We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done".
The folly of Naegele's Rule
The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.
Variants in cycle length
Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth.
The inaccuracy of ultrasound
First trimester: 7 days
14 - 20 weeks: 10 days
21 - 30 weeks: 14 days
31 - 42 weeks: 21 days
Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose (refer to links in resources section). Complete classes on tracking your cycle are also available through the Couple to Couple League.
ACOG and postdates
One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.
Sources:
Mittendorf, R. et al., "The length of uncomplicated human gestation," OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932.
ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy
There are no accidents. When you forget something and need to drive back home to get it, don’t just grab it and go, stop and count to ten, there is a good reason why it happened and you’ll never know it if you simply waste your time in self-deprecating statements.
We run too fast from point A to point B etc, and at times the only way that spirit can communicate with us is by slowing us down one way or another. If you don’t stop regularly during your daily routine, if nothing else to simply be grateful of what you have, you might end up getting sick, so that you have to slow down and then take stock. Your practice is there not for God’s benefit, but yours.
How often do you look down while you walk, your mind lost in thoughts of the future or past occurrences or desires? Repeating to yourself over and over again the same thing, reliving the same action, recalling the same feelings?
When you keep your eyes on the horizon and you really look at what you see, you are forced to do two things: stay in the present moment and rejoice at the simple beauty of a puffy cloud, majestic mountains, or even the entirety of your village. So no longer will you focus on yourself as a separate entity you'll become one with your surroundings. Losing yourself and becoming part of your Universe. What is yours only would not matter as much as what belongs to all. You will feel you are part of this wholeness.
So many of us doulas, nurses, midwives and even doctors need to regularly do some continuing education courses to renew our certifications and or licenses. This is such an important part of what we do. Recently I went to the DONA conference, and even though I admit at times I heard myself saying, "being there, done that," I still came out with some great new insights, new info, and a renewed feeling that what I am doing is exactly what I want to do. You know how important your continuing education is for your clients. Many times I have heard parents come home from the hospital or from family gatherings with old fashion believes that some doctor, nurses, and even doulas and midwives, still have about breastfeeding, caring for a new born, or pregnancy and delivery. After many years in the business, we all gravitate to workshops on subjects we have not seen before, strange and unusual situations, diseases, complications etc. Yet, once in a while doing the tried and true breastfeeding workshop, or even hearing Dr. Karp's lecture on the 5 Ss umpteen times has kept my practice up-to-date.
MYTHS DEBUNKED
Here are some old fashion myths that are still perpetrated by many who have not bothered to know what is new up there:
Myth 1 "You must induce before 41 weeks, or your baby will be too big and it will get stuck and die - A breech baby must be delivered via cesarean due to the high mortality risk -Once a cesarean always a cesarean or you could lose mom and babe"
So many doctors induce as early at 39 weeks using all sort of reasoning, including fetal mortality. There are only a handful of doctors I know in Los Angeles that deliver a breech baby. For the most part a breech is an automatic cesarean, and don’t even get me started with the VBACs since now many hospital will not allow, even if you find a doctor who is willing. Here are the risk factors according to Andrew Kotaska MD, OBGYN, (from his lecture “Normalizing Birth in the 21st Century” Dona Conference 2008.)
The risk of mortality is as follow:
• 1/1000 Stillbirths risk from 41 to 42 weeks of gestation
• 1/1000 Risk of perinetal death with cautious selective vaginal breech delivery
• 1/1000 Composite risk of perinatal death or hypoxic inschemic encephalopathy (HIE - Reduced brain oxygen in the baby’s brain) with VBAC
Think this is too high consider the comparison:
• 1/200 risk of miscarriage from genetic amniocentesis
• 1/1000 yearly risk death in a 40 year-old non-smoking Canadian man (doc is from Canada)
• 1/1000 background stillbirth risk over ten days at term
• 1/1000 risk of trysomy 21 (down syndrome) infant in a 31 Y/O woman
• 1/1000 risk of MVA (moving vehicle accident) driving for 4 years
It would seem that the risks we are willing to take with a routine amniocentesis are way higher then a simple VBAC. Dr Kotaska goes on to say that “The increased neonatal and maternal morbidity and cost in the index and future pregnancy make it unreasonable to perform 1000 C/S to prevent one perinatal death. The obstetrician should recommend against cesarean section to prevent risks similar in magnitude to background risks.” In short, women should be informed of their choices and the pitfalls of cesarean sections, and/or pitocin induction. Those pitfalls should be discussed with as much emphasis as the supposed advantages. Women need to demand that there is a discussion of all reasonable alternatives for all these situations. It is called informed consent, no longer should the doctor just establish that “the baby is too big, we need to induce, section” etc. Autonomy demands that the ultimate decision regarding care rests with the woman.
Marshall Klauss MD, in his lecture “How Doulas Can Reduce Cesareans by Their Care” (Dona International Conference 2008) told us that “With a cesarean section vs. a vaginal delivery, there is a higher illness rate as well as a higher death rate in the mother. (c/sec – 5.85/100,000 vs. vaginal – 2.06/100,000.) He further went on to dispel yet another myth:
Myth 2 “Honey, you’d want an epidural as soon as you get into the hospital. It will not hurt mommy or baby”
Dr. Klauss tells us that “An epidural in the a first time mother can delay the first stage labor by an additional 4 hours, and the second stage by an additional 1 ½ hour for a total of 5 ½ hours. With an epidural, the baby receives medicine almost immediately, and 15% of the time the mother and infant develop a fever of 38 degrees centigrade. On delivery after the baby is born, the staff takes the baby to the NICU for observation and a blood culture. The baby is separated from the mother and father but usually there is no infection. If the epidural is started before 4-5 cm of dilation of the cervix, there is a reasonable chance that the infant might not complete rotation, which leads to a posterior position that often leads to a c/section” Let’s add also that often the epidural leads to pitocin and failed induction is the number one cause for cesareans in the United States.
Myth 3 “You have no milk; the baby is hungry and losing weight. You should give baby formula”
I can’t begin to tell you how many times moms hear this at the hospital, it seems none has told the nurses that as long as the baby looks good and is nursing every 1 to 3 hours and mom's nipples are not getting sore, there is no need to do anything but nurse often. New born can lose up to 10% of their body weight in the first week. Is better to help mom switch breasts every 5 minutes or so and wait another day or two for the milk to come in. A thirsty baby nurses strongly and is in no danger. A baby given water or formula might not nurse so strongly and mom's confidence (and milk supply) will suffer for it. As Dr. Gordon says “Look at the baby not the scale.”
Myth 4“Your baby’s weight gain is not acceptable, go ahead and supplement with formula.”
When hearing this comment, pediatrician Jay Gordon MD, suggests asking yourself the following questions:
Is your baby eager to nurse?
Is your baby peeing and pooping well?
Is your baby's urine either clear or very pale yellow?
Are your baby's eyes bright and alert?
Is your baby's skin a healthy color and texture?
Is your baby moving its arms and legs vigorously?
Are baby's nails growing?
Is your baby meeting developmental milestones?
Is your baby's overall disposition happy and playful?
Yes, your baby sleeps a lot, but when your baby is awake does he have periods of being very alert? If you have answered yes to the above questions, you may want to progress on to two important questions which the "charts" seem to ignore.
How tall is mom?
How tall is dad?
If someone were to ask you what weight a 33 year old man should be, you would laugh. The range of possibilities varies according to height, bone structure, ethnicity and many other factors. Yet babies are expected to fit onto charts distributed throughout the country with no regard to genetics, feeding choice or almost anything else.
Myth 5 “When breastfeeding, don’t eat broccoli, tomatoes, onion, and garlic. It will give your baby colic!!!”
This is one of my favorites, so many ‘expert’ including friends and grandmas and even midwives and doulas speculate on what a mom should and should not eat and how what she eats gives baby colic. Here is what Kittie Frantz, R.N., C.P.N.P.-P.C, one of the lactation luminaries of Los Angeles, and professor at USC says about the subject:
“I find these myths come from the mother community and not the hospital! Who on earth is spreading this incorrect information? Which hospital? Egad! Most agree that a breast feeding mother should eat a VARIETY of good wholesome foods and she will do just fine. In a variety, too much of one food is diluted by the variety. It is that simple. For example: The FDA says to reduce the amount of certain fish to avoid large amounts of mercury for pregnant women, breast fed babies and small children. A variety of food would prevent getting too much of any one fish so that would take care of that issue! A mother should not be told never to eat fish while pregnant or breast feeding.
Manella did research on foods and flavors in mother's milk. She found that what mother eats flavors her amniotic fluid and her breast milk. Is that such a bad thing? The mother who ate onions in pregnancy, has a baby who is used to onion flavor and will enjoy it in her milk. Manella found that the garlic flavor actually makes baby suck better! Vanilla is like catnip to a baby. I am sure the same thing is true in cultures who eat spices and chilies in pregnancy and breast feeding. They do breast feed in Central America and India you know! I was donating my milk to research while I was nursing my son back in the 1960's. I loved horseradish and ate a lot of it. My son was avidly breast feeding so I never gave it a thought that the flavor got through. The lab called to ask me what I was eating as the monkeys were rejecting only my milk. They asked if I would stop the horseradish and I did and the monkeys then began to take my milk. My son, who had tasted the horseradish all through my pregnancy was used to it in my milk and loved it.
Foods like peanuts, tomatoes, cow milk, etc. are known allergens. These foods do not CAUSE allergy in a child of a family with no allergy to peanuts. A child who has inherited an allergy to that food will have an allergic reaction to the food if he ever eats the food. Eating peanuts would only effect babies born of families with known allergies to peanuts. Example: Allergists who saw severe peanut allergy reactions to two year olds getting their first peanut butter & jelly sandwich (pb & j) realized that humans do not have severe reactions to foods the first time they get them. They realized that the peanuts eaten in pregnancy was the first exposure in the amniotic fluid. The peanuts eaten while breast feeding was the second exposure. The pb & j was the third exposure and tipped the severe reaction. This would only have relevance to the family with a history of peanut allergy. Peanuts given to children of families without an allergy to peanuts would not develop the allergy. So why tell all pregnant and breast feeding women to avoid peanuts?
Broccoli, cabbage, beans often aggravate reflux in humans and some feel it causes gas to the eater. Does it do this to the baby from the breast milk? Don't know. If a baby is gassy or bothered by reflux, the mother might try avoiding these foods and see if her baby seems less bothered. If baby gets better, try eating the foods again next week to see if he gets bothered by them a second time. If he does not, then it was only a coincidence that the broccoli bean salad you ate was on the same day he was fussy. If he reacts the second time you ate these foods, stop again and see if he is better and reintroduce it a week later to see if he reacts again. If he does get fussy all three times, then avoid those foods. If he does not react each time, then it was probably just a coincidence. NOT ALL BABIES WILL REACT TO THESE FOODS! Why take all women off of them just because a few babies reacted? Avoid telling all the moms in your breast feeding support group to avoid these foods just because your baby reacted.
Sometimes I think giving mothers too many "breast feeding rules" is done by folks who have controlling tendencies. Are they trying to punish the woman for doing something so wonderful for her baby? Just remember that variety is still the spice of life and everything in moderation! Eat a well balanced diet of foods that are good for you: fruits, vegetables, whole grains, & protein. Eliminate from your diet only what family members are allergic to. If your family has allergies, you are probably in touch with an allergist. Consult your allergist for his/her advice. If you have no family allergies and you feel your baby is reacting to a food you have eaten, experiment. Every baby is different. Every family is different. Enjoy breastfeeding!”
What we know is that probably milk is the one allergen that most commonly brings a negative reaction. In August 2000, the American Academy of Pediatrics issued an official statement about allergenic proteins in a mother's diet appearing in her breast milk and creating problems for her baby. As Kitties says moderation is the name of this game, too often overtired moms simply open the fridge and start with cereal with milk, followed by scoops of cottage cheese, topped off with delivery pizza for dinner (dad’s contribution,) and we wonder why the baby is fussy????
About colic
Babies simply cry, that’s how they express themselves, often there isn’t anything truly wrong with them. They need to be heard, and parents should be taught how to calm them with cuddling techniques not drugs such as Mylicon. Too many babies have been wrongly diagnosed with colic, or the latest craze - acid reflux. Dr. Karp suggests that colic are grossly misdiagnosed. In fact only 10 to 15% of all babies do have colic and usually it comes from milk allergy and a very low percentage from other foods such as caffeine, also contained in chocolate. Dr. Karp jokes, “How can you call it colic if the screaming and fussy stops when the baby is either swaddled, or placed in a sling, or taken on a car ride? How can these actions make pain go away?” Is it really pain or is the baby just in need of something else? Reflux usually only happens in 1/50 crying babies. More women should be told to expect the baby crying and not to immediately go into “something must be wrong” mode.
Myth 6 “It sounds like your baby has a lot of gas, it’s probably colic”
Studies show that actually gas increases in babies’ stomach after the baby cries and not before. Dr. Gordon tells us, “Babies are gassy. That is an immutable fact caused by the need to double or triple one's weight in a year. Try doing that yourself and see if you don’t spend a little time gassy.”
Myth 7 “You just don’t have enough milk to feed your baby”
Here is a list of common early breastfeeding challenges according to Jacqueline Kelleher (in her lecture “When Mommy Really Want to, But It Just Isn’t Working” Dona conference 2008.)
For the baby:
• Attached frenulum
• Prematurity
• Down Syndrome
• Illness
• High Palate
• Cleft palate
Conditions in the mother that can lead to breastfeeding difficulties
• Hormonal problem (bleed out)
• Conical shaped breasts (insufficient tissue)
• Thyroid problems
• Postpartum mood disorder
• Retained placenta fragments
• Large nipples (flat nipples)
• Breast reduction or augmentation
Common early breastfeeding challenges
• IV fluids in labor
• High cesarean rates
• Separation in hours following birth
• Separation during hospital stay
• Lack of emotional support
• Lack of experienced support
• Contradictory information in support
Myth 8“Just One Bottle of Formula Won’t Hurt the Baby”
According to Dr. Gordon one bottle can make the a difference.
• Breastfed and formula-fed infants have different gut flora.
Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci. Babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species.
In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week.
When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached.
Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants.
• The neonatal GI tract undergoes rapid growth and maturational change following birth.
* Infants have a functionally immature and immuno-naive gut at birth.
* Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens.
* Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy.
* sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function.
* Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings.
* The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe.
These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation.
Thus, Dr Gordon suggests that, “Infant formula should not be given to a breastfed baby before gut closure occurs.”
Bottom line, unless there is a serious medical reason for low milk production a woman with enough professional support can breastfeed her baby. Unless there is a serious reason for the newborn to have formula supplement, breastmilk is best. By addressing any health issue before the birth and having the help of a professional Lactation Consultant can make a difference in your experience. Knowledge is power. If you know about breastfeeding before you go into the hospital all those nay-sayers about your ability to feed your baby can be, gently and lovingly, put in their place.
Keeping up to date is the only way I know we can serve our clients best. Not only by our recommendation but also by providing facts and figures they can show their provider when given old and no longer substantiated information.
Mothers can stand up for themselves demanding information that is accurate, proven and if needed with sound back up material. I often suggest, when a client has been told she must have a cesarean for elective reasons (such as your baby is too big, or VBACs are dangerous etc.,) that she should do as most people do when they are told they need major surgery – get a second opinion hopefully from a doctor who is mother-friendly. When it comes to feeding your baby, trust that you are the perfect mother and the perfect match for your baby, and unless you have a serious health problem all it takes is patience, loving support and when it gets difficult the resources to get professional help.
There are so many more myths and this is the very first article of a series I am planning to write to keep you up-to-date.
Visit my website at www.joyinbirthing.com to get our free monthly newsletter
I practice clinical hypnotherapy and a method of natural childbirth that uses hypnotic techniques to reduce stress and fear during labor and delivery, alleviating pain and making the birth experience positive and enjoyable. I also teach healthy infant mental, emotional and cognitive health and development.
I focuses on infant mental health and pre-birth bonding, where I use guided meditations and visualizations to help women communicate and empower their babies before birth. These hypno-therapeutic techniques are also used throughout pregnancy for maternal/prenatal stress reduction, self confidence, relaxation, strength and generally increasing positivity.
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