Sooner rather than later

We’re anticipating the arrival of our new child August 8, 2008.

It turns out that it’s not been any trouble to conceive.

More problematic, all the feelings surrounding it. Though, joy is the pervading emotion.

Childbirth classes no longer needed?

Busy times, as usual. Classes are hectic, the holidays brought guests and much-enjoyed socialization and much-appreciated camaraderie and closeness, and traveling is on the horizon. Little time right now for the essays, my book. Now and again only can I check in with the listservs or email groups. Here is something of interest you may have already seen, though I see the blog is still getting comments even today. Columnist Tara Parker-Pope reports on her Well blog that pregnant women “cutting childbirth class.” Before going to the content, I must say how grateful I am to see her use of the word “women” rather than the usual “ladies” (yes, truly!) that I am seeing all the time on certain email groups. Ladies! Parker-Pope says:

Although women are more obsessed than ever with health during their pregnancies, they seem to have lost interest in learning about the end of pregnancy, also known as childbirth, reports the November issue of Fit Pregnancy magazine.

“Fewer women are taking classes,’’ said Jeannette Crenshaw, president of Lamaze International. Ms. Crenshaw told the magazine that she believes several issues explain why women aren’t as interested in learning about childbirth. Many women, she says, are convinced they can’t deliver a baby without epidural pain relief. Television shows often depict birth as a dangerous event, even though serious problems are exceedingly rare among women delivering in the United States. And because many women work until nearly the last day of pregnancy, busy schedules often prevent them from scheduling a birthing class.

Marjie Hathaway, co-director of the American Academy of Husband-Coached Childbirth, which teaches what’s known as the Bradley Method of natural childbirth, also told the magazine that interest in childbirth classes has waned. “Today, women are more focused on prenatal testing and monitoring the pregnancy than in learning how to give birth,’’ she said.

Research shows that there’s no real difference in pain, labor interventions or birth outcomes among women who take childbirth classes and those who don’t, the magazine reports. The classes appear to attract women who are the most vigilant about their health during pregnancy. Women who enroll in a childbirth class are more likely to have quit smoking, keep prenatal appointments and to breastfeed after birth, the magazine notes.

…

But today hospital-based classes tend to focus more on a tour of hospital facilities rather than techniques to cope with labor pain. The magazine argues that women’s declining interest in childbirth classes is worrisome because it’s happening even as childbirth has become more “medicalized’’ than ever. During childbirth, a number of variables can arise and women have to make informed decisions about procedures like epidurals, episiotomies, induction and C-sections. “That’s where you reap the dividends of having had a teacher who explained each possible intervention and showed you how to be your advocate,’’ the magazine reports.

What is most instructive and interesting, however, as is often the case, is to be found in reading the comments.

Gift your organization

Every year for the holiday season in place of money we might spend on gifts to one another, my family gives a contribution to a worthy organization. This year we decided we wanted to support an organization that is doing good for pregnant women, mothers and babies. For several months now, I have been studying several organizations to see which might actually be the doing the most good. We now have decided the National Advocates for Pregnant Women will get our support this year. You can read about NAPW at their website. Here is what Katha Pollitt, The Nation, said about NAPW:

This spirited group, headed by the brilliant civil liberties lawyer Lynn Paltrow, supports the rights of poor, often minority, sometimes drug-using women to respectful healthcare and social services, and fights punitive “fetal rights” prosecutions and legislation. The women NAPW supports are at the center of a perfect storm made of antichoice politics, racism and the “war on drugs”: They need support and treatment, not to be arrested in their beds in the maternity ward, as happened in South Carolina, and clapped into prison. Pregnant women have constitutional rights too. And remember, as with all civil liberties issues, today it’s them; tomorrow it could be you. Send checks to 153 Waverly Pl., 6th floor, New York, NY 10011

I am very pleased with our choice.

SSRI antidepressants during pregnancy? No!

Dr. Peter Breggin clearly spells out the consequences for the babies of pregnant women who take SSRI antidepressants.  He lays out how the FDA and the CDC are not representing the facts accurately. Read the entire post, (Huffington) Pregnant Mothers Should Not Take SSRI Antidepressants.

Here is some of it: (my emphases)

On June 28, 2007 more than 250 headlines around the world promised that SSRI antidepressants (such as Prozac, Paxil, Zoloft, and Celexa) are safe for pregnant mothers and their developing babies. “Mom’s Antidepressant Use Poses Little Danger to Baby,” heralded the Atlanta Journal Constitution. “Antidepressants pose low birth defect risk,” claimed Boston Globe. The New York Times ran with the Associated Press’s article titled “Antidepressants Not Big Risk for Defects.” The Wall Street Journal’s coverage was titled “Reassurance on Antidepressants in Pregnancy.” The day before the news stories broke, the Centers for Disease Control spun the news in advance with a press release headlined, “New Study Finds Few Risks of Birth Defects from Antidepressant Use During Pregnancy” (CDC Division of Media, 2007).

The headlines and the CDC press release were incredibly misleading. In the CDC study, several severe birth defects were doubled or nearly tripled in frequency when SSRIs were taken in the first trimester. This combined with the other known toxic effects of SSRIs, including brain damage and dysfunction, make these drugs contraindicated in pregnancy.

SSRI antidepressant use by pregnant mothers in the first trimester of pregnancy have been shown to have previously unidentified links to three birth defects in two new studies reported in the New England Journal of Medicine. One study was associated with the Centers for Disease Control and Prevention (CDC) (Alwan et al., 2007) and the other with Boston University (Louik et al., 2007).

The study led by Sura Alwan and colleagues involving the CDC showed the following: “Anencephaly–birth without a forebrain–showed a 2.4 times greater occurrence in women who had taken SSRIs in the first trimester.” This is a catastrophic, fatal birth defect that is not correctable.

The study examined histories of 9622 cases of birth defects and 4092 controls who were infants born without birth defects. Some stillbirths (occurring at 20+ weeks gestation) were included but if anencephaly resulted in a spontaneous miscarriage or a planned abortion, these events would not appear in this study’s findings.

Omphalocele–babies born with organs outside the body–was found to be present 2.8 times as often in the SSRI-treated mothers compared to the control group. Some media portrayed this birth defect as a small hernia of the umbilical cord–but severity of the condition varies, usually requires surgery as well as weeks to years of adapting, and can be life-threatening.

Craniosynostosis–the premature closing of one or more sutures or fibrous joints knitting the bones of the infant’s skull–showed 2.5 times more prevalence in infants exposed in utero to SSRIs. This condition also varies in severity. It can be primarily a bone condition of the skull or it can be secondary to an underdeveloped brain in the infant.

Craniosynostosis occurs in about four per 10,000 births according to the National Institutes of Health. A 2.8 times greater occurrence of this condition will cause 2,305 more U.S. babies to be born each year with this birth defect as a result of their mothers taking SSRIs in the first trimester of pregnancy.

In the abstract to the report, the CDC study claimed that it found no association between SSRI use in pregnancy and heart defects in neonates. However, that’s not true. The study found that obese women who did not use SSRIs had an increased risk with heart defects and that obese women who did use SSRIs had an even greater risk of neonatal heart defects with an adjusted odds ratio of 5.9 (95% CI, 2.4-14.3)!

The second study by Carol Louik and her colleagues did not find an overall correlation between SSRI use and the two defects, craniosynostosis and omphalocele. It did however find an association between sertraline (Zoloft) and both omphalocele and septal defects in the heart, and between paroxetine (Paxil) and right ventricular outflow tract obstruction defects of the heart.

Louik made many statements to the press reassuring people, in effect, not to worry. She made no mention of other birth defects and neonatal problems associated with SSRI antidepressants. Her study had funding from two pharmaceutical companies, including GlaxoSmithKline, the manufacturer of Paxil (Seward, 2007), one of the most implicated antidepressants in regard to birth defects. The company’s money was well spent. Thanks in part to Louik’s highly publicized comments, headlines throughout the country played down the risk.

Nor are these the only birth defects related to SSRI consumption during pregnancy. In December of 2005, the FDA issued a Public Health Advisory warning that the risk of congenital malformation, especially of the heart, was increased by the consumption of Paxil in the first trimester of pregnancy. The American College of Obstetricians and Gynecologists (ACOG) (2006) warned pregnant women to avoid taking Paxil and also showed concern about any antidepressant exposure during pregnancy. Yet the CDC and researchers are using the new studies to exonerate SSRIs. This is clearly an orchestrated attempt to reassure the public after the FDA’s and ACOG’s earlier warnings.

The 2007 CDC study offers an illuminating discussion of other study findings concerning abnormal in utero development, including delayed ossification (bone development). “A specific role of serotonin in cardiac and craniofacial morphogenesis in the rodent embryo has also been established,” according to Alwan, et al. (2007) in the CDC study.

Newborns also go through withdrawal when their mothers have taken antidepressants during pregnancy. One study found a rate of 30% in neonates exposed in utero to SSRIs (Levinson-Castiel et al., 2006). Withdrawal symptoms in infants reported in various studies include irritability, high-pitched or weak crying, tremors, poor muscle tone, disturbed sleep, rapid breathing and respiratory distress, and increased admissions to the neonatal intensive care unit.
In addition, children exposed in utero to SSRIs have an increased risk of developing persistent pulmonary hypertension at birth. This disorder, which is estimated to occur in one or two infants for every 1000 live births, will occur six times more frequently in children exposed to SSRIs after the twentieth week of pregnancy. The disorder causes “significant morbidity and mortality” (Food and Drug Administration, 2006). These children have difficulty getting enough oxygen into their lungs. The two recent studies in the New England Journal of Medicine limited themselves to SSRI exposure during the first trimester; but the neonatal pulmonary hypertension studies show that some hazards will develop during exposure later in pregnancy. Again, the CDC and the researchers drew no attention to these hazards.

Withdrawal reactions confirm further potentially disastrous consequences of SSRIs to neonates that the CDC and the researchers failed to consider in their reassuring statements. Withdrawal reactions confirm that the brain of the fetus has been bathed in SSRIs and that is has suffered significant functional changes. It should be no surprise that it is not good to bath the growing brain in toxic drugs like SSRIs. Serotonin is intimately involved in the development of the brain in utero and SSRIs inhibit normal brain cell development (Norrholm and Ouimet, 2000). It is also known that SSRIs cause myriad toxic effects on neurons in living animals, causing brain cells to grow abnormally (Wegerer et al., 1999; Kalia et al., 2000). Unavoidably, similar effects must be taking place in the human fetus exposed to SSRIs. In addition, the SSRIs cause drastic biochemical imbalances in the brain, many of them persistent or permanent. At present we have no way of measuring the harmful impact on the growing brain and the future mind of the fetus; but exposure to SSRIs is bound to be harmful in the long run.

Also alarming is the Wall Street Journal report that antidepressant use during pregnancy has jumped from 5.7% in1999 to 13.4% in 2003 (Seward, 2007). The data was based on Medicaid patients and could be higher for the general population.

The reassuring attitude promoted in the CDC’s press release flew in the face of evidence linking SSRI exposure during pregnancy to increased birth defects, and the additional evidence of SSRI toxicity in the developing brain. It proclaimed that the study “found no significant increase in the risks for the majority of birth defects assessed…” But I’ve never heard of any prescribed drug that increases birth defects “for the majority of birth defects.” The assertion was sheer nonsense, carefully calculated to mislead and obfuscate.

Women and their doctors who only catch the headlines created by these studies are being grossly misled. SSRIs should never be used during pregnancy.

…when the mother has been taking an SSRI antidepressant, increasing her risk by 240%, we must hold responsible the doctor who prescribed it, the drug company who manufactured and falsely promoted it, and the medical establishment that covers up and minimizes the drastic hazards associated with these toxic chemicals, including risks to adults, children and the unborn.

Again, this is a must-read.