like a baby sloth, don't shoot with the camera in the vertical position. Photos taken in the horizontal (wide) position are best and give ample space to catching your baby in action -- reaching, waving, stretching out. And don't forget to zoom in now and then, close up on his face or her tiny foot or hand.

Stay horizontal, unless you like tall skinny photos.

Stay horizontal, unless you like tall skinny photos.

#4 Don’t Say "Smile!" To Your Baby or Whoever is Holding Him or Her

There is nothing more counter-productive (or forced) than telling someone to smile for the camera. Instead think of something else to say, anything else, whether the subject of your photos is a baby or a grown up.  Get their attention with a joke or a surprise word or move and help them smile spontaneously! Be imaginative. Use humor. Do something silly. For a baby, Peek-a-Boo works EVERY TIME!

Shoot quick -- that real smile is fleeting. You've got to get that shot before your subjects (at least the older ones) realize they are on camera and return to the fake, forced smiles.

#5 Remember the Rule of Thirds

Break your camera screen into thirds horizontally and vertically. Try to get your baby's face into any one of those thirds but the middle one. That middle square makes it a mug shot. The others make it art!

Here's the technical meaning of this phrase (thank you wikipedia): The rule of thirds is applied by aligning a subject with the guide lines and their intersection points, placing the horizon on the top or bottom line, or allowing linear features in the image to flow from section to section. The picture on the left is BAD. See the rock right in the middle of the phone? The picture on the right is following the rule. It's more interesting. By placing the rock in an outer third it the eye is led into the photo. 

BAD&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; GOOD

BAD                                                                                  GOOD

Rule of Thirds: This baby's face follows the rule! It is in the top right third of the frame.

Rule of Thirds: This baby's face follows the rule! It is in the top right third of the frame.

#6 Shoot Your Baby From Above

Oops we it's vertical but we're above this cute baby!

Oops we it's vertical but we're above this cute baby!

You have that sweet little thing in front of you and it's easy to forget your are bigger and taller than the baby!

Shoot from above. Put your baby in a basket and shoot down at her. A lot of professional photographers will climb up on a ladder and literally shoot down at those little angels you see on calendars.

If you DO climb up on a ladder over your newborn, of course exercise common sense. Be sure someone is holding the ladder.

And of course be sure you have your smart phone attached to your body somehow. someway -- by lanyard perhaps or taped to your palm if needbe. She's not going to smille if you drop your smart phone on her super smart brow.

Getting above your baby truly makes for some awesome newborn pictures!

Shoot from above!

Shoot from above!

#7 Print Print Print

Back up your phone frequently and make sure you print the photos you capture on your phone. Making printing a monthly task. Put it on your calendar and set aside and hour to gleen and pick and sent to print. Consider creating a photo book. A simple Google of Photobooks will give you lots of easy options for creating and printing photobooks online.

Birth Doula and Photographer

Probiotics in Pregnancy May Help Prevent Preemies & Life Threatening Pre-Eclamsia

Republished from / Source: BMJ (Medical Research Journal collective)

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Premature babies often need time to grow in incubators.

Premature babies often need time to grow in incubators.

Probiotics taken during pregnancy might help lower the risks of pre-eclampsia and premature birth, suggests observational research in the online journal BMJ Open. But timing may be crucial, the findings indicate.

Pre-eclampsia, a condition in which the mother's body mounts an exaggerated inflammatory response, affects up to 8 percent of all pregnancies, and can lead to severe complications for both mother and baby.

Premature birth (before 37 weeks) is a leading cause of illness and disability among the children born, affecting nearly one in 10 births in the US.

A growing body of evidence suggests that the mother's diet influences the outcome of pregnancy. And previous research has suggested that probiotics -- live bacteria and yeasts thought to promote good health -- might reduce certain complications of pregnancy.

To find out whether the timing of intake might be influential, the researchers used data on more than 70,000 pregnancies from the Norwegian Mother and Child Cohort Study (MoBa).

As part of the MoBa study, mums-to-be provided information on their diet, lifestyle, medical history, and other relevant background factors at 15, 22, and 30 weeks of pregnancy.

At 15 and 30 weeks, the questions included additional information on intake of different milk products containing probiotic bacteria before and during their pregnancy.

Nearly one in four (just over 23%; 6502) women said they had consumed probiotic milk products before their pregnancy; more than a third (over 37%; 11,221) had done so during early pregnancy; and a similar proportion (just over 32%; 12,784) had done so late on.

Intake of probiotic milk products was more common among older, more affluent and better educated women, who were pregnant for the first time.

Among the 37,050 women included in the pre-eclampsia analysis, the condition was diagnosed in one in 20 (5%; 1851). In 550 of these cases, it was severe. Probiotic intake was associated with a 20 percent lower risk of the condition, but only during late pregnancy.

And when differences between the severity of pre-eclampsia were looked at separately this association was significant only for those whose condition was severe.

Among the 34,458 women included in the premature birth analysis, 2858 babies were born early, some 1795 of which were spontaneous premature births, and 1065 of which were iatrogenic -- in other words, caused by the consequences of medical treatment.

A significant association emerged between probiotic intake during early pregnancy and an 11 percent lower risk of premature birth, rising to 27 percent for preterm birth late in the pregnancy.

The amount of probiotic consumed didn't seem to make any difference, the findings showed.

This is an observational study, so no firm conclusions can be drawn about cause and effect, nor were the researchers able to account for strain viability or shelf life, both of which may have influenced the findings. Further research is required, they emphasise.

Nevertheless, they conclude: "If future randomised controlled studies support a protective effect of probiotic consumption on reduced risk of pre-eclampsia and preterm delivery, recommending [it] would be a promising public health measure to prevent these adverse pregnancy outcomes."

Story Source:

Materials provided by BMJNote: Content may be edited for style and length.

Journal Reference:

  1. Mahsa Nordqvist, Bo Jacobsson, Anne-Lise Brantsæter, Ronny Myhre, Staffan Nilsson, Verena Sengpiel. Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in NorwayBMJ Open, 2018; 8 (1): e018021 DOI: 10.1136/bmjopen-2017-018021


Breastfeeding Safe Herbs & Supplments That May Keep Postpartum Mood Disorders at Bay

Skullcap -- an herb that may help reduce anxiety and stress during the postpartum period.

Skullcap -- an herb that may help reduce anxiety and stress during the postpartum period.

I've been asked by a lot of mothers experiencing the first symptoms of a possible postpartum mood disorder (PPMD) if there are any natural remedies to nip it in the bud or get on top of a budding problem. The answer is, if you think you are facing or experiencing a postpartum mood disorder (whether it's mild depression or something more ominous) consult with your primary care provider immediately -- that is your midwife, OB, family practice doctor or therapist. Don't let it linger. As you seek help, know this:

No woman should have to suffer in silence.

You are not broken.

You are not a bad mother.

You simply  may be one of millions of women whose hormomes and the unhealthy work-focused push of our society have manifested in a very real syndrome.

That said there are natural ways to approach PPMD. The following herbs and supplements may help and have been found to be safe while breastfeeding as long as you are taking them under the advisement care of a medical or naturopathic doctor..

NOTE: Before you take any of the following, consult with your doctor and a reputable, certified doctor of Chinese Medicine or Certfied Herbalist. Don't dose yourself by guessing.


  • Vitex helps to balance the hormonal cycle.
  • Motherwort can positively uplist mood
  • Camomile and scullcap are know anxiety reducers
  • Oats for emotional balance
  • St. Johns work is a powerful herbal antidepressant and should be taken under the direction of a ND or MD
  • Enhaling Lavender, or Lemon balm essential oil may help with emotional balance


  • Omega 3 fatty acids, such as those found in fish oil help to prevent and treat low mood, depression or other forms of PPMD
  • Calcium and Magnesium
  • Vitamin D
  • Folic acid as found in prenatal vitamin (which you should continue to take while nursing) or through deep, leafy greens
  • Sun. Yes, sit in the sun a lot (with sunscreen of course). Sun is loaded with Vitamin D, lack of which is definitely indicated in ALL mood and depression issues, not just postpartum mood concerns.

For more information, check out this great article by Dr. Kathleen Kendall-Tackket, an IBCLC certified lactation consultant.:

NYT Article: Pollution May Harm Babies InUtero

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Air pollution may be harmful to babies even before they are born, a new study has found.

Researchers in London calculated mothers’ exposure to air pollution and traffic noise in various parts of the city from 2006 to 2010. Then they amassed data on birth weights of 540,365 babies born during those years to women who lived in those areas.

The average pollution exposure was 14 micrograms per cubic meter of PM 2.5, the tiny particles that easily enter the smallest airways in the lungs. The researchers found that for each 5 microgram per cubic meter increase in PM 2.5, the risk of low birth weight increased by 15 percent. Low birth weight is a predictor of an increased risk for diabetes, heart disease and hypertension in later life.


The study, in BMJ, found no effect of traffic noise on birth weight.

The Environmental Protection Agency standard for PM 2.5 is 12 micrograms per cubic meter averaged over three years, and the World Health Organization suggests 10 as a limit. But the lead author, Mireille B. Toledano, an epidemiologist at Imperial College London, said that there really is no safe level of air pollution.

“For every 10 percent reduction in PM 2.5,” she said, “we can prevent 90 babies being born with low birth weight in London. The current limits are not protecting pregnant women, and they’re not protecting unborn babies.”

A version of this article appears in print on December 12, 2017, on Page D6 of the New York edition with the headline: Pregnancy: Unborn Babies and Polluted Air. Order ReprintsToday's Paper|Subscribe

Count Your Baby's Kicks

Counting kicks is easy to do.  It's important too! According to the information posted at, counting can save your baby's life. 

When you start your 3rd trimester, it’s time to start counting.

 Here’s how you do it:

  • Count the Kicks every day, preferably at the same time.
  • Pick your time based on when your baby is usually active, such as after a snack or meal.
  • Make sure your baby is awake first; walking, pushing on your tummy or having a cold drink are good wake-up calls.
  • To get started, sit with your feet up or lie on your side. Count each of your baby’s movements as one kick, and count until you reach 10 kicks.  After a few days you will be to see a pattern for your baby.  
  • Most of the time it will take less than a half-hour, but it could take as long as two hours.
  • Log your recorded times using our Count the Kicks App or a kick chart.

Why count kicks? The research is clear it could save your baby's life:

Research Citations

Click the links below to learn more.

Reduction of Late Stillbirth

Holm Tveit JV SE, Stray-Pedersen B, Bordahl PE, Flenady V, Fretts R, Froen JF: Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement. BMC Pregnancy Childbirth 2009, 9(32).

Fourteen hospitals in Norway participated in this study which aimed to improve care by providing written information to pregnant women about Decreased Fetal Movement and to provide guidelines on Decreased Fetal Movement to health care providers. There was an overall decrease of stillbirths by 1/3, with no increase of preterm births, or need for neonatal care.

ACOG Committee on Practice Bulletins with the Assistance of Ruth C Fretts: ACOG practice bulletin: Clinical management guidelines for Obstetrician-Gynecologists 102 03/2009: Obstet Gynecol 113: 748-761

Fretts R , Duru U: New indications for antepartum testing: Making the case for antepartum surveillance or timed delivery for women of advanced maternal age. Semin Perinatol 32:312-317, 2008 [PubMed-indexed for MEDLINE]

Froen JF, Heazell A, et al: Fetal movement assessment. Semin Perinatol 32:243-246, 2008 [PubMed-indexed for MEDLINE]

Froen JF, Tveit JV, et al: Management of decreased fetal movements. Semin Perinatol 32: 307-311, 2008 [PubMed-indexed for MEDLINE]

Fretts R: Stillbirth: Common causes and prevention strategies. Forum 25: 8-1-, 2007 [PubMed-indexed for MEDLINE]

Guidelines for Perinatal Care, 6th Edition, 2007, American Academy of Pediatrics and American College of Obstetricians and Gynecologists, page 114 (under paragraph entitled Assessment of Fetal Movement): "The perception of 10 distinct movements in a period of up to 2 hours is considered reassuring. After 10 movements have been perceived, the count can be discontinued for that day."

Reddy U: Prediction and prevention of recurrent stillbirth. Obstet Gynecol 1151-1164, 2007 [PubMed-indexed for MEDLINE]

Froen JF: A kick from within-fetal movement counting and the cancelled progress in antenatal care. J Perinat Med 32:13-24, 2004 [PubMed-indexed for MEDLINE]

Study of Maternal Observations and Memories of Stillbirths (MOMS Study)

5000 moms with stillbirths participated in answering questions regarding their pregnancy. 50% of the moms reported gradual decreased fetal movement several days prior to death. 56% of moms reported that this decreased movement was the first reason to believe that there was something wrong.

Fetal Movement Intervention Assessment (FEMINA)

FEMINA8 (Fetal Movement Intervention Assessment) is an ongoing international research collaboration to improve pregnancy outcome through better understanding of reduced fetal activity. Froen previously reported that 50% of mothers waited more than 24 hours without any fetal activity before contacting their doctor – 30% waited more than 48 hours.

Stillbirth Collaborative Research Network (SCRN)

Dr. Uma Reddy from the National Institute of Health (NIH), is leading the Stillbirth Collaborative Research Network (SCRN). This 5 year study will determine the incidence of stillbirth, determine risk factors and uncover the causes of stillbirth using a standard protocol that will review clinical history, protocols for pathologic examinations of the fetus and placenta.

It’s a great way to bond with your baby. Most importantly, it could save your baby’s life.

Lactivism - New Book Questions Breastfeeding Advantages

I was listening to NPR the other day when I heard this story about the new book by political scientist Courtney Jung, Lactivism. Throughout the interview, Ms. Jung made statements that made my blood boil. While there may be bits of research out there that question the advantages of breastfeeding, the vast majority of it supports nursing as highly beneficial to both mother and baby. That does not mean every woman can or should nurse and I don't know many breastfeeding advocates who believe that every woman should or can. In 20 years as a birth worker, I have rarely seen the kind of pressure that Ms. Jung describes being exerted on women to nurse at all cost. Generally I see the opposite. Women are encouraged to try it (after generations of being told not to) and then given very little support to continue if or when it gets rough. The book and Ms. Jung's statements are often misleading non-science and opinion. I found the NPR conversation with Ms. Jung decidedly one-sided. What are your thoughts?

Click here to listen:

Harper's Magazine: The Case Against Pregnancy Bed Rest

The Bed-Rest Hoax

The case against a venerable pregnancy treatment

By Alexandra Kleeman

After just a couple of days on bed rest, the material of your body begins to feel different: softer, heavier, a burden to the bone beneath. The thud of the heart in the chest feels deeper: each beat shifts your frame a little. Even though you haven’t used your back for anything, it aches — and when you twist into a new position the ache swivels along with the muscles, can’t be left behind. You fall asleep throughout the day but can’t sleep through the night, and when you bend a limb at the joint, it’s not the transparent sensation you’re used to — you can feel the muscles tugging, the socket creaking in protest. Your body becomes more present, weaker, and more vulnerable: you are aware of it as though it were an alarm that has not yet gone off but could at any moment.

This summer, I checked myself into a progressive Catholic convent in the Pacific Northwest to observe the effects of five days of bed rest on my body and mind. My plan was to spend all but thirty minutes of each day in a small room with framed Bible verses on the walls, lying on my back or side on a spartan twin-size cot. In the thirty minutes I was allowed out of bed, I would shower, take bathroom breaks, or fetch food from the communal kitchen to bring back and eat in bed. In the final moments before my experiment began, I stretched the inner muscles of my thighs and blinked in the warm sunlight. I tried to take pleasure in feeling ordinary, normal, mobile.

Though five days is a relatively short bed-rest regimen, the first week is when some of the most dramatic changes to the body occur. Deconditioning of the cardiovascular system begins within forty-eight hours. The amount of circulating blood decreases, the heart’s total output drops, and the body uses less and less oxygen. Within five days of immobilization, the arteries narrow and stiffen, and the interior lining of the blood vessels becomes less able to flex and tighten.

Illustrations by Shonagh Rae

The body scales itself down rapidly to meet the reduced physiological demands of its new state and then pauses. Eventually, over weeks, bone density decreases and muscle volume declines. Actin and myosin, the proteins that make up muscle, break down into free-floating nitrogen that is flushed from the body through the kidneys. Simply standing up can cause fainting, since the body is no longer used to pumping blood against the pull of gravity.

Hundreds of thousands of years of evolution have enabled us to walk upright, a task few other mammals can manage — sheep and rabbits often lose consciousness or die when held vertical. But the more time a body spends away from plumb, the greater its difficulty in readapting to normal life. For this reason, bed rest is used as an analogue for space travel in NASA experiments: the effect of weightlessness on human bodies can be simulated on Earth by putting subjects to bed at a six-degree negative incline. Prolonged rest is an extreme physiological challenge, a new environment for the body to navigate.

What I’ve described sounds like a sort of bodily erosion, a slow injury or gentle decay, but it also happens to be one of the most commonly prescribed treatments in the United States for pregnant women at risk of preterm birth. Each year as many as 700,000 pregnant women are prescribed some form of bed rest: from several hours a day to round-the-clock immobilization with breaks only to use the bathroom. For some types of high-risk pregnancy, the mother-to-be is hospitalized and prohibited from getting up to relieve or clean herself, from standing, or even from sitting propped up in bed. Strict bed rest — whether at home or in a hospital — often means that a woman has to forfeit exercise, income, and normal domestic tasks such as caring for her family or maintaining her home.

The practice continues despite a growing body of clinical evidence showing that strict bed rest offers no benefits to the fetus or to the mother. It has not been proved effective in treating gestational hypertension, preeclampsia, a shortened cervix, spontaneous abortion, or impaired fetal growth. The hazards of bed rest, on the other hand, are well substantiated: patients may suffer from bone loss, blood clots, muscle atrophy, weight loss, and psychological malaise. Enrollment in one study, in which women carrying twins were randomly admitted to the hospital for bed rest or assigned outpatient care with no activity restriction, was halted midway because of concerns about a possible detrimental effect to the hospitalized group.

Even so, bed rest remains a routine therapeutic intervention for pregnancy, with up to 95 percent of obstetricians reporting that they’ve prescribed it for their patients. Decades after the treatment fell out of favor for other conditions, pregnancy is the last remaining medical territory to which bed rest can lay claim. It is now the domain of those physi cally incapable of movement — those, for example, who have broken all their limbs — and expectant mothers.



The Mama Sherpas / A Great Documentary About How to Get the Birth You Want

Looking for a film that offers hope for better, less intervention heavy birth in the hospital and is NOT all about home birth or midwives? Ricki Lake and Abbey Epstein, the producers of The Business of Being Born and the documentary Breastmilk are back at with The Mama Sherpas, a documentary focused entirely on birth in the medical setting. But you won't just see the emergency C-section here -- you'll see that, yes, but also a water birth, a VBAC, a vaginal breech delivery all safely achieved. Check out Jessica Hartshorn's review in Parents Magazine by clicking on the URL or scrolling down the page:

"There is the way you picture your birth going, and then the way itactually goes, and rarely are those two the same.

But the premise of a new documentary called The Mama Sherpasis that maybe, perhaps, our country can inch toward a model where mothers work with both midwives and doctors to have births that are more comfortable, calm, and less of a surprise than, say, the emergency C-sections we so frequently hear about, or the induced births.

Because the documentary is executive-produced by Ricki Lake and Abby Epstein, the team behind The Business of Being Born (and the executive producers of the documentary Breastmilk) I first thought The Mama Sherpas might be another championing of home births and natural-everything. But it's entirely focused on several medical centers where doctors and midwives work side-by-side, in medical settings. There is always an emergency team on the premises if needed, which is reassuring as you watch, for instance, a woman attempt (successfully!) a vaginal breech birth.

Related: Is a Certified Nurse-Midwife Right for You?

The film chronicles plenty of mamas' labors—yes, there is a C-section, and yes, there is a water birth, and everything in between. The director, Brigid Maher, was motivated to do the film on her quest for a VBAC, a vaginal birth after having had a Caesarean, and she is entirely understanding of the fact that there is a time and place for every kind of medical intervention. Her objection is to women being pushed into a birth they don't want strictly for the convenience of the doctors and hospital staff. And her love of midwives seems to come from the fact that they are able to devote more time and patience to educating their clients, explaining when something is necessary and when it is a choice.

The takeaway, if you're pregnant or planning to have another baby, is that finding a midwife who will assist your birth is, at the very least, likely to give you more options than you would probably have working only with doctors and nurses whose job is to standardize the births they facilitate.

Use the firm to be inspired to ask questions, and to appreciate that perhaps we can all have a little more control of our births than we think. It will be available on DVD ($19.99) and iTunes($4.99 to rent) tomorrow, July 21. In the meantime you can watch the trailer or check them out on Facebook to follow the rollout of the film."

Jessica Hartshorn has been an editor at American Baby magazine for 17 years and yet is still sort of shocked when watching video footage of babies being born.

Never EVER Shake a Baby - A NYT Article Every New Parent Should Read

Shaken Baby Syndrome: A Diagnosis That Divides the Medical World - The New York Times

SEPT. 13, 2015

Perhaps no crime staggers the mind, or turns the stomach, more than the
murder of a baby, and so it is not a surprise when law enforcement comes
down hard on the presumed killers. Often enough, these are men and women
accused of having succumbed to sudden rage or simmering frustration and
literally shaken the life out of a helpless infant who would not stop crying or
would not fall asleep.
Shaken baby syndrome has been a recognized diagnosis for several
decades, though many medical professionals now prefer the term abusive head

It is defined by a constellation of symptoms known as the triad: brain
swelling, bleeding on the surface of the brain and bleeding behind the eyes.
For years, those three symptoms by themselves were uniformly accepted as
evidence that a crime had been committed, even in the absence of bruises,
broken bones or other signs of abuse. While many doctors, maybe most, still
swear by the diagnosis, a growing number have lost faith. Not that they doubt
that some babies have been abused. But these skeptics assert that factors other
than shaking, and having nothing to do with criminal behavior, may sometimes explain the triad.

Has the syndrome been diagnosed too liberally? Are some innocent
parents and other caretakers being wrongly sent to prison? Those questions, at
the complex intersection of medicine and the law, can stir strong emotions
among doctors, parents and prosecutors. They shape this first installment in a
new series of Retro Report, video documentaries that explore major news
stories of the past and their enduring consequences.

The video’s starting point is a Massachusetts criminal case that
introduced the concept of shaken baby syndrome to many Americans: the 1997
murder trial of Louise Woodward, an 18-year-old British au pair accused of
having shaken an 8-month-old boy, Matthew Eappen, so aggressively that he
died. Matthew also had injuries that may have predated Ms. Woodward’s
joining the Eappen family in Newton, outside Boston. The focus, however, was
on the triad of symptoms. To prosecution witnesses, they proved that the baby
had been shaken violently, his head hitting some hard surface.

Throughout, Ms. Woodward insisted on her innocence. But a jury in state
court found her guilty of second-degree murder, and she was sentenced to a
prison term of 15 years to life. Within days, though, the trial judge called the
murder conviction an injustice. He knocked down the charge to involuntary
manslaughter, reducing the young woman’s sentence to time already served,
279 days. Many in Massachusetts and beyond were outraged. Nonetheless, Ms.
Woodward was free to return to England.

The “nanny murder trial,” as headline writers called it, had an unfortunate
subplot. In some quarters of public opinion, Matthew’s mother, Deborah
Eappen, stood figuratively in the dock as well. A doctor — like her husband,
Sunil Eappen — she found herself under the sort of attack many working
women face to this day. The case, a New York Times article said in 1997, “put a
spotlight on the backlash against working mothers who consign their children
to the care of others.”

But the dominant issue was child abuse. Shaken baby syndrome is but one
aspect of this phenomenon. It is a topic in which statistics can be elusive
because reported episodes may not reflect the full extent of the problem. That
said, a report issued in April by a division of the Department of Health and
Human Services estimated that in 2013, more than 1,500 children in the
United States, or four a day, died from various forms of abuse or neglect.
Nearly three-fourths of the victims were under the age of 3. (Various studies
over the years have suggested that a serious threat to a small child’s well-being
is the presence of the mother’s live-in boyfriend.)

In the Woodward trial, a key prosecution witness was Dr. Patrick Barnes,
a neuroradiologist then at Children’s Hospital in Boston, now at Stanford
University. “I was adamant that it had to be child abuse, shaken baby
syndrome,” Dr. Barnes told Retro Report.

But after the trial, he rethought his testimony and in effect became a
penitent. He is now convinced that the diagnosis has been invoked too readily
in criminal cases and that other causes might explain any bleeding and brain
swelling. They include infections, earlier injuries from accidental falls and
even strokes that occurred in utero. Other doctors who share his outlook
question whether just shaking an infant, without resorting to other forms of
violence, could in fact produce the triad’s telltale signs. Testing that thesis,
though, may verge on the impossible: Who in the name of responsible science
is about to shake a roomful of babies to see what happens?
Without question, Dr. Barnes said, abuse exists, “and we have to do our
duty to protect children.” But families need protection, too, he said, and in
some criminal cases, “there is no doubt that errors have been made and
injustices have resulted.” Were he able to testify again in the Woodward trial,
he said, he would say that the medical findings do not confirm abuse and that
the baby’s injuries “could have been accidental.”

One of the more exhaustive studies of shaken baby syndrome’s legal
ramifications was conducted by The Washington Post and journalists from the
Medill Justice Project at Northwestern University. In March, they published
their analysis of about 1,800 abuse cases across the country that had reached
resolution since 2001. Far more often than not — 1,600 cases — the result was
a conviction. But the researchers found that in 200 cases, a substantial
number, charges were dropped or dismissed, defendants were acquitted or
convictions were overturned. The Retro Report video examines one such
instance, involving Quentin Stone, a California man whom a jury last year
cleared of charges that he had violently shaken his 3-month-old son to death.
Not that the medical establishment is starting to line up on Dr. Barnes’s
side. Far from it. Dr. Robert W. Block, a former president of the American
Academy of Pediatrics, stands firmly by the diagnosis, telling Retro Report
that abusive head trauma is supported by decades of observation.
The divisions within the medical world run so deep that they pain a
towering figure on this issue: Dr. A. Norman Guthkelch, a British doctor who
in 1971 found a connection between baby-shaking and brain injury. “There are
cases where people on both sides, both of whom I admire equally, are barely
able to speak to one another, and that’s a shame,” Dr. Guthkelch, who turned
100 this month, told NPR in 2011. Yet he, too, has come to believe that the
syndrome is applied too loosely in some criminal cases.

As the debate continues, Louise Woodward has carved out a new life in
Shropshire, in central England, where she teaches dance. Married, she has a
baby of her own now, a girl born 20 months ago. Even before her pregnancy,
she was quoted as telling The Daily Mail: “I know there are some people
waiting for me to have a baby so they can say nasty things. It upsets me, but
that is not going to stop me leading my life. I am innocent. I have done nothing

The videos with this article are part of a documentary series presented by The
New York Times. The video project was started with a grant from Christopher
Buck. Retro Report has a staff of 13 journalists and 10 contributors led by Kyra
Darnton. It is a nonprofit video news organization that aims to provide a
thoughtful counterweight to today’s 24/7 news cycle. Previous episodes are at To suggest ideas for future reports, email
© 2015 The New York Times Company

The Bottom Line: NEVER, EVER shake a baby. If you feel frustrated or overwhelmed by your baby's crying, call someone -- a friend, a family member or other helpful connection. Learn more about the Purple Period Program at

Go to 


Understanding the Purple Period of Crying

Learn more about why your newborn may be crying at

The Period of PURPLE Crying begins at about 2 weeks of age and continues until about 3-4 months of age. There are other common characteristics of this phase, or period, which are better described by the acronym PURPLE. All babies go through this period. It is during this time that some babies can cry a lot and some far less, but they all go through it.

Scientists decided to look at different animal species to see if they go through this developmental stage. So far, all breast feeding animals tested do have a similar developmental stage of crying more in the first months of life as human babies do.

When these babies are going through this period they seem to resist soothing. Nothing helps. Even though certain soothing methods may help when they are simply fussy or crying, bouts of inconsolable crying are different. Nothing seems to soothe them.

During this phase of a baby's life they can cry for hours and still be healthy and normal. Parents often think there must be something wrong or they would not be crying like this. However, even after a check-up from the doctor which shows the baby is healthy they still go home and cry for hours, night after night. "It was so discouraging," said one dad. "Our baby giggles and seems fine during the day and almost like clockwork, he starts crying around 6 pm. He is growing and healthy, so why does he cry like this?"

Often parents say their baby looks like he or she is in pain. They think they must be, or why would they cry so much. Babies who are going through this period can act like they are in pain even when they are not.

In my own case, I know my son was not sick. He was in the top percentile for growth, he giggled and was happy other times Then he would start to cry, and cry, and cry. The doctor kept telling me he is just fine.

After learning all of this, we decided we needed to share this information with other parents. We had to take this information and put it into a statement that told the story about this phase in a baby's life. Dr. Ronald Barr, a developmental pediatrician who has likely done more studies on infant crying than anyone in the world, came up with the phrase the Period of PURPLE Crying. His idea was to explain this phase to parents of new babies so they would know it was normal and they would be encouraged that it would come to an end.

The acronym PURPLE is used to describe specific characteristics of an infant's crying during this phase and let parents and caregivers know that what they are experiencing is indeed normal and, although frustrating, is simply a phase in their child's development that will pass. The word Period is important because it tells parents that it is only temporary and will come to an end.

- See more at: