peaceful parenting

Birth Spacing: Research Shows 3-5 Years Optimal for Mother and Baby Health

Two Years - The Former Invisible Norm

For many years, family planning experts generally agreed that at least a twenty-four month, or two-year, birth interval is important for infant, child and maternal health. Studies have shown that birth intervals less than two years are associated with adverse perinatal and maternal outcomes. Despite this knowledge, few governments, or international health organizations have birth spacing policies or programs.

Although birth spacing is at the heart of reproductive health/family planning, it is rarely addressed directly. In short, the two-year recommendation for birth spacing is an "invisible norm." A review of over one thousand abstracts from the health and development literature revealed that few programs address birth spacing for its health benefits. As a result, the health benefits of adequately spacing births are often left out from client education materials and provider training manuals. In the few countries that have birth spacing programs the terms "birth spacing" and "family planning" are incorrectly used as synonyms.

New Findings on the Optimal Birth Interval

Research on optimal birth spacing collected and commissioned by CATALYST has confirmed the long-held notion that the highest risks for adverse health outcomes for children and mothers often occur with the shortest birth intervals. In addition, the new research shows that there is substantially more health benefit gained from lengthening the birth interval beyond the previously recommended two years to a three to five year birth interval. The new research shows there is an optimal interval for birth spacing - a period associated with the lowest risks for adverse health outcomes - and that optimal interval is three to five years. Based on these groundbreaking new research findings, CATALYST and the Optimal Birth Spacing Champions has taken the position that the previous two year guidelines need to be revised to be: Three to Five Years for Optimal Birth Spacing.

The new research on optimal birth spacing comes from large retrospective cross sectional analyses that statistically controlled for potentially confounding socio-demographic and biological variables. Shea Rutstein examined the association between birth intervals and neonatal, infant and child health and nutritional outcomes using Demographic and Health Survey (DHS) data from fifteen developing countries in Africa, Latin America and Asia. Agustin Conde-Agudelo examined the association between birth intervals and perinatal, maternal, and adolescent health outcomes, using a database of over two million pregnancies in eighteen countries in Latin America and the Caribbean. Bao Ping Zhu examined the association between birth intervals and perinatal health in two U.S. States and between two racial groups. Their findings indicate that spacing births for three to five years has the greatest positive health impact on perinatal, neonatal, infant, child, maternal, and adolescent maternal health in both developing and developed countries. The findings ( Graphs: One and Two ) indicate that the lowest risks for fetal death, pre-term delivery, small for gestational age, neonatal death, and low birth weight occur when births are spaced from three to five years. The lowest risk for maternal morbidity and mortality also occur at three to five year birth intervals.

Graph One:

Graph Two:

CATALYST has crafted the graph Optimal Birth Spacing Interval: Maternal- Perinatal Risks to illustrate the recommended optimal birth spacing interval. Research findings on the association of birth intervals and maternal and perinatal health were plotted on an eighty- month timeline. As Figure 1 shows:

The current recommendation of two years is too close to the high risk period for both mother and child;

Most researchers, but not all, identify the period of lowest risk for adverse health outcomes from between 27 to 60 months;

Risks for the mother starts climbing at 60 months and becomes statistically significant at 69 months.

For the mother-child dyad, the data supporting an optimal birth interval window spans from 27 to 69 months. However, as a public health recommendation, it is safer to create a buffer of nine months at each end of the interval window (27 + 9 = 36 and 69 - 9 = 60). Based on these findings CATALYST, the OBSI Champions and USAID have recommended a 36-60 month or a 3-5 year window as the optimal birth spacing interval.

New Findings on the Determinants of Birth Spacing Behaviors

In order to better understand the larger social, cultural, religious, institutional and structural influences on birth spacing behaviors, CATALYST has gathered qualitative data through focus group discussions in four countries: Peru, Bolivia, India and Pakistan. Over 1,000 respondents participated in the focus groups. In 2003, CATALYST will conduct OBSI focus groups in Egypt. Results from the series will help CATALYST form a more comprehensive research base for new birth spacing programming.

OBSI Reports and Technical Papers

CATALYST has commissioned several studies by Dr. Agustin Conde-Agudelo, Consultant to the World Health Organization, and the Pan American Health Organization. These are presented in Optimal Birth Spacing: New Research from Latin America on the Association of Birth Intervals and Perinatal, Maternal and Adolescent Health (2002). The document is available in English and Spanish.

Other useful reports on optimal birth spacing include:

Birth Spacing: Research Update 2002 USAID.

Birth Spacing: A Call to Action 2002 USAID.

Three to Five Saves Lives, Population Reports, Volume XXX, Number 3, Series L, Number 13 Summer 2002 Population Information Program, Johns Hopkins University.

Espeut, Donna Spacing Births, Saving Lives: Ways to Turn the Latest Birth Spacing Recommendation into Results, 2002 ORC Macro, Child Survival Technical Support Project.

The following list provides a short bibliography of some of the recent studies in optimal birth spacing interval:

2000

Conde-Agudelo, A. and J. Belizan. Maternal mortality and morbidity associated with interpregnancy interval: A cross sectional study. British Medical Journal (321): 1255-1259.1998

2002

Conde-Agudelo, A. Analysis of the Association Between Maternal Age and Adverse Pregnancy Outcomes. Unpublished.

2002

Conde-Agudelo, A. Analysis of the Maternal-Perinatal Morbidity and Mortality Associated with Inter-Pregnancy Intervals Following a Miscarriage in Women and Adolescents. Unpublished.

2002

Conde-Agudelo, A. Maternal Sociodemographic and Obstetric Factors Associated with Short Birth Intervals in Women in Adolescents. Unpublished.

2000

Fuentes-Afflick, E., N.A. Hessol. Interpregnancy interval and the risk of premature infants. Obstetrics and Gynecology 95: 383-90.

2000

Rafalimanana, H. and C. Westoff. Potential effects on fertility and child health and survival of birth-spacing preferences in Sub-Saharan Africa. Studies in Family Planning 31 (2): 99-110.

2002

Jansen, W.H. D. Frick, and R. Mason. The "X" factor in birth spacers: age and parity in demand for birth-spacing in 15 developing countries. Paper Presented at the Population Association of America. May, 2002.

2002

Rutstein, S. Effect of birth intervals on mortality and health: multivariate cross-country analyses. Unpublished Data from Measure/DHS+ Macro International, Inc. Calverton Maryland.

2000

Skjaerven, R. et al. The interval between pregnancies and the risk of preeclampsia. New England Journal of Medicine 346 (1): 33-38.

2001

Zhu, B.P. et al. Effect of interval between pregnancies on perinatal outcomes among white and black women. American Journal of Obstetrics and Gynecology (185): 1403-10.

1999

Zhu, B.P. et al. Effect of the interval between pregnancies on perinatal outcomes. The New England Journal of Medicine (340): 589-94.

Related Reading:

Your Children's Future Successes May Depend on Birth Spacing

Women Risk Premature Birth if Second Pregnancy Occurs Too Quickly

Why I Waited 3 Years Between Pregnancies (Natural Mama)

Birth Order and Intelligence [A 3 year minimum between pregnancies]

Making the Case for Space: A Birth Spacing Opinion

Deep Nutrition: Why Your Genes Need Traditional Food (information included on spacing of pregnancies and how the nutrient stores impact health of a baby already born and a new baby on the way)

The Nourishing Traditions Book of Baby & Child Care

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Car Seats: Rear Facing Background Basics

By Hakan Svensson
Read more from Svensson at CarSeat.se

Image courtesy of De Su Mama

Children who sit rear facing in a car seat cut the risk for death or injury dramatically. But why is rear facing so much better and where did the idea come from?

There are three main reasons why rear facing is so much better. First is the outstanding protection of a child’s head, neck and spine in frontal collision - which accounts for roughly 80% of accidents. Second is superior protection in side collisions. A rear facing child is pushed further into the car seat where it’s well protected. Third is a social reason, rear facing car seats often work better because driver/passenger can more easily communicate with the child.

You will notice Sweden mentioned often regarding car seat safety, especially when discussing rear facing use. The Swedes started rear facing long before other countries and have led research in the area for the past 40+ years. Swedish car seats are also different, with virtually all seats allowing children to sit rear facing up to 25 kg. (55 lbs), one of the highest rear facing limits in the world. Rear facing past 12 months is yet unheard of for many parents in other nations, while many are just now learning of the huge safety benefits. And all the while, rear facing car seats are a Swedish invention, with children here having used them standardly since the 1960s.

It was a Swedish professor, the now legendary Bertil Aldman, who came up with the idea of rear facing car seats in the early 1960s. Professor Aldman took his inspiration from the seats the Gemini mission astronauts used for take-off and landing, specially moulded to distribute the forces over the whole back. He was watching a TV program with the astronauts in the Gemini space capsule and noticed they were laying on their back, in opposite direction of acceleration. No one back then imagined how revolutionary Aldman’s research would become. He is now well known internationally and is credited with saving thousands of children’s lives. Read more here about Aldman and his 'crazy idea' of how to keep children ultra-safe in cars.

Many ask about rear facing and the benefits -- is it really that much safer? Are the benefits real? Are lives actually saved? From 1992 through June 1997, only 9 children properly restrained rear-facing died in motor vehicle crashes in Sweden, and all of these involved catastrophic crashes with severe intrusion and few other survivors. Looking at statistics in Sweden, where the recommendation is for children to sit rear facing until age 4, it is obvious to see what a huge difference the simple concept of rear facing really make.

Professor Aldman is legendary for his research, but it is Thomas Turbell who is called the 'Father of rear facing' for his work at the highly regarded crash test facility VTI in Sweden. There are over a million rear-facing seats in use in Sweden, and we do not know of any cases where a child in a rear-facing car seat has been seriously injured in a frontal collision. Swedish accident research has shown that rearward facing children’s car seats reduce serious injuries by 92%, while the forward-facing seats only reduce injury by 60%.

In the last few years, the rest of Europe (and rest of the world) has also become aware of this. A number of cases are known in which children have been totally paralyzed as a result of neck injuries while using forward-facing seats. The idea of rear facing is very simple: children, not only babies, have weak neck and bone muscles which are well protected while rear facing. Volvo explained this very well in one sentence: In the event of a front-end collision, the whole of the child’s back takes the strain of the impact, not its much more vulnerable neck.

Image courtesy of CarSeatBlog.com

To learn more about rear facing, first take a look at the history behind it and how the Swedes have been been rear facing children for the past 40+ years with amazing results. Read more details about the safety benefits and why Extended Rear Facing (rear facing past 24 months) or ERF is superior compared to forward facing. Learn about safety of different positions in the vehicle and also if Isofix/LATCH really make a difference.

Related Reading:

Car Seats Are For CARS: http://www.mothering.com/green-living/car-seats-are-for-cars

Common Car Seat Errors: http://www.drmomma.org/2010/02/common-car-seat-errors.html

Do You Use Your Car Seat Correctly? http://www.drmomma.org/2010/02/do-you-use-your-carseat-correctly.html

Safety: Rear-Facing As Long As Possible: http://www.drmomma.org/2009/11/car-seat-safety-rear-facing-as-long-as.html

Rear-Face Car Seat Facing Still Beneficial http://www.drmomma.org/2009/07/rear-facing-car-seats-beneficial-after.html

Rear Face As Long As Possible http://www.drmomma.org/2009/11/car-seat-safety-rear-facing-as-long-as.html

Car Seats Photo Album on Facebook: https://www.facebook.com/media/set/?set=a.10150914937212671.414158.202794322670

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Peaceful Parenting Pumpkin Contest

Have a pumpkin sitting around waiting for your artistic genius? Join us in this year's Peaceful Parenting Creative Pumpkin Contest! Paint it, carve it, stick a baby in it - tie it into gentle parenting in some fashion, and let your imagination take flight. Snap a photo and send to DrMomma.org@gmail.com with your first name. We'll add all entries here on Halloween for sharing and the winner (by number of 'likes') will receive a $20 gift credit toward any item(s) in the advocacy galleries of good stuff: http://www.drmomma.org/p/info-cards.html (breastfeeding, birth, babywearing, gentle parenting, intactivism, etc.). Thank you for raising awareness and planting seeds of gentle parenting information this Halloween!

Entries (click image to 'vote' by likes on FB):

Related Reading:

Halloween MILK!

Peaceful Parenting Pumpkin Contest 2012

Breastfeeding Pumpkin Contest 2011

Breastfeeding Symbol Pumpkins

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Intact Care and No Retraction Agreement

The following intact care agreement was written by Jennifer Gardner and originally appeared at Mothers Against Circumcision. It has been edited slightly for sharing at DrMomma.org, with updates in care (i.e. water only to clean the genitals - no soap), advising physicians and terminology. Gardner shares that she, "Wrote this after my family and I moved from Michigan to Massachusetts. In taking my son to a new pediatrician for his four month check-up, I made the mistake of trusting the doctor to know not to retract the infant foreskin. I was wrong. He did - while I was standing right next to him. I then wrote up this agreement, which has been signed - and adhered to - by our current pediatrician. (It also helps that he's already "foreskin-friendly.") Many other parents of intact boys have since relayed their own stories, requesting a copy of the agreement."

Medical Professionals for Genital Autonomy has also assisted in the creation of a Prevention Pack for Physicians, that can be sent to any physician directly via Etsy.

Above graphic available as stickers or informational card here.

To:_______________________
Healthcare provider/s of our son

From: ____________________
His Parents

In providing health care for the above named person, I agree to the following:

1. This boy is not circumcised. He was left intact, on purpose, by his parents at birth, who refused the operation at that time, as they feel that it is not a medically indicated procedure for infants. They intend to keep him intact, and are informed on the proper (and wary of the improper) care of the intact penis.

2. The proper care of the intact penis is to "leave it alone" (per Dr. Sears, Dr. Fleiss, Dr. Winckler, the AAP, among others). His parents do not retract his foreskin, as it is unnecessary, and likewise will not allow anyone else to do so either. Only a very small percentage of babies and young children have foreskin that is retractable. In the majority, the foreskin is firmly attached to the glans (head) of the penis in much the same way as the fingernail is attached to the finger, and DOES NOT retract.

Furthermore, any retraction of the foreskin before natural separation has occurred, as early as age three, but as late as early adulthood, can cause irreparable damage through bleeding and the formation of adhesions. The ONLY person who may retract our son's foreskin is our son himself, once natural separation has occurred.

3. There is NO reason whatsoever to touch our son's penis during an exam: Not "to see inside," not "out of curiosity," not "to break adhesions” (the attach points are synechiae, not adhesions), not "to see if the foreskin retracts," not "to clean it," etcetera. I therefore agree that I will not touch this child’s penis for any reason. If I genuinely have a concern about whether his urethral opening is "fine" I will bring this point up to his parents and they can decide if there needs to be anything done. If they do decide that it needs to be looked at, only THEY, not I, will touch his penis.

4. The intact penis needs no special care, such as "irrigation" or "loosening of the foreskin." His parents wipe the OUTSIDE with a wipe at diaper changes, or with warm water at bath time. Any "cleaning" other than the afore-mentioned can cause irritation, infection, and problems down the road. When his foreskin has naturally separated on its own, his parents will inform him of the proper care concerning retraction, and concerning cleaning; (i.e. to retract gently when showering, rinse with warm water, and replace.)

5. As our son's parents, we have written this document as a preventative measure only, in response to a previous negative experience. It is not meant to single out any one person, but is meant to relay our wishes and concerns to all health care providers who see our son.

I have read the above information. I understand what I have read, fully, and agree to what is written herein. I will adhere to the above information, and know that if I do not, it will be seen in the eyes of his parents as purposeful abuse toward our son. If I sign, I will receive a copy of this document. If I do not agree to all that is written here, this child will not be looked after by me for his medical care.

Signed,

__________________________

Additional items at the Intact Care Resource Page.
Prevention Packs for Physicians on Etsy

Top 100 Names of the Year for Boys!

Expecting a beautiful little BOY? Congratulations! The fun is only just beginning as you search for the best name for your new little sweetheart. Some adore using popular names of the time, others desire a unique name of their own creation. But no matter which direction you go on his name, your perfectly made little baby will soon fill your life with wonder and delight - and your heart will never again be the same.

Included below are the 100 most popular names for boys in the United States this year, based on the Social Security Administration's latest statistics. Does your little one's name make the Top 100? We'd love to hear from you and know what name you chose. Drop a comment below, or join in the conversation any time on the Peaceful Parenting Facebook page, or private discussion group.

And if you have questions about all things BOY, drop a note any time to SavingSons@gmail.com and our clinicians and volunteers will do their best to get you the resources you are seeking.

❤ Happy Babymoon! ❤

1. Noah

2. Liam

3. Jacob

4. Mason

5. William

6. Ethan

7. Michael

8. Alexander

9. Jayden

10. Daniel

11. Elijah

12. Aiden

13. James

14. Benjamin

15. Matthew

16. Jackson

17. Logan

18. David

19. Anthony

20. Joseph

21. Joshua

22. Andrew

23. Lucas

24. Gabriel

25. Samuel

26. Christopher

27. John

28. Dylan

29. Isaac

30. Ryan

31. Nathan

32. Carter

33. Caleb

34. Luke

35. Christian

36. Hunter

37. Henry

38. Owen

39. Landon

40. Jack

41. Wyatt

42. Jonathan

43. Eli

44. Isaiah

45. Sebastian

46. Jaxon

47. Julian

48. Brayden

49. Gavin

50. Levi

51. Aaron

52. Oliver

53. Jordan

54. Nicholas

55. Evan

56. Connor

57. Charles

58. Jeremiah

59. Cameron

60. Adrian

61. Thomas

62. Robert

63. Tyler

64. Colton

65. Austin

66. Jace

67. Angel

68. Dominic

69. Josiah

70. Brandon

71. Ayden

72. Kevin

73. Zachary

74. Parker

75. Blake

76. Jose

77. Chase

78. Grayson

79. Jason

80. Ian

81. Bentley

82. Adam

83. Xavier

84. Cooper

85. Justin

86. Nolan

87. Hudson

88. Easton

89. Jase

90. Carson

91. Nathaniel

92. Jaxson

93. Kayden

94. Brody

95. Lincoln

96. Luis

97. Tristan

98. Damian

99. Camden

100. Juan

Having a GIRL? See the Top 100 most common names for girls here.

Photograph by Clare Fisher

Top 100 Names of the Year for Girls!

Expecting a gorgeous little GIRL? Congratulations! The fun is only just beginning as you search for the best name for your new little sweetheart. Some adore using popular names of the time, others desire a unique name of their own creation. But no matter which direction you go on her name, your perfectly made little baby will soon fill your life with wonder and delight - and your heart will never again be the same.

Included below are the 100 most popular names for girls in the United States this year, based on the Social Security Administration's latest statistics. Does your little one's name make the Top 100? We'd love to hear from you and know what name you chose. Drop a comment below, or join in the conversation any time on the Peaceful Parenting Facebook page, or private discussion group.

And if you have questions about all things GIRL, drop a note any time to DrMomma.org@gmail.com and our clinicians and volunteers will do their best to get you the resources you are seeking.

❤ Happy Babymoon! ❤

1. Sophia

2. Emma

3. Olivia

4. Isabella

5. Ava

6. Mia

7. Emily

8. Abigail

9. Madison

10. Elizabeth

11. Charlotte

12. Avery

13. Sofia

14. Chloe

15. Ella

16. Harper

17. Amelia

18. Aubrey

19. Addison

20. Evelyn

21. Natalie

22. Grace

23. Hannah

24. Zoey

25. Victoria

26. Lillian

27. Lily

28. Brooklyn

29. Samantha

30. Layla

31. Zoe

32. Audrey

33. Leah

34. Allison

35. Anna

36. Aaliyah

37. Savannah

38. Gabriella

39. Camila

40. Aria

41. Kaylee

42. Scarlett

43. Hailey

44. Arianna

45. Riley

46. Alexis

47. Nevaeh

48. Sarah

49. Claire

50. Sadie

51. Peyton

52. Aubree

53. Serenity

54. Ariana

55. Genesis

56. Penelope

57. Alyssa

58. Bella

59. Taylor

60. Alexa

61. Kylie

62. Mackenzie

63. Caroline

64. Kennedy

65. Autumn

66. Lucy

67. Ashley

68. Madelyn

69. Violet

70. Stella

71. Brianna

72. Maya

73. Skylar

74. Ellie

75. Julia

76. Sophie

77. Katherine

78. Mila

79. Khloe

80. Paisley

81. Annabelle

82. Alexandra

83. Nora

84. Melanie

85. London

86. Gianna

87. Naomi

88. Eva

89. Faith

90. Madeline

91. Lauren

92. Nicole

93. Ruby

94. Makayla

95. Kayla

96. Lydia

97. Piper

98. Sydney

99. Jocelyn

100. Morgan

Having a BOY? See the Top 100 names of the year for boys here.

Photograph by Kelly Brown

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Gestational Diabetes - A Diagnosis Still Looking for a Disease?

By Michel Odent, M.D.

Nowhere in obstetrics is there such a discrepancy between evidence and practice as in the matter of gestational diabetes. This diagnosis has been mentioned briefly in several issues of our newsletter, in order to illustrate the frequent 'nocebo effect' of prenatal care. (1,2,3,4) I have recently received so many phone calls of sorely distressed women that I find it necessary to provide updated answers to frequently asked questions.

How to explain?

How to explain with simple words the real meaning of this scary diagnosis? How to explain that it is not a disease like with symptoms leading to complementary inquiries, but the mere interpretation of a laboratory test?

It is essential to emphasize that such a diagnosis is made after the 'glucose tolerance test' is included in the battery of tests routinely offered to pregnant women. It is easy to illustrate this fact by referring to the results of a huge Canadian study.(5) In some parts of Ontario routine screening was interrupted in 1989, while it remained usual elsewhere in that state. It became clear that the only effect of routine glucose tolerance test screening was to tell 2.7% of pregnant women that they have gestational diabetes. It did not change the statistics of prenatal mortality and morbidity.

Simple physiological explanations can also help reassure a certain number of women. One role of the placenta is to manipulate maternal physiology for fetal benefit. The placenta may be presented as the advocate of the baby, so that the transfer of nutrients to the fetus is optimized. It is via hormonal messages that the placenta can influence maternal physiology. The fetal demand for glucose increase gradually throughout pregnancy. The mother is supposed to react to this demand by reducing her sensitivity to insulin(6) This leads to a tendency towards hyperglycaemia that is easily detectable after a meal or after ingesting glucose. Some women can compensate their peaks of hyperglycaemia more effectively than others by increasing insulin secretion. When hyperglycaemia peaks above a pre-determined conventional threshold, the term 'gestational diabetes is used. In general glucose tolerance will recover its usual levels after the birth of the baby.

Practical recommendations

The practical advice one can give to women carrying the label of 'gestational diabetes' should be given to all pregnant women.another reason to question the practical benefits of such a diagnosis. This advice concerns lifestyle, particularly nutrition and physical activity.

Nutritional counseling should focus on the quality of carbohydrates. The most useful way to rank foods is according to their 'glycaemic index'(GI). Pregnant women must be encouraged to prefer, as far as possible, low GI foods. A food has a high index when its absorption is followed by a fast and significant increase of glycaemia. In practice this means, for example, that pregnant women must avoid the countless soft drinks that are widely available today, and that they must also avoid adding too much sugar or honey in their tea or coffee. Incidentally, one can wonder if the tolerance test, which implies glucose consumption (the highest substance on the GI), is perfectly neutral and harmless. GI tables of hundreds of foods have been published in authoritative medical journals.(7) These tables must be looked at carefully, because the data they provide are often surprising for those who are still influenced by old classifications contrasting simple sugars and complex carbohydrates. Such classifications were based on the mere chemical formula.

From such tables we can learn in particular that breakfast cereals based on oats and barley have a low index. Wholemeal bread and pasta also are low-index foods. Potatoes and pizzas,(8) on the hand, have a high index and should therefore be consumed with moderation. Comparing glucose and fructose (the sugar of fruit) is a way to realize the lack of correlation between chemical formula and GI. Both are hexoses (small molecules with six atoms of carbon) and have pretty similar chemical formulas. Yet the index of glucose is 100.versus 23 for fructose. This means that pregnant women must be encourage to eat fruit and vegetables, an important point since pre-eclampsia is associated with an oxidative stress.

The quantity of carbohydrates should also be taken into consideration. French nutritionists showed that, among pregnant women with reduced glucose tolerance, there is no risk of having high birth weight babies if the daily consumption of carbohydrates is above 210g a day.(9) This implies a moderate lipid intake. About lipids, the focus should also be on their quality, the ratio between different fatty acids. For example we must take into account the fact that monounsaturated fatty acids (such as the oleic acid of olive oil) tend to increase the sensitivity to insulin. We must also stress that the developing brain has enormous need of very long chain polyunsaturates, particularly those abundant and preformed in the sea food chain.(10)

Advice regarding physical activity is based on theoretical considerations and on the results of observational studies. Skeletal muscle cells initially use glycogen stores for energy but are soon forced to use blood glucose, thus lowering glycaemia in the short term.(11) In addition, exercise has been shown to increase the insulin sensitivity of muscles and glucose uptake into muscular cells, regardless of insulin levels,(12) resulting in lower glycaemia. The effect of exercise on glucose tolerance has been demonstrated among extremely overweight women (body mass index above 33). 10.3% of obese women who took no exercise had a significant reduction of glucose tolerance, compared with 5.7% of those who did any exercise one or more times a week.(13) " A walk in the shopping mall for half an hour to an hour a couple of times a week is all that is needed", says author Raul Artal. According to what we currently know, the benefits of a regular physical activity in pregnancy should be a routine discussion during prenatal visits, whatever the results of sophisticated tests.

Looking for a disease

Almost everywhere in the world, 'gestational diabetes' is a frequent diagnosis. We should therefore not be surprised by the tendency to assign it the status of a disease. This might appear as a feat, since this diagnosis is not based on any specific symptom, but just on the effects of an intervention (giving glucose) on blood biochemistry. One of the ways to transform a diagnosis into a disease is to list its complications. The well-documented fact that women carrying this label are more at risk than others to develop later on in life a non-insulin dependent diabetes has often been presented as a complication.(14) But this 'type 2 diabetes' is not a consequence of reduced glucose tolerance in pregnancy. It is simply the expression, in another context, of a particular metabolic type. One might even claim that the only interest of glucose tolerance test in pregnancy is to identify a population at risk of developing a type 2 diabetes. But when a woman is looking forward to having a baby, is it the right time to bother her with glucose intake and blood samples, and to tell her that she is more at risk than others to have a future chronic disease? It is probably more important to talk routinely about nutrition and exercise.

Gestational hypertension has also been presented as a complication of gestational diabetes. In fact an isolated increased blood pressure in pregnancy is a transitory physiological reaction associated with good perinatal outcomes.(15, 16, 17, 18) Once more the concomitant expression of a particular metabolic type should not be confused with the evolution of a disease towards complications.

Professor Jarrett, a London epidemiologist, made a synthesis of the questions inspired by such associations. He stressed that women who carry this label are, on average, older and heavier than the overall population of pregnant women, and their average blood pressure is higher. This is enough to explain differences in perinatal outcomes. The results of glucose tolerance tests are superfluous. According to Professor Jarrett, gestational diabetes is a 'non-entity'.(19)

The concept of fetal complications is also widespread. Fetal death has long been thought to be associated with gestational diabetes. However all well-designed studies looking at comparable groups of women dismissed this belief, in populations as divers as Western European (20) or Chinese (21), and also in Singapore (22) and Mauritius.(23) High birth weight has also been presented as a complication. In fact it should be considered an association whose expression is influenced by maternal age, parity and the degree of nutritional unbalance. If there is a cause and effect relation, it might be the other way round: a big baby requires more glucose than a small one. It is significant that in the case of twins - when the demand is double - the glucose tolerance test is more often positive than for singleton pregnancies. Only hypoglycemia of the newborn baby might be considered a complication, although there are multiple risk factors.

Another way to transform a diagnosis into a disease is to establish therapeutic guidelines. Until now, no study has ever demonstrated any positive effect of a pharmacological treatment on the maternal and neonatal morbidity rates, in a population with impaired glucose tolerance. On the contrary no pharmacological particular treatment is able to reduce the risks of neonatal hypoglycaemia,.(24,25) However gestational diabetes is often treated with drugs. The frequency of pharmacological treatment has even been evaluated among the fellows of the American College of Obstetricians and Gynecologists (ACOG).(26) It appears that 96% of these practitioners routinely screen for gestational diabetes. When glycaemic control is not considered acceptable, 82% prescribe insulin right away, while 13% try first glyburide, an hypoglycaemic oral drug of the sulfonylureas family.

While practitioners are keen on drugs, there are more and more studies comparing the advantages of human insulin and synthetic insulins lispro and aspart,(27, 28) or comparing the effects of twice-daily regimen with four-times-daily regimen of short-acting and intermediate-acting insulins.(29) Meanwhile the comparative advantages of several oral hypoglycaemic drugs are also evaluated. The criteria are always short-term and 'glycaemic control' is the main objective.(30) The fact, for example, that sulfonylureas cross the placenta should lead to caution and to raise questions about the long-term future of children exposed to such drugs during crucial phases of their development.

The nocebo effect of prenatal care

After reaching the conclusion that the term 'gestational diabetes' is useless, one can wonder if it is really harmless. Today we understand that our health is to a great extent shaped in the womb.(31) Furthermore we can interpret more easily the effects of maternal emotional states on the growth and development of the fetus. In the current scientific context we can therefore claim that the main preoccupation of health professionals who meet pregnant women should be to protect their emotional state. In other words the first duty of midwives, doctors and other practitioners involved in prenatal care should be to avoid any sort of "nocebo effect". There is a nocebo effect whenever a health professional does more harm than good by interfering with the belief system, the imagination or the emotional state of a patient or of a pregnant woman. The nocebo effect is inherent in conventional prenatal care, which is constantly focusing on potential problems. Every visit is an opportunity to be reminded of all the risks associated with pregnancy and delivery. The vocabulary can dramatically influence the emotional state of pregnant women. The term "gestational diabetes" is a perfect example.

When analyzing the most common reasons for phone calls by anxious pregnant women, I have found that, more often than not, health professionals are ignorant of or misinterpret the medical literature, and that they lack of understanding and respect for one of the main roles of the placenta, which is to manipulate maternal physiology for fetal benefit.

Prenatal care will also be much cheaper on the day when the medical and scientific literature will be better interpreted!

Citations in:

Primal Health Research: A New Era in Health Research. Published quarterly by Primal Health Research Centre. Summer 2004, Vol. 12 No.1

An article of the same title appeared in The Journal of Prenatal & Perinatal Psychology and Health (JOPPPAH), Volume 19, Number 2, Winter 2004

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Medical Organization Position Statements on Circumcision

No national medical organization recommends the routine genital cutting of infants without medically justified need for such surgery to take place. Infant circumcision is clearly spoken against in many nations, regardless of babies' sex (female, male, intersex) and is not supported for all babies in any nation, even those that otherwise stem from within a cutting culture.

What follows are current medical position statements from organizations across the globe today. Full statements are readily available via online searches. When we recognize that no national medical organization recommends routine infant circumcision, it becomes clear that such things should not be funded with tax payer dollars (Medicaid and similar programs), covered by health insurance (genital cutting of infants is not performed as a health treatment), or pushed upon unknowing parents by any medical staff who stands to financially gain from performing unnecessary genital surgery upon a non-consenting human being.

You are welcome to download and print the above card,

or they arrive with most items via Etsy as large, glossy placards.

Related Reading:

Peer reviewed published research on circumcision and the functions of the foreskin: DrMomma.org/2007/01/circumcision-studies.html

Scholarly books: https://amzn.to/2L0tf4t

Registered Nurses on Circumcision: http://www.DrMomma.org/2014/01/registered-nurses-on-circumcision.html

On the ethics of registered nurses assisting in forced infant circumcision: http://www.DrMomma.org/2014/04/on-ethics-of-registered-nurses.html

The Day I Withdrew from Nursing School: http://www.DrMomma.org/2010/01/day-i-withdrew-from-nursing-school.html

The Medical Benefits of Infant Circumcision: http://www.DrMomma.org/2013/05/the-medical-benefits-of-infant.html

Foreskin Friendly Physicians by State: http://www.DrMomma.org/2007/01/foreskin-friendly-physicians.html

Intact Care & Circumcision Physician Packs (by/for those practicing in medical fields today): https://www.etsy.com/listing/538608349/physician-do-not-retract-prevention

Expecting Packs (for friends and family, can be mailed anonymously or with a personalized note): https://www.etsy.com/shop/SavingOurSons?section_id=21167625

Medical Professionals for Genital Autonomy

to join our advisory panel of physicians, email SavingSons@gmail.com

Child injured in car accident when belt moved behind her back

On August 6th, loving father, Jonah Fults, shared a photo of his daughter and the following description of what occurred when she moved her seatbelt behind her shoulder (instead of keeping it across her chest). It is a powerful reminder to all parents, and children who are using belts, to be sure they are used correctly. Many older children (out of car seats) are prone to moving the chest strap behind them "because it is uncomfortable," but this, or worse, is too often the result.

Jonah writes:

I'm posting a picture of my precious little Firecracker Demi who was hurt last Friday in a car accident. I want people to understand the importance of the correct utilization of a car seat. She put her shoulder belt behind her back. This low speed accident happened in a neighborhood close to the house that they left. So 'I'm just going right down the road' is no excuse! We all have done it. She went forward, and hit the seat or the door. She has an orbital bone fracture. We will know soon if surgery is required to keep her eye muscles working properly. Her brother was fine in a car seat on the other side. Please people, protect our little ones. This is the scariest thing I've ever been through. Head injuries are for real!

Related reading:

Common Car Seat Errors: http://www.drmomma.org/2010/02/common-car-seat-errors.html

Do You Use Your Car Seat Correctly? http://www.drmomma.org/2010/02/do-you-use-your-carseat-correctly.html

Car Seats Are For CARS: http://www.mothering.com/green-living/car-seats-are-for-cars

Safety: Rear-Facing As Long As Possible: http://www.drmomma.org/2009/11/car-seat-safety-rear-facing-as-long-as.html

Carseats lower oxygen levels in newborns (use only in the car when driving): http://www.drmomma.org/2010/02/aap-car-seats-lower-oxygen-levels-of.html

Rear-Face Car Seat Facing Still Beneficial http://www.drmomma.org/2009/07/rear-facing-car-seats-beneficial-after.html

AAP Healthy Children Car Seat Guidelines: http://www.healthychildren.org/english/safety-prevention/on-the-go/pages/car-safety-seats-information-for-families.aspx

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Teen Internet Addiction

Infographic By: Liahona Academy - Therapeutic School for Boys

Circumcision: Never Assume Parental Knowledge

By Jen Sugarbaker
names in this story have been changed to protect identies

I have a story of circumcision regret, not for my own son, but for a baby I did not save.

My brother Jim, and his girlfriend, Carrie, gave birth to a beautiful, premature baby boy. They live in the Northeast, and I live in the Southwest, but I communicate with Carrie frequently over Facebook as our boys are about the same age. When their son, Evan, was born a month and a half premature and placed in the NICU, I never even thought to talk with Carrie about circumcision. I just assumed that because her son was so small and fragile, she would not want to do anything to hurt him. I also knew that she was aware that my own son is intact, and that she would follow my lead.

I was shocked when my mother called and told me that my new nephew had been cut, only a few weeks after birth.

I learned an important lesson that day: if you know someone who is expecting, or has recently had a baby, TALK TO THEM about the dangers of circumcision and the benefits of keeping children intact. Never underestimate the other parent's naivety on the subject, or the powerful pressure a mother may be under from her partner, her family, or her medical providers to circumcise.

I wish now that I had spoken up for my nephew, and I refuse to let another opportunity like that pass me by. Please, do the same and speak up whenever you have the chance to do so.

Info packs (large and small), as well as postcards for a friend - are available via SOS here.

Hear from additional parents who are keeping future sons intact, and those who have worked through circumcision regret: DrMomma.org/2010/05/i-circumcised-my-son-healing-from.html

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Press Release: More than 200 Jewish Leaders Will Bless Intact Jewish Boys

At this Brit Shalom, the parents washed their son’s feet (Brit Rechitzah) as a symbolic sign of Jewish covenant and welcoming, rather than circumcising him. Other aspects of the service involved honoring of the parents and grandparents and giving the son his Hebrew name.

The movement to welcome newborn Jewish boys into Jewish life without the surgery of circumcision has reached a milestone—over 200 officiants are now available to perform the peaceful welcoming ceremony. Over 120 of these are rabbis. Many of these officiants are members of the Reform, Humanistic, Renewal, and Reconstructionist Jewish movements. Not all of the officiants on the list are opposed to circumcision, but some are. Several Rabbis on the list have intact grandsons, some have intact adopted sons.

While most celebrants are Rabbis and Cantors a variety of other Jewish Leaders are available to lead these rituals. Other celebrants include professors of Jewish Studies, Synagogue leaders, leaders of Jewish retreats, and Rabbinical students in a variety of Jewish movements.

Called brit shalom (Hebrew for covenant of peace), this alternative naming ceremony corresponds with traditional brit milah welcoming ceremony, except that there is no cutting of the baby. “They’re especially happy ceremonies, for that reason,” says Mark Reiss, M.D.

For 14 years, Dr. Reiss, has been recruiting celebrants of brit shalom for his web page. He estimates that an annual 300-500 boys are welcomed into the Jewish community with brit shalom ceremonies in the United States. Most U.S. states, several Canadian provinces, and other countries are represented on Dr. Reiss’ celebrants list. Twelve of the celebrants are in Israel, where a young Jewish Intactivist movement is budding (intactivist = intact + activist).

“The celebrants include rabbis, cantors and other lay leaders, who need not reject circumcision themselves, but want to accommodate parents who do. New celebrants are always welcome,” says Dr. Reiss.

Jewish parents including Natalie Bivas, Moshe Rothenberg, Diane Targovnik, Michael S. Kimmel, Sara Rockwell and Shawn Stark have written about their experiences holding a Brit Shalom and raising intact Jewish sons.

Those who wish to contact Dr. Reiss to request an officiant, to add their name to the list of celebrants, or to learn more about brit shalom may do so by phone (415) 647-2687 or by email at mdreissmd@gmail.com.