Saturday, October 31, 2009

Birth Among Dolphins

I swam with (wild) dolphins in the warm waters South of Cabo when I was pregnant and I certainly found it to be true that these creatures gravitated to me more than the other non-pregnant friends I was with. The dolphins seemed to be able to sense my child growing within. There are few things I have enjoyed more than swimming amidst these wise, peaceful creatures, and I can't say I haven't thought a time or two about an ocean birth myself... ;)

Currently, the Dolphin Attended Water and Natural Birth Center is underway in Hawaii. It sounds interesting, and yet the way that dolphins are treated (and captured/kept in captivity) around the world is rather alarming when you look into it. The recent film, The Cove, takes a brutally honest look into the 'swim with dolphin' programs, as well as the sale of mercury-filled dolphin meat around the world. I have to wonder if these 'birth with dolphin' ideas are along those same lines?



So, what do you all think?

Does anyone have more info on this particular video?




Debbie King wrote about another birth with dolphins:

Sarah Evans reached out, gently stroking the dolphin's side. Her labour pangs subsided as she breathed deeply, relaxing in the warm waters of the Red Sea.

Despite opposition from the Israeli authorities, Sarah had decided to go ahead and give birth with the dolphins to 'help' her. And although she had reservations about the lack of hospital facilities available if anything went wrong, within three hours she was holding a healthy baby son.

Sarah had flown out to the Israeli resort of Eilat specifically to give birth with dolphins in the Red Sea. She was one of six pregnant women and a team of doctors, therapists and masseurs who flew to Eilat after months of preparation by London obstetrician Dr. Gowri Motha. The idea was for the dolphins to act as aquatic 'midwives', helping the women to have a tranquil labour.

But the Israeli authorities were not impressed by the idea of the controversial births. Concerned for the safety of the women and their babies, they banned the scheme after health inspectors ruled it could expose mothers and babies to infections. But Sarah was absolutely determined to go ahead, and ignored the ruling. In the end, she was the only one in the group to experience giving birth in the Red Sea.

When she went into labour at midnight, 31-year old Sarah trekked from her hotel room to the beach and the Dolphin Reef sanctuary, where she gave birth to baby Samuel in a heated, glass-bottomed pool. As she hoped, the Reef's six dolphins - Hindu, Cindy, Shi, Dicky Dana and Domino - came to investigate. Sarah, who used Dr Motha's technique of self-hypnosis during her three-hour labour, was able to touch one of them as it circled around her. Husband Jonathan, a 30-year old recruitment agency owner, was there to cut the umbilical cord as Samuel came into world at 3am.

Dr. Motha, 43, has spent 20 years researching childbirth, and believes that dolphins can help a woman deliver with almost no pain by passing an underwater sonar messages of support. And Sarah agrees: "Giving birth in the Red Sea with the dolphins was the most wonderful experience of my life," she says. "I was in complete control of the situation and didn't feel under any pressure to perform, as you do in a hospital with the doctors and nurses milling about.

"It happened so quickly, and I wasn't in any pain. The dolphins came close - but not too close. It felt like they wanted their presence to be known, but didn't want to be too intrusive," she says. Just 30 minutes after the birth, Sarah walked up the sandy beach with her new-born son, and by 4 am she was celebrating with champagne back at the hotel. Sarah, who also has a three-year old son Joshua, says she has no regrets about her unusual labour, even though it meant sneaking out in the night to avoid the authorities.

Now back at home in East Sussex, she says she and baby Samuel are fighting fit. "My only reservation was that while I was in labour I didn't have the option of hospital facilities if I needed them," she says.

Dolphins are said to be able to sense if a woman is pregnant - before she may know herself in some cases - and if there are any pregnant women in the water, they often pay them particular attention.

The other five women who went to Eilat say swimming with the dolphins in the weeks leading up to giving birth was an experience they'll never forget. And Sarah describes how, when she was out swimming in the sea in the weeks before the birth, she'd feel Samuel kicking whenever the dolphins came near and she could touch them.

Dr. Motha, who's committed to encouraging women to opt for natural births and self-hypnosis techniques during labour, hailed the project as a great success. "The fact that one woman gave birth in the sea with dolphins made the trip worthwhile," she said.

"Women feel safe when they're in the water with dolphins. These wonderful mammals understand joy at a very deep level. Swimming with them enables a prospective mother to be in touch with joy, which is the true essence to birth. Hospitals tend to turn the birth of a child into an organized, sanitized affaire over which the professionals, rather than mothers have control."


For more information:
Underwater Birth & Dolphins

The Cove

Neonatal Resuscitation: Life that Failed

By George Malcolm Morley, MB ChB FACOG

Neonatology, perinatology and neonatal resuscitation developed to a great extent during the 1970’s in response to an epidemic of litigation involving birth brain injury; fetal monitoring was detecting fetal distress in utero, and specialized perinatal intensive care promised great improvement in neonatal morbidity and mortality. Today, in US hospitals, if a child is born alive, the chances of it dying within a few days are virtually zero; even some babies without a heartbeat are resuscitated. Perhaps one third of all neonates receive some form of resuscitation treatment, and the success in terms of mortality is excellent. About 6% to 10% of all neonates are “morbid” and need NICU care – many of these are preemies; again, NICU mortality is extremely rare; however, in terms of neurological and mental disability, especially in NICU babies, long-term morbidity is anything but rare. [1][2] The life-saving procedures of neonatal resuscitation and NICU care are much less successful in preserving brains. If resuscitation does not result in a five minute Apgar of 7 or more, neurological impairment is likely. [3]

The term “resuscitation” implies restoration of deficient life support systems, especially respiration; in the depressed newborn, that deficiency is in the placenta and cord, as the lungs have not yet begun to function. The rationale on which current resuscitation is based is that early detection of fetal asphyxia combined with rapid delivery and rapid establishment of pulmonary respiration (reversal of asphyxia) will prevent brain injury. If brain damage (neuron necrosis) has occurred in utero, resuscitation will not heal it; however, overt brain damage seldom is evident at birth, and it often appears after resuscitation. Hypoxic ischemic encephalopathy usually is diagnosed hours after birth when the child convulses; germinal matrix hemorrhage in preemies may develop a day or two after birth; mental and behavioral problems may not surface for years.

The general consensus is that birth “asphyxia” is the cause of the brain damage; hypoxia is a more precise term, although asphyxia implies arrest of respiration – respiration includes oxygen supply and removal of carbon dioxide. Iatrogenic resuscitation usually corrects this asphyxia promptly by initiating pulmonary ventilation; most organs survive superbly, all except the brain. This strongly implies that there are other factors active in neonatal “depression” besides hypoxia and acidosis that must be corrected during “resuscitation”. The placenta is much more than a respiratory organ. Correction of the placental / cord deficiency that caused the depression, and support of placental function are thus rational priorities in revival of a depressed neonate, just as they are in the “resuscitation” of the “distressed” fetus in utero.

In utero, the normal blood supply of the fetal brain is relatively hypoxic. Umbilical vein blood is fairly well oxygenated, but it is mixed in the inferior vena cava and in the heart with de-oxygenated blood from the venae cavae; this is then circulated systemically. The color of a normal newborn is purple – it has been purple for nine months – circulating a mixture of hemoglobin (blue) and oxyhemoglobin (red). It turns pink only after the fetal circulation is changed to the adult circulation, and is combined with aeration of the lungs. The fetal brain thus grows and develops with a copious blood supply that is only partially oxygenated, but which readily removes products of aerobic and anaerobic respiration and excretes them through the placenta. The fetal kidneys and gut thrive on blood with the same oxygen partial pressure as the blood flowing to the placenta to be oxygenated. The newborn brain and other organs are therefore relatively immune to pure hypoxic injury [4] as long as organ and placental perfusion are copious.

The same basic principles apply to the adult brain; five minutes or more of cardiac arrest will produce some brain damage or brain death; occlusion of a cerebral artery rapidly results in infarction (death) of the supplied tissue. On the other hand, five minutes or more of pure anoxia (e.g. breathing pure nitrogen) will produce unconsciousness that is fully reversible without brain damage provided that brain perfusion is not impaired. The integrity of the newborn brain is maintained (by perfusion and oxygenation) at normal (physiological) birth; therefore the physiological mechanisms that ensure these functions (perfusion and oxygenation) should be supported and/or duplicated during iatrogenic resuscitation if brain damage is to be avoided.

The severely depressed/asphyxiated newborn typically shows not only no sign of breathing, but also lack of muscle tone and reflexes needed to initiate breathing, as well as signs of hypoxia such as cyanosis; in the most severe cases, pallor indicates vasomotor collapse. Such a child has obviously suffered a major respiratory insult prior to or during birth; the cause of that insult and its specific effects are factors that must be corrected, if possible, in the resuscitation process. In any and every case of newborn depression, if a child is born alive – with a heart beat and a pulsating cord – the placental life support system has not failed completely; utilization of this system in resuscitation and transition to “adult” life support systems in the depressed newborn is essential in restoring the physiological state – health – without the incursion of organ damage, primary or secondary, from “birth asphyxia.” With early detection of fetal distress and with rapid delivery, the neonate’s central nervous system should be undamaged at birth; the objective of therapy should be that it remains so.

Normal (Physiological) Resuscitation at Birth – Transition
At normal (physiological) birth, the child “resuscitates” itself:
  • Its wet, cooling skin triggers the “cold crying reflex” and “cold pressor reflex.”
  • The fetal circulation is switched to the adult circulation.
  • The lungs are aerated, and the umbilical vessels then close reflexively.
There is no period of asphyxia or hypo-perfusion. [5] However, this description is very simplistic and incomplete.
The switch from placental to lung “breathing” is only a portion of the whole; the switch from placental alimentation and placental excretion to the newborn’s alimentary and excretory organs is also part of “natural” resuscitation. To initiate and establish the newborn functions of the lungs, gut, kidneys, and other systems, including the brain, continuous copious perfusion of these organs is required; a large transfusion of placental blood during natural childbirth “resuscitates,” or more correctly “activates” all these organ systems as the massive flow of blood through the placenta (40% of the fetal cardiac output) is diverted to these organs during physiological closure of the cord vessels.

Cord closure abruptly halts the placental supply of glucose to the brain (used in aerobic and anaerobic respiration); the neonatal liver (glycogen stores) must begin to maintain blood glucose levels. A major portion of the liver’s blood supply is from the hepatic portal vein that derives its blood from the mesenteric arteries. If the gut (and hence the liver) is not “copiously perfused,” hypoglycemia may result in a neonatal convulsion. Deficient perfusion of the liver may also be a factor in bilirubin excretion and “physiological” jaundice.

Copious perfusion of the neonatal kidneys with adequate blood pressure is required for solute excretion, fluid, electrolyte and acid-base regulation after the placenta ceases to function.

During the third stage of labor while the cord is pulsating, warm blood from the placenta courses through the newborn. After cord closure, temperature regulation is suddenly required of the neonate; switch of blood flow to and from the epidermis requires a copious amount of blood to regulate heat loss and heat retention.

In the fetus, pulmonary circulation is minimal; after the adult circulation is established, the entire cardiac output flows through the lungs. A major portion of the placental transfusion is utilized in establishing pulmonary blood flow after birth. Jaykka demonstrated that perfusion of the fetal lung “erected” the alveoli and actually initiated aeration; [6][7] the high colloid osmotic pressure of the circulating blood rapidly absorbs amniotic fluid from the erected alveoli. Thus adequate “copious perfusion” of the lungs may result in pulmonary oxygenation before any muscular respiratory effort occurs.

Respiratory effort is reflexively controlled through the central nervous system; hypoxia and increased concentration of carbon dioxide are strong stimulants for receptors. For the reflex to function, copious perfusion of the reflex circuit is required, as is copious perfusion of the respiratory muscles.

Third stage placental function and placental transfusion were dramatically demonstrated by Gunther [8]. In Figure 1., this particular child lived outside the uterus for nearly ten minutes without starting to “breathe”; the child was wrapped in a warm blanket and deprived of the “cold crying reflex.” This non-breathing newborn with an intact cord and placenta is in no distress and is not asphyxiated; note how it “kicked the bed.” Uterine systoles and diastoles produce virtual tidal waves of placental transfusion and blood loss during continuous placental circulation until pulmonary respiration is established; (Figure 1) thereafter, transfusion proceeds in a step-wise manner, each uterine transfusion being arrested by sphincter closure of the umbilical vessels, resulting in plateaus until the final blood volume is attained and permanent cord closure occurs.

Yao [9] demonstrated that full placental transfusion, impelled by gravity, occurred within 30 seconds if the child was held 40 cms below the level of the placenta. The natural position adopted by “primitive” mothers is squatting, and the child is delivered downwards; such a child receives very rapid “resuscitation” from gravitational placental transfusion. Ventilation of the lungs, which reflexively relaxes pulmonary arterioles, greatly facilitates placental transfusion and pulmonary perfusion. Whether the placental transfusion is effected by gravity or by uterine contraction or by both, it is regulated and terminated reflexively by the child and results in a blood volume that is optimal for survival; those reflexes have been honed to perfection by natural selection over millions of years.

An additional factor in “normal” resuscitation/transition is increased systemic blood pressure [10] caused by placental transfusion, the cold pressor reflex and closure of the umbilical arteries; this may reverse blood flow in the ductus arteriosus and increase “erection” of lung tissue. Increased blood pressure also increases glomerular filtration in the kidneys and causes increased fluid loss into the extra-cellular space resulting in hemo-concentration. The consequent increase in plasma colloid osmotic pressure prevents pulmonary edema and dries up the lungs. After crying started in Figure 1, the child received a transfusion of nearly 100 mls of blood within one minute; this was forced (by maternal uterine contraction) into the venae cavae, liver, heart and lungs of the child at high pressure – see Figure 2. Jaykka’s “erection” of alveoli could well be done by pressure generated by the maternal uterus or gravity, not the neonate’s heart.

Thus natural “resuscitation” is the physiological switch from the placental life support system to all the independent corresponding organ systems of the newborn; it involves much more than ventilation of the lungs. The most important factor is the placental transfusion that increases the newborn’s blood volume by 30% to 50%, the additional blood being utilized to activate and establish the functioning of these organ systems. Comprehension of this physiology is essential for elucidating the factors in neonatal depression and in iatrogenic resuscitation that produce the variety of pathology seen in the NICU following incomplete recovery of the depressed newborn.

Iatrogenic Resuscitation

The routine procedure for resuscitating an “at risk” or depressed newborn is immediate clamping of the umbilical cord followed by transfer to a warmer where the child’s airway is cleared (by visualization of the vocal cords and tracheal suction in cases of meconium staining) and the baby is stimulated by rubbing the skin. If respiration does not occur within 30 seconds or so, bag-mask ventilation is started; if this fails to produce spontaneous respiration, endo-tracheal intubation is performed with positive pressure ventilation.

Immediate cord clamping produces the major deviations from “natural resuscitation”; placental oxygenation, placental acidosis regulation, placental glucose supply and placental transfusion are all abruptly aborted and the child is subjected to a period of complete asphyxiation until the lungs function. The warmer deprives the child of the cold crying and cold pressor reflexes. Bag-masking or intubation ventilation readily aerates the alveoli; this reflexively dilates pulmonary arterioles and promotes pulmonary perfusion and the switch from fetal to adult circulation; however, without additional blood volume that is normally supplied by placental transfusion, less than optimal pulmonary perfusion may occur resulting in less than optimal gas exchange and incomplete closure of the foramen ovale and the ductus arteriosus. [5][11]

The immediately clamped newborn has, in effect, been subjected to a massive hemorrhage, [12] losing up to 50% of its blood volume; however, the actual amount of blood loss varies greatly with the circumstances of the particular birth and with the speed with which the cord is clamped. At normal, spontaneous delivery, the contracting uterus may squeeze blood into the child during the second stage of labor; if the child cries before the trunk is delivered, the contraction that delivers the child may also deliver a “full” placental transfusion before the clamp can be applied. Similarly, a mother who delivers in the squatting position will usually transfuse the child fairly adequately by gravity before the clamp can be applied. A normal, spontaneous delivery (with the mother supine) followed by immediate placement of the child on the mother’s abdomen may result in considerable gravitational blood loss into the placenta if the clamp is placed during uterine diastole. Rarely, when a clamp happens to be placed during a strong uterine contraction, the child may be over-transfused with blood that would have drained back into the placenta had the clamp not been placed. In general, most newborns that breathe immediately after a normal vaginal delivery will not lose a critical amount of blood volume from early cord clamping.

This, no doubt, has led to complacency about immediate cord clamping; however, many immediately clamped newborns, especially those that are apneic, have much less than an optimal blood volume, and some are very blood volume deficient. After a “normal” birth and immediate cord clamping, they may develop infant anemia months later, [13] and years later, in grade school, they may be found to be mentally deficient. [14][15]

The apneic child that is delivered above the level of the placenta that is in a relaxed uterus will suffer gravitational blood loss into the placenta. This fact is used as rationale for immediate clamping at cesarean section. The procedure certainly prevents immediate newborn blood loss, but the sectioned child thus delivered is routinely hypovolemic from loss of placental transfusion. Sectioned newborns have a higher incidence of RDS and persistent fetal circulation (PFC) than do vaginal deliveries; Landau [16] completely prevented RDS in sectioned babies by leaving the placenta attached and suspending it above the child like an I.V. A significant number of perfectly normal, term babies die from PFC following elective c-section. [5][11]

Premature babies are routinely immediately clamped for transfer to resuscitation. The premature placenta is relatively large in relation to the fetus and contains a correspondingly larger portion of the feto-placental blood volume. The blood loss from immediate clamping is, therefore, correspondingly greater. All such preemies develop anemia. Shock lung (RDS/ hyaline membrane disease [HMD]) is a common complication. Kinmond [17] prevented RDS in preemies by gravitational placental transfusion and also eliminated the need for red cell transfusion. The routine use of physiological cord closure has NEVER been reported; there are many indications that such preemies would be healthier than those of Kinmond. [18] In the extremely immature infant, preservation of the placental circulation with immersion of the placenta in an appropriate nutrient medium would appear to be rational therapy to support the immature life support systems. RDS and HMD are readily produced in newborn foals by immediate cord clamping and in newborn rabbits and puppies by removal of blood volume. [19] It would appear that adequate blood volume at birth is essential for normal lung function. RDS/HMD from hypovolemia may occur at any age regardless of the presence or absence of surfactant in the lungs.

The most common cause of fetal distress in labor is cord compression (cord around the neck, cord prolapse, knot in the cord, oligohydramnios), and measures to relieve cord compression (re-positioning the patient, amnio-infusion, elevation of the presenting part, stopping labor with uterine relaxants) may succeed in returning the fetal heart tracing to normal – may resuscitate the fetus. If these measures do not succeed, the child is born “depressed,” its cord is clamped immediately, and it is transferred to the resuscitation table. Intra-partum cord compression impedes cord venous blood flow (oxygenated, non-acidotic) to the child while allowing cord arterial flow (high pressure) to engorge the placenta. Thus the very “depressed” child (following cord compression) is born in hypovolemic shock, complicated by hypoxia and acidosis – limp and pallid. Immediate cord clamping seals its fate.

If the cord is not clamped and the compression is relieved, (knot loosened, cord unwound from the neck) and the child is lowered, blood drains from the engorged placenta into the child and the hypovolemic, hypoxic shock is reversed within 30 seconds with transfusion of oxygenated, non-acidotic blood; placental respiration reverses the “depression.” This third stage therapy mimics successful intra-uterine resuscitation.

If the cord compression has been of some duration (“intra-uterine asphyxia,” Linderkamp [13]), e.g. oligohydramnios, the high hydrostatic pressure in the placental capillaries may have dehydrated the fetus, causing marked hemoconcentration. This situation is often reversed in utero by amnioinfusion; if it is not corrected, the immediately clamped neonate is prone to develop the “hyper-viscosity syndrome,” a combination of dehydration, hypovolemia and hemoconcentration. [20] While placental circulation and placental transfusion (delayed clamping) may help in this situation, in the more severe cases, the cord vessels are constricted and little placental blood is available; intravenous hydration may also be needed to restore physiology.

In asphyxia caused by placental abruption, increase in carbon dioxide may dilate placental and cord vessels, causing a shift in blood volume from the fetus; in the pre-term fetus, the more premature the child, the higher is the placental portion of the feto-placental blood volume. In nearly all “risk” deliveries subjected to immediate cord clamping, there is strong potential for severe hypovolemia at birth.

The neonate reacts to hypovolemia with massive generalized vaso-constriction that shifts volume circulation from less vital organs to the heart and brain. Depending on the degree of hypovolemia, the clinical signs vary from weakness to those of hypovolemic shock: pallor, hypotension, hypothermia, oliguria / anuria, metabolic acidosis, anemia and respiratory distress syndrome (RDS) otherwise known as “shock lung.” Hypoglycemia caused by deficient liver perfusion has already been mentioned. These signs and symptoms and their related pathology are present to some degree in practically every child admitted to the NICU. They are seldom recognized for what they are, because neonatologists are indoctrinated with the concept that placental transfusion is a pathological event and that an immediately clamped newborn has a normal blood volume. Many neonatologists have never seen a newborn that has closed its cord physiologically.

There are many consequences of this conceptual error – the insufficient and tardy use of blood volume expanders and blood transfusion in ischemic encephalopathy; the use of medication (vasoconstrictors) to maintain blood pressure in hypovolemic shock while vasoconstriction is causing oliguria and ischemic necrosis of the bowel – necrotizing entero-colitis; the use of surfactant to treat RDS (shock lung) while the hypovolemic shock remains untreated and lungs are under-perfused. All of these and other consequences, and especially those consequences relating to brain damage, [12][21] become irrelevant when the conceptual error is corrected and rational management of neonatal depression is employed.

In the late 1960’s and the early 1970’s, Windle [12] and Myers [21] published papers on brain damage in Rhesus monkeys produced by timed periods of birth asphyxia. Necrosis of basal nuclei, brain stem nuclei and the cerebral cortex was induced by various means of birth asphyxia, all of which included disruption of the placental circulation at birth. The clinical results varied from spastic paralysis / decerebrate rigidity to memory dysfunction without obvious neurological impairment; these were correlated with autopsy examination of the brain, sometimes done years after birth. Myers published two very significant recordings of resuscitation.
The newborn monkey in Figure A was perfectly normal until its cord was clamped. Its heart rate dropped immediately and precipitously; its blood pressure rose momentarily (due to umbilical artery closure), then fell immediately (due to decreased venous return), recovered (due to endogenous epinephrine release) and then fell to zero during the interval that the experimenters prevented pulmonary respiration. Ten minutes after immediate clamping, the blood pressure was so low that there was effective cardiac arrest, despite the persistent electrical cardiac activity. At this stage, the brain was not being perfused and was undergoing necrosis. When resuscitation (pulmonary ventilation) was started 25 minutes after immediate clamping, much brain damage had already occurred. Massive doses of Epinephrine, cardiac massage and ventilation produce “life”; however, this monkey was already brain dead. Autopsy findings confirm brain death. Multiple other studies using the same technique and shorter periods of asphyxia and hypotension produced regular patterns of basal nuclear necrosis and brain stem nuclear necrosis at autopsy that were preceded by corresponding neurological defects in surviving monkeys.

In Figure B, depriving the mother of oxygen asphyxiates this monkey fetus; gradual (and severe) fetal bradycardia follows, but blood pressure does not fall significantly and brain perfusion is maintained despite severe bradycardia. Blood pressure is the product of cardiac output and peripheral resistance; bradycardia indicates less cardiac output; vasoconstriction in all organs except the heart and brain is maintaining brain perfusion. Ventilation with the placental circulation intact results in full recovery of blood pressure and heart rate – there is no loss of blood volume; cord clamping (3.5 minutes after birth) causes an increase in blood pressure. This newborn monkey is normal, however, delay in resuscitation with prolonged hypoxia/anoxia will eventually reduce cardiac output and blood pressure, resulting in brain damage. Windle produced asphyxia (and brain damage) by abruption of the placenta and leaving the fetus inside the sac; he did not record the time of cord clamping. Some mildly depressed neonates recovered with no permanent neurological deficit, however, memory and attention deficit dysfunction was demonstrated and necrosis of the inferior colliculus was seen at autopsy.

Several factors are contrasted in these two charts. In 'A' the newborn is not hypoxic at birth – brain damage occurs after birth; in 'B' the newborn is markedly hypoxic at birth, but incurs no brain damage. Resuscitation in 'A' is started much later than in 'B'. Resuscitation (extreme) in 'A' results in rapid oxygenation, but blood pressure levels never attain pre-birth levels despite intense vasoconstriction. Resuscitation (early and minimal) in 'B' results in gradual restoration of oxygenation; blood pressure levels never fall significantly and blood pressure rises as pulmonary oxygenation improves. The effects of cord clamping contrast vividly: In ‘A’, clamping before the lungs are ventilated results in bradycardia and eventual loss of blood pressure. In ‘B’, clamping after ventilation produces a rise in blood pressure and an increase in heart rate. Gasping in ‘A’ is against a closed endo-tracheal tube that ensures asphyxia. Had those gasps been functional, the newborn might have survived; the following paragraphs elucidate that possibility.

Peltonen, using fluoroscopic filming of the thorax at birth, describes in detail the hazards of clamping the cord before the first breath.[10] He notes immediate marked decrease in cardiac size due to incomplete filling of the ventricles. The umbilical vein is as large as the inferior vena cava and returns 40% of the cardiac output. Loss of this massive venous return from the placenta results in virtual cardiac collapse and is relieved only by blood flow through the lungs. [10] Peltonen’s comment on this is decisive:
“On the basis of these observations, it would seem that the closing of the umbilical circulation before aeration of the lungs has taken place is a highly unphysiological measure, which should thus be avoided. Although the normal infant survives without harm, under certain unfavorable conditions, the consequences may be fatal.”
From this language, it would seem that Peltonen witnessed an irreversible cardiac arrest following immediate cord clamping on a depressed newborn; he had good reason to proscribe the procedure universally. Myers’ recording of the precipitous drop in heart rate (and cardiac output) immediately following cord clamping in Fig. A is confirmatory evidence for the recommendation. Peltonen then notes the strong correlation between clamping before the first breath and the severity of RDS, and comments on the continuing function of the placental circulation during the third stage of labor:
“There is thus good reason in cases of resuscitation to keep the umbilical circulation intact.”
Yet, today, every premature child, every compromised child, every newborn “at risk” has its cord clamped immediately in the panicked rush to the resuscitation table. Very, very few die following the procedure, but RDS is a common sequel; many incur neurological impairment [2] and many more remain disabled and dependent on others for the rest of their lives.[1] Growth and development of the brain continues for years after birth, and optimal nutrition and sustenance are required for optimal growth and development. A hiatus in this progress caused by loss of a large amount of blood volume at birth and subsequent anemia may not become apparent for years. [14] [15] The following comment of Windle applies to all immediately clamped newborns:
“A child with a slight brain defect often appears no different from a normal child. His intelligence quotient may lie in the range considered normal, but one never knows how much higher it would have been if his brain had escaped damage in the uterus or during birth.” [12]
Peltonen [10] and Linderkamp [13] published the two most comprehensive review articles on placental transfusion; both noted the strong correlation between immediate cord clamping and infant anemia. Linderkamp concluded:
“It may be speculated that the prevention of severe iron deficiency in infants living under primitive conditions is more important than the risk of circulatory overload shortly after birth. In civilized countries, a medium placental transfusion appears to be more appropriate in order to avoid the risk of hyperviscosity, whereas iron deficiency in later infancy is probably less dangerous.”
Within a few years, multiple reports [14, 15] of infant anemia being associated with learning and behavioral disorders and mental deficiency in grade school children filled the literature, but none of these authors have made the association of anemia / mental defects with immediate cord clamping at birth. The broad spectrum of brain injury, from neonatal death through spastic paraplegia to memory and mental dysfunction, produced in monkeys by Windle and Myers has been and is being reproduced repeatedly in human neonates by means of immediate cord clamping and current methods of neonatal resuscitation. Today, an epidemic of immediate cord clamping correlates with an epidemic of PDD and autism.
Discussion and Commentary
During the third stage of labor, transition from placental dependency to self-sufficiency in life support is well understood by most midwives, lay and professional; the term used is “transing.” Most physicians think (and are taught) that this physiological process is pathological. For the midwife-home-delivered baby, the pulsating cord is routinely allowed to close itself regardless of the condition of the child at birth. Few if any of these neonates need NICU admission; this is a strong indication that delayed cord clamping – transing - is not a routine cause of pathology (jaundice, polycythemia, hypervolemia, hyperviscosity). In the depressed home-delivered neonate, transing is used as an essential factor in resuscitation; again, the paucity of NICU admissions attests to its value in these cases. On the other hand, that paucity may be due to home deliveries being very selective and of the low risk variety; however, the complexity of the transition process, however perfect, does make it prone to accidents.

The baby inadvertently delivered en route to the hospital is routinely healthy on arrival despite the lack of a cord clamp; on the other hand, the fetus that arrives with a prolapsed cord protruding from the vulva is routinely dead. The results of early detection of cord prolapse / fetal distress and treatment by immediate section are usually good, but not routinely so. No rational person would clamp the prolapsed cord in the vagina; rational therapy aims at relieving the cord compression. The only purpose of emergency delivery of the “at-risk” fetus is to establish pulmonary respiration before impaired cord /placental function injures the child; what contorted logic can sanction immediate destruction of the child’s only life support system before pulmonary respiration is established? The procedure of immediate cord clamping is universally condemned in obstetrical literature, yet it is practiced routinely. [23]

The ultimate example of this irrationality is ACOG’s Obstetrical Practice Bulletin 138 [23] that advocates immediate cord clamping for arterial cord blood sampling and pH studies in all at risk deliveries; this practice is widespread in the western world. The purpose of the cord blood studies is to (medico-legally) document the oxygenation/asphyxia status of the child at the moment of birth. The results have no bearing on the immediate treatment or resuscitation of the child; they have no correlation with the oxygenation/asphyxia status of the child in the hours and minutes before birth (prenatal scalp pH studies do); however, they do document that the neonate has been deprived of a portion of its natural blood volume and that it was subjected to a period of complete asphyxia until its lungs became functional. Immediate cord clamping does correlate with neonatal hypotension,[21][10] hypovolemia,[13][12][17] RDS,[10][20][17][19] cerebral palsy [12][21] and infant anemia[13][17] that correlates with mental deficiency. [15][14]

The costs of birth injury in terms of parental agony are matched by the enormous medical and medico-legal economic burdens it generates. Bulletin 138 [23] is an extreme example of legal defensive medical malpractice – an injurious procedure that results in or accentuates the very pathology that it supposedly documents. Kinmond [17] came to a very significant and pertinent conclusion regarding the use of delayed clamping / placental transfusion at premature delivery (the transfused preemies were much less morbid (injured) than those immediately clamped):
“This intervention at preterm deliveries has clinical and economic benefits.”
Perinatologists, neonatologists and trial lawyers have pointedly ignored the study. Kinmond’s economic benefits of routinely converting a potentially morbid preemie into a healthy small baby would render these professions virtually redundant. The use of “transing” at every delivery, especially at “risk” deliveries and during resuscitation would produce even more of these economic benefits for patients, but not for these professions. The economic impact of downsizing or closing NICU’s nation-wide and the virtual disappearance of birth injury lawsuits will not occur without strong resistance from those being economically impacted; the campaign of silence and misinformation regarding the cord clamp and placental transfusion from the medical, legal, insurance and hospital professions and the peer review press has succeeded well for many years.
“Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child.” - Erasmus Darwin, Zoonomia, 1801 [24]
Regarding cutting a cord that is around the neck:
“Let the loop be loosened to enable it to be cast off over the head. … [or] by slipping it down over the shoulders. … If this seems impossible, it should be left alone; and in the great majority of cases, it will not prevent the birth from taking place, after which the cord may be cast off. … Should the child be detained by the tightness of the cord, as does rarely happen, … the funis may be cut … Under such a necessity as this, a due respect for one’s own reputation should induce him to explain, to the bystanders, the reasons which rendered so considerable a departure from the ordinary practice so indispensable. I have known an accoucheur’s capability called harshly into question upon this very point of practice. I have never felt it necessary to do it but once. … The cord should not be cut until the pulsations have ceased.” - Charles D Meigs, M.D. Professor of Midwifery Philadelphia, 1842 [25]
Placental function was the only resuscitative option available to the above authors, and its preservation was of obvious value. Destruction of the infant’s only functioning life support system was clearly understood to be injurious not only for the child, but for the physician’s reputation. Destruction of physiology invariably produces pathology. Immediate cord clamping (ICC) can destroy the physiology that activates all the life support systems of the newborn child; while ICC may impair the function of various organs, the most vulnerable are the metabolically active areas of the brain where ischemic necrosis produces a lifelong defect. ICC is a very injurious and irrational procedure; those that use it put the newborn, themselves and their profession in jeopardy. Those that use, advocate and promote ICC [23] are invited to explain their morality.

Rational neonatal resuscitation primarily involves the restoration and maintenance of adequate circulation through the brain and all feto-placental life support organs and systems. Amputation of a functioning placenta, and the blood volume contained in it, is an obviously injurious procedure; the organ most vulnerable to permanent injury is the brain.

Copyright February 9, 2003, George Malcolm Morley, MB ChB FACOG


References:
  1. Hack M, et al., Outcomes in Young Adulthood for Very Low Birth-weight Infants. New Engl J Med, Vol. 346, No.3, Jan, 2002:149-157
  2. Robert L. Goldenburg: The Management of Preterm Labor (an expert’s view) Obstetrics & Gynecology Vol. 100, No. 5, Part 1, November 2002, p1020-1037
  3. Thorngren-Jerneck K. et al. A Population Based Register Study of One Million Term Births. Obstetrics & Gynecology 2001 Vol. 98 No. 1: 1024-1026
  4. Kirks D. Thorne Griscom. Practical Pediatric Imaging, Third Edition, 1998, p 154
  5. Morley GM. Letters Obstetrics & Gynecology, Vol 97, No.6,June 2001, 1024-1026
  6. Jaykka S. Capillary Erection and Lung Expansion. Acta Paediatr. 1965 [nppl] 109.
  7. Jaykka S. An experimental study of the effect of liquid pressure applied to the capillary network of excised fetal lungs, Acta Paediatr. 1957; Supp 112:2-91.
  8. Gunther M. The transfer of blood between the baby and the placenta in the minutes after birth. Lancet 1957;I:1277-1280.
  9. Yao AC, Lind J. Effect of Gravity on Placental Transfusion. Lancet, 1969, II:505-508
  10. Peltonen T. Placental Transfusion, Advantage - Disadvantage. Eur J Pediatr. 1981;137:141-146
  11. Levine et al. Mode of Delivery and Risk of Respiratory Diseases in Newborns. Obstetrics & Gynecology, 2001; 97: 439-42
  12. Windle W. Brain Damage by Asphyxia at Birth. Scientific American. 1969 Oct;221(4):76-84.
  13. Linderkamp O. Placental transfusion: determinants and effects. Clinics in Perinatology 1982;9:559-592
  14. Lozoff B. Jimenez E. Wolf AW. Long Term Development Outcome in Infants with Iron Deficiency. N Eng J Med 1991; 325: 687-94.
  15. Hurtado EK et al. Early childhood anemia and mild to moderate mental retardation. Am J Clin Nut. 1999; 69(1): 115-9.
  16. Landau DB. Hyaline membrane formation in the newborn: hematogenic shock as a possible etiological factor. Missouri Med1953; 50: 183.
  17. Kinmond S et al. Umbilical Cord Clamping and Preterm Infants: a Randomized Trial. BMJ 1993; 306: 172-175
  18. Morley GM. Letter: Ibuprofen and Indomethacin. European Journal of Pediatrics, January 2003
  19. Mahaffey Leo W. Rossdale, PD. Convulsive Syndrome In Newborn Foals Resembling Pulmonary Syndrome In The Newborn Infant; The Lancet 1959 1223-1225.
  20. Morley GM. Cord Closure: Can Hasty Clamping Injure the Newborn? OBG Management July 1998; 29-36.
  21. Myers RE (1972) Two patterns of perinatal brain damage and their conditions of occurrence. American Journal of Obstetrics and Gynecology 112:246-276.
  22. ACOG Committee Opinion Number 138 - April 1994, published in the International Journal of Gynaecology and Obstetrics 45:303-304 [54], reaffirmed 2000, and listed as current in Obstetrics & Gynecology, February 2002.
  23. Darwin E. (1801) Zoonomia, 3rd edition. London: vol III page 302
  24. Meigs, CD. (Professor of Midwifery and Diseases of Women and Children in Jefferson Medical College) The Philadelphia Practice of Midwifery, second edition, 1842, page 193.


RELATED READING:

Nuchal Cord Midwifery Files [Gentle Birth]

Umbilical Cord Around Baby's Neck - Dangerous or Not?

Nuchal Cords: The Perfect Scapegoat [Midwife Thinking]

Nuchal Cords [Delayed Cord Clamping - website]

Babies born with nuchal cord [Gloria Lemay video]

Nuchal Cords are Necklaces, Not Nooses [Midwifery Today]

The Nuchal Cord at Birth: What to Midwives Think? [Abst]


In this video on pregnancy myths, OB/GYN Hakakha reminds parents (in the 7th 'section' of this video) that the cord is often around a baby's neck while inutero and at birth and is rarely a cause for concern.


~~~~

Umbilical Cord Around Baby's Neck - Dangerous or Not?

By Misha Safranski
Read additional work by Safranski here

As a confirmed birth junkie, I have heard over and over again birth stories where the baby was born by cesarean for either fetal distress or failure to descend, and the difficulties are blamed on "the cord was around the baby's neck". Is this condition - scientifically termed "nuchal cord" - actually dangerous? A new study backs up previous research showing that nuchal cord is not the threat it's perceived to be.

A study published this year in the Journal of Perinatal Medicine showed there were no statistically significant differences in outcomes of post-term pregnancies involving a nuchal cord verses no nuchal cord. Drs. Ghosh and Gudmundsson performed color ultrasound on 202 women with post-term pregnancies. Nuchal cords were detected in 69 of the women. There were no significant differences in Apgar scores, umbilical cord anomalies, cesarean section, perinatal death or admission of the baby to the NICU (neonatal intensive care unit).

These findings confirm what has been found in most of the past research on nuchal cord outcomes. A 2006 study from the Archives of Obstetrics and Gynecology was on a much larger scale, looking at the outcomes of 166,318 deliveries during a 15 year study period, 24,392 of which had a documented nuchal cord at birth. The authors, Sheiner et. Al, conclude: "Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary."

The interesting thing about the Sheiner study is that despite the equivalent outcomes among nuchal cord babies and those without the cord wrapped around the neck, there were higher rates of labor induction and non-reassuring fetal heart tones during labor among the nuchal cord cases. These two factors are most likely related. We know without a doubt that induction of labor can cause fetal distress. The fact that there were higher induction rates in the nuchal cord group could very well explain the higher rate of transient fetal distress. Induction is nearly always accompanied by AROM (artificial rupture of membranes), which can cause undue pressure on the cord, which can in turn result in blips in the heart tones. Regardless of the cause, the outcomes were still good.

Finally, we look at yet another study which demonstrated that nuchal cord does not result in worse outcomes. In a 2005 study looking at the effects of nuchal cord on birthweight and immediate neonatal outcomes, Mastrobattista, et. Al examined the outcomes of 4426 babies, 775 of whom had a nuchal cord. They found that there were no significant differences between the two groups in birthweight, non-reassuring fetal hearttones, Apgar scores below 7, or operative vaginal deliveries. The cesarean rate was actually highest among the women whose babies did not have a nuchal cord.

The most important thing to keep in mind is that unborn babies do not breathe through their mouth and neck - they receive oxygen through the umbilical cord. This is why it normally doesn't matter if the cord is around the neck (unless the cord is being compressed too much, which is fairly rare). The baby cannot "choke to death" before she/he is born. What we can conclude from the overwhelming majority of data is that nuchal cord - or "cord around the neck" - is not pathological; that is to say, it's not an abnormality. It is a normal condition of the umbilical cord and typically causes no problems with the delivery, even though doctors frequently try to convince parents otherwise.

References:

J Perinat Med. 2008;36(2):142-4. Nuchal cord in post-term pregnancy - relationship to suspected intrapartum fetal distress indicating operative intervention. Ghosh GS, Gudmundsson S. Department of Obstetrics and Gynecology, Malmö University Hospital, Malmö, Sweden.

Arch Gynecol Obstet. 2006 May;274(2):81-3. Epub 2005 Dec 23. Nuchal cord is not associated with adverse perinatal outcome. Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel. sheiner@bgu.ac.il

Am J Perinatol. 2005 Feb;22(2):83-5 Effects of nuchal cord on birthweight and immediate neonatal outcomes. Mastrobattista JM, Hollier LM, Yeomans ER, Ramin SM, Day MC, Sosa A, Gilstrap LC 3rd. Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.


~~~~

Related Information:

Gloria Lemay: Cord Around the Neck

Unwrapping a Nuchal Cord [video]

The Umbilical Cord

Nuchal Cord Midwifery Files

Neonatal Resuscitation: Life that Failed

Lotus Birth

In this video on pregnancy myths, OB/GYN Hakakha reminds parents (in the 7th section of this video) that the umbilical cord is often around a baby's neck while inutero and at birth and it is rarely a cause for concern.


Tuesday, October 27, 2009

Dr. Sears Statement on Circumcision

By William Sears, M.D.
Read more from Sears at AskDrSears.org


Circumcision is a decision that many parents face, and there is a lot of misconception and out-of-date information that parents read today. Here is a summary of the pertinent issues that you should consider when making this decision.

1. Medical benefits - THERE ARE NONE! Do not circumcise your baby because you think there are some medical benefits. A recent review by the American Academy of Pediatrics looked at all the data from the past decades to see if there truly were any medical benefits. Their conclusion - NO. There are no significant medical benefits that make circumcision worth doing.

Here are a few benefits that we used to think were true, and now know are not.

* Cleanliness - although a circumcised penis does not produce any of its own antibodies or natural lubrication like an intact ('uncircumcised') penis does, THIS IS NOT A MEDICAL BENEFIT. As an infant the foreskin is tightly adhered to the glans (head) of the penis and does NOT produce anything anyway. As an adult, the intact penis can be rinsed in the shower just like a woman rinses her genitals. In addition, there are many health benefits for the antibodies and natural lubrication produced by the intact penis.

* Decreased risk of STD's - this was a myth that we now know is not true.

* Decreased risk of penile cancer - it used to be thought that circumcised men had a much lower chance of cancer of the penis. We now know that this benefit is much smaller than previously thought. The AAP determined that this benefit is so tiny, it is not worth circumcising for this reason.

* Avoiding infections in the foreskin - occasionally intact foreskins get irritated. This is easily treated with warms water and washing. Rarely, the irritated foreskin becomes infected. This requires antibiotics, but is easily treatable. Even if this does happen in a person's lifetime, it is not a reason to circumcise at birth.

* Avoiding the need to do it later on - VERY RARELY, someone has a problem with recurrent infections in the foreskin that need antibiotic treatment. Some of these men then need to be circumcised in an operating room under general anesthesia. This is extremely rare, however, and is not a reason to circumcise everyone at birth.

* Avoiding bladder infections (or UTIs) - it used to thought that circumcised boys and men had a much lower chance of bladder infections. The AAP now knows that this benefit is very small, and is only true for the first year of life. After that, there is no difference in the number of bladder infections. Again, not a reason to circumcise.

THEREFORE, IF YOU DECIDE TO CIRCUMCISE YOUR CHILD, DO NOT DO SO BECAUSE YOU THINK THERE IS ANY MEDICAL BENEFIT.

2. Religious reasons - some people choose to circumcise for religious or cultural reasons. This is a personal decision.

3. Don't want to be teased - while this may have been true in the U.S. decades ago, the truth is that your intact kids will be in good company in the locker room when they are teenagers. Less and less people in the U.S. are now circumcising their boys and we currently see the majority of baby boys leaving the hospital intact (uncircumcised). In addition, almost 90% of the rest of the world's men are intact.

4. Too much trouble to take care of - some people think that an intact penis is too much trouble to pull back and clean, especially during childhood. Well, the truth is, you are not even supposed to pull back the foreskin until it naturally comes back on its own sometime between the ages of 3-years to the teenage years (depending on the boy). So there really isn't anything to even take care of until then. Intact = Don't Retract! Only Clean What is Seen.

5. Want your boy to look like dad - the main difference that your child will notice between him and dad is the hair. He won't even notice any difference in the penis until he is old enough that you can then explain to him the difference. At that point, what man and his son compare genitals?



Intact
vs.
Circumcised

So, what are the reasons TO circumcise that have not been scientifically dispelled as myths?

Here is the list:

Religious reasons - as discussed above. That is all. There really is no good reason to circumcise other that personal preference and religious reasons.

What are the reasons NOT to circumcise?

Consider these:

1. Leave nature alone - whether you believe God created all men and women with a prepuce organ (nicknamed 'foreskin' in men), or nature simply evolved all men and women this way, there must be some reason that all mammals have foreskins. Why change something that God/nature has created?

2. Sensation and sexual pleasure - the foreskin is filled with nerves (70,000+ which is more than any other body organ), and is therefore extremely sensitive to touch. This enhances sexual pleasure. The foreskin is also the only part of the penis that has muscle - 'smooth muscle tissue' - which is not found anywhere else on the genitals.

3. Protects the glans (head) of the penis - the glans is another highly sensitive area and meant to be an internal organ. The foreskin protects the glans from constant rubbing and chaffing against clothing that desensitizes and calluses it over the years. This preserves sexual pleasure.

4. Ethical issues - there are groups of people worldwide, including highly esteemed medical societies, that oppose routine circumcision because they feel it is unethical for anyone to decide to alter the penis of a child without the child's consent. Parents who are deciding whether or not to circumcise their son may wish to consider the impact this may have in the future if the child decides they wish they were not circumcised.

So, when making this decision, the first thing to ask yourself is this - "Do I have any good reason to circumcise my baby?" If your answer is for religious reasons, then follow your faith. If not, and you can't think of any other significant reason other than just "because", then consider the above information as you make your decision.


For more answers to common parenting questions, see Ask Dr. Sears or check out a copy of his hugely popular book, The Baby Book: Everything You Need to Know About Your Baby From Birth to Age 2.


Hear from another physician, Dr. Dean Edell, on infant circumcision: 


Dr. Bob Sears on circumcision: 


[END NOTE]

While we appreciate Dr. Sears' direct and simplified version of an answer to this often pondered question, we are not in agreement in terms of genital cutting for religious reasons. Baby girls are currently protected (by law) against any form of circumcision because of the religious views of their parents. Baby boys deserve the same legal protection. If it is not okay to cut one child, it is not okay to cut another - no matter the personal religious views of those advocating for the genital mutilation. When a girl or boy reaches an age when s/he can decide upon the religion of his/her choosing, s/he can at that point also decide what to do with her/his own genitals.

For more resources written by Jews on the topic of Judaism and Circumcision, see these links.

For more resources written by Christians on the topic of Christianity and Circumcision, see these links.

For more resources written by Muslims on the topic of Islam and Circumcision see:
http://www.quranicpath.com/misconceptions/circumcision.html
http://www.quran.org/khatne.htm

Going into more detail on proper intact care and the many reasons to keep boys intact would be a good idea in Sears' statement -- for their own health/immunological benefits, to avoid the impact that circumcision has on breastfeeding, development, stress hormones, pain response, colic, sleep, attachment, fussiness, post-traumatic stress, brain function, sexual experience later in life, etc. There are so many reasons to protect babies' wholeness and they are not covered in enough detail in this brief response.

~~~~ 

Further information on the prepuce, intact care and circumcision linked at: Are You Fully Informed?

Monday, October 26, 2009

MRI Studies: The Brain Permanently Altered From Infant Circumcision



Two of my physics professors at Queen's University (Dr. Stewart & Dr. McKee) were the original developers of Positron Emission Tomography (PET) for medical applications. They and a number of other Queen's physicists also worked on improving the accuracy of fMRI for observing metabolic activity within the human body.

As a graduate student working in the Dept. of Epidemiology, I was approached by a group of nurses who were attempting to organize a protest against male infant circumcision in Kinston General Hospital. They said that their observations indicated that babies undergoing the procedure were subjected to significant and inhumane levels of pain that subsequently adversely affected their behaviours. They said that they needed some scientific support for their position. It was my idea to use fMRI and/or PET scanning to directly observe the effects of circumcision on the infant brain.

The operator of the MRI machine in the hospital was a friend of mine and he agreed to allow us to use the machine for research after normal operational hours. We also found a nurse who was under intense pressure by her husband to have her newborn son circumcised and she was willing to have her son to be the subject of the study. Her goal was to provide scientific information that would eventually be used to ban male infant circumcision. Since no permission of the ethics committee was required to perform any routine male infant circumcision, we did not feel it was necessary to seek any permission to carry out this study.

We tightly strapped an infant to a traditional plastic "circumrestraint" using Velcro restraints. We also completely immobilized the infant's head using standard surgical tape. The entire apparatus was then introduced into the MRI chamber. Since no metal objects could be used because of the high magnetic fields, the doctor who performed the surgery used a plastic bell ("Plastibell") with a sterilized obsidian bade to cut the foreskin. No anaesthetic was used.

The baby was kept in the machine for several minutes to generate baseline data of the normal metabolic activity in the brain. This was used to compare to the data gathered during and after the surgery. Analysis of the MRI data indicated that the surgery subjected the infant to significant trauma. The greatest changes occurred in the limbic system concentrating in the amygdala and in the frontal and temporal lobes.

A neurologist who saw the results to postulated that the data indicated that circumcision affected most intensely the portions of the victim's brain associated with reasoning, perception and emotions. Follow up tests on the infant one day, one week and one month after the surgery indicated that the child's brain never returned to its baseline configuration. In other words, the evidence generated by this research indicated that the brain of the circumcised infant was permanently changed by the surgery.

Our problems began when we attempted to publish our findings in the open medical literature. All of the participants in the research including myself were called before the hospital discipline committee and were severely reprimanded. We were told that while male circumcision was legal under all circumstances in Canada, any attempt to study the adverse effects of circumcision was strictly prohibited by the ethical regulations. Not only could we not publish the results of our research, but we also had to destroy all of our results. If we refused to comply, we were all threatened with immediate dismissal and legal action.

I would encourage anyone with access to fMRI and /or PET scanning machines to repeat our research as described above, confirm our results, and then publish the results in the open literature.

Dr. Paul D. Tinari, Ph.D.
Director,
Pacific Institute for Advanced Study



More on Circumcision and Neurological/Brain Impact Studies:

Circumcision Pain Studies End Early Due to Infant Trauma

Infant Pain Impacts Adult Sensitivity and Perception

Study: A Bicultural Analysis of Circumcision

CIRP.org catalog of peer reviewed research on circumcision and brain damage.


Additional information (books, websites, articles) cataloged at: Are You Fully Informed?

Saturday, October 24, 2009

Plum Organics Baby Food Recall

Our son skipped the 'baby food' stage, having exclusively breastfed till 10 months, he went straight to 'finger foods' made up of primarily tiny fruit and veggie pieces. However, I know a lot of parents who shop for baby food items at Whole Foods (a natural foods grocery store that, I admit, I am addicted to), and Plum Organics is one of the 'better' baby foods out there. Plum Organics baby foods are sold primarily at Whole Foods, Target, and Babies R Us.

They recently had a recall on their Portable Pouches (which our son did try once at 13-months of age and decided it wasn't for him). There is no scary problem with the pouches - but the blend of apples and carrots was not accurate as per the label, so the company has issued the recall in order to meet quality guidelines. Interestingly, the products impacted were ONLY sold at Babies R Us and Target stores - NOT at Whole Foods.

The letter sent from Plum Organics founder, Gigi Lee Chang, is below.


October 19, 2009

Dear Parents,


I wanted to let you know that, today, Plum Organics voluntarily recalled a small portion of our Apple & Carrot Baby Food in Portable Pouches after a routine test determined the formulation was incorrect. Plum Organics immediately investigated the matter and confirmed that a mixing error was to blame which resulted in an improper blend of carrots and apples.

We have recalled all Apple & Carrot Baby Food in Portable Pouches with the best by date of May 21, 2010 and marked with the following number “890180001221” located at the bottom of the package.


No illnesses have been reported in connection with this product. We conducted extensive testing of samples of every Plum Organic product manufactured before and after this batch and all samples were found to be within the standard guidelines.


Consumers can return any Plum Organics Apple & Carrot pouch-based baby food with the above “best by” date and UPC code to Toys-R-Us or Babies-R-Us for a full reimbursement.
Please accept my deepest apologies for this inconvenience.

If you have any further questions, please contact Plum Organics at info@plumorganics.com.


Sincerely,

Gigi Lee Chang

Founder

Thursday, October 22, 2009

Foreskin Restoration



Prepuce (Foreskin) Restoration: It's good for men, good for women.

If you were cut at birth against your will, it may be something that is difficult to come to grips with. Maybe it is something that is even easier ignored. Circumcision: it is one of those areas that the more you know, the worse it is. The amputation of the prepuce robs a man of SO much -- and it also robs his partner of a normal, natural, fully functioning sexual experience.

Thanks to the initial endeavors of a few, restoration is becoming more popular now in the United States (the only nation in the world where the majority of the adult male population is without a normal, intact penis). While a circumcised man will never be able to regrow the 70,000 nerve endings, core vessels, ridged band, complete frenulum, glands and mucus membranes, smooth muscle, and various aspects of the prepuce organ that were amputated, he CAN restore some aspects of normalcy to his glans (head) of the penis and his/his partner's experience of sexuality.

A small number of men who have restored refer to themselves as being uncircumcised. This is not the same as being intact (having never endured the amputation of circumcision). Restoring men report many aspects of *life* are improved. And their sexual partners report the same.

The National Organization of Restoring Men lists the following as reasons that men today are choosing to restore:

Pleasure. The new foreskin adds pleasure to the penis during sexual activity. For most men seeking restoration, this alone is reason enough to restore.

Protection. The foreskin protects the glans from the abrasiveness of clothing. When protected, the glans will regain much of its original sensitivity.

Privacy. Like the female clitoris, the glans (head) of the penis is intended to be an internal organ, visible only when aroused.

Aesthetics. 87% of the world's men are intact and feel an intact penis is normal, natural and attractive.

Wholeness. When seeing their circumcision scar, many men sense that part of their body is missing, which is very similar to women who have had a breast removed. Seeking physical and emotional wholeness is quite natural.

Emotional pain. When feeling hopeless over their unchosen circumcised state, men can be helped to manage anger by doing something about a condition which they had always believed was irreversible.

Resentment. A 1991 survey of 301 males seeking restoration information showed that 70% of those circumcised as infants or children resent their parents for their circumcision. Regaining power over their bodies reduces resentment.

Empowerment. Victims of rape, crime and child or spousal abuse typically report a deep sense of helplessness and vulnerability. Who is more helpless and vulnerable than a restrained newborn having part of his penis amputated? Men restore to take back control of their bodies from the damage done by parents, their physicians and our culture.

Restoration isn't sought only by those circumcised at birth. Some children are unwillingly circumcised. Others were pressured "for their own good" by friends, sex partners, or military. Some immigrants circumcised themselves or their sons "to be American." Afterward, most males note a significant decrease of sensitivity, among other side-effects, which lead some to restore.

To discover more about restoration and hear from men who have or are restoring see:

Restoring Foreskin: http://www.RestoringForeskin.org

National Organization of Restoring Men: http://www.NORM.org

Restoring Tally: http://www.RestoringTally.com

TLC Tugger: http://www.TLCTugger.com

Foreskin Restoration.net: http://Foreskin-Restoration.net/forum

My Foreskin Restoration Network: http://myfrn.org

Foreskin Restore: http://www.foreskinrestore.com/main.html

"Extra Features" on the DVD "CUT: Slicing Through the Myths of Circumcision"

Book: The Joy of Uncircumcising by Jim Bigelow (download an e-book copy here).

Information on the many functions of the foreskin by Drs. Fleiss and Hodges.

Read the stories of other men, or have your story heard, by joining men across the nation who are speaking up about how the non-consenting genital cutting and amputation of their prepuce as an infant has impacted them as adults: Circumcision Class Action Lawsuit

For more information on how circumcision hurts women (and restoration, in turn, benefits women) see:
* Article: How Circumcision Hurts Women by Jocel Them
* Article: Improve Marital Sex: Keep the Foreskins by Dr. Dean Edell
* Article: How Male Circumcision Impacts Your Love Life by Dr. Christine Northrup
* Study: Effects of Male Circumcision on Female Arousal and Orgasm
* Article: A Change in How Intercourse Works by the National Org of Circ Info & Res, CO
* Video: Penis 101 (How Circumcision Changes Intercourse for Men & Women) by Marilyn Milos
* Crystallized Pathology: The Clitoris, the Penis, and Women's Sexual Health by Danelle Frisbie (drop me a note if you'd like a pdf excerpt version)
* Website: Sex As Nature Intended [graphic site]
* News Brief: Male Circumcision Increases HIV rates among Women in Africa
* Review above listed book excerpt on the Functions of the Foreskin by Dr. Fleiss & Dr. Hodges


Thank you, to all the fathers out there who were cut at birth, but are now protecting your sons (and their future partners) from the same loss! You are heroes changing the United States as we speak.

If you have a friend who is considering cutting his son so that this new little baby boy may (in some wild stretch of the imagination) 'match' his father's circumcised adult penis, check out the documentary and vlog by Penn & Teller on this very topic. We do not need to continue this abuse through generations.

above image from The Intactivism Pages



Below, Ron Low briefly discusses some of the work he does with TLC Tugger:


Effects of Male Circumcision on Female Arousal and Orgasm

By Gillian A. Bensley and Gregory J. Boyle
Department of Psychology
Bond University, QLD, Australia





While vaginal dryness is considered an indicator for female sexual arousal disorder, (1,2) male circumcision may exacerbate female vaginal dryness during intercourse. (3) O’Hara and O’Hara reported that women who had experienced coitus with both intact and circumcised men preferred intact partners by a ratio of 8.6 to one. (4) Most women (85.5%) in that survey reported that they were more likely to experience orgasm with a genitally intact partner: ‘They [surveyed women] were also more likely to report that vaginal secretions lessened as coitus progressed with their circumcised partners (16.75, 6.88–40.77).’ (4)

Presence of the movable foreskin makes a difference in foreplay, being more arousing to the female. (4) Women reported they were about twice as likely to experience orgasm if the male partner had a foreskin. (4) The impact of male circumcision on vaginal dryness during coitus required further investigation.


We conducted a survey of 35 female sexual partners aged 18 to 69 years who had experienced sexual intercourse with both circumcised and genitally intact men.

Participants completed a 35-item sexual awareness survey. Women reported they were significantly more likely to have experienced vaginal dryness during intercourse with circumcised than with genitally intact men χ2 (df = 1, n = 20) = 5.0, p <0.05.5

Women who preferred a circumcised male sexual partner averaged 27.3 years of age (SD = 8.2), while those whose stated preference was for a genitally intact partner had a mean age of 36.4 years (SD = 13.7). Thus, the role of the male foreskin in preventing loss of vaginal lubrication during intercourse may become more discernible with increasing age among women. We reported:


During intercourse, the skin of an intact penis slides up and down the shaft, stimulating the glans and the nerves of the inner and outer foreskin. On the outstroke, the glans is partially or completely engulfed by the foreskin with more skin remaining inside the vagina than is the case with the circumcised penis. This ‘valve’ mechanism is thought to retain the natural lubrication provided by the female because the bunched up skin acts to block the lubrication escaping from the vagina, which results in dryness. (5)

Our work, which supports the hypothesis of Warren and Bigelow (3) and the findings of O’Hara and O’Hara (4) about the role of the male prepuce during coitus is fully reported in Denniston et al. (5)
Research generally has not considered possible adverse effects of male circumcision upon female sexual arousal and response. While Moynihan reported that vibratory thresholds, blood flow and hormone levels were studied, (1) there was no mention of circumcision status of the male partner. Likewise, Leiblum failed to control for male circumcision status. (2) In light of published findings, (4,5) this is a serious methodological omission.

Most likely, reported vaginal dryness and the related clinical designation ‘female arousal disorder’ is but a normal female response to coitus with a man with an iatrogenically deficient penis. (5)

It is imperative that future studies of female arousal disorder record and control the circumcision status of male sexual partners.


References:
  1. Moynihan R. The making of a disease: female sexual dysfunction. BMJ 2003;326:45–7.
  2. Leiblum SR. Arousal disorders in women: complaints and complexities. Med J Aust 2003;178:638–40.
  3. Warren J, Bigelow J. The case against circumcision. Br J Sex Med 1994;Sept/Oct:6–8.
  4. O’Hara K, O’Hara J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int 1999;83 Suppl 1:79–84.
  5. Bensley GA, Boyle GJ. Physical, sexual, and psychological effects of male infant circumcision: an exploratory survey. In: Denniston GC, Hodges FM, Milos MF, editors. Understanding circumcision: a multi-disciplinary approach to a multi-dimensional problem. New York: Kluwer Academic/Plenum Publishers; 2001. p. 207–39.
Related Reading: 

Male Circumcision and Women's Sexual Health [List of Resources] 


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