Friday, May 16, 2008

who would even take the time to read this much? (besides you flo)

my friend and i were talking about how we dont get why people freak out about women having any amount of alcohol when they're pregnant but its no questions asked when putting narcotics into your body to make life easier for yourself. .... how does this make any sense? i get if you're completely opposed to both, but if you're to pick one that's safer to me the more reasonable thing is small amount of alcohol not a drug
that causes paralysis of your entire lower body, potentially forever, not to mention numerous complications etc. i guess i do get it... i mean i think it makes no sense but i could see thinking that way if all i knew was what doctors say... cause they act like alcohol will kill your baby but epidurals are "completely safe", when they have never been proven to be, in fact proven more often to be the opposite.

this is info from a frequently asked questions website about epidurals....

Research on the Effects of Epidural
The summary to follow in this FAQ is from a book: "Obstetric Myths versus Research Realities" by Henci Goer, pub. Bergin & Garvey, 1995 ISBN 0-89789-427-8. (send me email if you want ordering info - I love this book, but do not wish to abuse the net with advertisements!)

Ms. Goer has written medical pamphlets and magazine articles for 10 years, and is an ASPO (Lamaze) certified childbirth educator and labor support person (doula). She has read through the literature, given overviews and abstracts as well as the citations for those who wish to read the original research. She starts out with a section on how to understand the statistics and read the literature with an eye to a well-designed study. The amount of work in this book could only be appreciated by seeing it - I have included only a few of her citations and this is only one of many topics covered... This book was written for birth professionals, but a consumer-oriented version is coming soon (est. early 1999).

Here is the summary from the section on epidurals:

Epidurals substantially increase the incidence of oxytocin augmentation, instrumental delivery, and bladder catheterization. (21 studies cited) [Saunders, NJ, et al. "Oxytocin infusion ... primiparous women using epidural..." BMJ 1989;299:1423-1426]

In first-time mothers, epidurals substantially increase the cesarean rate for dystocia. (12 studies cited) [Thorp, JA, et al. "The effect of intrapartum epidural ..." Am J Ob Gyn, 1993;169(4):851-858]

Epidurals decrease the probability that a posterior or transverse baby will rotate. Oxytocin does not help. (7 studies)

Having an epidural at 5cm dilation or more eliminates both excess posterior/transverse and excess cesarean for dystocia. (2 studies)

Epidurals may not relieve any pain or may not relieve all pain. (3 studies)

Innovations in procedure - lower dosages, continuous infusion, adding a narcotic - have not decreased epidural related problems. (13 studies) [Naulty, JS. "Continuous infusions of local ..." (this is a literature review) Int. Anes. Clin. 1990;28(1):17-24]

Delaying pushing until the head has descended to the perineum increases the chances of spontaneous birth. (a time delay of 1 hour is not really delaying - it needs to be a positional not timed thing...) Evidence is divided as to whether letting the epidural wear off before pushing increases spontaneous delivery. (4 studies)

Maternal complications of epidurals include: [Uitvlugt, A. "Managing complications of Epidural Analgesia" International Anesthesia Clin. 1990;28(1):11-16]

* Maternal hypotension(5 studies). This reduces uteroplacental blood supply and can cause fetal distress. (8 studies)
* Convulsions (4 studies)
* Respiratory paralysis (3 studies).
* Cardiac Arrest (6 studies)
* Allergic Shock (2 studies)
* Maternal nerve injury due to needle injury, poor positioning, forceps injury, infection, hematoma, or subarachnoid injection of chloroprocaine. The last three usually cause permanent injury. (9 studies)
* Spinal headache (3 studies)
* Increased maternal core temperature. (2 studies)
* Temporary urinary incontinence. (1 study)
* Long-term backache (weeks to years), headache, migranes, numbness, or tingling. (2 studies)

Serious complications occur despite proper procedure and precautions. The epinephrine test dose can cause complications. (12 studies)

Epidural anesthetics "get" to the baby. (5 studies)

Epidurals do not protect the fetus from distress. In fact, they cause abnormal fetal heart rate, sometimes severe, which may occur with or independant of maternal blood pressure (11% - 43% depending on the study and type of medication used - the 43% was found with Bupivacaine, the most common drug for epidural.) (15 studies) [Stavrou C, et al. "Prolonged fetal bradycardia during epidural analgesia" S Afr Med J 1990;77:66-68]

Epidurals may cause neonatal jaundice. (2 studies) [Clark, DA & Landaw, SA. "Bupivacaine alters red blood cell ... jaundice associated with maternal anesthesia" Pediatr. Res. 1985; 19(4):341-343]

Epidurals may cause adverse neonatal behavioral and physical effects. (these are both direct effects and indirect effects from the increased rate of labor complications and interventions.) The importance of this is debated. (4 studies)

Epidural anesthesia may relieve hypertension, but hypertensive women are at particular risk of epidural-induced hypotension, which reduces placental blood supply. (2 studies)

the book's author is henci goer check it out.

and this is just many different opinions about what women do in europe... where overall people tend to be healthier, happier and less stressed....

Do European women give up drinking?
January 2004

I am currently pregnant with my second, and just as with my first, I am missing wine with dinner. I was so careful in my first pregnancy to avoid alcohol altogether, except for a very occasional sip. I always felt, though, and still do, that the prevailing no-amount-is-safe orthodoxy in this country is a little extreme, and probably inaccurate. I know that we have a number of European women in this network, and I would like to ask them about how drinking and pregnancy are viewed in Europe. I am especially curious about France and Italy where wine is so much a part of the dining experience. Do women in France and/or Italy stop drinking altogether when they get pregnant? Or do they continue to drink a glass of wine with dinner? What do French/Italian doctors and midwives tell their patients about drinking wine (or other alcohol) during pregnancy? How do French and Italian women view the no-alcohol-at-all approach in the U.S? Any French femmes out there with views to share?

I am an American who spent her first pregnancy in Paris. My OB was an American, though she had been there for quite a while. In my experience, the ''no-amount-is-safe orthodoxy'' you described is particularly American. At restaurants, waiters would be routinely surprised, even shocked, when I would pass on having a glass of wine, even when I was visibly (very visibly!) pregnant. In fact, a few times my OB even directed me to have a glass! During that pregnancy I drank wine fairly often (a couple of glasses a week? My memory is rusty), but I did not drink hard alcohol nor did I drink during the first trimester (but that part is just personal superstition, not based on medical evidence). I'm now pregnant again (in the Bay Area this time) and, although my opinion on the! subject hasn't changed, I've found that I drink less -- though it may simply be because we go out to dinner less frequently!
I am not a European mother, but I have been in the health information field for several years and I can tell you this: no health education or prenatal care expert will go on the record saying that any amount of alcohol during pregnancy is okay. Alcoholism is such a problem, and the effects of binge drinking so devastating, that the safe public health message is to abstain completely. No one knows what a ''safe'' amount of alcohol is either, as scientists are loathe to run those kinds of studies on pregnant women, for obvious reasons. Privately, you might get your obstetrician to say that a drink or two in the last trimester is okay, or don't worry about that Tom Collins you drank before you knew you were pregnant. Probably there is a big c! ultural difference in the approach to alcohol in pregnancy, between here and Europe, but it is based on true concern about problems caused by alcohol abuse in pregnancy. a health writer
I'm neither from Italy or France, but from Spain, where the wine culture is also very extended. The tendency I've seen while visiting pregnant and have heard from friends who leave there is that, in general, the attitude it more relaxed with regards to wine and other alcoholic beverages. I think the believe is that as long as it's not in excess and accompanied by food it won't harm the baby and it may help the future mom!

While I cannot give you the French view, here is my personal European perspective. I am German and spent the first few months of my pregnancy over there. ! ; I asked my very experienced OB/GYN (he's been caring for pregnant women for about 30 years) about alcohol. He thinks that there is no evidence that the occasional glass of wine harms the baby. His general recommendation about nutrition was to eat/drink what you really crave, and to leave out anything that you have to force yourself to take - with the following precautions as far as alcohol is concerned:

1. No regular drinking (i.e. every single day).

2. No binge drinking (i.e. having quite a few drinks in one session).

3. Not hard liquor; stick to wine or beer.

Having said that, a German friend of mine strongly craved wine throughout part of her pregnancy, and had a small glass of wine almost every night over dinner for quite a few weeks (I believe this must have been in the second trimester). Her little boy is gorgeous and perfectly healthy. I also have a friend who had a hard time calming down! and going to sleep during pregnancy. She had a glass of beer virtually every night before going to bed, deciding that sleepless nights or medication would be more harmful to the baby than the beer (her baby is also bright and healthy).

Most of my European friends probably went the moderate route I took. I cut back on my 'wine every night with dinner' habit but continued to have the occasional glass throughout my pregnancy. It's a very personal decision, and only you can decide what you are comfortable with. Whatever you choose, though, don't let others make you feel guilty!! Many women around the world drink some wine during pregnancy and have perfectly healthy babies. You clearly care, and you'll find the right middle ground that works for you and your baby.

Having just reviewed some of the literature on the effects of alcohol during pregnancy for the pediatric theory class I teach to nurse practitioners students, I would have to say that drinking during pregnancy is a very bad idea. They are still studying this issue and there may be periods of increased susceptibility, or genetic susceptibility, but they don't know enough to say how these variations affect the fetus. There was an article about this research in the NYT a few months back. You might want to go back and read it. I was surprised to learn how small amounts of alcohol can have subtle, but nasty, effects on some fetuses, see citation below:

''Adverse behavioral effects in children exposed prenatally to risk levels as well as low and moderate levels of alcohol have been reported by many researchers. Neonatally, habituation to stimuli (lessening of response to repetitive stimuli) was most affected and at 8 months, significant effects were observed by using! the Bayley Mental Developmental Index and Pyschomotor Developmental Index scales (global scales of infant behavioral functioning). 17 Furthermore, infants have longer reaction times when exposed prenatally to low to moderate levels of alcohol. 18....These findings suggest that alcohol teratogenesis can affect academic and social functioning even with prenatal alcohol exposure at social drinking levels.''

Sokol, Robert J. MD. Delaney-Black, Virginia MD, MPH. Nordstrom, Beth PhD. Fetal Alcohol Spectrum Disorder. JAMA. 290(22):2996- 2999, December 10, 2003

''Fetal alcohol exposure (even at ''social drinking'' levels) is associated with developmental difficulties in adolescence that are consistent with problems seen earlier in life. Clinicians should understand the potential role prenatal alcohol exposure plays in behavioral and cognitive problems'' J. Am. Acad. Child Adolesc. Phsychiatry, 1997, 36(9):1187-1194.

I'm not European (sorry!) but I am an epidemiologist and toxicologist. We obsess about finding the lower limit of toxicity/effect. Yes the research says that one drink a day is within the acceptable limits but we are notoriously poor at measuring things in people who vary so greatly. Believe me, the epidemiology is not that good. I say, why take a chance? that is your child. Buy some pomagranate juice or the best grape juice you can find and get some peace of mind.

Hi! I'm French, just returned to France after a year in Berkeley. I've never stopped drinking a little wine with dinner during my 3 pregnancies, and I felt OK with that. Important for me was not to drink without a meal, no strong alcohol, only wine (French wines have less alcohol that Californian wines)a! nd never more that one small glass. I was a little more careful when nursing my baby than when I was pregnant.

I think the no-alcohol rule is reasonable, but I don't feel like being reasonable all the time, it's important to be happy !

As an American mom who enjoys a glass of wine with dinner -- or two ... or even three ;^) --as much as any of those bon vivant French femmes out there, here's my unofficial & personal opinion for which the Berkeley Parents Network cannot be held legally responsible or liable: Hold off until after the first trimester, then go ahead & uncork that lovely merlot & sip in moderation. Since you'll only be having one small glass with dinner, do consider treating yourself & upgrading to a finer-than-usual vintage. I did do a bit of research on the wine & pregnancy issue. It's hard to find information on this since doctors, nurses, midwives, & publishers of pregnancy information *have* to stick to the ''no amount is safe during pregnancy'' orthodoxy for legal as well as professional reasons. Since nobody knows the exact point at which alcohol consumption crosses the line from harmless to posing a hazard to the baby's development, it's better to err on the side of caution & try to avoid negative outcomes & the accompanying potential for lawsuits. However, it really *is* better to avoid alcohol & other potentially harmful environmental factors (paint fumes, dangerous falls, serious illnesses, etc.) during the first trimester, because that's when the baby's central nervous system & other vital organs begin developing. Those four margaritas you quaffed before you knew you were pregnant are probably okay though (as long as this isn't a normal habit), since humans are pretty resilient & it takes a week or so for the egg to implant in your uterus & begin sharing your blood supply.

You can also find more honest & open perspectives on email newsgroups like this one & online message boards hosted by medical & women's Web sites.

I got pregnant while we were traveling in Italy in 2001. We had friends in Milan who arranged for me to visit their OB, and it was very interesting. He scoffed at the idea of having to give up wine, and said that a glass at lunch or dinner was fine. However, he was very concerned that I understand the widespread problem of toxiplasmosis in Italy, due to the number of feral cats in the fields where produce was growing. He told me to absolutely avoid rare meats and uncooked vegetables--no salad! (He also had a very fancy ultrasound machine with two viewing screens, so that my husband could watch the results sitting at a desk rather than leaning over me at the examining table. And he gave us a video of the ultrasound! But it was in the European video format, so we never watched it.)

Here's an affirmative response re: alcohol while pregnant. In both my pregnancies, I had episodes of strong early contractions, and guess what? My doctors (two different practices) both times suggested that I lie down and have a glass of wine or two. Of course I was very apprehensive about this. But they assured me that it was safe and might very well help slow down the contractions. In both cases, I was past the first trimester, and in both cases they also urged me to make sure that I was well-hydrated. So I think it's safe within reason, but I should also clarify that I never had more than a glass or so of wine a week. My kids show no ill effects (and neither was born early).

I'm sure you will get lots of comments on this one! Wine has been an important mutual interest for my husband and I for more than 20 years ! (wine groups, vacations to wine regions, collecting, etc.). During my first pregnancy, I had maybe 3-4 SIPS of wine the entire pregnancy. My second pregnancy I had a heart to heart with my OB (tops in the field) and asked whether it would be truly harmful if I occasionally had a 1/2 glass of wine with dinner. My OB said that her insurance wouldn't allow her to say it was okay, but in fact especially after the first trimester, a little wine with dinner wasn't going to do any harm. A pediatric MD friend of mine agreed. My European friends say that their doctors allow up to TWO GLASSES per day!! Personally, I was very happy to be able to have a half glass now and then. It certainly added to my quality of life during my pregnancy and while I undertand the dangers of fetal alchohol syndrome - its beyond belief that an occassional glass of wine with food after the first trimester could do harm. The syndrome w! as associated with alcoholic or heavy drinking women but given that a link was made between alcohol and birth issues, the medical community (really, the insurance companies) began preaching a ''zero tolerance'' rule. On the other hand, I did completely give up shellfish during my pregnancies!! By the way, both of my children were born totally healthy!

I stayed away from absolutely everything when I was pregnant the first time. However, when I went into early labor, I was given a combination of drugs to stop the labor that were horrible. When the same thing happened with my second pregnancy, my new O.B. told me to go home and drink a glass of wine. I was surprised, and she pointed out that the glass of wine was far less harmful to the baby than the combination of drugs I had been given to stop labor the last time. I continued to drink a glass of wine, or a beer, almost daily for the rest of my pregnancy, which not only prevented my early labor, but also tasted good, too! BTW, my babies were both over 8 pounds, and as healthy as could be. I would say that certainly in your last trimester, there is no medical reason w! hy you can not have a glass of wine here and there. For the record, ask you O.B. Mine (who is very well respected) said it was fine.
My wonderful OB told me that I could have a drink a day, more or less, when I told him I missed my after-work glass of wine or beer. Both my sons are big, bright, handsome fellows. I didn't have a drink every day, but many days I did have one. I suppose no alcohol is a good goal, but the level of puritanism now tied to pregnancy is sort of out of hand, IMHO. Use your noggin -- that's all it is.

I found the attitude to drinking while pregnant in this country to be a bit silly. I am British and the general consensus in the UK is that it is perfectly fine to have a few glasses of wine per week, but o! f course, that binge drinking should be avoided. While I was pregnant I encountered women here who were rude enough to criticise me when I drank in public. I find this very offensive, and puzzling too, given that many of the same women were perfectly happy to take drugs during childbirth! Incidentally, I gave birth to a very healthy nine pound baby, so I say go ahead and enjoy your glass of wine!
Here's a voice from Italy. Our doctors recommend moderation with alcohol, however an occasional glass a of wine at meals is OK. I was living in Scotland when I got pregnant and there the rule was maximum 1 unit of alcohol per day (1 unit= a glass of wine or a pint of beer!). It always seemed like a lot of alcohol to me and since it didn't appeal to me while pregnant I avoided it altogether for the first trimester, but I had a half a glass of wine a few times during the rest of the pregnancy.

While I was pregnant I had a pregnancy book from the U.S., Canada and France. Interestingly they said different things about alcohol. The U.S. book recommended to completely stop drinking alcohol, the Canadian book said that once in a while wine was fine and the French book suggested that one glass of wine a day is fine but to watch out for hard liquor. So I made up my own rule of one glass of wine a day on the weekend only.

Both my children were born in Europe - one in Switzerland, the other in Belgium - where the extreme precautions taken in America are viewed as exactly that. Of course I asked my OB/GYN in both countries about wine during pregnancy (and hair coloring as well - go ahead, but perh! aps wait until after the first trimester) and was told to enjoy a glass of wine, if I wished, with my dinner. As long as I was in otherwise good health and the pregnancy was going well, there were no major precautions given (obviously a glass of wine is different than a gin and tonic - use your judgement!). No raw fish, no soft cheeses (Brie and the like) - and that was it (one will often see French and Belgian women enjoying Steak Americaine/Steak Tartare, a popular dish consisting of finely minced raw steak mixed with raw egg and capers - a health nightmare for us cautious Americans!!!). Take my doctors' advice and enjoy your glass of wine - of course stop at one, and drink a glass of water with it perhaps, but there is no reason to avoid it completely. In Denmark they might tell you red wine is good for your breastmilk; in Belgium, dark beer! I enjoyed a glass of wine when I felt like it and both my children were b! orn healthy and enormous. Be prudent about your consumption and enjoy your pregnancy!!!!

my American-born cousin who has lived in Italy all her adult life says beer is great for breast milk production and they believe it helps with colic. For pregnancy she said you don't want to drown the baby but a glass or so of wine is considered normal in her region, she lives in the town of Perugia (1 or 2 glasses of wine may in fact be considered none at all.) I am not European but have several friends and family members who are, and I did drink occasionally during my pregnancy. I don't think I felt like it in the first trimester, but after that I would have a half glass of wine occasionally and on a handful of occasions had a full glass. A good friend of mine is European and is now the head of the pediatric clinical education program at Cornell University, as well as the mother of two children. Her opinion is that drinking in moderation is absolutely fine. My daughter was 9 plus pounds and was completely healthy at birth, and she's now 19 months and has met every developmental milestone early. The thing that I found surprising was that even after you have the baby the sanctimonious attitude continues. Although there have ! been no reliable studies showing that moderate drinking has a negative impact on breastfed babies, and even a few studies that show the opposite, you will read in many U.S. baby books that you should not drink ANYTHING while breastfeeding. Once again, I have drunk in moderation since having our daughter, who is still breastfed, and I have not noticed any impact on her. A mom who believes in everything in moderation

When my sister-in-law was pregnant in France, she was told to limit herself to a glass of wine with meals, no more than 2 cups of coffee, and no more than 5 cigarettes. Recommendations for baby care are different too. Those recommendations have a cultural basis, not just a scientific one. In all probability, the greatest health risk to drinking an occasional glass of wine during pregnancy is that someone might see you drinking it and attack you. Still, I w! anted to mention the information about smoking, since I suspect many people in this area would have a very different reaction to a pregnant woman smoking 5 cigarettes/day. Jennifer

I've also read the NYT article and other reports on the latest research on alcohol and pregnancy. It's reported that alcohol, even a very small amount, can actually cause more damage in the baby's brain than drugs. If you wouldn't do drugs ''occasionally'' or ''just a small amount'' while you're pregnant, you certainly wouldn't want to drink alcohol either. It's probably better to be on the safe side and not drink, for just 9 months. Chris

Regardless of what doctors here or in Europe advise, they can't guarantee everything that goes on inside our bodies. Ultimately, we are responsible for our bodies and their intake. Please ask you! rself if you want to risk guilt, if something goes wrong and live with the feeling that something may not have happened "if only you did something differently". I'm actually not much of a disciplined person myself, but when I was pregnant I considered it an honor and chose to change my nutrition from one day to the next (in practice of learning how to serve my baby's needs - not a bad time to start) and as soon as I had my entire body back to myself, I went back to wine, beer, french fries and the occasional junk food. (I guess, it also helped in just gaining 30+ lbs instead of 50-60). I just knew I had given it my best intentions and the rest was up to fate - I was at peace with that. another European mom

I appreciate the diversity of opinions expressed regarding drinking while pregnant. I am concerned that in the responses it would seem that the main danger to exposing a fetus! s to alcohol is fetal alcohol syndrome which may sound extreme to folks who do not have a great deal of information. There are many other possible devastating outcomes: in my family of origin, one of my siblings ended up with the condition of hydrocephalus which translates to a whole variety of health problems, not the least of which is life long developmental disability. Was this due to my mother's drinking while pregnant? While I cannot say for sure, there is much evidence (both anecdotal and from medical professionals)to suggest that the drinking was a primary cause. This has impacted our family immeasurably, both in direct ways (the life long care for my sibling, for instance) as well as the less tangible ground swells of unspoken guilt and blame.

When I was pregnant, I read the literature carefully and determined that a very few glasses of wine in my final trimester would be acceptable. My baby is healthy and fine- but I think it is imperative that women know as much as possible about the dangers- and that for those nine months, what we don't know (and after reading the variety of responses, it is clear that we do not know definitively)can have devastating effects. I would urge- no matter what evidence you have from other cultures- that you make a glass of wine the rare exception until your body is no longer the nest of the growing baby. anon

and i think this is the article they are all talking about in the new york times, but i can't be sure....

either way, there's not much research on drinking lightly while pregnant and even if there is, its up for grabs... but there is a lot about epidurals.... more than what's on this blog if you want it.... anyway, so silly.


Gombojav Tribe said...

I would take the time to read it! :-) And I did!

meg said...

did flo even read all of that? and in one sitting?

I was sold from the first paragraph anyways...or wait, even before the first paragraph. Epidurals are scary. full stop.