tag:blogger.com,1999:blog-47380620310523718852024-03-17T10:07:55.672-07:00The Well-Rounded MamaSize-Acceptance Warrior, Birth Activist, and One Fierce Mama.Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.comBlogger485125tag:blogger.com,1999:blog-4738062031052371885.post-81788455520787885442019-05-29T02:29:00.001-07:002019-05-29T02:29:36.950-07:00It is with much sorrow that we tell of the passing of Kmom<div dir="ltr" style="text-align: left;" trbidi="on">
It is to my great sorrow that I must write that Kmom, aka Pamela Vireday my wife, passed away on May 23 from complications due to ALK Positive Lung Cancer (non-smoking lung cancer). Her four children were singing to her at the moment, and we were all together at the time.<br />
<br />
She never wrote about her cancer here, wanted to keep that issue out of this blog. But as she researched her cancer she found the blogs and information from other cancer patients, and she found comfort in what they wrote. So she created another blog to help others, as part of her legacy too. <a href="https://cancercontinuum.blogspot.com/">https://cancercontinuum.blogspot.com/</a><br />
<br />
We will keep these blogs active for a long long time. She left over 163(!) drafts for this particular blog alone, so there is plenty of material available. I am hoping for a future editor to take over the blog because this is not my area of expertise.<br />
<br />
Let me thank you in advance for your condolences and sympathies, and know that we her family are okay at the moment. Moving forward from this point is always hard, will be ups and downs. But we are together and she is always with each of us.<br />
<br />
For you dear reader, she would say take care of yourself too. Light a candle, meditate, hit pool noodles together, have squirt gun fights, talk to someone who will listen. Do what you need to do to mourn. And use the information you find here as you need, to carry on the purpose of this blog in your own ways.<br />
<br />
Signed, Richard Vireday. Loving Husband, Father to our Children, Her Best Friend.<br />
<br /></div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com11tag:blogger.com,1999:blog-4738062031052371885.post-91084257995985756062019-03-14T17:54:00.000-07:002019-03-14T17:54:54.465-07:00Colicky Baby? Nursing Problems? Consider Cranio-Sacral Therapy<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMx0-0qm0meFBDA8olPqAWAlW0kLyheSUco9RHpjelMF5eDGI2hkxUrfQDlsR7YpMJjr-m0Iyg2TKazHbyCw5UhNn4WKxPAsKGE8M_2db9ogDkMPtAiSuH5QkuKe7Dxa8KRREUyWA6IOo/s1600/screaming+baby.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMx0-0qm0meFBDA8olPqAWAlW0kLyheSUco9RHpjelMF5eDGI2hkxUrfQDlsR7YpMJjr-m0Iyg2TKazHbyCw5UhNn4WKxPAsKGE8M_2db9ogDkMPtAiSuH5QkuKe7Dxa8KRREUyWA6IOo/s320/screaming+baby.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
When my first baby was born, she had a rough time. So did we. She spent hours screaming. She couldn't settle down to sleep for long until the middle of the night. She just wasn't a happy baby. I felt so bad for her, and I certainly felt like a bad mother.<br />
<br />
She was like this for FOUR MONTHS, four verry longgggg months.<br />
<br />
We tried everything we could think of but nothing worked. Going for walks often helps but not for this baby. Going for a drive helps many babies but just seemed to make this one worse. Jiggling and swaying sometimes helped but mostly it didn't. Vacuums and washing machines, no luck.<br />
<br />
There were times I got so frustrated that I put her into her playpen, nice and safe, and let her scream while I went into the bathroom around the corner and pounded the walls with my fists and cried too. Better the wall than the baby, I reasoned. Afterwards I could return to her calmer and more able to respond lovingly. Sometimes I called up my husband at work and told him, "<i>Get home NOW!!" </i>because I couldn't stand it any longer. We would tag team parent to keep sane on the really tough days. There's no question, a colicky baby is extremely difficult at times.<br />
<br />
My baby cried so much sometimes that even the neighbors heard. A neighbor who lived behind us diagonally suggested Craniosacral therapy. She had a child with cerebral palsy and said it worked wonders for him when he was a fussy newborn.<br />
<br />
I was intrigued and tempted. But in the end it sounded way too "woo-woo" for me so I never tried it. I just couldn't trust my baby to it. She was my first baby and I just couldn't bear to try anything out of the ordinary. So we all suffered through together.<br />
<br />
My daughter finally did outgrow the colic, but it was a loooooooooooong four months, let me tell you. While she was always a sensitive baby in many ways, after that she got a lot easier to deal with and she was definitely much happier.<br />
<br />
My second baby was much more easy-going, thank goodness. As long as he got nursed on time and held plenty, he was a happy guy. He had his own challenges, as all babies do, but nothing like as his sister.<br />
<br />
My third baby, though, <i>was</i> a lot like his sister. To this day, they follow each other's patterns in many ways. When he was born and started having troubles with crying and sleeping, I knew I was NOT going to go through Colic Hell again. So I decided to heed my neighbor's suggestion and try Craniosacral therapy.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Stresses from Birth</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm3kpBiunnQVpd4E1esKkGOagP9Len_5_1sBEzl3P8ODjpfUsJhgfwErbRrWZkBe5kSn5LJVMK5WCvIC8XTfZ2xHFJ4O8A6437TjDrsia-6h1EtI-j6sQGPbg3DQFNjNw7irJhIxWH5SM/s1600/03-baby-crying.w700.h700.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="700" data-original-width="700" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm3kpBiunnQVpd4E1esKkGOagP9Len_5_1sBEzl3P8ODjpfUsJhgfwErbRrWZkBe5kSn5LJVMK5WCvIC8XTfZ2xHFJ4O8A6437TjDrsia-6h1EtI-j6sQGPbg3DQFNjNw7irJhIxWH5SM/s320/03-baby-crying.w700.h700.jpg" width="320" /></a></div>
<br />
When a baby is born, there is a lot of twisting and turning to navigate the mother's pelvis. This can be stressful on the baby's head and neck areas. In addition, the baby's head is made of separate bones that can fold in on each other slightly like a vegetable steamer so it can fit through the pelvis more easily.<br />
<br />
However, after the birth all the pressure and twisting and turning may not leave these bones moving freely. Craniosacral therapy aims to restore that freedom of movement and ease, as well as a free flow of cerebral spinal fluid.<br />
<br />
Craniosacral therapy (CST) is a very light-touch, hands-on therapy. It uses the pressure of the weight of a nickel on the baby's skin to slowly and carefully address any misalignment in the baby's head, neck, sacrum, or soft palate. It aims to restore good nerve function so the baby's systems can operate optimally.<br />
<br />
Some births are more stressful on the baby than others. Births that tend to benefit most from CST include:<br />
<ul style="text-align: left;">
<li>Forceps/vacuum births</li>
<li>A very slow and/or difficult birth</li>
<li>A traumatic birth</li>
<li>A birth where the baby was malpositioned or got "stuck" </li>
<li>An extremely fast birth</li>
<li>A cesarean birth</li>
</ul>
<div>
Some people might think that a cesarean would be easiest on the baby, but it's actually just a different kind of stress. Babies born by cesarean are pulled out sideways through a small incision; sometimes that happens easily and sometimes it doesn't. Thus some cesarean babies can also have a difficult time post-birth.</div>
<br />
Some of the behaviors that CST might be able to help include:<br />
<ul style="text-align: left;">
<li>Fussy babies who don't soothe easily</li>
<li>Babies who don't sleep well</li>
<li>Babies who have digestion or elimination problems</li>
<li>Babies with lots of spitting up or reflux</li>
<li>Babies with Colic</li>
<li>Breastfeeding problems</li>
<li>Difficult latching for baby; resulting sore nipples for moms</li>
<li>Babies who favor turning their heads to one side</li>
<li>Babies who favor one breast or position for nursing</li>
<li>Babies who seem overly sensitive</li>
</ul>
<b><span style="color: #cc0000; font-size: large;">CST Controversy</span></b><br />
<b><br /></b>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhze0vGxToWAgAy4HtuvqcUPMdwowiD2RPMDU_QXM9zyeLGcoM-W0XfcluU4XaLXfrIoiOLrs88rlysfQ_XmhaO-roYe1wDNuFhjld_qxxrZE5vxyLz0xcb83PVzBbvdNG6ez7svIkt6BQ/s1600/babycrying+with+fists.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="486" data-original-width="648" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhze0vGxToWAgAy4HtuvqcUPMdwowiD2RPMDU_QXM9zyeLGcoM-W0XfcluU4XaLXfrIoiOLrs88rlysfQ_XmhaO-roYe1wDNuFhjld_qxxrZE5vxyLz0xcb83PVzBbvdNG6ez7svIkt6BQ/s320/babycrying+with+fists.jpg" width="320" /></a></div>
<br />
Unfortunately, there is NO gold standard evidence on Craniosacral therapy. Like many alternative medicine fields, the research is mostly based on case studies, which basically amount to someone's story that it works. Anecdotal evidence is not irrelevant, but it is not science.<br />
<br />
Critics <a href="https://www.painscience.com/articles/craniosacral-therapy.php" target="_blank">charge</a> that the idea behind Craniosacral therapy is nonsensical, that there is "no plausible mechanism of action," that studies end up producing conflicting diagnoses from different practitioners instead of consistent results, and that what studies there are mostly come from the inventor of the technique, which could easily bias the results. These are all valid <a href="https://www.kckidsdoc.com/kc-kids-doc/will-craniosacral-therapy-cst-help-my-baby-nurse.html" target="_blank">concerns</a>.<br />
<br />
When you watch or experience Craniosacral therapy, it certainly appears as very "woo-woo." It certainly fits many stereotypes of alternative medicine quackery, and there really <i>isn't</i> any good proof that it works. All it has going for it are people's testimonials about how helpful it can be in some cases, which could be caused by a placebo effect as much as anything. As one critic writes, "<i>No one can deny that craniosacral therapy is relaxing. But, then again, so is a nap & a nap is cheaper</i>."<br />
<br />
So I can't say there's <i>proof </i>that CST works, but there are plenty of stories out there of its helpfulness. Take that as you will. For some people, these stories are enough to at least give CST a try. For others, it's absolutely not. If you are willing to try it, go for it. If it all sounds far too woo-woo and quackery to you, don't try it. The decision is always yours.<br />
<br />
All I can do is share my personal stories in which Craniosacral therapy was helpful to my family. I started out as a total skeptic on it, completely unwilling to buy into it. But I was so desperate to avoid the 4-month Colic Hell I'd experienced with my first that I was willing to suspend my disbelief and give it a try on the desperate hope that it might help. I fully expected it to fail -- but it didn't. I have since used it in enough situations that I think it's worth considering if you find a very skilled and experienced provider that has the specialized training needed.<br />
<br />
<b><i><span style="color: #38761d;">Colic</span></i></b><br />
<br />
The first time our family tried CST, it was on baby #3. He had trouble settling down and going to sleep, had trouble sleeping for more than a few minutes at a time, and was just generally fussy, crying, and unhappy. At 2 weeks old I took him in for some CST. I used a pediatric chiropractor trained in CST. I stood right beside them so I could snatch him away if needed.<br />
<br />
When we started, his arms and his legs were tucked up tight against his body and his little hands were held tightly in fists. He was a tense little guy. When the therapist started, she put one hand on his head and one hand underneath his sacrum. He began crying and tensed up even further. As his crying intensified (it didn't last long), I was just about ready to grab him and give up. Just then he gave a loud cry, a HUGE sigh, and relaxed his whole body. His legs fell to his sides, his arms relaxed, and his little fists uncurled. He stopped crying and fell deeply asleep. He napped all through the appointment and then was bright and cheery later on. That night, he slept SO well!<br />
<br />
We used CST several times with him as a baby and he seemed to really breathe into it and enjoy it each time. It did seem to help him resolve whatever had been causing his colic.<br />
<br />
There is an interesting description of CST for young babies, along with many CST resources, <a href="http://www.carolgray.com/about-craniosacral-therapy/craniosacral-therapy-for-infants-and-chidren/" target="_blank">here</a>.<br />
<br />
<b><i><span style="color: #38761d;">Nursing Issues</span></i></b><br />
<br />
We used CST on my 4th baby too. Not because she had colic but just as a precaution and because it had helped my other babies. But then one night when she was several months old, my husband fell asleep while holding her. He inadvertently relaxed his grip on her and she rolled off his lap and fell onto the floor. She cried very loudly but didn't seem hurt at all. However, after that, nursing all of a sudden hurt. It had been fine before that fall, but suddenly nursing seemed to pain her, and I know it pained me. Her latch had changed and I was left very sore. She was fussy too.<br />
<br />
So we got her into our same pediatric chiropractor as soon as we could. She had me nurse the baby just before the treatment, then did the treatment, and had me nurse her again just after it. It was like night and day, the difference! It no longer hurt, the baby was satisfied and not fussy after, and I had no pain from her latch afterwards. Obviously, something about the treatment itself had changed things for the baby, even though the treatment looked like nothing was being done. It obviously had <i>some </i>effect.<br />
<br />
It makes logical sense to me that CST might be able to help nursing issues. Often the CST therapist will put on a medical glove and have the baby suck on an upside down finger. In this way they are evaluating the baby's suck and latch, and if anything is off, they can adjust the palate with a little light pressure from the inside. Works like a charm and did not seem rough at all.<br />
<br />
There is a good article describing what a lactation consultant is looking for when treating a breastfeeding baby, which can be found <a href="http://www.lowmilksupply.org/craniosacral.shtml" target="_blank">here</a>.<br />
<br />
<b><i><span style="color: #38761d;">Fibromyalgia</span></i></b><br />
<b><i><br /></i></b>My eldest child went on to develop fibromyalgia as an adult. She's pretty functional most of the time but she does deal with a lot of pain, including headaches. We have found that Craniosacral therapy is the ONLY thing that really dials down her pain levels effectively. Because fibromyalgia is a chronic condition, she seems to do best if she goes for CST treatment about once a month. She has to pay for her own CST but it helps her so much she makes room for it in her limited budget. She's a real believer in it.<br />
<br />
There is one small study that supports the use of CST for fibromyalgia. The details can be found <a href="https://journals.sagepub.com/doi/abs/10.1177/0269215510375909" target="_blank">here</a>.<br />
<br />
<b><i><span style="color: #38761d;">Headaches</span></i></b><br />
<br />
In my fourth pregnancy I began to experience a lot of headaches. There was a lot of stress in my life at that point as I was a caregiver to a dying parent, but these felt like more than just stress headaches. None of my usual headache fixes were working very well, so when I was a few months' pregnant I decided to try CST.<br />
<br />
Some people feel immense emotional releases during CST but I felt a weird physical release during my first session. The therapist was working on my sacrum, an area that has given me lots of trouble. All of a sudden my low back got really really warm. I asked her if she had turned on a heating pad or anything, but she swore she hadn't. The heat kept increasing until finally it peaked and went away suddenly. That was the only time that I have ever experienced anything like that during CST so it's not routine, but it was powerful and it was real. I don't see how it could have been faked. I wasn't expecting anything like that so it wasn't my expectations setting up a physical reaction. It was strange but I have to say the headaches disappeared afterwards.<br />
<br />
Some years later, I was in a bad car accident. I was waiting to turn left on a country road when the car behind me struck me at full speed, 55+ MPH. He was on his cell phone and didn't notice that I had stopped. The impact shattered my car windows and totaled my van and changed my life.<br />
<br />
I reminded myself it could have been much worse. There was no blood and no bones broken, so I counted myself lucky. I went home to my children that night. However, I didn't realize how much trauma my soft tissues, shoulders, neck, head, back, and knees took until later. It took me a long time to recover from the worst of it and I still have lingering problems from it even now.<br />
<br />
One of the more difficult effects I had was headaches -- sudden, <i>blinding</i> headaches that felt like someone was suddenly stabbing me in the eye with an ice pick. This was different than any headache I'd ever had before. I tried chiropractic care and acupuncture; they were very helpful for the rest of my symptoms but didn't begin to touch my headaches, which were very debilitating.<br />
<br />
Finally I decided to try Craniosacral therapy. I found someone who did CST for people with traumatic brain injuries, concussions, and veterans returning from war. She worked on me multiple times and slowly the blinding ice-pick headaches went away. It was effective for my headaches when <i>nothing </i>else was.<br />
<br />
So that's my experience with Craniosacral Therapy. I've found it useful in several different scenarios, and I know a number of other women who have found it useful for colic, nursing problems, and head injuries.<br />
<br />
CST still makes me cringe every time I watch it because it seems <i>so </i>woo-woo and unbelievable. I would point out again that it's not been proven. It's possible the good results I and others have gotten have simply been due to the healing effect of hands-on touch and a desire to believe that it's helpful, but honestly I don't think a placebo effect is enough to explain it all.<br />
<br />
I don't believe every claim that's made for CST, but I know it was helpful for me and my kids. I certainly believe it's worth considering for certain things like colic, nursing problems, headaches, and fibromyalgia.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Summary</span></b><br />
<b><br /></b>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGFHZ11dwrpfHw5rmeH36YmhuhkKzvJ4kyr1FCIKOEmVrTFhBu1WVXkrOgsPPpYwkC2PFAP9FQHP3mWjExaLv2ZIQh8wKwoEhXJMAqVKo2OPiJIpxgyhjXgNl4PFDcjpvHayFgIQOKaHE/s1600/baby-hands+on+head.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="681" data-original-width="968" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGFHZ11dwrpfHw5rmeH36YmhuhkKzvJ4kyr1FCIKOEmVrTFhBu1WVXkrOgsPPpYwkC2PFAP9FQHP3mWjExaLv2ZIQh8wKwoEhXJMAqVKo2OPiJIpxgyhjXgNl4PFDcjpvHayFgIQOKaHE/s400/baby-hands+on+head.jpg" width="400" /></a></div>
<b><br /></b>
Craniosacral therapy is light, hands-on therapy that many people report being helpful. I first got to know it as a treatment for colic and nursing problems but it may be helpful for other indications as well. It is very woo-woo in nature and hard to justify scientifically, yet the favorable anecdotal experiences of many should not be dismissed either.<br />
<br />
Currently, there is no good-quality proof that Craniosacral therapy is effective. However, most of the material critical of CST is based on a few limited reviews from 2006 and 2011. It's time for higher quality protocols and less dismissive research.<br />
<br />
Until we have that research, it is up to each family whether or not to try Craniosacral therapy. If you do try it, choose a practitioner who is very experienced and has several levels of training in it. Some will be massage therapists with advanced training, while others will be pediatric chiropractors who have additional CST training. If you use it for colic or nursing problems, you want someone trained in newborn issues.<br />
<br />
You can find a directory of some Craniosacral therapy practitioners with training in babies and breastfeeding <a href="http://www.carolgraycenterforcststudies.com/member-directory/" target="_blank">here</a>.<br />
<br />
<br />
<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">Resources</span></b><br />
<br />
Neonatal Netw. 2016;35(2):105-7. doi: 10.1891/0730-0832.35.2.105. <b><span style="color: purple;">Feeding in the NICU: A Perspective from a Craniosacral Therapist. </span></b>Quraishy K. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/27052985" target="_blank">27052985</a><br />
<blockquote class="tr_bq">
Completing full feedings is a requirement for discharge for babies in the NICU. interaction between the nerves and the muscles of the jaw, tongue, and the soft palate is required for functional sucking and swallowing. Jaw misalignment, compressed nerves, and misshapen heads can interfere with these interactions and create feeding difficulties. craniosacral therapy (CST) is a noninvasive manual therapy that is perfect for the fragile population in the NICU. CST can be used as a treatment modality to release fascial restrictions that are affecting the structures involved in feeding, thereby improving feeding outcomes.</blockquote>
<div style="text-align: left;">
</div>
<ul style="text-align: left;">
<li>"<a href="http://www.carolgray.com/about-craniosacral-therapy/craniosacral-therapy-for-infants-and-chidren/" target="_blank">CST for Infants & Children</a>," by Carol Gray</li>
<li>"<a href="https://www.greenchildmagazine.com/craniosacral-therapy-for-babies/" target="_blank">The Benefits of Craniosacral Therapy for Newborns</a>" by Venetia Moore, Greenchild Magazine, January 12, 2018. </li>
<li>"<a href="https://kellymom.com/bf/concerns/child/cst/" target="_blank">CranioSacral Work and Other Gentle Body work for Helping Breastfeeding Problems</a>," www.kellymom.com breastfeeding resource</li>
<li><a href="http://www.carolgray.com/about-craniosacral-therapy/craniosacral-therapy-for-infants-and-chidren/">http://www.carolgray.com/about-craniosacral-therapy/craniosacral-therapy-for-infants-and-chidren/</a></li>
<li>"<a href="http://www.lowmilksupply.org/craniosacral.shtml" target="_blank">Breastfeeding and CranioSacral Therapy: When It Can Help</a>" by Dee. Kassing, IBCLC </li>
<li><a href="http://www.carolgraycenterforcststudies.com/member-directory/">http://www.carolgraycenterforcststudies.com/member-directory/</a></li>
<li><a href="https://www.ncbi.nlm.nih.gov/pubmed/26891636">https://www.ncbi.nlm.nih.gov/pubmed/26891636</a> - CST for PTSD and traumatic brain injury</li>
</ul>
<br />
<br />
<br />
<br />
<br />
<br /></div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com2tag:blogger.com,1999:blog-4738062031052371885.post-78784648447747399462019-02-19T19:38:00.002-08:002019-02-19T19:38:39.879-08:00Thicc Not Sick video<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/aD9x7_aFsN0?start=19" width="560"></iframe><br />
<br />
Just had to share this. Excellent work, Kristen Bartlett and Ashley Nicole Black! You hit all the top points we've been making for years, with humor and no holds barred. Great job! And thank you Samantha Bee for bringing their work forward to a national platform.<br />
<br />
*<i><b>Warning</b></i>: <i>Salty language and off-color humor, if you prefer to avoid that sort of thing</i></div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-51437452884900601152019-02-04T18:36:00.000-08:002019-02-04T18:36:07.246-08:00VBAC and Prior Cervical Dilation<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsAm1ydeepUDmaGjWNmwWbisilPJPYHDVPLJYLB95kZKi7Eee4K5Aw_Fo1bq84wsHB_8O-SA9srpypJD7Ok8Q9eThlduVjr8Z4eZz2Xsaz0_JAF15aFK2EuyDr_ePVzWyBEQpWJEsDLFo/s1600/trimmed+VBAC+stats.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="280" data-original-width="584" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsAm1ydeepUDmaGjWNmwWbisilPJPYHDVPLJYLB95kZKi7Eee4K5Aw_Fo1bq84wsHB_8O-SA9srpypJD7Ok8Q9eThlduVjr8Z4eZz2Xsaz0_JAF15aFK2EuyDr_ePVzWyBEQpWJEsDLFo/s400/trimmed+VBAC+stats.PNG" width="400" /></a></div>
<br /></div>
Some providers look for any excuse to discourage people from Vaginal Birth After Cesarean (VBAC). They might tell you that you're not a good candidate for VBAC because you are too old, too fat, too short, that you have to have your baby before your due date, that you've gained too much weight, and on and on.<br />
<div>
<br /></div>
<div>
One of the tools that is sometimes used to discourage VBAC is the prior dilation in the previous labor. Some have been told that if they dilated nearly all the way or even all the way to 10 cm, they have little or no chance at a VBAC. Others have been told the opposite, that if they didn't dilate very far previously, their chances of VBAC are low.<br />
<div>
<br /></div>
<div>
But what does the research actually say? </div>
<div>
<br /></div>
<div>
<b><span style="color: #cc0000; font-size: large;">Prior Dilation and VBAC</span></b></div>
<div>
<b><br /></b></div>
<div>
A New York study (<a href="https://www.ncbi.nlm.nih.gov/pubmed/9083318" target="_blank">Hoskins and Gomez 1997</a>) was one of the first studies to look at prior dilation and its association with later VBAC. It found a much greater VBAC rate in those who had a c-section at lower dilation. The VBAC rate at later dilation was only 13%.<br />
<br />
However, this is the <i>only </i>study I could find that had more VBACs in the group with less dilation. But because this 1997 study was the first one to really examine the question, its findings have stuck in many doctors' memories, despite contradictory studies, so you sometimes still hear this argument.</div>
<div>
<br /></div>
<div>
A small Nigerian study (<a href="https://www.ncbi.nlm.nih.gov/pubmed/14692061" target="_blank">Onifade and Omigbodun, 2003</a>) found that prior dilation had no influence on later VBAC. They concluded, "the maximum cervical dilatation reached before primary caesarean section need not be factored into a decision for VBAC."</div>
<div>
<br /></div>
<div>
On the other hand, most studies have found that the greater your dilation in a previous labor, the <i>better </i>your chances at a subsequent VBAC.<br />
<br />
One <a href="https://www.ncbi.nlm.nih.gov/pubmed/11576583" target="_blank">2001 Canadian study</a> found a higher VBAC rate (75%) among those whose cesareans occurred after dystocia in the second stage of labor/after full dilation. Do note, though, that the group where dystocia occurred in the first stage still had a 66% VBAC rate.<br />
<br />
A Korean study (<a href="https://www.ncbi.nlm.nih.gov/pubmed/19900044" target="_blank">Kwon 2009</a>) also found that those with greater prior dilation had more VBACs.</div>
<div>
<br /></div>
<div>
A Danish study (<a href="https://www.ncbi.nlm.nih.gov/pubmed/23025257" target="_blank">Abildgaard 2013</a>) had a very low overall VBAC rate but even so found more VBACs in those with greater prior dilation. N=373 women had a Trial of Labor. Those with 4-8 cm dilation before their first cesarean had a 39% VBAC rate, whereas those who were fully or nearly fully dilated at cesarean had a 59% VBAC rate. </div>
<div>
<br /></div>
<div>
And now, a new study (<a href="https://www.ncbi.nlm.nih.gov/pubmed/30132803" target="_blank">Lindblad Wollman 2018</a>) also suggests that the chance of VBAC is increased with greater prior dilation. This was a large population-based cohort study in Sweden for 6 years from 2008-2014; such a large study gives its findings extra heft. N=3,116 women with 1 prior cesarean had a Trial of Labor (TOL). 70% had a VBAC. In those who had a prior cesarean for dystocia:</div>
<div>
<blockquote class="tr_bq">
... increasing cervical dilation in first labor decreased the risk of repeat cesarean in second labor. The adjusted RR of repeat cesarean was 2.48 with dilation ≤5 cm, 1.98 with dilation 6-10 cm, and 1.46 if fully dilated. </blockquote>
<blockquote class="tr_bq">
CONCLUSIONS: <b>Almost 70% of all women eligible for trial of labor after cesarean had a vaginal birth, even women with a history of labor dystocia had a good chance of success.</b> A greater cervical dilation in the first delivery ending with a cesarean was not in vain, since the chance of vaginal birth in the subsequent delivery increased with greater dilation.</blockquote>
Overall, the research suggests pretty strongly that the more dilation you had previously, the better your likelihood for a VBAC later. Why might that be? Perhaps the key is how ripe the mother's cervix was before labor (a ripe cervix dilates more easily), and that once you've fully dilated once, you're likely to again.<br />
<br />
What it <i>doesn't</i> mean is that someone who didn't dilate very far the first time is a bad candidate for a VBAC. As the Swedish study above points out, "even women with a history of labor dystocia had a good chance of success."<br />
<br />
But really, in the end, who cares how many centimeters you dilated last time? The point is that with patience and a supportive provider, most people will have a VBAC, regardless of risk factors. That's all you really need to know.<br />
<br />
<div>
<b><span style="color: #cc0000; font-size: large;">Providers, Stop Looking for Excuses </span></b></div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzfddwKOlbCEaHgymn7383YraZTroblwIfIFPbD1uerznVjL6k7y7M-GDYfG6yvlZHK3A3JHobxy-eR6CPgiob0mmkJSwoN1Y8EyEdfAYsi1ehpBQdJ3zk6Qg4g85JuxXBLo_L-KDAcxg/s1600/VBAC-or-Repeat-Cesarean-VEP.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="359" data-original-width="639" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzfddwKOlbCEaHgymn7383YraZTroblwIfIFPbD1uerznVjL6k7y7M-GDYfG6yvlZHK3A3JHobxy-eR6CPgiob0mmkJSwoN1Y8EyEdfAYsi1ehpBQdJ3zk6Qg4g85JuxXBLo_L-KDAcxg/s400/VBAC-or-Repeat-Cesarean-VEP.jpg" width="400" /></a></div>
<div>
<br /></div>
<div>
<br /></div>
As the top graphic of this post points out, VBAC is woefully underused. About 90% of those with prior cesareans are eligible for a VBAC, yet only about 10% end up having one. Yes, some people choose repeat cesareans, and some people labor for a VBAC but end up with another cesarean. However, the biggest reason for the low number of VBACs is because VBAC has been strongly discouraged by many providers.<br />
<br />
Some providers won't support VBAC at all. Others pretend to be supportive but place so many limitations on a trial of labor that almost no one gets a VBAC. Others limit trials of labor to only those with the MOST favorable risk factors.<br />
<br />
<b>Providers, stop making excuses. Don't use <a href="http://www.pubmed.gov/30132803">prior cervical dilation</a> or past <a href="https://wellroundedmama.blogspot.com/2018/04/vbac-after-cesarean-for-arrest-of.html">arrest disorder</a> or <a href="https://wellroundedmama.blogspot.com/2018/02/cinderella-vbacs-and-gestational-age.html">gestational age</a> or <a href="https://wellroundedmama.blogspot.com/2017/08/vbac-prediction-models-actual-results.html">Body Mass Index</a> or <a href="https://www.ncbi.nlm.nih.gov/pubmed/28851168" target="_blank">maternal age</a> or any of a thousand other lame excuses to discourage people from a VBAC.</b><br />
<br />
Arbitrarily limiting VBAC to those with only the most favorable factors makes the repeat cesarean rate far too high, results in far too many complications, and does more harm than good. Our skyrocketing rate of <a href="https://www.ncbi.nlm.nih.gov/pubmed/30471891">placental abnormalities</a>, <a href="https://wellroundedmama.blogspot.com/2013/06/cesarean-scar-pregnancy-another.html">cesarean scar pregnancies</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001799/">maternal mortality rates</a> reflect that. <br />
<br />
<b>Sure, certain factors may make a VBAC slightly more or less likely, but the stark truth is that the majority of those who labor will <i>have </i>a VBAC, even when there are <a href="http://www.pubmed.gov/28255520">less favorable risk factors</a>.</b><br />
<br />
Stop looking for excuses to not support VBAC. Stop the high-handed paternalism that peremptorily decides birthing choices for others. Stop infantalizing women and taking away their autonomy to make their own medical decisions. People should be counseled about the benefits and risks of each option, but in the end the <a href="https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Ethical-Decision-Making-in-Obstetrics-and-Gynecology">final choice</a> belongs to the mother.<br />
<br />
Unless someone has a legitimate medical contraindication, stop discouraging people from pursuing a VBAC if they want one.</div>
<div>
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">References</span></b><br />
<br />
Acta Obstet Gynecol Scand. 2018 Dec;97(12):1524-1529. doi: 10.1111/aogs.13447. Epub 2018 Sep 25. <b><span style="color: purple;">Risk of repeat cesarean delivery in women undergoing trial of labor: A population-based cohort study.</span></b> Lindblad Wollmann C, Ahlberg M, Saltvedt S, Johansson K, Elvander C, Stephansson O. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/30132803" target="_blank">30132803</a><br />
<blockquote class="tr_bq">
... We investigated the association between indication of first cesarean and cervical dilation during labor preceding the first cesarean and risk of repeat cesarean in women undergoing trial of labor. MATERIAL AND METHODS: A population-based cohort study using electronic medical records of all women delivering in the Stockholm-Gotland region, Sweden, between 2008 and 2014. The population consisted of 3116 women with a first cesarean undergoing a trial of labor with a singleton infant in cephalic presentation at ≥37 weeks of gestation... In women with a cesarean due to dystocia, increasing cervical dilation in first labor decreased the risk of repeat cesarean in second labor. The adjusted RR of repeat cesarean was 2.48 with dilation ≤5 cm, 1.98 with dilation 6-10 cm, and 1.46 if fully dilated. CONCLUSIONS: <b>Almost 70% of all women eligible for trial of labor after cesarean had a vaginal birth, even women with a history of labor dystocia had a good chance of success. A greater cervical dilation in the first delivery ending with a cesarean was not in vain, since the chance of vaginal birth in the subsequent delivery increased with greater dilation.</b></blockquote>
Acta Obstet Gynecol Scand. 2013 Feb;92(2):193-7. doi: 10.1111/aogs.12023. Epub 2012 Nov 5. <b><span style="color: purple;">Cervical dilation at the time of cesarean section for dystocia -- effect on subsequent trial of labor. </span></b>Abildgaard H, Ingerslev MD, Nickelsen C, Secher NJ. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/23025257" target="_blank">23025257</a><br />
<blockquote class="tr_bq">
... DESIGN: Retrospective study. SETTING: University hospital in Copenhagen capital area. POPULATION: All women with a prior cesarean section due to dystocia who had undergone a subsequent pregnancy with a singleton delivery during 2006-2010. METHODS: Medical records were reviewed for prior vaginal birth, cervical dilation reached before cesarean section and induction of labor, gestational age, use of oxytocin, epidural anesthesia and mode of birth was collected. RESULTS: A total of 889 women were included; 373 had had a trial of labor. The success rate for vaginal birth among women with prior cesarean section for dystocia at 4-8 cm dilation was 39%, but 59% for women in whom prior cesarean section had been done at a fully or almost fully dilated cervix (9-10 cm) (p < 0.001). Among the women with a previous vaginal delivery prior to their cesarean section, the success rate for vaginal birth was 76.2%, in contrast to 48.9% in the group without a previous vaginal delivery (p < 0.01). CONCLUSION: Women who had a trial of labor after a prior cesarean section for dystocia done late in labor and women with a vaginal delivery prior to their cesarean section had a greater chance of a successful vaginal birth during a subsequent delivery.</blockquote>
J Matern Fetal Neonatal Med. 2009 Nov;22(11):1057-62. doi: 10.3109/14767050902874089. <b><span style="color: purple;">Cervical dilatation at the time of cesarean section may affect the success of a subsequent vaginal delivery.</span></b> Kwon JY, Jo YS, Lee GS, Kim SJ, Shin JC, Lee Y. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/19900044" target="_blank">19900044</a> <br />
<blockquote class="tr_bq">
... The medical records of women attempting VBAC between January 2000 and February 2008 were reviewed. All women had only one previous cesarean and underwent spontaneous labor. RESULTS: Among 1148 enrolled women, 956 (83.3%) achieved a successful VBAC. Birth weight, previous indication for cesarean delivery and oxytocin augmentation were significantly associated with VBAC outcome. By multivariate analysis, a cervical dilatation >or=8 cm at previous cesarean was independently predictive of successful VBAC in women with a previous cesarean for non-recurrent indications (p = 0.046), yielding a VBAC success rate of 93.1%, whereas the extent of cervical dilatation at the previous cesarean did not affect the outcome of subsequent delivery in women with a previous cesarean for recurrent indications. CONCLUSIONS: Women with cesarean for non-recurrent indications who achieved a cervical dilatation >or=8 cm may be the best candidates for VBAC, with the greatest likelihood of a successful VBAC. Labor progress at previous cesarean can serve as a valuable indicator for VBAC outcome in women with a previous cesarean for non-recurrent indications, and therefore should be discussed as part of preconception counseling.</blockquote>
Obstet Gynecol. 1997 Apr;89(4):591-3. <b><span style="color: purple;">Correlation between maximum cervical dilatation at cesarean delivery and subsequent vaginal birth after cesarean delivery.</span></b> Hoskins IA, Gomez JL. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/9083318" target="_blank">9083318</a><br />
<blockquote class="tr_bq">
... Relevant records of the index pregnancy (group I) were reviewed for cervical dilatation at cesarean delivery, oxytocin use, indication, neonatal weight, and epidural use. The records of the subsequent pregnancy (group II) were reviewed for successful VBAC rates, neonatal weight, oxytocin, and epidural use. RESULTS: There were 1917 patients in the study. The indications for cesarean in group I were ... arrest disorders (80%)... In those with previous cesarean deliveries for arrest disorders with cervical dilatation at 5 cm or less, the VBAC success rate was 67%. It was 73% for 6-9 cm dilatation and 13% for the fully dilated group (P < .05). CONCLUSIONS: Patients who attempt a VBAC may be counseled that a cesarean delivery at full dilatation is associated with a reduced chance of a subsequent successful VBAC.</blockquote>
AJP Rep. 2017 Jan;7(1):e31-e38. doi: 10.1055/s-0037-1599129. <b><span style="color: purple;">Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population</span></b>. Maykin MM, Mularz AJ, Lee LK, Valderramos SG. PMID: <a href="http://www.pubmed.gov/28255520">28255520</a> Full free text <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330796/">here</a>.<br />
<blockquote class="tr_bq">
OBJECTIVE: To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. METHODS: We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal-Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (<35%), moderate (35-65%), and high (>65%). The actual versus predicted success rates were compared. RESULTS: In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p < 0.001) and moderate (61 vs. 52%; p = 0.003) groups. In the high probability group, the observed and predicted VBAC rates were the same (79%). CONCLUSION: When the predicted success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.</blockquote>
<b>Other So-Called "Risk Factors" for Failed VBAC</b><br />
<ul style="text-align: left;">
<li><a href="https://wellroundedmama.blogspot.com/2018/04/vbac-after-cesarean-for-arrest-of.html" target="_blank">https://wellroundedmama.blogspot.com/2018/04/vbac-after-cesarean-for-arrest-of.html </a></li>
<li><a href="https://wellroundedmama.blogspot.com/2018/02/cinderella-vbacs-and-gestational-age.html">https://wellroundedmama.blogspot.com/2018/02/cinderella-vbacs-and-gestational-age.html</a></li>
<li><a href="https://wellroundedmama.blogspot.com/2017/08/vbac-prediction-models-actual-results.html">https://wellroundedmama.blogspot.com/2017/08/vbac-prediction-models-actual-results.html</a></li>
<li><a href="https://wellroundedmama.blogspot.com/2013/06/cesarean-scar-pregnancy-another.html">https://wellroundedmama.blogspot.com/2013/06/cesarean-scar-pregnancy-another.html</a></li>
<li><a href="https://www.ncbi.nlm.nih.gov/pubmed/28851168">https://www.ncbi.nlm.nih.gov/pubmed/28851168</a></li>
</ul>
</div>
</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-32959152897938175332019-01-21T22:47:00.000-08:002019-01-21T22:47:36.713-08:00Metformin Use in Nondiabetic Obese Pregnancy <div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOtVh_HVh0OYUpzRw9AAd_rjoXtnAyjTrU53Y8N71nDGJ0y6zJKCJoI-lPPA2-nR1utrqk-4yMoO032CbyAw6fG-Z8rfyZ_EodCldAHiaYQcsGTZuks3LFXSiO033AGBWOAID1LB-tXIc/s1600/Metformin+to+prevent+fat+babies+2011+Daily+Mail+snip.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="251" data-original-width="699" height="142" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOtVh_HVh0OYUpzRw9AAd_rjoXtnAyjTrU53Y8N71nDGJ0y6zJKCJoI-lPPA2-nR1utrqk-4yMoO032CbyAw6fG-Z8rfyZ_EodCldAHiaYQcsGTZuks3LFXSiO033AGBWOAID1LB-tXIc/s400/Metformin+to+prevent+fat+babies+2011+Daily+Mail+snip.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i><a href="https://www.dailymail.co.uk/health/article-1384801/Pregnant-women-given-drugs-prevent-babies-born-obese.html" target="_blank">Article</a> from The Daily Mail, 2011</i></td></tr>
</tbody></table>
<br />
One of the strongest concerns doctors have about pregnancies in the "obese" is that larger people tend to have larger (macrosomic) babies. Although most macrosomic babies are born just fine, they do have higher rates of shoulder dystocia (babies who get stuck) and related injuries, as well as low blood sugar at birth and more cesareans. So doctors want to do everything they can to prevent abnormally big babies.<br />
<br />
Some macrosomia is tied to high blood sugar and high insulin levels. So in hopes of preventing big babies, doctors have been using the diabetes medication, metformin, in those diagnosed with Gestational Diabetes (GD) or Polcystic Ovarian Syndrome (PCOS).<br />
<br />
A number of <a href="https://www.ncbi.nlm.nih.gov/pubmed/22137984" target="_blank">studies</a> have confirmed that metformin use in women with GD does modestly <a href="http://www.pubmed.gov/30458653" target="_blank">reduce</a> the rate of <a href="https://www.ncbi.nlm.nih.gov/pubmed/21083860" target="_blank">big babies</a>. It also lowers the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26440203" target="_blank">rate </a>of <a href="https://www.ncbi.nlm.nih.gov/pubmed/23205605" target="_blank">early pregnancy loss</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/20926533" target="_blank">prematurity</a> in PCOS. More research is needed but metformin does seem to be a very helpful drug for people with GD or PCOS. No one is questioning this use of metformin.<br />
<br />
However, the use of metformin in obese women WITHOUT gestational diabetes or PCOS is a different story. Doctors note that even high BMI people who are <i>not</i> diabetic have larger babies on average. So the working theory has been that these women must be pre-diabetic or have strong insulin resistance that increases fetal size.<br />
<br />
So doctors began prescribing metformin to nondiabetic obese women in hopes that lowering insulin levels and borderline blood sugar would cut the odds of a big baby.<br />
<br />
The practice was aggressively <a href="https://www.dailymail.co.uk/health/article-1384801/Pregnant-women-given-drugs-prevent-babies-born-obese.html" target="_blank">marketed</a> to the public as a way to prevent "obese babies" before its research was even completed (see headlines quoted here from The Daily Mail <a href="https://www.dailymail.co.uk/health/article-1384801/Pregnant-women-given-drugs-prevent-babies-born-obese.html" target="_blank">2011</a> and <a href="https://www.dailymail.co.uk/health/article-2123700/Babies-treated-womb-obesity-Overweight-mothers-diabetes-pill-cut-risk-having-fat-child.html" target="_blank">2012</a>).<br />
<br />
But what <i>does </i>the research say about this use of metformin? Here is a quick summary of the three largest trials.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">The Studies on Non-Diabetic High BMI Women</span></b><br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiklEsnySGcV88idmWOFZWHEhOtptHd__7i8pwK0sbj_1pWxlT3jXrHVb-gDwSEcdMSnjPVnYl246__9XnRJ5QuOQoH5q1QGIHqkasvz2KI1kTXC7l5pMKWWCyd4C1T_onuRvK_rgQ-CzU/s1600/babies+treated+in+the+womb+for+obesity.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="310" data-original-width="913" height="135" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiklEsnySGcV88idmWOFZWHEhOtptHd__7i8pwK0sbj_1pWxlT3jXrHVb-gDwSEcdMSnjPVnYl246__9XnRJ5QuOQoH5q1QGIHqkasvz2KI1kTXC7l5pMKWWCyd4C1T_onuRvK_rgQ-CzU/s400/babies+treated+in+the+womb+for+obesity.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>From <a href="https://www.dailymail.co.uk/health/article-2123700/Babies-treated-womb-obesity-Overweight-mothers-diabetes-pill-cut-risk-having-fat-child.html" target="_blank">article</a> in the Daily Mail, 2012</i></td></tr>
</tbody></table>
<b><i><span style="color: #38761d;">Chiswick 2015</span></i></b><br />
<br />
Several years ago, a large study called the EMPOWaR trial (<a href="https://www.ncbi.nlm.nih.gov/pubmed/26165398" target="_blank">Chiswick 2015</a>) tested this theory in the U.K.<br />
<br />
This study involved 15 hospitals and was a large, randomized, double-blind placebo-controlled trial, the gold standard of research. It had n=434 participants with a BMI over 30 for analysis. The maximum metformin dose was 2500 mg.<br />
<br />
To authors' great surprise, they found that metformin did NOT lower neonatal size.<br />
<b><br /></b>
<i><b><span style="color: #38761d;">Syngelaki 2016</span></b></i><br />
<br />
Some common criticisms of the EMPOWaR study were that the metformin dose was too low, the participants weren't fat enough to show any big effect, and they did not take doses strictly enough.<br />
<br />
Therefore, in a subsequent study published in the prestigious New England Journal of Medicine (<a href="https://www.ncbi.nlm.nih.gov/pubmed/26840133" target="_blank">Syngelaki 2016</a>, the MOP trial), n=400 participants were limited to those with a BMI over 35. This study, too, was a randomized, double-blind study with placebo controls and was more racially diverse.<br />
<br />
The researchers increased the metformin dose to a maximum of 3000 mg and made sure there was strong adherence to the medication. By limiting the analysis to those with a BMI over 35, increasing the dosage, including more women of color, and making sure metformin was consistently used, the authors hoped to show more of an effect.<br />
<br />
To their surprise, results were again similar. While the metformin group had a slightly lower weight gain, fetal size was the <i>same </i>between groups.<br />
<b><br /></b>
<b><i><span style="color: #38761d;">Dodd 2019</span></i></b><br />
<br />
Researchers just can't leave this theory alone.<br />
<br />
Now there is a new study (the GRoW trial) out, also testing the metformin theory (<a href="http://www.pubmed.gov/30528218" target="_blank">Dodd 2019</a>). This trial was done in Australia and included women with a BMI over 25 (in other words, both "overweight" and "obese"). No previous study had included those in the overweight category.<br />
<br />
This also was a gold standard randomized study, n=514 participants. It used doses of up to 2000 mg.<br />
<br />
It also found slightly less weight gain in the metformin group but NO difference in birthweight of the babies.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Research Summary</span></b><br />
<br />
There have been a few other, small studies about metformin use in nondiabetic women, but none have been as large or as strong as these studies. No study so far has found that metformin lowers neonatal birthweight in nondiabetic women. That message is very clear and consistent.<br />
<br />
There were other outcomes that weren't as clear. Some, but not all, studies found a mild lowering of prenatal weight gain. Some found decreased incidence of preeclampsia, while others did not. No other outcomes were routinely affected.<br />
<br />
At this point, the hypothesis that metformin will "normalize" the size of high BMI women's babies has pretty well been disproven. I'm sure there will be more studies on it because the theory is a favorite of many OBs, but these are strong studies and frankly, I doubt they'll be overturned.<br />
<br />
The good news is that no babies seem to have been harmed in these studies. However, many of the mothers experienced significant gastrointestinal side effects from the metformin and this some caused drop-outs or scaled-back dosing. If you've ever taken metformin, you know the G.I. effects can be <i>considerable</i>. This certainly affects people's quality of life. As a result, it's not something that should be prescribed lightly.<br />
<br />
<b>The take-home message from research: Metformin is a great drug that can be useful for some indications (like GD or PCOS) but in nondiabetic high BMI women it does not lower neonatal birthweight. As the authors of the EMPOWaR study concluded:</b><br />
<blockquote class="tr_bq">
<b><span style="color: blue;">... metformin should not be used to improve pregnancy outcomes in obese women without diabetes.</span></b></blockquote>
<b><span style="color: #cc0000; font-size: large;">The Fat-Shaming Around These Studies</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4YXUclhMvEZIN58RkaeG1EJ0kZT98YvdWtKl4URbRVeEWB3u2wADZiZGl1W8Cyuu_1eM2rC59ofaUTvWm5JpQ-OqeCXB8cr0iUdH-YBaq8fkz3K1ZaK1Pb4aTHLHaC6jzaPzNVbQmaNQ/s1600/Daily+Mail+2012+Prevent+being+born+obese.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="701" data-original-width="944" height="296" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4YXUclhMvEZIN58RkaeG1EJ0kZT98YvdWtKl4URbRVeEWB3u2wADZiZGl1W8Cyuu_1eM2rC59ofaUTvWm5JpQ-OqeCXB8cr0iUdH-YBaq8fkz3K1ZaK1Pb4aTHLHaC6jzaPzNVbQmaNQ/s400/Daily+Mail+2012+Prevent+being+born+obese.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Illustration from</i> the <i>2012 Daily Mail <a href="https://www.dailymail.co.uk/health/article-2123700/Babies-treated-womb-obesity-Overweight-mothers-diabetes-pill-cut-risk-having-fat-child.html" target="_blank">article</a></i></td></tr>
</tbody></table>
It has to be pointed out that the U.K. public health campaign around these studies was glaringly fat-shaming.<br />
<div>
<br /></div>
<div>
Look at the caption above. Fat women are accused of letting their babies be "born obese," of passing on their toxic obesity in the womb through their carelessness about their health. They use the classic picture of a fat body with the head cut off, depersonalizing the subject. The person is even holding a roll of fat, pointing out visual blame so the negative message is even clearer. </div>
<div>
<br />
The articles were filled with scary summaries of the <a href="https://wellroundedmama.blogspot.com/2009/11/second-annual-turkey-awards.html" target="_blank">risks of obesity and pregnancy</a>, without any context for those risks, how often they <i>don't</i> happen, and what can be done about them when they do. It's not unreasonable to inform women of size of the possible risks around weight and pregnancy, but it's another thing to <a href="https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=327" target="_blank">misrepresent those risks</a> to scare or shame women <a href="https://wellroundedmama.blogspot.com/2018/07/9th-turkey-awards-obesity-eugenics.html" target="_blank">out of pregnancy</a>.<br />
<br />
The campaign was attempting to inflame the public about irresponsible fat people, implying that they refuse to be healthy and are costing the NHS huge amounts of money, taking money away from everyone else. The U.K. is a very fat-phobic place and the government is scapegoating fat people for their healthcare budget woes.<br />
<br />
The language of the campaign was also offensive. They used the terms "fat babies" or "obese babies" in order to shame the mothers, but a big baby is not necessarily the same as an "obese" baby. They are conflating fetal size caused by diabetic complications with big babies that are simply larger than average.<br />
<br />
All big babies are not alike. Some babies are big because of blood sugar issues, and these babies do tend to be abnormally proportioned and have more issues at birth. On the other hand, some babies are just naturally larger without it being pathological. There is a significant difference between a diabetic's baby that is 9 lbs. but only 16 inches long and a 9 lb. baby that is 22 inches long. The first is abnormal and a true concern; the second is proportional and most likely genetic. The first type often has problems being born safely and has many complications; the second type of big baby is proportional and can usually be born vaginally.<br />
<br />
Furthermore, the campaign is simplistic and misleading. Not all obese mothers have macrosomic babies; one <a href="https://www.ncbi.nlm.nih.gov/pubmed/10892363" target="_blank">study</a> found that only 17% of obese women had macrosomic babies while 83% of them did NOT. Subjecting all obese women to metformin "just in case" means medicating many people who wouldn't produce a big baby anyhow. What potential harm might that be doing?<br />
<br />
Some people of average size also have macrosomic babies without blood sugar or insulin issues; no one knows why some babies are bigger than others. And many big babies do have vaginal births; <a href="http://www.pubmed.gov/17464808">Navti 2007</a> found that 83% of women who had babies around 10 pounds or more were able to have vaginal births. This shows that even very big babies can often be born vaginally, given time, patience, sufficient mobility, and a calm caregiver. We need to stop panicking over babies that are larger than average and save our intervention for those who truly need it.<br />
<br />
<b><i>Researchers</i>: Stop trying to put the baby on a diet before it is even born. Metformin for reducing fetal size does not work in nondiabetics. </b><br />
<b><br /></b>
<b><i>Public Health Campaigns</i>: Stop promoting weight stigma and fat-shaming in your campaigns about obesity and pregnancy. </b><br />
<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">References</span></b><br />
<br />
Lancet Diabetes Endocrinol. 2019 Jan;7(1):15-24. doi: 10.1016/S2213-8587(18)30310-3. Epub 2018 Dec 4. <b><span style="color: purple;">Effect of metformin in addition to dietary and lifestyle advice for pregnant women who are overweight or obese: the GRoW randomised, double-blind, placebo-controlled trial. </span></b>Dodd JM, Louise J, Deussen AR, Grivell RM, Dekker G, McPhee AJ, Hague W. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/30528218" target="_blank">30528218</a><br />
<blockquote class="tr_bq">
... GRoW was a multicentre, randomised, double-blind, placebo-controlled trial in which pregnant women at 10-20 weeks' gestation with a BMI of 25 kg/m2 or higher were recruited from three public maternity units in Adelaide, SA, Australia. Women were randomly assigned (1:1) via a computer-generated schedule to receive either metformin (to a maximum dose of 2000 mg per day) or matching placebo. Participants, their antenatal care providers, and research staff (including outcome assessors) were masked to treatment allocation... FINDINGS: Of 524 women who were randomly assigned between May, 28 2013 and April 26, 2016, 514 were included in outcome analyses (256 in the metformin group and 258 in the placebo group). Median gestational age at trial entry was 16·29 weeks (IQR 14·43-18·00) and median BMI was 32·32 kg/m2 (28·90-37·10); 167 (32%) participants were overweight and 347 (68%) were obese. There was no significant difference in the proportion of infants with birthweight greater than 4000 g (40 [16%] with metformin vs 37 [14%] with placebo; adjusted risk ratio [aRR] 0·97, 95% CI 0·65 to 1·47; p=0·899). Women receiving metformin had lower average weekly gestational weight gain (adjusted mean difference -0·08 kg, 95% CI -0·14 to -0·02; p=0·007) and were more likely to have gestational weight gain below recommendations (aRR 1·46, 95% CI 1·10 to 1·94; p=0·008). ... INTERPRETATION: <b><span style="color: blue;">For pregnant women who are overweight or obese, metformin given in addition to dietary and lifestyle advice initiated at 10-20 weeks' gestation does not improve pregnancy and birth outcomes.</span></b></blockquote>
N Engl J Med. 2016 Feb 4;374(5):434-43.doi: 10.1056/NEJMoa1509819. <b><span style="color: purple;">Metformin versus Placebo in Obese Pregnant Women without Diabetes Mellitus</span></b>. Syngelaki A, Nicolaides KH, Balani J, Hyer S, Akolekar R, Kotecha R, Pastides A, Shehata H. PMID: <a href="http://www.pubmed.gov/26840133">26840133</a><br />
<div>
<blockquote class="tr_bq">
<i>[kmom summary]</i> Randomized double-blind, placebo controlled trial. Limited to those with BMI over 35 and upped the metformin dosage. Less preeclampsia and less weight gain in metformin group but no difference in birth weight. "CONCLUSIONS: Among women without diabetes who had a BMI of more than 35, the antenatal administration of metformin reduced maternal weight gain but not neonatal birth weight."</blockquote>
Lancet Diabetes Endocrinol. 2015 Oct;3(10):778-86. doi: 10.1016/S2213-8587(15)00219-3. Epub 2015 Jul 9. <b><span style="color: purple;">Effect of metformin on maternal and fetal outcomes in obese pregnant women (EMPOWaR): a randomised, double-blind, placebo-controlled trial. </span></b>Chiswick C, Reynolds RM, Denison F, Drake AJ, Forbes S, Newby DE, Walker BR, Quenby S, Wray S, Weeks A, Lashen H, Rodriguez A, Murray G, Whyte S, Norman JE. PMID: <a href="http://www.pubmed.gov/26165398">26165398</a> Free full text <a href="http://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(15)00219-3.pdf">here</a>.</div>
<div>
<blockquote class="tr_bq">
<i>[kmom summary]</i> Randomized placebo-controlled, double-blind study in 15 hospitals in the U.K. on nondiabetic women. Results: "Metformin has no significant effect on birthweight percentile in obese pregnant women."</blockquote>
Previous discussion of these studies and others:<br />
<ul>
<li><a href="https://wellroundedmama.blogspot.com/2011/12/fourth-annual-turkey-awards-leaps-of.html">https://wellroundedmama.blogspot.com/2011/12/fourth-annual-turkey-awards-leaps-of.html</a></li>
<li><a href="https://wellroundedmama.blogspot.com/2015/10/metformin-does-not-lower-birthweight.html">https://wellroundedmama.blogspot.com/2015/10/metformin-does-not-lower-birthweight.html</a></li>
<li><a href="https://wellroundedmama.blogspot.com/2016/03/once-again-metformin-does-not-reduce.html">https://wellroundedmama.blogspot.com/2016/03/once-again-metformin-does-not-reduce.html</a></li>
</ul>
<div>
<b><i><span style="color: #38761d;">Metformin for Gestational Diabetes or PCOS</span></i></b><br />
<br />
J Matern Fetal Neonatal Med. 2018 Nov 20:1-141. doi: 10.1080/14767058.2018.1550480. [Epub ahead of print] <b><span style="color: purple;">Metformin-treated-GDM has lower risk of macrosomia compared to diet-treated GDM- A retrospective cohort study. </span></b>Bashir M, Aboulfotouh M, Dabbous Z, Mokhtar M, Siddique M, Wahba R, Ibrahim A, Al-Houda Brich S, Konje JC, Abou-Samra AB. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/30458653" target="_blank">30458653</a><br />
<blockquote class="tr_bq">
...This is a retrospective cohort study that included GDM women compared to normoglycaemic controls between March 2015-December 2016 in the Women's Hospital, Qatar. RESULTS: The study included 2221 women; of which 1420 were normoglycaemic, and 801 were GDM (358 GDM-D and 443 GDM-T)... Women in the GDM-T group had lower GWG/week compared to GDM-D (-0.01 ± 0.7 versus 0.21 ± 0.51 kg/week; p < 0.001). After correcting for age, prepregnancy weight and GWG; GDM-T had higher risk of preterm labour (OR 1.66; 95% CI 1.20-2.22), and C-section (OR 1.37, 95% CI 1.02-1.85) and reduced risk of macrosomia (OR 0.56; 95% CI 0.32-0.96) and neonatal hypoglycaemia (OR 0.49; 95% CI 0.28-0.82). CONCLUSION: ... Treatment with metformin reduces maternal weight gain, the risk of macrosomia and neonatal hypoglycaemia compared to diet alone.</blockquote>
J Clin Endocrinol Metab. 2010 Dec;95(12):E448-55. doi: 10.1210/jc.2010-0853. Epub 2010 Oct 6. <b><span style="color: purple;">Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study. </span></b>Vanky E et al. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/20926533" target="_blank">20926533</a><br />
<blockquote class="tr_bq">
<i>[kmom summary] </i>n=274 PCOS pregnancies. Randomized controlled trial with placebos. Less prematurity, but more pre-eclampsia in metformin group. Less weight gain in metformin group. No difference in fetal size between groups. </blockquote>
</div>
</div>
</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-38155638465937311592019-01-12T03:53:00.000-08:002019-01-12T03:53:19.345-08:00Induction: Don't Break The Waters Early<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhizcFS10GyXG2m3JMdlWx3JRgVjjsfqm23DlmZsPFmDoZWNxlEepBa8JghiwSCA4h5hbZeCJfbWxQOnbsLtbZhkmTQF_RrcPPzcbQ8F2nm8XwDv9kOx1mCKpUSV09pxD7SRAXBvyIEvhw/s1600/Amniotomy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="578" data-original-width="857" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhizcFS10GyXG2m3JMdlWx3JRgVjjsfqm23DlmZsPFmDoZWNxlEepBa8JghiwSCA4h5hbZeCJfbWxQOnbsLtbZhkmTQF_RrcPPzcbQ8F2nm8XwDv9kOx1mCKpUSV09pxD7SRAXBvyIEvhw/s400/Amniotomy.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Amnihooks, which are used to artificially break a woman's waters</i></td></tr>
</tbody></table>
<br />
New research (<a href="http://ww.pubmed.gov/30396229" target="_blank">Pasko 2018</a>) suggests that when care providers induce high BMI women, they should NOT break the waters in early labor (early amniotomy), especially in first-time mothers.<br />
<br />
Breaking the waters early is commonly done to speed up labor. Sometimes it is done to place an internal monitor to monitor the baby more easily, but usually it is used to intensify contractions and shorten labor. Caregivers assume that this will help obese women avoid a cesarean.<br />
<br />
However, the results from this new study suggest that early amniotomy actually <i>increases</i> the risk for a cesarean instead.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Study Details</span></b><br />
<br />
In this retrospective cohort study, women with Class III "obesity" (body mass index ≥40 kg/m2) who were being induced (n=285) were placed into two groups.<br />
<br />
The first group (n=107) received early amniotomy before 4 cm dilation, and the other group (n=178) received late amniotomy.<br />
<br />
<b>The group who received early amniotomy had <i>double</i> the cesarean risk of those who did received later amniotomy.</b><br />
<b><br /></b>
<b>In first-time (nulliparous) mothers, the risk for cesarean was <i>tripled</i> with early amniotomy. </b><br />
<b><br /></b>
The length of labor was not shortened in either group. So the whole justification for using early amniotomy (shorter labor, fewer cesareans) for obese women was irrelevant.<br />
<br />
An older study (<a href="https://www.ncbi.nlm.nih.gov/pubmed/11045324" target="_blank">Sheiner 2000</a>) which examined induction by early amniotomy concluded:<br />
<blockquote class="tr_bq">
In order to decrease the CS rates, induction should probably start with cervical ripening techniques in order to improve the Bishop scores.</blockquote>
<a href="https://wellroundedmama.blogspot.com/2012/02/induction-math-importance-of-bishop.html" target="_blank">Bishop Scores</a> are a measure of how ripe and ready for labor the cervix is. Inductions on an unripe cervix are <a href="https://www.ncbi.nlm.nih.gov/pubmed/15802392" target="_blank">more likely to fail</a> and result in cesarean, especially in first-time moms. Bishop scores tend to be <a href="https://www.ncbi.nlm.nih.gov/pubmed/29797415" target="_blank">lower</a> at the start of inductions in women of size, which is probably an important factor in higher weight women's induction failures. <br />
<br />
Women of size also <a href="https://www.ncbi.nlm.nih.gov/pubmed/30021565" target="_blank">tend</a> to have <a href="https://www.ncbi.nlm.nih.gov/pubmed/22105434" target="_blank">longer labors</a> and generally <a href="https://www.ncbi.nlm.nih.gov/pubmed/30394154" target="_blank">take longer</a> in latent (early) labor before reaching active labor. Yet despite this, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24400789" target="_blank">research shows</a> that early amniotomy is used <i>more</i> often in higher weight women. This needs to change.<br />
<br />
How can early amniotomy (also known as Artificial Rupture of Membranes or early AROM) affect labor? When the water is broken, the cushioning around the baby is removed. Labor becomes much more painful, and there is risk for infection. The baby may be more likely to experience an abnormal heart rate (distress). If the baby is not well-positioned when AROM occurs, then the baby can become stuck in that position and have difficult getting out (labor dystocia). These factors can add up and result in a cesarean.<br />
<br />
The take-home message from this study on high BMI women is obvious: <b>Avoid having your waters broken before active labor begins (now defined as at least 6 cm dilation). <span style="color: blue;">This is especially important if you are a first-time mother. </span></b><br />
<br />
Of course, parents have to remain flexible in labor; plans may need to change. For example, if baby may be in trouble and external monitoring is not working well, then breaking the water sooner to place an internal monitor may make sense. But most of the time, amniotomy should not be done early in labor, especially in obese first-time mothers.<br />
<div>
<br /></div>
<span style="color: #cc0000; font-size: large;"><b>Induction Hints</b></span><br />
<br />
It is best to await spontaneous labor whenever possible, so always question whether an induction is truly necessary. However, it's a hard truth that sometimes induction of labor does become medically necessary. If so, there are some lessons from research that may lessen your risk for cesarean. Most apply to women of all sizes but may be particularly relevant for higher weight women.<br />
<br />
Ask your provider about your Bishop Score; if your cervix isn't ripe (<a href="https://www.ncbi.nlm.nih.gov/pubmed/15802392" target="_blank">Bishop score <5</a>), ask if the induction can be delayed. If it cannot be delayed, ask for techniques to help <a href="https://wellroundedmama.blogspot.com/2012/02/induction-math-importance-of-bishop.html" target="_blank">ripen the cervix</a> before pitocin is started and realize that you may need more time to reach active labor. Some research suggests that Foley catheter or prostaglandin (PGE2) inductions may be <a href="https://www.ncbi.nlm.nih.gov/pubmed/27560557" target="_blank">more effective</a> in women of size than misoprostol (Cytotec).<br />
<br />
Women of size may also need a <a href="https://www.ncbi.nlm.nih.gov/pubmed/26210857" target="_blank">larger dose</a> of pitocin to <a href="https://www.ncbi.nlm.nih.gov/pubmed/19935035" target="_blank">keep</a> an induced labor going strong, but this must be done cautiously because too much pitocin can send the baby into fetal distress. Wait and see how you and baby respond before increasing the dosage and go slowly with any adjustments.<br />
<br />
Be sure you have a care provider who understands that latent labor tends to <a href="https://www.ncbi.nlm.nih.gov/pubmed/15516383" target="_blank">take longer</a> in higher weight women and will give you plenty of time. Many cesareans in women of size are done before active labor, and many could probably be <a href="https://wellroundedmama.blogspot.com/2010/11/failure-to-wait.html" target="_blank">prevented</a> if caregivers were <a href="https://www.ncbi.nlm.nih.gov/pubmed/26756259" target="_blank">more patient</a> and waited <a href="https://www.ncbi.nlm.nih.gov/pubmed/20708166" target="_blank">longer</a> before <a href="http://www.pubmed.gov/21099592" target="_blank">moving</a> to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/27561206" target="_blank">cesarean</a>.<br />
<br />
Be sure your baby is in an optimal position for birth before the induction if possible. Chiropractic care may help align the pelvis and maximize the space for an easier birth. If the baby is posterior (facing your front) in labor, ask your caregiver for manual rotation, which clearly <a href="https://www.ncbi.nlm.nih.gov/pubmed/17906022" target="_blank">reduces</a> the risk for <a href="https://www.ncbi.nlm.nih.gov/pubmed/20350240" target="_blank">cesarean</a> in several <a href="https://www.ncbi.nlm.nih.gov/pubmed/22765887" target="_blank">studies</a>.<br />
<br />
Maintain your <a href="https://www.ncbi.nlm.nih.gov/pubmed/25411538" target="_blank">mobility</a> as much as possible and don't get <a href="https://www.ncbi.nlm.nih.gov/pubmed/25411541" target="_blank">stuck in bed on your back</a>. Make gravity work for you. Upright positions <a href="https://www.ncbi.nlm.nih.gov/pubmed/24105444" target="_blank">reduce</a> the length of labor and the risk for cesarean. Special positions like <a href="https://www.ncbi.nlm.nih.gov/pubmed/16336365" target="_blank">hands and knees</a> or an exaggerated <a href="https://www.ncbi.nlm.nih.gov/pubmed/29537658" target="_blank">Sims position</a> may help malpositioned babies turn more easily. You can read more aboutvarious labor and birth positions <a href="https://wellroundedmama.blogspot.com/2015/03/historical-and-traditional-birthing.html" target="_blank">here</a>.<br />
<br />
As discussed, don't let the caregivers break the waters until you are well into <a href="http://www.pubmed.gov/30396229" target="_blank">active labor</a>. If possible, let the waters break on their own. Keeping the waters intact as long as possible can help a malpositioned baby turn more easily.<br />
<br />
Hire a <a href="https://www.ncbi.nlm.nih.gov/pubmed/28681500" target="_blank">doula</a> to give professional labor support. One <a href="https://www.ncbi.nlm.nih.gov/pubmed/18507579" target="_blank">study</a> found a cesarean rate of 13.4% in a group of first-time mothers with doulas, whereas the cesarean rate in the group without doulas was 25%. The difference was even more marked in those whose labors were induced; the group with doulas had a cesarean rate of 12.5%, vs. a 58.8% rate in those without doulas.<br />
<br />
These ideas should improve your chances of a normal vaginal birth with an induction. Of course there are no guarantees, but rest assured that with enough time and patience, a reasonably ripe cervix, a well-positioned baby, and good support, many <a href="https://www.ncbi.nlm.nih.gov/pubmed/22836819">inductions</a> in women of size can result in vaginal births. <div>
<br /></div>
<br />
<br />
<span style="color: #cc0000; font-size: x-large;"><b>Re</b><b>ference</b></span><br />
<br />
Am J Perinatol. 2018 Nov 5. doi: 10.1055/s-0038-1675331. [Epub ahead of print] <b><span style="color: purple;">Pregnancy Outcomes after Early Amniotomy among Class III Obese Gravidas Undergoing Induction of Labor. </span></b>Pasko DN, Miller KM, Jauk VC, Subramaniam A. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/30396229" target="_blank">30396229 </a><br />
<blockquote class="tr_bq">
OBJECTIVE: We sought to evaluate differences in pregnancy outcomes following early amniotomy in women with class III obesity (body mass index ≥40 kg/m2) undergoing induction of labor. STUDY DESIGN: This is a retrospective cohort study of women with class III obesity undergoing term induction of labor from January 2007 to February 2013. Early amniotomy was defined as artificial membrane rupture at less than 4 cm cervical dilation. The primary outcome was cesarean delivery. Secondary outcomes included length of labor, a maternal morbidity composite, and a neonatal morbidity composite. A subgroup analysis examined the effect of parity. Multivariable logistic regression was used to adjust for covariates. RESULTS: Of 285 women meeting inclusion criteria, 107 (37.5%) underwent early amniotomy and 178 (62.5%) underwent late amniotomy. Early amniotomy was associated with cesarean delivery after multivariable adjustments (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.21-3.47). There were no significant differences in length of labor or maternal and neonatal morbidity between groups. When stratified by parity, early amniotomy was associated with increased cesarean delivery (aOR, 3.10; 95% CI, 1.47-6.58) only in nulliparous women. CONCLUSION: <b>Early amniotomy among class III obese women, especially nulliparous women, undergoing labor induction may be associated with an increased risk of cesarean delivery.</b></blockquote>
<br />
<br /></div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com1tag:blogger.com,1999:blog-4738062031052371885.post-29236660469007286962019-01-02T20:46:00.001-08:002019-01-02T20:46:49.507-08:00Hospitals with Midwives on Staff Have Better Outcomes<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc7xCIPV-9ZW1INeUE7ymbPc8hM-CribBtsUpUCSzHFESVJO7Im6z2GdP8ee_8nXlh0aGsyCQIk0NFTY0_dl_mT2i5fhsUFOtoRUXQQtN6ylTh70G_zOYXWj-pOTIzSwwIL5scZsLZRno/s1600/handshake.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="576" data-original-width="1024" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc7xCIPV-9ZW1INeUE7ymbPc8hM-CribBtsUpUCSzHFESVJO7Im6z2GdP8ee_8nXlh0aGsyCQIk0NFTY0_dl_mT2i5fhsUFOtoRUXQQtN6ylTh70G_zOYXWj-pOTIzSwwIL5scZsLZRno/s400/handshake.jpg" width="400" /></a></div>
<br />
Here are two recent studies showing that hospitals with midwives and doctors practicing together ("interprofessional" centers) have better outcomes than hospitals with only doctors. One study is on first-time mothers (nulliparous), and the other study is on women who have given birth before (multiparous), to separate out the possible effects of parity.<br />
<br />
In first-time mothers, women were much less likely to be induced or have oxytocin augmentation of labor in interprofessional/collaborative centers. The cesarean rate was 12% lower in interprofessional centers too.<br />
<br />
For multiparous mothers (multips), women were again much less likely to be induced or have augmentation of labor in interprofessional centers. The first-time cesarean rate was 36% lower, and the Vaginal Birth After Cesarean (VBAC) rate was 31% higher than in institutions with only doctors. Neonatal outcomes were similar between the two types of centers.<br />
<br />
The implication here is that not only do midwives lower the rates of interventions without endangering outcomes, they also influence the hospital culture in a positive way. Doctors who work with midwives tend to be more flexible about interventions, less likely to push a cesarean without need, and more likely to support VBACs.<br />
<br />
If you are considering a hospital birth, try to choose a hospital with both doctors and midwives on staff, one with low overall cesarean rates, and strongly consider hiring a doula for professional labor support. Most women can safely be attended by a midwife, so make that your first choice if you can. If a risk comes up that means that you need to see an OB or high-risk maternal fetal medicine (MFM) specialist, the midwife will refer you to one, probably one that is supportive of the parents' birth wishes whenever conditions allow.<br />
<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">References</span></b><br />
<br />
Birth. 2018 Nov 11. doi: 10.1111/birt.12407. [Epub ahead of print] <b><span style="color: purple;">Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: A Consortium on Safe Labor study. </span></b>Neal JL, Carlson NS, Phillippi JC, Tilden EL, Smith DC, Breman RB, Dietrich MS, Lowe NK. PMID: <a href="http://www.pubmed.gov/30417436" target="_blank">30417436</a><br />
<blockquote class="tr_bq">
...Our objective was to compare labor processes and outcomes for low-risk nulliparous women birthing in United States medical centers with interprofessional care (midwives and physicians) versus noninterprofessional care (physicians only). METHODS: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk nulliparous women who birthed in interprofessional (n = 7393) or noninterprofessional centers (n = 6982). .. <b>women at interprofessional medical centers, compared with women at noninterprofessional centers, were 74% less likely to undergo labor induction (risk ratio [RR] 0.26; 95% CI 0.24-0.29) and 75% less likely to have oxytocin augmentation (RR 0.25; 95% CI 0.22-0.29). The cesarean birth rate was 12% lower at interprofessional centers (RR 0.88; 95% CI 0.79-0.98).</b> Adverse neonatal outcomes occurred in only 0.3% of births and were thus too rare to be modeled. CONCLUSIONS: The care processes and birth outcomes at interprofessional and noninterprofessional medical centers differed significantly. <b><span style="color: blue;">Nulliparous women receiving care at interprofessional centers were less likely to experience induction, oxytocin augmentation, and cesarean than women at noninterprofessional centers</span>. </b>Labor care and birth outcome differences between interprofessional and noninterprofessional centers may be the result of the presence of midwives and interprofessional collaboration, organizational culture, or both.</blockquote>
Birth. 2018 Nov 9. doi: 10.1111/birt.12405. [Epub ahead of print] <b><span style="color: purple;">Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: A Consortium on Safe Labor study. </span></b>Carlson NS, Neal JL, Tilden EL, Smith DC, Breman RB, Lowe NK, Dietrich MS, Phillippi JC. PMID: <a href="http://www.pubmed.gov/30414200" target="_blank">30414200 </a><br />
<blockquote class="tr_bq">
...We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. METHODS: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). .. women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. CONCLUSIONS: <b>Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. </b>Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes.</blockquote>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-55724030819273600292018-12-27T20:01:00.002-08:002018-12-27T20:41:29.268-08:00External Cephalic Version after Prior Cesarean - 2018 study<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgasGGtoFRXv8ErLRiwcjIDEU971yTOt4KOGGxSASy3NZgqXPITBiEFWBEceOQzeTwhZuX2YRF4EQ5O_INSmxjfi98KTW3k-bkYChVwNQC86N5EApc81MgDBCYAIcrHxLyww9PkZceXwh8/s1600/Version-Breech+am+fam+Phys+1998+permission.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgasGGtoFRXv8ErLRiwcjIDEU971yTOt4KOGGxSASy3NZgqXPITBiEFWBEceOQzeTwhZuX2YRF4EQ5O_INSmxjfi98KTW3k-bkYChVwNQC86N5EApc81MgDBCYAIcrHxLyww9PkZceXwh8/s400/Version-Breech+am+fam+Phys+1998+permission.jpg" width="400" /></a></div>
<br />
People whose babies are breech and have a history of a prior cesarean are often told that External Cephalic Version (ECV), manually encouraging the baby to turn head-down, is simply not a choice for them. The fear is that manipulation done during an ECV might make the uterus rupture along the scar from the prior cesarean.<br />
<br />
We have discussed ECV after a Prior Cesarean <a href="https://wellroundedmama.blogspot.com/2016/11/external-version-for-breech-after-prior.html" target="_blank">extensively</a> before. The results of all the studies so far suggest that ECV after prior CS is not unduly risky and can avoid many unnecessary repeat cesareans. ECV should be offered to women at term with a breech presentation, regardless of prior cesarean status. Unfortunately, ECV is woefully underutilized. One <a href="https://www.ncbi.nlm.nih.gov/pubmed/19032661">study</a> from New Zealand estimated that only 26% of eligible patients with breech presentations were referred for ECV.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">2018 Study</span></b><br />
<br />
Recently, a new study (<a href="http://www.pubmed.gov/30412904" target="_blank">Impey 2018</a>) was published that looks again at the question of ECV after prior cesarean (CS). Its results were both encouraging and disappointing.<br />
<br />
In this new U.K. study, researchers looked back retrospectively over a 16 year period and found 100 cases where babies of women with a prior cesarean presented breech at term, were offered, and consented to a ECV.<br />
<br />
Basically, the study found about a 50% rate of success in turning the baby head-down. Those who had head-down babies afterwards had a trial of labor after cesarean (TOLAC), and 68% had a VBAC.<br />
<br />
The authors did a literature search on ECV after prior CS and found no increased rate of uterine rupture after ECV. That agrees with the literature search we did.<br />
<br />
However, the authors chose to dilute this good news by pointing out that while ECV avoided some cesareans, only 30 women out of the 100 original group had a VBAC. In other words, while they found the practice safe, the way they word the abstract made it sound like instituting a practice of ECV after prior cesarean is not worth pursuing because it is only marginally successful.<br />
<br />
This flies in the face of previous research. <b>The big question is why their ECV success rate was so low.</b> Only 50% of their ECV tries worked to turn the baby head-down. That reduced their candidates for TOLAC by <i>half</i>, and then only about 2/3 of these women had a VBAC. That's why the final numbers were low.<br />
<br />
If you look at comparable studies, <a href="http://www.pubmed.gov/27624629" target="_blank">Weill 2016</a> had a 74% ECV success rate, while <a href="http://www.pubmed.gov/24245964" target="_blank">Burgos 2014</a> had a 67% ECV success rate. Why were their results so much better? That's what the UK study authors should be asking themselves. Seems like they need training on how to do ECV more successfully.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Summary</span></b><br />
<br />
<b>The good news from the study is that External Cephalic Version after a prior cesarean is safe. </b>There are potential risks inherent to the procedure, of course, but these risks do not appear to be any greater in women with prior cesarean than in those without a prior cesarean. And of course, the alternative of an automatic repeat cesarean with a breech carries its own potential risks that also must be considered. The choice should be up to the mother.<br />
<br />
<b>The bad news from the study is how few women with prior cesareans are being offered ECV and how low the ECV success rate was.</b> It took <i>16 years</i> in the study to find a data pool of 100 women who had a prior cesarean and a breech presentation at term who were offered an external version and who accepted it. ECV is tremendously underused, especially in those with a prior cesarean. And a ECV success rate of only 50% is pitiful. Better training is obviously needed.<br />
<br />
External Cephalic Version at term can avoid many unnecessary cesareans, yet it is woefully underused in many institutions. It is a reasonable choice that needs to be expanded, especially in women with prior cesareans. Furthermore, training to achieve greater ECV success rates in more places needs to occur.<br />
<b><br /></b>
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">References</span></b><br />
<br />
Eur J Obstet Gynecol Reprod Biol. 2018 Dec;231:210-213. doi: 10.1016/j.ejogrb.2018.10.036. Epub 2018 Oct 22. <b><span style="color: purple;">External cephalic version after previous cesarean section: A cohort study of 100 consecutive attempts.</span></b> Impey ORE, Greenwood CEL, Impey LWM. PMID: <a href="http://www.pubmed.gov/30412904" target="_blank">30412904</a><br />
<blockquote class="tr_bq">
OBJECTIVE: External cephalic version is commonly not performed in women with a previous cesarean section. Fear of uterine rupture and cesarean section in labor are prominent. The risks, however, of these are unclear. This study aims to document the safety and efficacy of external cephalic version in women with a prior cesarean section in a series of 100 consecutive attempts, and to perform a literature of the existing literature. STUDY DESIGN: This is a retrospective cohort study of prospectively collected data of external cephalic version attempts in women at term with a previous cesarean section, and a literature review of previously published series. External cephalic version was performed by one of 3 experienced operators, with salbutamol tocolysis if appropriate, using ultrasound to visualize the fetal heart and place of fetal parts. RESULTS: 100 women with a prior cesarean section underwent external cephalic version over a 16-year period in one institution. 68% had no previous vaginal delivery. The external cephalic version success rate was 50%, and 30 (63.8%) of these subsequently delivered vaginally. There were no cases of uterine rupture or other complications. A literature review of series containing a total of 549 cases revealed no cases of uterine rupture or perinatal death. CONCLUSIONS: External cephalic version in women with a prior cesarean section is safe but enables a vaginal birth in only about a third of women.</blockquote>
Aust N Z J Obstet Gynaecol. 2016 Sep 14. doi: 10.1111/ajo.12527. [Epub ahead of print] <b><span style="color: purple;">The efficacy and safety of external cephalic version after a previous caesarean delivery. </span></b>Weill Y, Pollack RN. PMID: <a href="http://www.pubmed.gov/27624629">27624629</a> <br />
<blockquote class="tr_bq">
BACKGROUND: External cephalic version (ECV) in the presence of a uterine scar is still considered a relative contraindication despite encouraging studies of the efficacy and safety of this procedure. We present our experience with this patient population, which is the largest cohort published to date. AIMS: To evaluate the efficacy and safety of ECV in the setting of a prior caesarean delivery. MATERIALS AND METHODS: A total of 158 patients with a fetus presenting as breech, who had an unscarred uterus, had an ECV performed. Similarly, 158 patients with a fetus presenting as breech, and who had undergone a prior caesarean delivery also underwent an ECV. Outcomes were compared. RESULTS: ECV was successfully performed in 136/158 (86.1%) patients in the control group. Of these patients, 6/136 (4.4%) delivered by caesarean delivery. In the study group, 117/158 (74.1%) patients had a successful ECV performed. Of these patients, 12/117 (10.3%) delivered by caesarean delivery. There were no significant complications in either of the groups. CONCLUSIONS: ECV may be successfully performed in patients with a previous caesarean delivery. It is associated with a high success rate, and is not associated with an increase in complications.</blockquote>
BJOG. 2014 Jan;121(2):230-5; discussion 235. doi: 10.1111/1471-0528.12487. Epub 2013 Nov 19. <b><span style="color: purple;">Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study. </span></b>Burgos J, Cobos P, Rodríguez L, Osuna C, Centeno MM, Martínez-Astorquiza T, Fernández-Llebrez L. PMID: <a href="http://www.pubmed.gov/24245964">24245964</a><br />
<blockquote class="tr_bq">
OBJECTIVE: To determine if external cephalic version (ECV) can be performed with safety and efficacy in women with previous caesarean section. DESIGN: Prospective comparative cohort study. SETTING: Cruces University Hospital (Spain). POPULATION: Single pregnancy with breech presentation at term. METHODS: We compared 70 ECV performed in women with previous caesarean section with 387 ECV performed in multiparous women (March 2002 to June 2012). MAIN OUTCOME MEASURES: Success rate, complications of the ECV and caesarean section rate. RESULTS: The success rate of ECV in women after previous caesarean section was 67.1% versus 66.1% in multiparous women (P = 0.87). The logistic regression analysis confirmed this result (odds ratio 0.93, 95% CI 0.52-1.68; P = 0.82) adjusted by the variables associated with success of ECV. There were no complications in the previous caesarean section cohort. The vaginal delivery rate in the previous caesarean section cohort was 52.8% versus 74.9% in the multiparous cohort (P < 0.01). There were no cases of uterine rupture. CONCLUSION: Based on our data, we conclude that complications are uncommon with ECV in women with previous caesarean section, with a success rate comparable to that of multiparous women. Uterine scar should not be considered a contraindication and ECV should be offered to women with previous caesarean section with breech presentation at term.</blockquote>
Click <a href="https://wellroundedmama.blogspot.com/2016/11/external-version-for-breech-after-prior.html" target="_blank">here</a> for older references on ECV after CS.</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-79934096668443678822018-12-20T22:32:00.004-08:002018-12-20T22:32:53.693-08:00HAES Heroes: Joanne Ikeda<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhg6yKVl3kVWgsLA2Bp_SDumM56TDQuSef7L-FjYwandGLepYw8aefwGUBpM_u6ZVBAZlBE7oRD9MANhu9NK0m5M-oK03UuyPdfVrzvvYSk0de_yegKf13hZg8YUkhvBuUvfn-_qK5vJ10/s1600/Joanne_Ikeda+purple.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="512" data-original-width="512" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhg6yKVl3kVWgsLA2Bp_SDumM56TDQuSef7L-FjYwandGLepYw8aefwGUBpM_u6ZVBAZlBE7oRD9MANhu9NK0m5M-oK03UuyPdfVrzvvYSk0de_yegKf13hZg8YUkhvBuUvfn-_qK5vJ10/s400/Joanne_Ikeda+purple.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Joanne Pakel Ikeda</i></td></tr>
</tbody></table>
This post is to remember and honor one of our Health At Every Size® heroes.<br />
<br />
Joanne Pakel Ikeda died on November 27, 2018 at age 74. She was a faculty member of the Nutritional Sciences Department at the University of California, Berkeley, for nearly 35 years. She helped students gain knowledge and skills in nutrition education and counseling.<br />
<br />
She was well-known for her advocacy for the Health At Every Size model. In fact, she and Frances Berg <a href="https://sizediversityandhealth.org/haes-expert.asp?id=51" target="_blank">coined the phrase</a>. From her <a href="https://www.legacy.com/obituaries/sfgate/obituary.aspx?n=joanne-ikeda&pid=190873802" target="_blank">obituary</a>:<br />
<blockquote class="tr_bq">
<b>Joanne was known for her role in the development of a new approach to weight management entitled Health at Every Size® (HAES). Mid-career she came to the conclusion that subjecting large people to food restriction, body dissatisfaction, and size discrimination was futile and only resulted in physical, psychological and social damage to these individuals. <span style="color: blue;">She and others determined that rather than focus on weight, the focus needed to be on health. </span>Research showed that many large people could improve all aspects of health with lifestyle modifications unaccompanied by weight loss.</b></blockquote>
The idea to focus on health instead of weight was a radical, transformative notion in the field of nutrition and medicine and turned the field on its ear. While it has gained a great deal of traction, HAES sadly remains radical to many in those fields, but she never backed down. She was especially determined to protect children from becoming casualties in the “war on obesity” by promoting a Health at Every Size approach for them instead. Here is one of the posters she lent her support to.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw0_F6Rzo7ujGb2NO8Y2uHy8SbKKjMttJJzhBskfB3jZqXQpnARXWp0iahQbxbQMpJzQbpOI3DdtgXh7aU-sEbQyQzKPie9w-2qOuEPHYQwibvZq_ClHhxo1qyIEyLFL0J20FUXX2WEEk/s1600/joanneikeda_done-dlm.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1067" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw0_F6Rzo7ujGb2NO8Y2uHy8SbKKjMttJJzhBskfB3jZqXQpnARXWp0iahQbxbQMpJzQbpOI3DdtgXh7aU-sEbQyQzKPie9w-2qOuEPHYQwibvZq_ClHhxo1qyIEyLFL0J20FUXX2WEEk/s400/joanneikeda_done-dlm.png" width="266" /></a></div>
<br />
Joanne fought hard for size acceptance for all ages and spoke at many conferences and other occasions about Health At Every Size. She worked with <a href="https://www.naafaonline.com/dev2/">NAAFA </a>(National Association for Fat Acceptance), which is where I met her. She helped establish <a href="https://www.sizediversityandhealth.org/">ASDAH</a>, the Association for Size Diversity and Health. She backed up her beliefs with action by testifying before the San Francisco Board of Supervisors about an ordinance banning size discrimination in employment, housing, adoptions, jury selection and other domains. That took guts. <br /><br />Joanne did not just specialize in weight-related issues. She also studied the nutritional habits of various ethnic groups, immigrants, and low-income people in California and developed culturally sensitive nutrition education materials. She was a visionary in her field in many ways. <br /><br />She accrued so many honors, I will only list a few here. She served as President of the California Academy of Nutrition and Dietetics, then was elected President of the Society for Nutrition Education and Behavior. She was co-founder of the UC Berkeley Center for Weight and Health. In 2018 she received the Helen Denning Ullrich Award for Lifetime Excellence in Nutrition Education.<br /><br />I had the honor and pleasure of hearing Joanne speak in person and getting to chat with her afterwards. She was a warm, unassuming person, but she also knew her research and her points were evidence-based. She was very modest and humble but she also knew how to make a vehement rhetorical point when needed and wasn't hesitant to call out medical professionals on their assumptions and errors. She gave me lots of warmth and encouragement for my work on pregnancy in women of size, which was much appreciated as pregnancy is very much an overlooked area in HAES and size acceptance. As a parent, I particularly appreciated her advocacy for higher weight children in the midst of virulent anti-obesity public health campaigns. <br /><br />Joanne Ikeda was a god-send to the size acceptance community and people of size, and we will sorely miss her presence and influence. Our hearts go out to her family and friends.<br /><br /><div class="separator" style="clear: both;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEXwuoIi0106SJIHxvSVtz1xNgOyoI2w3e3Og3NjiTntw0J2gG7Eu08WgcsznbRRAQVOK21ixmw3Y0VU9HMV-R1pKO5g-lb2Ap-zB68Xj88NYBbNY1y1xnPx-eOXtJgJ_ZTb5twDCQNZ4/s1600/joanne+ikeda+scarf.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="266" data-original-width="190" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEXwuoIi0106SJIHxvSVtz1xNgOyoI2w3e3Og3NjiTntw0J2gG7Eu08WgcsznbRRAQVOK21ixmw3Y0VU9HMV-R1pKO5g-lb2Ap-zB68Xj88NYBbNY1y1xnPx-eOXtJgJ_ZTb5twDCQNZ4/s400/joanne+ikeda+scarf.jpg" width="285" /></a></div>
<b><span style="color: #cc0000; font-size: x-large;"><br /></span></b>
<b><span style="color: #cc0000; font-size: x-large;"><br /></span></b>
<b><span style="color: #cc0000; font-size: x-large;">Resources</span></b><br />
<br />
Obituary: <a href="https://www.legacy.com/obituaries/sfgate/obituary.aspx?n=joanne-ikeda&pid=190873802">https://www.legacy.com/obituaries/sfgate/obituary.aspx?n=joanne-ikeda&pid=190873802</a><br />
<br />
Articles:<br />
<br />
<ul style="text-align: left;">
<li><a href="https://blogs.berkeley.edu/author/jikeda/">https://blogs.berkeley.edu/author/jikeda/</a> </li>
<li><a href="https://ucanr.edu/blogs/blogcore/postdetail.cfm?postnum=28960&sharing=yes">https://ucanr.edu/blogs/blogcore/postdetail.cfm?postnum=28960&sharing=yes</a></li>
<li><a href="https://christyharrison.com/foodpsych/5/how-diet-culture-harms-your-health-with-joanne-ikeda" target="_blank">How Diet Culture Harms Your Health</a> - podcast and interview with Joanne</li>
<li><a href="https://sizediversityandhealth.org/haes-expert.asp?id=51">https://sizediversityandhealth.org/haes-expert.asp?id=51</a></li>
</ul>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-41941369997274206692018-12-07T22:22:00.000-08:002018-12-07T22:22:23.885-08:00How to Find a Chiropractor in Pregnancy: Part Two<div dir="ltr" style="text-align: left;" trbidi="on">
<div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcjBiR2FZnhs2u4M4bKfUUNRrY4xVH0mEaeh4Q5Uyvc2TWqA8NiE9NvHyvUrk8-4Bm9Tp2DHxPudPQp4wjRXNBHC3BkRZu_4E3T45CmEM5-SOuE-DdSotZ08A6-H4QkwB5wOxIk131aLo/s1600/DSC_1079A.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1190" data-original-width="1600" height="296" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcjBiR2FZnhs2u4M4bKfUUNRrY4xVH0mEaeh4Q5Uyvc2TWqA8NiE9NvHyvUrk8-4Bm9Tp2DHxPudPQp4wjRXNBHC3BkRZu_4E3T45CmEM5-SOuE-DdSotZ08A6-H4QkwB5wOxIk131aLo/s400/DSC_1079A.jpg" width="400" /></a></div>
<br />
We have been <a href="https://wellroundedmama.blogspot.com/2018/11/chiropractic-care-in-pregnancy-part-one.html" target="_blank">discussing</a> chiropractic care in pregnancy and how it can be helpful towards a more comfortable pregnancy and possibly a more efficient labor and birth.<br />
<br />
Many people are interested in seeing a chiropractor, but some know nothing about how to find a good chiropractor for pregnancy.<br />
<br />
Basically, all chiropractors receive some training in treating pregnant women, so you could see most chiropractors and get at least some help. However, some chiropractors are more highly trained in pregnancy than others and you are probably better off with those.<br />
<br />
Your best bet is to find a chiropractor who is trained in the <a href="https://icpa4kids.com/media/1160/webster_technique.pdf" target="_blank">Webster Technique</a>, which is a specific protocol that looks at the alignment of the sacrum and pelvis and the balancing of soft tissues (muscles, ligaments) around it:<br />
<blockquote class="tr_bq">
The Webster technique is a specific chiropractic analysis and diversified adjustment. The goal of the adjustment is to reduce the effects of subluxation and/or SI [<i>sacroiliac</i>] joint dysfunction. In so doing neurobiomechanical function in the sacral/pelvic region is improved.</blockquote>
The Webster Technique is not just for pregnant people, but can be applied to any weight-bearing person. However, its focus on relieving restrictions in the pelvis and restoring balance to the soft tissues in the area may be particularly very useful for pregnancy.<br />
<br />
Chiropractors who have extra training in working with pregnant people can be found in several ways. There are several chiropractic professional organizations, and they can be a good place to start your search. These organizations are similar in many ways, but may have differences of opinion on certain philosophies or treatments, etc.<br />
<br /></div>
<div>
<b><span style="color: #38761d;"><i>International Chiropractic Pediatric Association</i></span></b><br />
<br />
The International Chiropractic Pediatric Association (ICPA) has a list of chiropractors who specialize in working with kids and pregnant mothers, or who have completed a training course in Webster's Technique, which addresses the specific needs of the pregnant body.<br />
<br />
You can find a pediatric chiropractor with the ICPA at <a href="http://icpa4kids.org/Find-a-Chiropractor/">http://icpa4kids.org/Find-a-Chiropractor/</a>.<br />
<br />
However, this is not a complete list of all the chiropractors who are certified in the Webster Technique. The chiropractors on this list are ones who have asked to be put on this referral list. There may well be other chiropractors in your area who have been trained in the Webster Technique but did not sign up for this list. You can call the ICPA and ask if there are others in your area trained in the Webster Technique.<br />
<br />
According to the ICPA <a href="http://icpa4kids.org/About-the-ICPA/advanced-chiropractic-pediatric-credentials-and-research-contributor-status.html" target="_blank">website</a>, the ICPA has created a tiered level of training. The first level is "Webster-Certified," which means extra class time beyond the chiropractic degree specializing in the Webster Technique for pregnancy. It is often the starting point for even more advanced training.<br />
<br />
The next level is Pediatric Certification, but there are several levels of this. Some program participants have the initials F.I.C.P.A after their names, and undergo 120 hours of continuing education. Other participants undergo an expanded program of 200 hours and have the initials, C.A.C.C.P., after their names. The highest level of training is the Pediatric Diplomate, which requires 400 hours of continuing education, and these chiropractors have the initials D.A.C.C.P. after their names.<br />
<b><i><span style="color: #38761d;"><br /></span></i></b>
<br />
<div>
<b><i><span style="color: #38761d;">International Chiropractic Association</span></i></b><br />
<br />
The International Chiropractic Association (ICA) has a Council on Pediatric Chiropractics. Their focus is on treating children, but their definition of "pediatrics" includes in-utero babies so they treat pregnant women as well. Many of these ICA members have gone on to become Board Certified in chiropractic pediatrics in a 3-year post-graduate course of over 360 hours. These chiropractors have "D.I.C.C.P." after their names as well as "D.C." Look <a href="http://icapediatrics.com/about-us/member-directory/" target="_blank">here</a> for lists of those with a DICCP diploma.</div>
<div>
<br />
The ICA also has a list of members who are trained chiropractors who are interested in and specialize in children, but who may or may not have the further training that a "DICCP" diplomate has. Some of the chiropractors on this list are in the process of working on the DICCP diplomate program but have not finished it yet. Regardless, they may be excellent possibilities as well.<br />
<br />
In addition, the ICA can be reached at 1 (800) 423-4690 to ask for referrals in person. Ask for a pediatric chiropractor who knows the Webster Technique. </div>
<br /></div>
<div>
<b><i><span style="color: #38761d;">Other Possible Sources</span></i></b><br />
<br />
Not everyone who is certified in Webster's Technique is going to be on the ICA or ICPA lists, but they are good first places to start looking. If you can't find anyone in your area from these lists, it doesn't mean there is no one to help you. Keep looking; many women who initially think there is no one in their area who can help them do eventually find help. It just may not be from the above sources.<br />
<br />
<b>One of the best ways to find a Webster-certified chiropractor is to try calling your local homebirth midwives, childbirth educators, and doulas and asking for a recommendation. </b>Often they are familiar with the healthcare professionals in the area that offer pregnancy-related services and can recommend the best ones to you, saving you a lot of time and trouble.<br />
<br />
If you cannot find a chiropractor trained in the Webster Technique in your area, you could consider a chiropractor who has extensive experience with pregnant women. Even basic chiropractic care may help enough to make a difference in your comfort level. But if you have a choice, someone trained in the Webster technique is probably preferable. </div>
<div>
<br /></div>
<div>
People in countries that don't have chiropractors may want to try an osteopath. Osteopaths also do body manipulation to help align the body and relieve restrictions, although not quite in the same way as chiropractors. However, not all osteopaths do manipulations anymore. You might need to find one who has had classical osteopath training.<br />
<br />
In some areas, chiropractors can be hard to find. If all else fails, try cold-calling all the chiros and/or osteopaths in your area. Ask them:<br />
<ul style="text-align: left;">
<li>If they have experience and training in treating pregnant women (and what that training might be)</li>
<li>How much of their practice is devoted to pregnant women and babies</li>
<li>What kind of special equipment they have for accommodating the growing belly of pregnant women</li>
<li>If they have been trained in either Webster Technique, the pelvic "diaphragmatic release," or any other technique which might be especially helpful to a pregnant person</li>
<li>If they have not been trained in any of these techniques and/or are not experienced with pregnant women, do they know of any chiropractors in the area who are?</li>
</ul>
Talk to them on the phone if you can and get an idea of how experienced they are and whether they "click" with you. If they sound good, consider trying them for one visit to see how things go. Some chiropractors will do a free consultation so you can visit their practice and check them out. Others might let you observe someone else's treatment (with the patient's permission) so you can see the techniques in action. Ask how many pregnant women the doctor usually sees. Ask for referrals from other patients. Call the midwives in your area and see if they have any experience with <i>that </i>chiropractor.<br />
<br />
Remember, all chiropractors are not alike. Some use pretzel adjustments by twisting and turning the patient's body. Some use a drop table to give a little bit of extra force to the adjustment without having to push on the patient as hard. Some use an activator, a spring-loaded small tool that exerts less force for those who dislike traditional adjustments. Some do hands-on work so subtle it's hard to know they are doing anything. There are many, many techniques and styles out there.</div>
<div>
<br />
Keep your "quackometer" on alert and don't be afraid to try a different chiropractor if one doesn't seem right to you, if the treatment seems unreasonable or ineffective to you, or if they seem too profit-driven. If one chiropractor doesn't work well for you, it doesn't mean that none will. Sometimes it's just a matter of finding the one that fits you and your needs.<br />
<br />
If in the end you decide that chiropractic care is not for you, that is a perfectly legitimate choice as well. Many women go through pregnancy without chiropractic care and do just fine. But if you have lots of back pain, pelvic pain, or a history of falls and/or accidents, it may be worth searching a little harder to find the right chiropractor for your needs. </div>
<div>
<br /></div>
<div>
<b><span style="color: #cc0000; font-size: large;">My Chiropractic Search Story</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtVrYITx5rwWynkkk_ihe5UQl9yN1n0qxNaf_pZWoHyAXbpXS5ziK1AK_Sbo7zFEkpyI3oEUWJ3zuAVRd-A0B6u5RgPP8sjEYBMNcGYgSEIO_09yIsegjAd8KhlvJDMup2xWjnQFcwcok/s1600/Restore-Balance-e1510760197659.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtVrYITx5rwWynkkk_ihe5UQl9yN1n0qxNaf_pZWoHyAXbpXS5ziK1AK_Sbo7zFEkpyI3oEUWJ3zuAVRd-A0B6u5RgPP8sjEYBMNcGYgSEIO_09yIsegjAd8KhlvJDMup2xWjnQFcwcok/s320/Restore-Balance-e1510760197659.jpg" width="320" /></a></div>
<br />
Although I didn't really experience much significant back problems before pregnancy, once I was pregnant I began to have <i>tremendous </i>back pain, sciatica, and pubic symphysis pain, probably from a series of minor car accidents years before. My care providers shrugged my pain off as a normal part of pregnancy, but by the end of my second pregnancy I could hardly walk at times. This certainly didn't seem normal to me, so I decided to consider a chiropractor.<br />
<br />
My search for a chiropractor was long and involved. At the time, there were no lists from the ICA or the ICPA to check, and the local chiros I consulted did not even know about the Webster Technique. I saw several different chiros or osteopaths (D.O.s) over the years, looking for some help. It took a long time to find the right one. </div>
<div>
<br /></div>
<div>
The first chiro I tried was a sports specialist available through the local family doctor's office. Unfortunately, he was majorly fat-phobic and obviously disgusted by my body. He never physically evaluated my back or pelvis, and he never touched me. He told me that my back pain was because I wasn't getting enough exercise, and gave me some special exercises to do for the muscles in the area. I tried them; they didn't help. I gave up the idea of chiro care for several years.<br />
<br />
In my third pregnancy, I stepped up the effort to find some help. None of the doctors or midwives I saw knew of anyone who knew the Webster Technique. I saw an osteopath who had never heard of the Webster Technique, told me my back and pelvis were fine despite all my pain, and was basically no help.<br />
<br />
My prenatal yoga teacher in that pregnancy eventually mentioned a chiropractor who used a less forceful "Network" technique for adjustments and who specialized in sacrum pain. I decided that this was better than nothing and saw this chiro. These treatments did not really help much but he happened to know of a young chiropractor in the area who was in the process of getting her DICCP diplomate from the ICA, so he referred me to her.<br />
<br />
Amazingly, this chiro had <i>just </i>learned the Webster Technique at a recent class session and was able to help me out. She was shocked at how badly my back and pelvis were out of alignment. My back and pubic symphysis pain improved greatly within an hour or two after treatment. Although we weren't trying to turn the baby with the adjustment, the baby turned from posterior to anterior within an hour after the adjustment, the first time any of my babies had been anterior in three pregnancies. I went on to have a few more appointments in that pregnancy to keep things aligned and fine tune everything. Two weeks later, my baby was born by VBAC, Vaginal Birth After Cesarean.<br />
<br />
My third labor and birth was SO much easier than my first two. In my first pregnancy, I had pushed for 2 hours with a malpositioned baby, then had a cesarean. In my second pregnancy, I had pushed for 5 hours with a posterior baby, then had a cesarean. In this pregnancy, I pushed for <i>12 minutes</i> and the baby was born. He was born so quickly the doctor didn't even make it to the birth; the nurse had to catch the baby. I attribute the relative ease of this birth to the chiropractic care and the fact that the baby had turned to anterior, unlike my previous babies. </div>
<div>
<br />
In my fourth pregnancy, I tried an ICPA-trained chiro who was located much closer to home because I was tired of the long drive to my usual chiropractor. The new chiro was perfectly nice and very competent, but she didn't "get" my body and was not able to give much relief. So even though this chiropractor knew the Webster Technique, was very well-trained and knowledgeable, and was certified through the ICPA, she wasn't the right chiropractor for me. </div>
<div>
<br /></div>
<div>
At one point, I also tried a different osteopath, one with more "classical" manipulation training, and did not find those results as effective either. I eventually went back to a chiropractor trained by my original chiropractor, realizing that a long drive was well worth the trouble to get better results. He focused not only on my back/sacrum, but especially on my pubic symphysis and supporting ligaments because of my pain there, and we found that I tended to respond to that protocol best.<br />
<br />
I gave birth to my ten-pound baby (a pound bigger than my cesarean babies) with just 24 minutes of pushing. I'm sure it was not <i>all </i>due to just chiropractic care, but I do believe that a lot of it was. I was glad I had persevered in my chiropractic search.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Summary</span></b><br />
<br />
Finding a good chiropractor for pregnancy is not always easy. Just as not every OB or midwife is equally effective for everyone, it's important to find a chiropractor that "gets" your body, uses techniques that you find helpful, and is always respectful and responsive to your concerns.<br />
<br />
Don't just stop at the first chiro you find, try it once, and then conclude that chiropractic care is not for you. Try out several different styles if you can. If you can't do that, get the advice of local midwives and doulas because they often know the very best people in the area to recommend. Their guidance can save you a lot of time and effort. Remember, just as with an OB or midwife, it's all about finding a provider who is compatible with <i>you</i>.<br />
<br />
My own story shows the importance of searching for the practitioner who is right for you. The first chiros and osteopaths I tried were not able to help me. Had the ICA or ICPA lists been available then, my original pregnancy chiro would not have been listed because she was still in the process of training. An ICPA-trained chiro that I tried later looked great on paper but was not effective for me. The chiros I saw saw for the fourth pregnancy were not listed because neither of them is a DICCP diplomate ─ but they were trained by a DICCP diplomate and so were familiar with the techniques needed. The chiropractor that was the closest and most convenient to me did not turn out to be the best chiropractor for my body. It took quite a bit of "shopping around" to find a chiro that worked well for <i>my </i>needs,<i> </i>but in the end it was well worth the work.<br />
<br />
There are no easy or quick answers to searching for a good chiropractor for pregnancy. If at first you don't find a Webster Technique chiropractor, keep trying. If the chiro you try at first doesn't seem able to help you or you don't get good results with them, be willing to try others. Good and bad chiros are all over; lists can be a good place to start your search but ultimately they don't tell you much about the quality of the chiropractors themselves.<br />
<br />
Nothing substitutes for actually trying something and keeping the search up till you find one that really clicks with <i>your</i> needs.</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-85027502960812022872018-11-28T03:44:00.001-08:002018-11-28T03:44:29.468-08:00Chiropractic Care in Pregnancy: Part One<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1-zZ1EKfwbiVAd_ES6yCYdsusVBNQvpsZqvFOB4XoLBeDTfxyQkZ6rAKZHe7vi68C4yTDAYQBdNBqNP3wOG0FVUHzeQh63j8penUeBckvmud3xD8vfL0CMdLoSeaH-CqDdOyyOX3mP04/s1600/Relieving%252BBack%252BPain%252Bin%252BPregnancy%252Bwith%252BChiropractic.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="800" data-original-width="800" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1-zZ1EKfwbiVAd_ES6yCYdsusVBNQvpsZqvFOB4XoLBeDTfxyQkZ6rAKZHe7vi68C4yTDAYQBdNBqNP3wOG0FVUHzeQh63j8penUeBckvmud3xD8vfL0CMdLoSeaH-CqDdOyyOX3mP04/s400/Relieving%252BBack%252BPain%252Bin%252BPregnancy%252Bwith%252BChiropractic.png" width="400" /></a></div>
<br />
Many people experience back and pelvic pain in pregnancy.<br />
<br />
For some this is just a passing phenomenon, a little discomfort that goes along with the hormones of pregnancy relaxing the pelvis and helping it expand for the birth. Some mild back and joint discomfort is common in pregnancy and does not have to be a problem.<br />
<br />
For others, however, back and joint pain becomes a significant and long-lasting problem that can become debilitating. Some find it difficult to turn over in bed, to get dressed in the morning, to walk any distance, or even to sit comfortably for long. Some are in constant pain from it; a few even end up using a walker or in a wheelchair, unable to walk without aid.<br />
<div>
<br /></div>
Fortunately, chiropractic care is often helpful in these cases. Many pregnant people report pain relief and more mobility with chiropractic care. Yet some are not sure about the wisdom of chiropractic care in pregnancy.<br />
<br />
Here are some answers to the most common questions about chiropractic care for pregnancy, and help in finding a pregnancy chiropractor for those who want it.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Purpose of Chiropractic Care During Pregnancy</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5wCq3Ezz7rKSBGK4yj6x4LDlmy1uw4QZeVqadTL2E50vPXMkKp7HtVprXDsuFXHPh55RJn0nkxsUZOo9kAAZopTK33LFxn4xyL2Vq7joLqYSdssXwreWbam8ILSEbqDlgS2blm4GTuMo/s1600/Restore-Balance-e1510760197659.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5wCq3Ezz7rKSBGK4yj6x4LDlmy1uw4QZeVqadTL2E50vPXMkKp7HtVprXDsuFXHPh55RJn0nkxsUZOo9kAAZopTK33LFxn4xyL2Vq7joLqYSdssXwreWbam8ILSEbqDlgS2blm4GTuMo/s320/Restore-Balance-e1510760197659.jpg" width="320" /></a></div>
<br />
While many doctors say that back and pelvis pain is "normal" in pregnancy and there is nothing that can be done to help it, chiropractors do not believe that significant or long-lasting pain is "normal" at all, and they know from experience that much of it <i>can</i> be helped.<br />
<br />
They believe pain occurs when the spine or pelvis are out of alignment or the muscles and soft tissues around them are unbalanced. This can present as back pain, pain in the buttocks that radiates down the leg (sciatica), pubic symphysis pain in the front of the pelvis, hip pain, tailbone (coccyx) pain, stabbing pains in the abdomen when the mother moves too quickly or sneezes (round ligament spasm), neck pain, difficulty walking, difficulty turning over or lifting one leg, difficulty getting in and out of cars, and sometimes shoulder or rib/side pain.<br />
<br />
If you are experiencing this kind of pain in pregnancy, chiropractic care may help make pregnancy more comfortable. Chiropractors believe that chiropractic care can help pregnant people in several different ways:<br />
<ul style="text-align: left;">
<li>By creating more room in the pelvis for baby to maneuver through</li>
<li>By improving nerve function so that contractions are more effective</li>
<li>By relieving imbalances or tensions in the ligaments and soft tissues supporting the uterus</li>
</ul>
The most basic component of chiropractic care is to make sure the bony passage around the baby (the pelvis) is as open and well-aligned as possible, creating the largest possible space for the baby to move through.<br />
<br />
Many women who have had cesareans have been told that their "sacrum is too prominent" or "too flat," that their pubic arch is "too flat/narrow," that "there is a bone in the way," or simply that their "pelvis is too small/narrow" for a baby to maneuver through. However, after chiropractic care, many of these same women have gone on to <a href="https://wellroundedmama.blogspot.com/2018/04/vbac-after-cesarean-for-arrest-of.html" target="_blank">give birth to bigger babies</a> than their "stuck" cesarean babies, simply because the pelvic passage is now optimized and the baby has more room. It doesn't seem like such treatment would make much more space, but getting into good alignment can actually make enough difference to maximize the space and help make an easier birth.<br />
<br />
Chiropractors also place great importance on good nerve function. They believe that a misaligned spine impedes nerve function. They believe that poor alignment can not only affect the body physically by making less room for the baby to get out, but also by causing ineffective, uncoordinated contractions because of poor nerve function. From his article on "<a href="http://www.plus-size-pregnancy.org/ChiroSafetyinPreg.html" target="_blank">The Safety of Chiropractic Care in Pregnancy</a>," Dr. Jason Lindekugel (D.C.) writes:<br />
<blockquote class="tr_bq">
Chiropractic manipulation seeks to balance the joints of the body in order to normalize nerve function...In restoring joint function, chiropractors are relieving nerve irritation which in turn relaxes muscles and the ligaments of the pelvis and uterus. So, proper nerve function is the goal, not just “cracking” joints.</blockquote>
Finally, chiropractors believe that by relieving any misalignments, they will create more space and improve nerve function, lessening the risk for dystocia (slow, unproductive labors) and hopefully resulting in safer, faster, and more effective labors and births.<br />
<br />
Some people mistakenly think that chiropractors are practicing obstetrics and manually trying to turn babies into position. This is not true. Chiropractors are trying to create conditions to normalize the body's functions so the mother has the best possible chance at an effective labor and birth.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Effectiveness of Chiropractic Care in Pregnancy</span></b><br />
<b><br /></b>
But is seeing a chiropractor in pregnancy that helpful? What does the research say?<br />
<br />
Traditionally, chiropractors have done research differently than mainstream medicine. They have relied more on case reports and case series rather than gold-standard randomized studies. They often didn't use control groups because they were loathe to deny anyone care, especially in pregnancy. Even when mainstream studies were done, sample sizes tended to be small. So there are limits to many studies done in the past.<br />
<br />
However, there are now a number of studies and reviews using more rigorous methodology that are reassuring. Here is a summary of a few.<br />
<br />
A 2013 <a href="http://www.pubmed.gov/23123166" target="_blank">prospective randomized study</a> in pregnant patients with low back and pelvic pain compared usual obstetric care with obstetric care plus additional chiropractic care. It found that those patients who received the additional chiropractic care improved significantly, while those who received just standard obstetric care did not improve at all.<br />
<br />
A 2014 <a href="http://www.pubmed.gov/24690125" target="_blank">study</a> found that the improvement from chiropractic care was long lasting. Nearly 90% of study participants were improved a year later. Several other studies (see references below) have also found significant improvement with chiropractic care in pregnancy, with few adverse events.<br />
<br />
A 2012 <a href="http://www.pubmed.gov/23946024" target="_blank">Canadian review</a> stated:<br />
<blockquote class="tr_bq">
Massage therapy and chiropractic care, including spinal manipulation, are highly safe and effective evidence-based options for pregnant women suffering from mechanical low back and pelvic pain.</blockquote>
In 2015, the Cochrane Collaboration, a leader in evidence-based care, <a href="http://www.pubmed.gov/26422811" target="_blank">reviewed</a> a series of studies on alternative care practices in pregnancy like acupuncture, craniosacral therapy, and osteomanipulation (basically chiropractic care). They found the quality of evidence "moderate," and that osteomanipulative therapy did significantly reduce low back and pelvic pain in pregnancy. Furthermore, any adverse events were "minor and transient."<br />
<br />
It should be noted that no matter what the research says, some people will never be comfortable trying chiropractic care, and that's okay. If chiropractic care is not for you, don't feel pressured into it. Women have been having babies for thousands of years without having chiropractic care. Most will do fine without it. However, if you are having lots of back pain or pelvic pain, you might want to reconsider it.<br />
<br />
If you are still not sure, you might try exploring the possibility further without committing to it. Ask local midwives and doulas for recommendations of good pregnancy chiropractors, then call and ask if you can do a non-treatment consult about your case. Find out how the chiropractor makes room for the pregnancy belly during treatment and the techniques they might use. See if you can observe treatment during an appointment (if the patient gives permission). Often this is enough to reassure people that chiropractic care in pregnancy is reasonable and safe. However, whatever you decide, remember that it's always <i>your </i>choice.<br />
<br />
<div>
<b><span style="color: #cc0000; font-size: large;">When To See a Chiropractor and How Often</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh7UoxpwzeOOMaSULQyGr6-hSxEkqmuWP69ipGQ1rzj44YdTSHNATGB1tywnPtKgnHgW7hPMobLsKsahtw-LFGj3aMyW-gh5Bj-xwC5BLuXU5JYp81DUdme6rcbXhdlawcT_EstjBeH-g/s1600/chiro+checking+pregnant+woman+Garden+State+Family+Chiropractic.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1068" data-original-width="1600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh7UoxpwzeOOMaSULQyGr6-hSxEkqmuWP69ipGQ1rzj44YdTSHNATGB1tywnPtKgnHgW7hPMobLsKsahtw-LFGj3aMyW-gh5Bj-xwC5BLuXU5JYp81DUdme6rcbXhdlawcT_EstjBeH-g/s400/chiro+checking+pregnant+woman+Garden+State+Family+Chiropractic.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Photo credit: <a href="http://www.gardenstatefamilychiro.com/prenatalchiro.html" target="_blank">Garden State Chiropractic</a> </i></td></tr>
</tbody></table>
If you do decide to see a chiropractor in pregnancy, one common question is when to start seeing them and how often. Unfortunately, there is no simple answer to this. The answer totally varies from woman to woman, depending on each person's unique needs.<br />
<br />
Ideally, people would start seeing a chiropractor before or between pregnancies so that any serious issues can be taken care of before the hormones of pregnancy start softening and loosening the ligaments, making it hard to maintain chiropractic adjustments. The more serious a person's issues, the smarter it would be to start care before pregnancy instead of waiting till after they are pregnant. <br />
<br />
However, many people only start experiencing significant pain once they are already pregnant. Others may have limits on the amount of chiropractic visits that are covered under their insurance, or they have no chiropractic coverage and must pay cash. Therefore, many want to try and maximize the benefit of the visits by timing them carefully, and that may mean limiting them to pregnancy only, or even to the last third of pregnancy only. <br />
<br />
The problem is that no two people's problems are alike, and there is no one prescription that fits all everyone's needs. The loosening hormones of pregnancy increase as pregnancy progresses, so generally speaking it's better to start treatment sooner than later. However, if you have only a few visits that are covered by insurance or you have limited ability to pay for them out-of-pocket, then you may want to save your visits for the third trimester. However, if you do this and you have really significant alignment issues, you also run the risk of not getting enough treatment to really fix the problem in time. So there is no one answer for every woman. It really depends on the unique circumstances of your particular situation. If you are in a significant amount of discomfort, that usually indicates a problem that should be addressed sooner than later.<br />
<br />
Generally speaking, chiropractors prefer to see women before they become pregnant to start resolving any long-standing misalignment issues. Once you become pregnant, most chiropractors want to see you on the same approximate schedule that a doctor or midwife sees you, which is about once a month in the first 2 trimesters, bi-weekly in weeks 32-36, and every week after 36 weeks until the baby is born.<br />
<br />
Now obviously, that's the ideal schedule. A lot depends on what's happening with the body. If a pregnant woman comes in as a new patient and has a lot of major alignment issues going on, most chiropractors are going to want to see her weekly (or more) until her alignment issues are better, and then they will go back to the standard schedule noted above. <br />
<br />
Other women may not need to be seen even every month. If the chiropractor finds that there is nothing to adjust, then he/she should send you home and elongate the time between visits. Some lucky women find that their pain goes away after a couple of chiropractic treatments and then they're done and never need to go back.<br />
<br />
On the other hand, some women need to visit more often than weekly. When treatment is first initiated, frequent visits are important to start retraining the body's muscles and ligaments to "remember" the new alignment consistently. So there may be a flurry of frequent visits in the beginning that slowly space out farther and farther as the woman's body adapts to the new patterns, and then visit frequency comes and goes, depending on the woman's needs. In women with a history of major alignment issues, it's not unusual for the woman to go back to seeing the chiropractor very frequently near the end of pregnancy because the ligaments are so loose by then that it's difficult to maintain any adjustments. It all depends on the needs of the woman and her comfort levels. <br />
<br />
However, a chiropractor should not force you to buy a pre-packaged bundle of "x" amount of visits for "x" cost. Some doctors offer this as a way for patients to save money, but the package should be flexible so that if you didn't end up needing "x" amounts of visits, you wouldn't have to have them. Furthermore, a pre-defined schedule of visits cannot anticipate what your body will need and how it responds to treatment; for some people more frequent visits might be needed, while others may need much less. A "one size fits all" package is a sign you should seek out a different chiropractor instead. <br />
<br />
Unfortunately, there are bad chiropractors/quacks out there, just as there are quack doctors. Because of this, some people reject all chiropractors altogether. But the reasonable response to quack doctors is not to ignore all medical advice and shun all doctors, but instead to find a better, reputable doctor, one whose treatment philosophy and methods align with your preferences.<br />
<br />
The same goes for chiropractors. If you find a bad one, don't be afraid to leave and try another one. Get recommendations from other mothers or childbirth professionals to help guide you to the more reputable and helpful practitioners. Also, there are many different styles of chiropractic care and ways to adjust people. If you don't like one style, keep trying till you find a chiropractor that uses techniques you are comfortable with and seems to "get" your particular body needs. Listen to your instincts; if your intuition is saying that a particular chiropractor is not for you, then find a new one.<br />
<br />
Fortunately, most chiropractors are legitimate professionals and are not just out to make a quick buck. They should evaluate your condition, suggest a plan of care, and then keep re-evaluating your need for visits based on how well you respond to treatments. Their care plan should be dynamic and changing in response to your own needs and comfort. <br />
<br />
In short, there is no one pattern of visits that you "should" follow. Ideally, you should try to start chiropractic care before pregnancy, and then in pregnancy see the chiropractor monthly, then bi-weekly, then weekly in the last month. However, this schedule is not set in stone and should be adjusted to the unique needs of each person. <br />
<br />
<b><span style="color: #cc0000; font-size: large;">Summary</span></b><br />
<b><br /></b>
To summarize, the purpose of chiropractic care during pregnancy is to:<br />
<ul style="text-align: left;">
<li>Keep the body well-aligned to make the maximum possible space available for baby to pass </li>
<li>To optimize nerve function so that contractions can be effective and coordinated</li>
<li>To balance joints, ligaments, and muscles of the uterine supporting structures so baby has the best chance to assume the easiest possible position for being born </li>
</ul>
In other words, chiropractic care during pregnancy may help pregnancy be more comfortable, and hopefully help labor and birth be easier for mother and baby. Although further research is needed, the research we have so far suggests that chiropractic care in pregnancy can be very helpful for low back and pelvic pain.<br />
<br />
<br />
<br /></div>
<div>
<b><span style="color: #cc0000; font-size: x-large;">References</span></b><br />
<b><br /></b>
<b><i><span style="color: #38761d;">Chiropractic Care for Low Back and Pelvic Pain in Pregnancy</span></i></b><br />
<b><br /></b>
Cochrane Database Syst Rev. 2015 Sep 30;(9):CD001139. doi: 10.1002/14651858.CD001139.pub4. <b><span style="color: purple;">Interventions for preventing and treating low-back and pelvic pain during pregnancy.</span></b> Liddle SD, Pennick V. PMID: <a href="http://www.pubmed.gov/26422811" target="_blank">26422811</a></div>
<div>
<blockquote class="tr_bq">
"...<b>There was moderate-quality evidence...from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability,</b> and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain.When reported, adverse effects were minor and transient."</blockquote>
Am J Obstet Gynecol. 2013 Apr;208(4):295.e1-7. doi: 10.1016/j.ajog.2012.10.869. Epub 2012 Oct 23. <b><span style="color: purple;">A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy.</span></b> George JW, Skaggs CD, Thompson PA, Nelson DM, Gavard JA, Gross GA. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/23123166" target="_blank">23123166</a><br />
<blockquote class="tr_bq">
...We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period. STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks' gestation, with follow-up at 33 weeks' gestation.... Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants. RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements. CONCLUSION: <b>A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.</b></blockquote>
Chiropr Man Therap. 2014 Apr 1;22(1):15. doi: 10.1186/2045-709X-22-15. <b><span style="color: purple;">Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. </span></b>Peterson CK, Mühlemann D, Humphreys BK. PMID: <a href="http://www.pubmed.gov/24690125" target="_blank">24690125</a> <br />
<blockquote class="tr_bq">
...RESULTS: 52% of 115 recruited patients 'improved' at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year...CONCLUSIONS: Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of 'improvement' in the logistic regression model.</blockquote>
J Midwifery Womens Health. 2006 Jan-Feb;51(1):e7-10. <b><span style="color: purple;">Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series.</span></b> Lisi AJ. PMID: <a href="http://www.pubmed.gov/16399602" target="_blank">16399602</a><br />
<blockquote class="tr_bq">
...This retrospective case series was undertaken to describe the results of a group of pregnant women with low back pain who underwent chiropractic treatment including spinal manipulation. Seventeen cases met all inclusion criteria. The overall group average Numerical Rating Scale pain score decreased from 5.9 (range 2-10) at initial presentation to 1.5 (range 0-5) at termination of care. Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0-13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1-5). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.</blockquote>
J Chiropr Med. 2016 Jun;15(2):129-33. doi: 10.1016/j.jcm.2016.04.003. Epub 2016 May 25. <b><span style="color: purple;">Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study. </span></b>Bernard M, Tuchin P. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/27330515" target="_blank">27330515</a><br />
<blockquote class="tr_bq">
...A pregnant 35-year-old woman experienced insidious moderate to severe pregnancy-related lumbopelvic pain and leg pain at 32 weeks' gestation. Pain limited her endurance capacity for walking and sitting. Clinical testing revealed a left sacroiliac joint functional disturbance and myofascial trigger points reproducing back and leg pain...The patient was treated with chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice in 13 visits over 6 weeks. She consulted her obstetrician for her weekly obstetric visits. At the end of treatment, her low back pain reduced from 7 to 2 on a 0-10 numeric pain scale rating. Functional activities reported such as walking, sitting, and traveling comfortably in a car had improved. CONCLUSION: This patient with pregnancy-related lumbopelvic pain improved in pain and function after chiropractic treatment and usual obstetric management.</blockquote>
Further articles: <a href="http://icapediatrics.com/resources/articles/pregnancy-and-chiropractic/">http://icapediatrics.com/resources/articles/pregnancy-and-chiropractic/</a><br />
<br />
<b><i><span style="color: #38761d;">Safety of Chiropractic Care, </span></i></b><b><i><span style="color: #38761d;">Attitudes Towards Chiropractic Care</span></i></b><br />
<br />
JAMA. 2017 Apr 11;317(14):1451-1460. doi: 10.1001/jama.2017.3086. <b><span style="color: purple;">Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. </span></b>Paige NM. PMID: <a href="http://www.pubmed.gov/28399251" target="_blank">28399251</a></div>
<blockquote class="tr_bq">
OBJECTIVE: To systematically review studies of the effectiveness and harms of SMT for acute (≤6 weeks) low back pain...Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.</blockquote>
<div>
Chiropr Man Therap. 2012 Mar 28;20:8. doi: 10.1186/2045-709X-20-8. <b><span style="color: purple;">Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature.</span></b> Stuber KJ, Wynd S, Weis CA. PMID: <a href="http://www.pubmed.gov/22455720" target="_blank">22455720</a></div>
<blockquote class="tr_bq">
CONCLUSIONS:<b> There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. </b>While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.</blockquote>
<div class="results_settings one_setting" id="result_action_bar" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; overflow: auto; position: relative; width: 863.094px; zoom: 1;">
<div>
</div>
</div>
<div style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 13px;">
</div>
<div class="" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 13px;">
<span class="nowrap" id="result_sel" style="white-space: nowrap;"></span></div>
<div class="empty" id="messagearea" style="background-color: white; border: none; clear: both; font-family: arial, helvetica, clean, sans-serif; font-size: 13px;">
</div>
Can Fam Physician. 2013 Aug;59(8):841-2<b><span style="color: purple;">.Optimizing pain relief during pregnancy using manual therapy. </span></b>Oswald C, Higgins CC, Assimakopoulos D. PMID: <a href="http://www.pubmed.gov/23946024" target="_blank">23946024</a><br />
<blockquote class="tr_bq">
...As pregnant women move into their second and third trimesters, their centres of mass shift anteriorly, causing an increase in lumbar lordosis, which causes low back and pelvic girdle pain. Increasing recent evidence attests to the effectiveness and safety of treating this pain using manual therapy. Massage therapy and chiropractic care, including spinal manipulation, are highly safe and effective evidence-based options for pregnant women suffering from mechanical low back and pelvic pain.</blockquote>
J Evid Based Complementary Altern Med. 2016 Apr;21(2):92-104. doi: 10.1177/2156587215604073. Epub 2015 Sep 8. <b><span style="color: purple;">Attitudes Toward Chiropractic: A Survey of Canadian Obstetricians.</span></b> Weis CA, Stuber K, Barrett J, Greco A, Kipershlak A, Glenn T, Desjardins R, Nash J, Busse J. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/26350243" target="_blank">26350243</a><br />
<blockquote class="tr_bq">
We assessed the attitudes of Canadian obstetricians toward chiropractic with a 38-item cross-sectional survey...Overall, 30% of respondents held positive views toward chiropractic, 37% were neutral, and 33% reported negative views. Most (77%) reported that chiropractic care was effective for some musculoskeletal complaints, but 74% disagreed that chiropractic had a role in treatment of non-musculoskeletal conditions. Forty percent of respondents referred at least some patients for chiropractic care each year.... </blockquote>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-67894485472720231722018-11-02T16:50:00.001-07:002018-11-02T16:50:38.823-07:00The High Price of Multiple Cesareans<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRzx2NS0gwjxFHykTSsNdlaIBbXmKdD5egLB_NXCOBV_Sdr8BzbwkTi94Oo2YSHF6uoNCsNS0sAz8Pl2wu-FgaLRHo3kXPGRW9S_Q5KY7t_9WNxnH_5EFHa5dFTAq2dfwtW62B23bCi7c/s1600/scalpel_in_hand.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="299" data-original-width="396" height="301" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRzx2NS0gwjxFHykTSsNdlaIBbXmKdD5egLB_NXCOBV_Sdr8BzbwkTi94Oo2YSHF6uoNCsNS0sAz8Pl2wu-FgaLRHo3kXPGRW9S_Q5KY7t_9WNxnH_5EFHa5dFTAq2dfwtW62B23bCi7c/s400/scalpel_in_hand.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
A recent study once again reinforces the message that the more cesareans are done, the higher the risk for complications.<br />
<div>
<br />
In previous posts, we have mostly discussed cesarean risks in terms of future pregnancies. We have written about Placenta Accreta Spectrum <a href="https://wellroundedmama.blogspot.com/2018/10/women-are-dying-from-this-taking.html" target="_blank">several times</a> here already. This is where the placenta implants <a href="http://www.wellroundedmama.blogspot.com/2013/08/placenta-accreta-part-one-what-is.html" target="_blank">too deeply</a> into the uterus. This is a <a href="http://wellroundedmama.blogspot.com/2013/09/placenta-accreta-part-three-risks-to.html" target="_blank">life-threatening potential complication</a> of <a href="http://wellroundedmama.blogspot.com/2013/09/placenta-accreta-part-four-diagnosis.html" target="_blank">pregnancies after cesareans</a>, and the <a href="http://wellroundedmama.blogspot.com/2013/09/placenta-accreta-part-two-life.html" target="_blank">risk goes up</a> with the number of prior cesareans. </div>
<div>
<br /></div>
<div>
<b>However, the risks with multiple cesareans aren't limited only to future pregnancies</b>.<br />
<br />
This <a href="http://www.pubmed.gov/30372778" target="_blank">new study</a> highlights that the risk for other problems occurring during and after surgery also rises with the number of prior cesareans. The study found that: </div>
<div>
<ul style="text-align: left;">
<li>After 2 cesareans, the risk for organ injury and hysterectomy increased</li>
<li>After 3 cesareans, the risk for hemorrhage (massive bleeding) and surgical site complications increased</li>
</ul>
</div>
<div>
<div>
Injuries to organs around the area are serious because they usually involve the bladder or intestines. The more abdominal surgery someone has, the greater the risk for <a href="https://www.ncbi.nlm.nih.gov/pubmed/27770246" target="_blank">adhesions</a>, scar tissue that can cause internal organs to <a href="https://www.ncbi.nlm.nih.gov/pubmed/24007252" target="_blank">stick together</a>. This can make it difficult to operate in the area without causing collateral damage to organs nearby. If organ injury occurs, it can have lifelong consequences for the mother's urinary and/or G.I. system. Even if organ injury does not occur, adhesions alone can cause significant pain. For some people, it causes life-long severe pain. </div>
<div>
<br /></div>
<div>
Obviously, the risk for major bleeding increases with surgery. Each successive surgery takes longer because of the scar tissue, and that increases the risk of hemorrhage even more. Some women need blood transfusions during or after the surgery. Many suffer problems with anemia, which can affect milk supply. Those with very severe hemorrhages may even experience <a href="https://en.wikipedia.org/wiki/Sheehan%27s_syndrome" target="_blank">Sheehan's Syndrome</a>, life-long endocrinological problems because severe bleeding affected the pituitary gland. </div>
<div>
<br /></div>
<div>
The risk for completely losing your uterus (hysterectomy) also increases with more cesareans. This is usually due to cases of accreta or in response to severe bleeding. The placenta cannot detach properly with accreta, or the uterus doesn't clamp down properly during surgery and the bleeding can't be stopped. Often the only way to keep the mother alive may be to take her uterus out, forever altering her fertility. . </div>
<div>
<br /></div>
<div>
In addition, surgical site complications increase with each surgery. These can include infections, which can go septic and spread to the entire body. Although rare, some women die due to infections after cesareans. Others lose their uterus. Other surgical complications include seromas and hematomas (pockets of fluid or blood around the wound), and the surgical wound not healing (dehiscence). While these can be treated, they often cause long-term wounds and a painful recovery. They complicate recovery and make mothering difficult.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">The Take Away Message</span></b></div>
<div>
<br />
Sometimes when cesareans are questioned, people get all defensive. Mothers who had their babies by cesarean may feel like they are being judged or that some may think them less of a mother because of their cesarean. Doctors may feel defensive and point out the many times that cesareans have saved lives.<br />
<br />
That's not what this is about. This is not about any <i>one </i>person's cesarean or a judgment about whether that cesarean was necessary or lifesaving. This is a public health issue about the <u>overuse</u> of cesareans and the potential consequences of that. The take away message here is:</div>
<div>
<blockquote class="tr_bq">
<b><span style="color: blue;">All of the potential complications of cesareans need to be taken more seriously and cesareans used only when truly necessary. </span></b></blockquote>
Cesareans are <i>not </i>evil. They can be a wonderful, life-saving intervention, and no one should feel like less of a mother because they had a cesarean. However, cesareans do carry risk. When overused or done without need, they can cause severe problems and <a href="https://www.theexpertinstitute.com/case-studies/woman-dies-following-c-section/" target="_blank">even death</a>, especially when multiple repeat cesareans are being done. <br />
<br />
National Public Radio has been running an excellent series on <a href="https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger" target="_blank">maternal mortality</a> in pregnancy, as well as on <a href="https://www.npr.org/2017/12/22/572298802/nearly-dying-in-childbirth-why-preventable-complications-are-growing-in-u-s" target="_blank">near-misses</a> (where the mother almost dies during or just after pregnancy), that highlights many of these complications: </div>
<blockquote class="tr_bq">
...according to the CDC, the rate at which women are suffering nearly fatal experiences in childbirth has risen faster than the rate at which they're dying. Based on the rate per 10,000 deliveries, serious complications more than doubled from 1993 to 2014, driven largely by a fivefold rise in blood transfusions. That also includes a nearly 60 percent rise in emergency hysterectomies — removal of the uterus and sometimes other reproductive organs, often to stem massive bleeding or infection. In 2014 alone, more than 4,000 women had emergency hysterectomies, rendering them permanently unable to carry a child. The rate of new mothers requiring breathing tubes increased by 75 percent, as did the rate of those treated for sepsis, a life-threatening inflammatory response to infection that can damage tissues and organs. </blockquote>
<blockquote class="tr_bq">
"These numbers are really high, and far too many of them are preventable," said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative and a national leader in efforts to reduce maternal deaths and injuries...</blockquote>
<blockquote class="tr_bq">
...more than 135 expectant and new mothers a day — or roughly 50,000 a year, according to the Centers for Disease Control and Prevention — endure dangerous and even life-threatening complications that often leave them wounded, weakened, traumatized, financially devastated, unable to bear more children, or searching in vain for answers about what went wrong. </blockquote>
Although certainly not the only factor in the rising rate of complications, many of these near-death and fatal experiences begin with cesareans. The same NPR article noted:<br />
<blockquote class="tr_bq">
Only about one-third of U.S. C-sections are medically justified, according to [Eugene] DeClercq, the Boston University maternal health expert. A web of factors explains the rest, including hospital culture (C-section rates vary widely from one institution to the next); efforts to make childbirth more convenient (C-sections can be scheduled); and indirect financial incentives. Because C-sections normally take much less time than vaginal deliveries, they are more cost-effective for hospitals and providers. Additionally, several studies point to the influence of "defensive medicine," a term for doctors' fears of being blamed by their patients for not having done everything possible to avoid medical problems.</blockquote>
The culture of cesareans is strong in many hospitals, and as a result many <a href="https://news.aetna.com/2015/10/c-section-most-common-surgery-often-unnecessary/" target="_blank">unnecessary cesareans</a> are being done. And once a woman has had a cesarean, she is often pressured into further cesareans by doctors who say Vaginal Birth After Cesarean (VBAC) is "too risky." But the fact is that multiple repeat cesareans are not risk-free either. Both VBAC and Repeat Cesarean have risks to mother and baby that must be carefully weighed. It should be up to the mother to decide which choice to pursue.<br />
<br />
<b>Research is clear that taken as a group, cesareans are <i>not </i>risk-free and should not be taken lightly or done routinely. </b><br />
<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: large;">References</span></b><br />
<br />
Am J Perinatol. 2018 Oct 29. doi: 10.1055/s-0038-1673653. [Epub ahead of print] <b><span style="color: purple;">Risk of Maternal Morbidity with Increasing Number of Cesareans.</span></b> Sondgeroth KE, Wan L, Rampersad RM, Stout MJ, Macones GA, Cahill AG, Tuuli MG. PMID: <a href="http://www.pubmed.gov/30372778" target="_blank">30372778</a><br />
<blockquote class="tr_bq">
OBJECTIVE: To estimate the risk of perioperative morbidity with increasing number of cesareans. STUDY DESIGN: We conducted a retrospective cohort study from 2004 to 2010. Patients delivered by cesarean were included. Outcome measures were a composite organ injury (bowel or bladder), hysterectomy, hemorrhage requiring transfusion, severe morbidity, or surgical site complications... RESULTS: Of the 15,872 women in the cohort, 5,144 had cesarean delivery: 3,113 primary, 1,310 one prior, 510 two prior, and 211 three or more prior cesareans. There was a significant increase in organ injury, hysterectomy, and surgical site complications with increasing number of cesareans. In multivariable analysis, the risk of organ injury and hysterectomy was increased compared with primary cesarean after two prior cesareans, and after three or more cesareans for hemorrhage requiring transfusion and surgical site complications. CONCLUSION: <b>The risks of organ injury and hysterectomy are increased after two or more prior cesareans, and risks of hemorrhage and surgical site complications are increased after three or more cesareans.</b></blockquote>
Arch Gynecol Obstet. 2017 Feb;295(2):303-311. doi: 10.1007/s00404-016-4221-8. Epub 2016 Oct 21. <b><span style="color: purple;">Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section. </span></b>Arlier S, Seyfettinoğlu S, Yilmaz E, Nazik H, Adıgüzel C, Eskimez E, Hürriyetoğlu Ş, Yücel O. PMID: <a href="http://www.pubmed.gov/27770246" target="_blank">27770246</a> <br />
<blockquote class="tr_bq">
PURPOSE OF INVESTIGATION: We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity. MATERIALS AND METHODS: We analyzed intra-abdominal adhesions of 672 patients. RESULTS: Among the patients, 173, 206, 151, and 142 underwent CS for the first, second, third, and fourth time or more, respectively. There were adhesions in 393 (58.5 %) patients. Among first CSs, there were no adhesions, the rate of maternal morbidity [Morales et al. (Am J Obstet Gynecol 196(5):461, 2007)] was 26 %, and the rate of neonatal morbidity (NM) was 35 %. <b>Among women who have history of two CSs, the adhesion rate was 66.3 %, the adhesion score was 2.05, MM was 14 %, and NM was 21 %. Among third CSs, these values were 82.1, 2.82, 23, and 14 %, respectively. Among women who have history of four or more CSs, these values were 92.2, 4.72, 31.7, and 18 %, respectively. Adhesion sites and dense fibrous adhesions increased parallel to the number of subsequent CSs. </b>Increased adhesion score was associated with 1.175-fold higher odds of NM and 1.29-fold higher odds of MM. The rate of NM was eightfold higher in emergency-delivered newborns (emergency: 39.4, 40 %; elective: 4.9 %). MM was 20 and 26 % for elective and emergency CSs, respectively. CONCLUSIONS: Emergency operations and adhesions increased complications.</blockquote>
<br />
<ul style="text-align: left;">
<li><a href="https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger"><b>https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger</b></a> - National Public Radio article on maternal mortality in childbirth nationwide</li>
<li><a href="https://www.npr.org/2017/12/22/572298802/nearly-dying-in-childbirth-why-preventable-complications-are-growing-in-u-s" target="_blank"><b>https://www.npr.org/2017/12/22/572298802/nearly-dying-in-childbirth-why-preventable-complications-are-growing-in-u-s</b> </a> - National Public Radio article on near-misses and serious maternal morbidity, one in an excellent series of articles about maternal mortality in the U.S.</li>
<li><a href="https://news.aetna.com/2015/10/c-section-most-common-surgery-often-unnecessary/"><b>https://news.aetna.com/2015/10/c-section-most-common-surgery-often-unnecessary/</b></a> - article about the increase in cesarean rate and how many cs are unnecessary</li>
</ul>
</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-36002488831286491062018-10-25T02:08:00.002-07:002018-10-25T02:08:39.203-07:00Remaking Jam That Didn't Gel<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSCxzzsrbwCGBdDXsoO3y3Wb8V7jRA13SdGbbXw1Zzzn8PtygE5SaZxMdFgHVqCG3WNLPJj_jul-6eF5p88Mamzgf7KwqsGGjf582jgtPlOkS1GlEE0WzreayAagTOdL53YlpcROyk6QY/s1600/plum+jam+with+plums.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="260" data-original-width="320" height="325" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSCxzzsrbwCGBdDXsoO3y3Wb8V7jRA13SdGbbXw1Zzzn8PtygE5SaZxMdFgHVqCG3WNLPJj_jul-6eF5p88Mamzgf7KwqsGGjf582jgtPlOkS1GlEE0WzreayAagTOdL53YlpcROyk6QY/s400/plum+jam+with+plums.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
I've been preserving and canning food for a while now. I'm no expert but I've had pretty good luck so far with applesauce, chutney, jellies, and all kinds of jams.<br />
<br />
Until now.<br />
<br />
Yep, I just had a couple of large batches of jam fail spectacularly.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">The Backstory</span></b><br />
<br />
This summer we had a HUGE crop of plums in our yard from just two plum trees. Stupendously big crop. SO. MANY. PLUMS.<br />
<br />
We gave plums away, we dried plums, we made plum chutney, we made plum sauce, we made plum pies. And <i>still </i>we had plums coming out our ears.<br />
<br />
So we decided to try to make plum jam. This is not a jam I'd ever made before. A friend made me plum jam from a different type of plum a few years ago and I didn't like it at all. Thus, we'd never tried plum jam with our plums...but we were ready to try anything to get rid of all these plums!<br />
<br />
So we made a few successful batches of plum jam, and I tried a little on toast one day. WOW. I was so surprised. I <i>loved</i> this plum jam. I think the difference was ours was made with Italian plums which makes a delicious, thick, extremely flavorful jam. I immediately knew I'd be making more.<br />
<br />
We finished picking all the rest of the plums...we got like 3-4 <i>big</i> buckets more. So we decided to make several batches of jam, using up the last of the regular pectin (Sure-Jell) in my cupboard. The first batches went well, no problems. The last batch, though, was a full-sugar recipe (which I rarely use because I find it too sweet). But I was out of my preferred pectin, and I'm loathe to waste food. So we winced and made full-sugar plum jam. We thought we followed all the directions correctly, but in the end it never gelled.<br />
<br />
So now I had a whole bunch of jars full of plum syrup. This is not something I am likely to use. I have some raspberry syrup from a batch of raspberry jelly that didn't set up a couple of years ago and we are <i>still </i>trying to use it up. Mostly we add it to lemonade to make Raspberry Lemonade, but it doesn't take much so it takes forever to use up. All those jars of Plum Syrup were never going to get used.<br />
<br />
So I thought, let's see if we can remake that jam and get it to set up properly. I'd never done this before so I did a little research and found some articles online.<br />
<br />
<b>Keep in mind, the information below is pertinent only to jams with an added pectin like Sure-Jell (either the pink box or the yellow box).</b><br />
<br />
Cooked jam without any added pectin is another story entirely and not covered here; <a href="https://foodinjars.com/" target="_blank">Food in Jars</a> is a good website for that type of jam. Directions for remaking jams with Pomona Pectin can be found on the <a href="http://www.pomonapectin.com/jell" target="_blank">Pomona Pectin website</a>.<br />
<br />
General information about different types of pectins and the pros and cons of each can be found in my <a href="https://wellroundedmama.blogspot.com/2012/09/canning-pecking-about-pectins.html" target="_blank">article on pectins</a>. This article gets a lot of online traffic so hopefully people are finding it useful.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Why Gelling May Fail</span></b><br />
<b><br /></b>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWnt3N7x1iRIGhg6ac8SYzvQEzQJIqJxoit1rjdq9uxL2a2lyQ5J2K2PzJsOuWtWOZaXr7mS3M10lZgWHq06u-i7wcru_CSfaVpdn15QCmhUxxGARQcsiL66qupdHZy7ngwYbSlajXO2E/s1600/plum+jam+on+spoon.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="360" data-original-width="640" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWnt3N7x1iRIGhg6ac8SYzvQEzQJIqJxoit1rjdq9uxL2a2lyQ5J2K2PzJsOuWtWOZaXr7mS3M10lZgWHq06u-i7wcru_CSfaVpdn15QCmhUxxGARQcsiL66qupdHZy7ngwYbSlajXO2E/s400/plum+jam+on+spoon.jpg" width="400" /></a></div>
<br />
When it comes right down to it, making jams and jellies is really a chemistry experiment. Certain reactions are needed in order to make gelling action happen. Basically you cook up mashed fruit, then add a certain amount of sugar, acid, and pectin in order to make those reactions happen. Get the balance right and you get lovely jam or jelly. Get the percentage wrong and you get a runny mess.<br />
<br />
Fruits naturally have some pectin in their cell structures, especially in the skins and seeds. The goal of cooking the fruit is to break down the pectin in the individual fruit so it can then build a mesh with the pectin from other fruits. This makes a gel where fruit bits are suspended in a latticework of pectin.<br />
<br />
The problem is that pectin molecules repel each other. Acidity is needed to overcome this and let pectin molecules bond with each other to make the lattice structure. Sugar is needed to bond with the water so the water doesn't overwhelm the pectin. So all of these, heat, sugar, acid, and pectin, are needed in just the right amounts and timing to make jam or jelly.<br />
<br />
Here is a quote about the process from a <a href="https://www.thenakedscientists.com/articles/questions/what-makes-jam-set-or-not" target="_blank">science blog</a>:<br />
<blockquote class="tr_bq">
The whole chemistry of jam making is all about making this pectin that's in the fruit break down and become water soluble. That then recombines, and all of those hydrogen bonds that are holding it together recombine in a chemical reaction with the fruit acid and with the sugar, and that makes a lovely network that forms a gel, and that's the kind of jelly-like substance of jams. </blockquote>
<blockquote class="tr_bq">
So you need to get that chemical reaction right, the pectin amount right, the fruit acid right, and the amount of sugar right so that you make the right consistency of that network that will hold your jelly together, your jam together, so you don't get fruit sauce.</blockquote>
Fruits that are naturally high in pectin <i>and </i>acidity <a href="https://www.thespruceeats.com/high-and-low-pectin-fruit-1327800" target="_blank">like</a> quince, underripe apples, red currants, cranberries, and gooseberries are an exception. They often don't need anything except cooking in a little water to set up and gel.<br />
<br />
Here are a few reasons why an added-pectin jam of most other fruit may fail to set up/gel:<br />
<ul style="text-align: left;">
<li><b>Not enough acidity</b> - Some fruits have enough acidity on their own to gel without adding lemon juice, but most fruits need added acidity via lemon juice, lime juice, vinegar, or other acids. If you didn't add enough acid, the fruit won't gel</li>
<li><b>Not enough sugar </b>- Box pectin jam recipes should not be altered. If you use less than the full amount of sugar, the jam will not set up. Therefore, follow the recipe on the box and measure exactly; don't try to make it "healthier" by using less sugar. The recipe depends on <i>that</i> exact amount of sugar. The exception is Pomona Pectin, which uses a type of pectin that doesn't need sugar to activate it; it uses calcium instead. If you want to reduce sugar in jams, use Pomona Pectin, but remember that most jams need at least <i>some</i> sweetener for the sake of taste </li>
<li><b>Too much water added </b>- Using too much water to cook the fruit can throw off the balance of pectin, acid, and fruit. Use only enough to keep the fruit from burning </li>
<li><b>Doubling a batch or making too large a batch </b>- Jam batches need to be made one at a time, no more than 4-6 cups of fruit at a time. You can't double a batch and expect it to set up properly. One of the annoying things in jamming is having to make and clean up each batch separately. But that's better than having to throw it all away!</li>
<li><b>You didn't get a hard enough boil </b>- Added pectin needs a hard boil of about a minute in order to activate properly. If you didn't boil the pectin long enough, the gel may fail. If the pan boiling the fruit plus pectin was too deep, then the heating may be uneven, affecting the gel</li>
<li><b>Cooked too long</b> - Some jams turn out runny because they were boiled <i>too</i> long. Overcooking can destroy the ability of the pectin to sustain its structure</li>
<li><b>Using over-ripe fruit - </b>The riper the fruit, the less acid and pectin it contains, and the runnier the resulting jam. If you use very ripe fruit, either add more pectin and acid or add some under-ripe fruit to balance the batch. Another choice can be to add in fruit naturally rich in pectin and acid like the ones listed above if you don't mind the extra flavors in your jam </li>
<li><b>Pectin too old</b> - Some types of pectin lose their effectiveness if not used within the first year. Pomona Pectin does not have this issue but it's the only one that is reliably long-lasting</li>
<li><b>Leaving the jars in hot water too long - </b>If you put the jars into the canning pot too soon, before the water has boiled, the total exposure to heat may become too much and break down the pectin structure. Likewise, if you leave the jars in the hot water too long afterwards, that can also break down the pectin. After the 10 minute canning time and the 5 minute rest time afterwards in the canning pot, take the jars out immediately and place on a towel on the counter</li>
<li><b>Tipping the jars - </b>Some resources say that tipping the jars to the side as you take them out of the canning pot (or while they are cooling on the counter) can destroy the pectin bonds that are trying to form. Pick jars straight up out of the canner and leave them on the counter. Resist the temptation to tip them and check the set until at least 24 hours have passed </li>
<li><b>Not waiting long enough - </b>Some jams with some pectins don't set up for a long time, even a week or two. You can always just let them set on the counter and see if the gel improves</li>
</ul>
Bottom line, if your jam didn't set up, the most likely cause is that you were out of balance with your sugar/acid/pectin, or you didn't cook it for the right amount of time. However, there are a few other nitpicky mistakes that even experienced jammers can make. If you have a significant jam failure, review the list and see if any apply.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Remaking Syrupy Jam</span></b><br />
<b><br /></b>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbifTDRI3zJSlthFPlnRrYeRroD3hRwmwVO1NHHdugjfQXo2hanxfYrpAx92t-ii60b5FcVMDEhHqJwL8hyphenhyphensL5M26F8FPGi_hO5U0a98TP37coUIlTxZTLI0qlzH9alP5T0q2ISa5RR9E/s1600/Making_blackberry_jam_-_3+%25281%2529+Emoke+Denes+CCA+4.0.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="800" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbifTDRI3zJSlthFPlnRrYeRroD3hRwmwVO1NHHdugjfQXo2hanxfYrpAx92t-ii60b5FcVMDEhHqJwL8hyphenhyphensL5M26F8FPGi_hO5U0a98TP37coUIlTxZTLI0qlzH9alP5T0q2ISa5RR9E/s320/Making_blackberry_jam_-_3+%25281%2529+Emoke+Denes+CCA+4.0.jpg" width="320" /></a></div>
<b><br /></b>
Whatever caused your syrupy jam, don't throw it away. Even very experienced jammers have had batches fail, so they have certain techniques for fixing a failed gel. They don't always work but they are worth a try. The following is the most commonly recommended technique for remaking jam.<br />
<b><br /></b><span style="color: purple;">First, be sure you have everything you need ready to go ahead of time. This includes a canner full of hot water; funnels, jar-lifters, and ladles clean and ready to go; extra <u>new</u> lids for the jars; and enough extra sugar, pectin, and lemon juice to remake the jam.</span><br />
<br />
<span style="color: purple;">Open the lids of the runny jam (these lids cannot be reused for canning). Pour the jam out into a glass measuring cup until it makes a total of 4 cups. Clean the old jars in soapy water and rinse, or use new clean, sterilized jars. </span><br />
<br />
<span style="color: purple;">Mix 1/4 cup sugar, 1/2 cup water, 2 tablespoons bottled lemon juice, and 4 teaspoons powdered pectin. Heat up until it has been brought to a rolling boil. </span><br />
<span style="color: purple;"><br /></span>
<span style="color: purple;">Add the 4 cups of syrupy jam. Stir continuously until the whole thing has been brought to a rolling boil. Keep boiling for at least 30 seconds more, but don't overboil. </span><br />
<span style="color: purple;"><br /></span>
<span style="color: purple;">Remove from heat, ladle into jars, put on NEW lids, add screwtops, then can in a waterbath canner for 10-15 minutes, depending on the size of the jars. Turn off heat and let jars sit in water for 5 more minutes, then immediately remove jars straight up out of the canner without tipping them. Put them on a towel on your counter overnight. Don't check or tip them until 24 hours have passed. </span><br />
<br />
Some people <a href="https://www.thekitchn.com/5-ways-to-thicken-homemade-jam-234749" target="_blank">report</a> that chia seeds can be used to thicken up a runny jam, if you are open to that. Personally, I dislike chia seeds so I have never tried this but if you like them it may be worth a try.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Remain Philosophical About Results</span></b><br />
<b><br /></b>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEWYbyjNUbqycNhMYJQX0iWuJmpSJHvjy-SkqIZ72_nqKleYmIxMKtV_MJ5tjKjO35j0c0lrzIUh2uLoUqKK_G4Y27HcfkGsl8m1Mr0TZkfANu5zYW5lmkrkquzSaIymOBWv27xIweUdo/s1600/1200px-Fruit_Leather_%25288407322482%2529+Leslie+Seaton.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="800" data-original-width="1200" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEWYbyjNUbqycNhMYJQX0iWuJmpSJHvjy-SkqIZ72_nqKleYmIxMKtV_MJ5tjKjO35j0c0lrzIUh2uLoUqKK_G4Y27HcfkGsl8m1Mr0TZkfANu5zYW5lmkrkquzSaIymOBWv27xIweUdo/s320/1200px-Fruit_Leather_%25288407322482%2529+Leslie+Seaton.jpg" width="320" /></a></div>
Sometimes you can seemingly do <i>everything </i>right and a jam will simply not set up. Who knows what went wrong? All you can do is give it your best shot at redoing it. About half to two-thirds of the time, you can fix a runny jam. Sometimes you never do. Don't be afraid to just give up and call it Syrup at some point. Feel free to pretend that's what you wanted all along. Plenty of cooks before you have done the same!<br />
<br />
Don't throw away your results. People use syrupy jam as toppings for pancakes, waffles, ice cream, yogurt, or desserts like poke cake. Our family sometimes adds it to lemonade to make a special drink during the summer. It can also be dehydrated into fruit leather, like above. Or you can add a little corn starch and use it as a glaze for roasted meats. It's surprisingly tasty as a glaze with pork in particular. (If that sounds weird, think about cranberry sauce with turkey at Thanksgiving. Same principle of fruit with savory.)<br />
<br />
My first try at remaking syrupy plum jam was a mixed success. Some of it came out perfectly; no problem with the set the second time around.<br />
<br />
However, about half of it didn't set again. Oh well. Considering how many batches of plum jam we made, that still left me with a lot more Plum Syrup than I wanted. On the other hand, we saved half the batch. I consider that a win.<br />
<br />
I'm not quite sure why some batches failed in the original jam. My guess is we got sloppy in our measuring because of how much fruit there was and used too much fruit at once. I also think the last batch of pectin was from an older box. Also, my daughter helped, so she may have cooked it too long; I'm not sure. But at least we were able to rescue about half of the runny batches and remake them properly.<br />
<br />
The rest of the syrupy jam we just made into <a href="https://nchfp.uga.edu/how/dry/fruit_leathers.html" target="_blank">Plum Fruit Leather</a>, using both the oven and a dehydrator. Same great flavor, and at least we didn't waste it!<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">Resources and References</span></b><br />
<ul style="text-align: left;">
<li><a href="https://www.oregonlive.com/foodday/index.ssf/2009/08/post_6.html">https://www.oregonlive.com/foodday/index.ssf/2009/08/post_6.html</a> - The guide I used; basic practical information and tips in simple language, based off of government's site below</li>
<li><a href="https://nchfp.uga.edu/how/can_07/remake_soft_jelly.html">https://nchfp.uga.edu/how/can_07/remake_soft_jelly.html</a> - U.S. Government info about remaking too-soft jams</li>
<li><a href="https://nchfp.uga.edu/how/can7_jam_jelly.html">https://nchfp.uga.edu/how/can7_jam_jelly.html</a> - U.S. Government site about canning </li>
<li><a href="https://extension.oregonstate.edu/sites/default/files/documents/8836/sp50604remakingsoftjellies.pdf">https://extension.oregonstate.edu/sites/default/files/documents/8836/sp50604remakingsoftjellies.pdf</a> - Oregon State Extension's quick hand-out on remaking jam</li>
<li><a href="http://pickyourown.org/how_to_fix_runny_jam.htm">http://pickyourown.org/how_to_fix_runny_jam.htm</a> - Old website, not well laid out, but the information is generally good</li>
<li><a href="https://extension.psu.edu/preventing-jam-and-jelly-from-not-setting" target="_blank">https://extension.psu.edu/preventing-jam-and-jelly-from-not-setting </a>- Corny video from Penn State Extension to explain how to prevent jam failure; slow and boring but good information</li>
<li><a href="https://www.finecooking.com/article/how-to-get-fruit-jellies-and-jams-to-gel" target="_blank">https://www.finecooking.com/article/how-to-get-fruit-jellies-and-jams-to-gel </a>- Basic info</li>
<li><a href="https://www.seriouseats.com/2014/08/jam-making-101-pectin-sugar-gel-point.html">https://www.seriouseats.com/2014/08/jam-making-101-pectin-sugar-gel-point.html</a> - The science behind gelling, but more for non-pectin jams</li>
<li><a href="https://www.exploratorium.edu/cooking/icooks/article_6-03.html">https://www.exploratorium.edu/cooking/icooks/article_6-03.html</a> - More on the science behind gelling and pectins</li>
<li><a href="http://pickyourown.org/pectin.htm">http://pickyourown.org/pectin.htm</a> - Pectin levels of various fruits, types of pectin, etc.</li>
<li><a href="https://www.thespruceeats.com/high-and-low-pectin-fruit-1327800">https://www.thespruceeats.com/high-and-low-pectin-fruit-1327800</a> - Pectin and acidity levels of various fruits </li>
<li><a href="https://www.finecooking.com/article/the-science-of-pectin">https://www.finecooking.com/article/the-science-of-pectin</a> - All about pectins</li>
<li><a href="https://www.theguardian.com/science/blog/2013/oct/03/science-magic-jam-making">https://www.theguardian.com/science/blog/2013/oct/03/science-magic-jam-making</a> - the history of jam making </li>
</ul>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-24462986386828371692018-10-16T21:50:00.000-07:002018-10-16T21:50:13.284-07:00We Remember: Pregnancy and Infant Loss <div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ6pxltkTAYOFDRcwMEE-LjmEsR7xDSgflkA_axQ6ckWj8dhx-dSx7_RJVO79B0d0v9vwbHYEkkozYaUTg60Vo_7hQoLRHcJxmNWlkMtLAP9x5XxNYd5AjnrP5nIqP6inJPoZDIyH3j6A/s1600/empty+crib.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="270" data-original-width="340" height="317" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ6pxltkTAYOFDRcwMEE-LjmEsR7xDSgflkA_axQ6ckWj8dhx-dSx7_RJVO79B0d0v9vwbHYEkkozYaUTg60Vo_7hQoLRHcJxmNWlkMtLAP9x5XxNYd5AjnrP5nIqP6inJPoZDIyH3j6A/s400/empty+crib.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
October is Pregnancy and Infant Loss Awareness Month. I have a number of friends who have lost babies to miscarriage, stillbirth, or early death. It's more common than you might think. My heart always is heavy when I think of the babies missing in their lives, of who these babies might have become.<br />
<br />
If you know someone who has lost a baby to miscarriage, stillbirth, or early infant death, please give them sympathy and a listening ear. Don't tell them how to feel or second-guess their situation, but just listen. If the time seems right, ask them how they are doing or offer to just hold them. They may not want to grieve in front of others, so a card or a message of love and support can be helpful yet still allow them to grieve in private. Take your cue from the mother as to what kind of support she needs. Don't assume she'll be "over it" in a month or two. That loss will likely live on in her heart forever.<br />
<br />
<i><b><span style="color: purple;">We remember:</span></b></i><br />
<blockquote class="tr_bq">
<b><span style="color: purple;"><i>the babies born sleeping</i><i>those we carried,<br /> </i><i>but never held,<br /> </i><i>those we held,</i><i>but could not take home.</i><i>those who came home,<br /> </i><i>but could not stay. </i></span></b></blockquote>
<br /> <br />
<br /></div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-38818695442459761062018-10-09T20:27:00.000-07:002018-10-09T20:27:47.426-07:00Women Are Dying From This: Taking Cesareans Seriously<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQZOlmiF0nKtyNNimBll-falxrepEs62QT1J0v4oknBgMCD9GHh_MYaBwUEGV9fHMPg1L_JI7bjAbbXw5iOd24x1a1lrEQvdQy6_g8cyovDJWfyAEykBQTLcrsUCW4MpP4ZRSAnppZVMI/s1600/blood+transfusion.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="800" data-original-width="800" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQZOlmiF0nKtyNNimBll-falxrepEs62QT1J0v4oknBgMCD9GHh_MYaBwUEGV9fHMPg1L_JI7bjAbbXw5iOd24x1a1lrEQvdQy6_g8cyovDJWfyAEykBQTLcrsUCW4MpP4ZRSAnppZVMI/s400/blood+transfusion.png" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
When women have cesareans, they are rarely warned that a possible complication can be placental problems in future pregnancies.<br />
<br />
Many women (and especially <a href="https://www.ncbi.nlm.nih.gov/pubmed/22542116" target="_blank">higher weight women</a>) are pressured into cesareans in their first pregnancy. Many of these same women are counseled away from Vaginal Birth After Cesarean (VBAC) and into repeat cesareans in subsequent pregnancies.<br />
<br />
Few of these women have been told that cesareans raise the risk for Placenta Accreta, a very serious complication, and that <i>every </i>cesarean increases the risk for it. I know *I* wasn't told this. This is a tremendous disservice to parents and to the importance of informed consent.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">About Accreta</span></b><br />
<br />
In Placenta Accreta, the fertilized egg implants near or on scar tissue in the uterus. This scar tissue is usually from a prior cesarean, but can also be from a D&C procedure, fibroid removals, a perforation from an IUD, or any uterine surgery or instrumentation. The placenta then grows into the uterine wall in this scar tissue. After the baby is born (often prematurely), the placenta can't separate properly and bleeding can become prolific. If the bleeding is not resolved, the mother can die.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsXLpKxMP2KxL4_ndJnaA6ngGa8LfVBrybBL9MSBLt6UYcqqWqfn7_Lh2NcVSgDsbxMzTlRvMF6kPo41PxoeIVgIeIJ5oAbDfjLT4_3MQfC5nx7fWkxD5gdfB4iWpI10zLlNukyy7SwQI/s1600/accreta+degrees%252C+page2anesthesiology.org.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="976" data-original-width="1600" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsXLpKxMP2KxL4_ndJnaA6ngGa8LfVBrybBL9MSBLt6UYcqqWqfn7_Lh2NcVSgDsbxMzTlRvMF6kPo41PxoeIVgIeIJ5oAbDfjLT4_3MQfC5nx7fWkxD5gdfB4iWpI10zLlNukyy7SwQI/s320/accreta+degrees%252C+page2anesthesiology.org.jpg" width="320" /></a></div>
There are degrees of Placenta Accreta. When the placenta grows into the uterine wall, that's <i>Placenta Accreta. </i><br />
<br />
When the placenta invades the muscles of the uterus, that's known as <i>Placenta Increta</i>.<br />
<br />
When the placenta grows through the uterine wall and into nearby organs like the bladder, that's called <i>Placenta Percreta</i>. All are extremely serious conditions, but percreta is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/29733839" target="_blank">most serious</a> of all.<br />
<br />
The accreta rate has <a href="https://www.ncbi.nlm.nih.gov/pubmed/23466142" target="_blank">risen over the years</a> as the cesarean rate has increased. Doctors are seeing more and more cases these days of what used to be a very rare complication. Some <a href="http://abcnews.go.com/Health/life-threatening-placenta-accreta-rise/story?id=22900241">data</a> indicate that the accreta rate has risen from about 1 in 4000 in the 1970s to about 1 in 533 now.<br />
<br />
You can read more about this in my blog series on Placenta Accreta.<br />
<ul style="text-align: left;">
<li><a href="http://www.wellroundedmama.blogspot.com/2013/08/placenta-accreta-part-one-what-is.html">Part One</a> - What Is Placenta Accreta?</li>
<li><a href="http://wellroundedmama.blogspot.com/2013/09/placenta-accreta-part-two-life.html">Part Two</a> - Life-Threatening Complication of Prior Cesarean </li>
<li><a href="http://wellroundedmama.blogspot.com/2013/09/placenta-accreta-part-three-risks-to.html">Part Three</a> - Risks to Mother and Baby</li>
<li><a href="http://wellroundedmama.blogspot.com/2013/09/placenta-accreta-part-four-diagnosis.html">Part Four</a> - Diagnosis, Treatment, and a Cautionary Story</li>
</ul>
The absolute numerical risk of accreta occurring in any one person is low, even with prior cesareans. Most women who have had cesareans will not experience an accreta. However, it is such a life-threatening condition that even a relatively small incidence carries a tremendous burden of complications, cost, and potential loss of life.<div>
<br /></div>
<div>
The more cesareans you have had, the greater the risk for accreta. In one very large <a href="http://www.ncbi.nlm.nih.gov/pubmed/16738145">study</a> (Silver 2006), accreta was present in:<br /><ul style="text-align: left;">
<li>0.24% of women undergoing their first cesarean (previously unscarred)</li>
<li>0.31% of women undergoing their second cesarean (one prior cesarean)</li>
<li>0.57% of women undergoing their third cesarean (two prior cesareans)</li>
<li>2.13% of women undergoing their fourth cesarean (three prior cesareans)</li>
<li>2.33% of women undergoing their fifth cesarean (four prior cesareans)</li>
<li>6.74% of women undergoing their sixth or more cesarean (five or more prior cesareans)</li>
</ul>
</div>
<div>
This is why it is important to avoid automatic repeat cesareans and to keep VBAC a viable choice. Multiple repeat cesareans are the single most preventable factor for accretas. <div>
<br /></div>
<div>
Accreta does sometimes occur after only one cesarean, like the woman in the video below, and that's why it's important to prevent a first cesarean whenever possible as well.<br /><br />
<b><span style="color: #cc0000; font-size: large;">One Mother's Accreta Story</span></b><br />
<br />
This mother had only had ONE prior cesarean, but still developed accreta with baby #2. Her first cesarean was a planned cesarean, urged by her OB. She was never warned that her cesarean meant accreta was a potential risk for the future.<br />
<br />
THIS is why the high cesarean rate matters. On a case-by-case basis, a cesarean can be a good thing. But the public health implication of a high cesarean rate is that more women will develop life-threatening complications like placenta accreta, more babies will be born prematurely, and more women will die or experience permanent damage. Sometimes even after only <i>one </i>cesarean.<br />
<br />
If we want to decrease maternal mortality rates and prevent complications from accreta, we MUST decrease cesarean rates. As the mother in the video below states:<br />
<blockquote class="tr_bq">
<span style="color: purple;">A cesarean can be a life-saving intervention. The goal is not to eliminate cesareans. The goal is to make decisions regarding cesareans appropriately, and to recognize that even an uncomplicated cesarean and recovery can still put the mother at significant future risk....</span></blockquote>
<iframe allowfullscreen="true" allowtransparency="true" frameborder="0" height="315" scrolling="no" src="https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2Fpatientsafetymovement%2Fvideos%2F1227789404025251%2F&show_text=0&width=560" style="border: none; overflow: hidden;" width="560"></iframe><br />
<br />
She continues:<br />
<blockquote class="tr_bq">
<span style="color: purple;">"There are too many cesareans now, 1 in 3 births, and researchers estimate that as many as 50% of those are unnecessary.</span> </blockquote>
<blockquote class="tr_bq">
<span style="color: purple;">And since a prior cesarean is a significant risk factor for developing a future accreta, that means that </span><span style="color: #cc0000; font-weight: bold;">there are women developing accreta when it could have been prevented.</span><span style="color: blue; font-weight: bold;"> </span><span style="color: purple;">So the easiest way to reduce the amount of accretas is to reduce cesarean levels...</span> </blockquote>
<blockquote class="tr_bq">
<b><span style="color: purple;">Women are dying from this, and mothers are dying from this. We need to take the risks of a cesarean seriously."</span></b></blockquote>
<br />
<br /></div>
</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-66420440906063453772018-09-30T15:12:00.000-07:002018-09-30T15:12:34.704-07:00Exercise Reduces the Risk for Gestational Diabetes in Higher Weight Women<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3mrZBqrG3GDR5w-hf8_2fL3cabrXHQiIZ1dCbRf9J_-WjKgdQCMpUozdk3eIDhGbekDSVGpK7ntmZwrSm15zUcE_67dal4k0f6gpwnodKwKYMPxOM43zYd_4BuHeqeZ1dn6TIJ79d3qw/s1600/Padded+Lillies%252C+HAES+on+Tumblr.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="333" data-original-width="500" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3mrZBqrG3GDR5w-hf8_2fL3cabrXHQiIZ1dCbRf9J_-WjKgdQCMpUozdk3eIDhGbekDSVGpK7ntmZwrSm15zUcE_67dal4k0f6gpwnodKwKYMPxOM43zYd_4BuHeqeZ1dn6TIJ79d3qw/s400/Padded+Lillies%252C+HAES+on+Tumblr.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>The Padded Lilies</i></td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
Here is a recent research review that found that physical exercise reduced the risk for gestational diabetes (GD) in "obese" and "overweight" women during pregnancy.<br />
<br />
Here is a summary of the research review, and also a discussion of how to use exercise and food timing and choices to keep your blood sugar as normal as possible during pregnancy.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Quick View of Study Details</span></b><br />
<br />
The authors reviewed 13 studies with a total of 1,439 participants. On the up side, they found that physical exercise reduced gestational weight gain and the risk of gestational diabetes (GD). This is good news.<br />
<br />
On the other hand, exercise made no difference in the risk for blood pressure issues, macrosomia (big babies), cesarean rates, or premature births. This isn't bad news, but it does point out that exercise is not the panacea that some doctors hope it would be.<br />
<br />
How significant are these findings? Well, it depends on the finding.<br />
<br />
The weight gain finding is negligible. The difference in weight gain between groups was extremely small, about 1.14 kg. That's about two and a half pounds total. Not exactly a lot, and not enough to really make a difference in outcomes between groups. But doctors being doctors, you know they are doing cartwheels over even that. (Like 2 or 3 pounds makes a big difference in complication rates.)<br />
<br />
<b>However, the difference in risk for GD was more substantial.</b> The relative risk of getting diagnosed with GD was 0.71 in the groups that had more exercise. That's nearly a 30% cut in risk for getting GD, which is significant. That should be paid attention to by people of size and their medical professionals.<br />
<br />
The strength of this review was that it didn't just rely on results from one or two studies. They reviewed thirteen studies, which makes for stronger conclusions because the results are less likely to be from chance.<br />
<br />
One weakness of the review is that 1,439 participants is a bit small for 13 studies. That means a lot of the individual studies were on the small side, and small studies run the risk of biasing the results. The review also noted that there was little information on newborn outcomes and that future studies should account for these concerns in their study design.<br />
<br />
These are all important points. Better studies with more participants and tracking of neonatal outcome are needed. But what we have so far suggests that exercise is helpful in larger women.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Pregnancy Exercise for Plus-Sized Women</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhslgd10cWWPuzkjxu0Sw2Mxp7HetUhy8hvX3pPuenduq6DHP6we61gjrW-HNcOxPeB5HX8WfXgnypQYkXHJBCNentz8q8MuYtd8FZiavnsJRw9BNsWiUe0dUxoimxZgkeowgjCzrdHzkI/s1600/fat+woman+walking.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="147" data-original-width="221" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhslgd10cWWPuzkjxu0Sw2Mxp7HetUhy8hvX3pPuenduq6DHP6we61gjrW-HNcOxPeB5HX8WfXgnypQYkXHJBCNentz8q8MuYtd8FZiavnsJRw9BNsWiUe0dUxoimxZgkeowgjCzrdHzkI/s320/fat+woman+walking.jpg" width="320" /></a></div>
Women of size vary in their utilization of exercise. It's a myth that fat people never exercise. Some do lots of exercise, some don't do any, while most are somewhere in the middle. Here are some practical suggestions for increasing exercise in pregnant women who recognize the importance of exercise.<br />
<br />
Exercise doesn't have to mean running marathons or even running at all. Forget the little skinny doctors who tell you that the only "real" exercise is running. Walking is one of the best exercises for pregnant folks, and it's <i>much </i>easier on the knees and hips. All you need are comfortable clothes and supportive shoes. Just go outside and take a walk around your neighborhood.<br />
<br />
If your neighborhood is unsafe or not conducive to walking, walk around your yard or inside your house. Or get a second-hand treadmill or exercise bike for cheap off of eBay and use that inside.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2RAX4_MhFRwubL7iynlaUM0WFARylUEdU36S938sZD-OIpL9PrQ3YL0G0EjUPQmDwaGwbQWeSLEmtxgGb-aRNc1QggTe6xFqO8oskUUYHdpwTdZb5rkVhej3EB4Rz-XuOaXAz8Vnnweg/s1600/swimming+in+pregnancy%252C+iStock.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="257" data-original-width="475" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2RAX4_MhFRwubL7iynlaUM0WFARylUEdU36S938sZD-OIpL9PrQ3YL0G0EjUPQmDwaGwbQWeSLEmtxgGb-aRNc1QggTe6xFqO8oskUUYHdpwTdZb5rkVhej3EB4Rz-XuOaXAz8Vnnweg/s320/swimming+in+pregnancy%252C+iStock.jpg" width="320" /></a></div>
Swimming or water aerobics is another exercise that works particularly well for women of size. While it's a pain to get in and out of a swimsuit when extremely pregnant, the buoyancy in the water is incredibly soothing to larger bodies. And water immersion has a strong beneficial effect on reducing swelling near the end of pregnancy, which can be quite helpful. Plus it just feels <i>great! </i><br />
<br />
Water immersion can be particularly important for women with <a href="https://wellroundedmama.blogspot.com/2015/06/lipedema-part-1-lipedema-vs-lymphedema.html" target="_blank">lipedema</a>. The hormone changes of pregnancy can sometimes cause lipedema to get worse. But the pressure of having your legs underwater forces fluid back into your lymph system and helps it flow more freely. Remember, the lymph system doesn't have a pump like the heart directing it; it relies on exercise to improve lymph flow. If you have any degree of lipedema, it's especially important to be in water as much as you can. Even if you don't swim, just walking around in the pool is helpful.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_RHehPdzwJwIi6-Q0c3IVhozadVDpU5bAvJu2DmRs68oUUH6GbQus1anM-dOTnOWX15VNYuSTtCNWQSbwI3cDO4htQ-VG8EPYZILYmO_s635gU8cF5GmqBzyc40zDcfK96PCFFDHwWoU/s1600/pregnant+on+birth+ball.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="680" data-original-width="490" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_RHehPdzwJwIi6-Q0c3IVhozadVDpU5bAvJu2DmRs68oUUH6GbQus1anM-dOTnOWX15VNYuSTtCNWQSbwI3cDO4htQ-VG8EPYZILYmO_s635gU8cF5GmqBzyc40zDcfK96PCFFDHwWoU/s320/pregnant+on+birth+ball.jpg" width="230" /></a></div>
Prenatal yoga can be another excellent choice. It's not as aerobic as other forms of exercise but the stretching and strengthening can be very helpful. The relaxation poses at the end of most classes are great for helping blood pressure and stress levels. And prenatal yoga classes tend to be more size-accepting and tolerant of different fitness levels than regular yoga classes.<br />
<br />
If the weather outside keeps you from getting your usual exercise in, try walking or dancing around your house, going up and down the stairs, or some vigorous vacuuming. Even just using some cans to do a set of arm curls can help. <i>[Don't laugh! I did all of those things during icy weather in my pregnancies, and even just vacuuming showed a difference in my blood sugar readings. These things helped me keep my blood sugar normal.]</i><br />
<br />
If you haven't exercised much recently or are out of shape, start with what you <i>can</i> do and don't judge yourself about it. Start slowly, then increase the amount and frequency of what you are doing. Building a regular time for exercise in your daily routine is helpful. If you miss a workout, don't stress over it; just get back into it as soon as you can. Remember, any exercise is better than no exercise.<br />
<br />
If you already exercise regularly, good for you! Give yourself props for what you are doing. Consider intensifying your routine by adding more sessions or changing up the kind of exercise you do. Keeping it fun helps keep it a part of your life.<br />
<br />
Sometimes people sabotage their exercise by focusing on the wrong things. They compare themselves to others as they exercise, they feel self-conscious in front of others, or the peanut gallery in the brain keeps a running commentary of negative remarks. Put aside the negativity. Do what you can and don't beat yourself up about your fitness level, your looks, your shape, or whatever your personal demons are. Don't indulge in negative self-talk but instead focus on your improvement. Think or say body affirmations or pregnancy affirmations during your workouts. The repetition of positive affirmations during exercise can be powerful.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Exercise and Food for Managing Blood Sugar</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6aeokyfWUs1TUFSfjjGqE-jIW7m3Y4LmZXUzbTPWuPi30T4Rbar6S5w_dAxq4gjvQgN0WTUtSjybdjf-IpfRiW2MEzt7UmcvRJGOZgRP2VF4K3jVQ5_IkdPjwfIlOJbazodDEP0nPBLw/s1600/pregnant+in+the+pool+by+ladder.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="175" data-original-width="287" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6aeokyfWUs1TUFSfjjGqE-jIW7m3Y4LmZXUzbTPWuPi30T4Rbar6S5w_dAxq4gjvQgN0WTUtSjybdjf-IpfRiW2MEzt7UmcvRJGOZgRP2VF4K3jVQ5_IkdPjwfIlOJbazodDEP0nPBLw/s320/pregnant+in+the+pool+by+ladder.jpg" width="320" /></a></div>
<br />
As the study review shows, exercise can be an important part of managing blood sugar in pregnancy for women of size. However, there are ways to increase the effectiveness of exercise even more.<br />
<br />
These are suggestions taken from the experiences in my own four pregnancies and from helpful advice from medical professionals to me and others. In my first pregnancy, I had a marginal glucose test result and was diagnosed with GD. I was put into a program to learn how to manage my blood sugar and given a glucometer. My pregnancy went fine and my baby was healthy, but that diagnosis made me subject to many more interventions than I truly needed. So I became determined to be as proactive as possible for any future pregnancies.<br />
<br />
In my next three pregnancies, I never had GD again, despite being about the same size each time and getting older. I didn't change my weight or what I ate, but I did change how much I exercised and the food combination and timings of what I ate. Just doing that helped me avoid GD again, but I never took it for granted. I always considered myself borderline to be cautious, and I used my glucometer regularly every day to help make sure my blood sugar was staying normal.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnisjZmC7LYT0KagohibHnz6-_4gAIIrceJSRqKcOf6QjxzUyylFfMJ4_rBwFyTsUkaE_-b1QTC3LxYkV41iNTN71FAFc467HIa0cmIIOhu_KW7ADxYhCh_AYVBXbxemD25D4y46g0Vuc/s1600/glucometer+3.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="800" height="160" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnisjZmC7LYT0KagohibHnz6-_4gAIIrceJSRqKcOf6QjxzUyylFfMJ4_rBwFyTsUkaE_-b1QTC3LxYkV41iNTN71FAFc467HIa0cmIIOhu_KW7ADxYhCh_AYVBXbxemD25D4y46g0Vuc/s320/glucometer+3.jpg" width="320" /></a></div>
If your family history (strong history of diabetes), prior medical history (prediabetes or prior GD), or medical condition (PCOS or reactive hypoglycemia) put you at extra risk for GD, then you should probably consider buying a glucometer and measuring your blood sugar regularly. That will give you information to guide you in what your "danger times" are, how you respond to various foods, and when adding exercise would be most beneficial. Glucometers are pretty affordable and can be bought at your local pharmacy. However, if money is an issue, your care provider may have one that you can borrow for free, leaving you just the cost of testing strips.<br />
<br />
If you have a glucometer, you can see how <i>your </i>particular body responds to the blood sugar challenges of pregnancy. For example, some pregnant women have the most trouble after meals, while others have the most trouble with their fasting numbers first thing in the morning. The way you manage each is different.<br />
<br />
Generally speaking, exercise intensity is less important than exercise <i>frequency</i> from a blood sugar point of view. It's not how hard you work out that matters most, but the regularity with which you do it. In other words, walking even just a little every day is better for your blood sugar than a more intense workout once or twice a week. You are trying to lessen insulin resistance and make the insulin you have work more efficiently, and regular daily exercise works the best at this. Intensity is important for improving aerobic response, but frequency is the most important factor for blood sugar regulation. Try to exercise every day if possible, or at least five days a week.<br />
<br />
Timing of exercise and smart food combinations are also important. Pregnant women tend to have several problem spots, like early mornings or after meals or certain foods. Placental hormones increase insulin resistance in order to increase the energy available to the baby. That means a meal that might not make your blood sugar high when not pregnant can result in a high reading during pregnancy. Or you get high readings from certain foods that don't normally raise your blood sugar when not pregnant.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisUboE6mbSSETITfVBTWGYWHrFbLZFs_whOgyzsMAXPMXuTG65K0Av-0IWRzQxA0rbiQqQ3iIynbBRL_1QJDJuBUOEclqxXSIPfCK4MjQ3nDOw9SwnP6x-rFh86dHhpFx7qPYq3aj6Two/s1600/cereal+and+milk.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="183" data-original-width="275" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisUboE6mbSSETITfVBTWGYWHrFbLZFs_whOgyzsMAXPMXuTG65K0Av-0IWRzQxA0rbiQqQ3iIynbBRL_1QJDJuBUOEclqxXSIPfCK4MjQ3nDOw9SwnP6x-rFh86dHhpFx7qPYq3aj6Two/s200/cereal+and+milk.jpg" width="200" /></a></div>
If you find that your blood sugar is most volatile in the morning after breakfast, rest assured that this is a common problem for pregnant women. Many people do not eat protein with breakfast but consume very carb-intense breakfast meals like cereal with milk, a glass of juice and a muffin, or similar meals. Protein slows down the energy spike from a carb-heavy meal and keeps it from crashing later. So adding a protein food to your breakfast is one of the best things you can do to reduce morning blood sugar spikes. Taking a quick walk after breakfast is also great at smoothing out blood sugar spikes. Doing both (adding protein and going for a walk after breakfast) works best for blunting the post-breakfast spike common in many pregnant women.<br />
<br />
Some women are intensely sensitive to certain foods at breakfast and can get blood sugar spikes from them in the morning, but no spikes from the same food later in the day. It has to do with the surge of placental hormones that often happens in the mornings. Some women who are especially sensitive simply cannot drink milk or juice at breakfast or even have fruit, but later in the day those foods are okay. The glucometer can help you discover whether you have problems with certain foods or at certain times.<br />
<br />
If your blood sugar is running a little high routinely after <i>all</i> your meals, a couple of short walks each day after meals is helpful. Remember, shorter walks done more often is better than a longer walk every few days. If meals are your vulnerable time, then schedule your exercise times to happen after meals. Just work on getting your heart rate up for a sustained amount of time.<br />
<br />
Avoiding heavy intake of carbs is helpful to improving blood sugar after meals. There's no need to eliminate all carbs, but avoid or minimize carb-intense foods like breakfast cereal, juice, muffins, pizza, bagels, and other obvious foods. Try to keep your carb intake to around 60g or less with each meal (a piece of bread is usually around 15g of carb). If you are not sure of the carb content of a food, look at the label. If there is no label, google it to get a general idea. If you do decide to have a carb-intense meal or snack for a special occasion, taking protein with your carbs or getting in some exercise afterwards can often improve blood sugar markedly, but don't do this often because it is easy to overdo.<br />
<br />
Some people don't have much trouble with high blood sugar after meals, but instead have problems first thing in the morning after the overnight fast. If you have a tendency to high fasting blood sugars first thing in the morning, you need to investigate further because your approach to managing it will be different depending on its cause.<br />
<br />
If your morning fastings are running just a bit high and you don't know why, try a substantial protein snack late in the evening and then take a short walk or workout before bed. Sometimes a little snack and exercise before bedtime is all you need to help the blood sugar normalize overnight.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1hMrxNZGYGy_HqurKno8h2Ud8EDlnxjLm5kTUbX27j4sq_VULHRp0kfszVmnGtQa6_M6d8DlS7k5GlgC9j6M0vcYd9VR-NDeFDYVOPyxkLVLFpFzqAzPj0ld_-iDrgoeHL7HsF9_p97w/s1600/bounce.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1200" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1hMrxNZGYGy_HqurKno8h2Ud8EDlnxjLm5kTUbX27j4sq_VULHRp0kfszVmnGtQa6_M6d8DlS7k5GlgC9j6M0vcYd9VR-NDeFDYVOPyxkLVLFpFzqAzPj0ld_-iDrgoeHL7HsF9_p97w/s200/bounce.png" width="200" /></a></div>
Some women have high fasting blood sugar because they experience a "bounce." In other words, their blood sugar goes too low in the night so the body compensates by burning fat for energy, thus raising the blood sugar sharply to create enough energy for the baby. A side effect of going too low at night is spilling ketones, which is a by-product of burning fat for energy. A small amount of ketones on occasion is not a reason for concern, but a large amount of ketones on a regular basis is potentially risky for the baby. You can buy ketone sticks over the counter at local pharmacies if you want to keep track of that.<br />
<br />
The best way to treat a "bounce" is to prevent it in the first place. Going too long without eating is a classic cause of a bounce. If you eat dinner at 6 the night before and then don't eat breakfast until 8 the following morning, that's a 14 hour fast. While that might be fine in a non-pregnant person, it's too long for many pregnant people. The body will respond by burning fat for energy and causing the morning blood sugar to go high. Keep your overnight fasts to 8-10 hours if you are having trouble with high fasting numbers in the morning.<br />
<br />
Another common cause of a morning "bounce" is exercising before breakfast. You would think that this would be helpful in preventing high blood sugar, but again, it may cause you to go too low after an overnight fast. The liver produces glucagon and the body burns fat in order to give you the energy you need for the workout, but the price is that your blood sugar becomes elevated. Eating first and <i>then </i>exercising can solve that problem quite easily.<br />
<br />
If you suspect you are experiencing an overnight bounce, the solution is to add a good snack before bedtime. However, the snack must be considered carefully. Adding a high-carb bedtime snack with no accompanying protein will spike the blood sugar and then make it crash in the middle of the night, setting up a bounce when the body compensates. A better bedtime snack is a protein-heavy snack with a whole-grain carb, which should give longer-lasting, more even energy that can regulate overnight blood sugar and prevent a bounce.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitlGR1b4AAziwABmit-GUUHb3Fiwa6tLyEaiK6la5jxenp5USBD4XPaCjGtNQNBo0BR7N0cD-h3sV59uvjU43N8uJDXmIv2undUJ0IR0mBR6JZ4Po39ziCXNlSYQghMePV99fYQzAsfDk/s1600/Trigger-Thumb-Image.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="356" data-original-width="667" height="106" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitlGR1b4AAziwABmit-GUUHb3Fiwa6tLyEaiK6la5jxenp5USBD4XPaCjGtNQNBo0BR7N0cD-h3sV59uvjU43N8uJDXmIv2undUJ0IR0mBR6JZ4Po39ziCXNlSYQghMePV99fYQzAsfDk/s200/Trigger-Thumb-Image.jpg" width="200" /></a></div>
Some people find that they have "trigger foods" that cause high readings. For example, when I was pregnant I found that corn tended to make my blood sugar spike. I also found I could not consume cereal without a spike. If I ate protein with my cereal, it blunted the spike, but not enough for my satisfaction, so I just eliminated cereal from my intake. It was just a food I found I could not consume during pregnancy.<br />
<br />
If you have reactive hypoglycemia (a tendency towards very uneven blood sugar), then eating protein every 2-3 hours is helpful. It keeps your blood sugar much more even and less prone to spikes and crashes. Eating protein every 2-3 hours is also great for people who are having a lot of pregnancy nausea, which is often related to unstable blood sugar. That doesn't mean it will prevent all vomiting; it won't. But it might well lessen it. Even if you throw up, go rinse your mouth, rest for a few moments, and then eat a small amount of protein. The secret is to avoid large amounts of food at once, but to graze frequently during the day, emphasizing protein foods with any carbs. That will help blunt the spike/crash cycle that can be so hard on the body and the baby. People with hypoglycemia also should eat well before their exercise routines and carry some quick energy foods with them in case they go low during exercise.<br />
<br />
If you have tried all of these ideas and you are still getting high blood sugar numbers, you may need additional help to normalize your blood sugar. Your medical professional will help you decide whether to use medications like metformin or insulin. If you do end up needing insulin, it <i>doesn't </i>mean that you have failed, just that your pancreas cannot create enough insulin anymore to compensate for the insulin resistance from the increasing hormones of late pregnancy. Progesterone in particular peaks in the third trimester a month or more after the usual GD tests, so you may start out fine with dietary control and still end up needing insulin. Either way, don't feel guilty; it's just the way your body copes with pregnancy hormones.<br />
<br />
These are just a few ideas that many women have found helpful in managing blood sugar during pregnancy. However, it's important to emphasize that not all GD can be prevented. Sometimes people still get GD no matter how hard they work at healthy eating and regular exercise. And while most people can manage their blood sugar with diet alone, some may also need medications or insulin to keep their blood sugar normal. If you get GD, don't view it as a personal failure. Just remember that with good care, most women with GD have good outcomes. Dealing with GD is just what you need to do to help give your baby the best possible start.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Take Home Message</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdh-jMZiMW04_sUiHamPXMpq4J4ZKfOWR5M2xZ-SILYVgRTJRUKEpiGs3U76OzfYieKKOFjqBCS_yzDTSbpY3OwEqSXVsuK5e_XUyUhh_2xeDRqde6Oxs8db0XHptmoUp0uLupJRCksl0/s1600/buffmama.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="340" data-original-width="181" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdh-jMZiMW04_sUiHamPXMpq4J4ZKfOWR5M2xZ-SILYVgRTJRUKEpiGs3U76OzfYieKKOFjqBCS_yzDTSbpY3OwEqSXVsuK5e_XUyUhh_2xeDRqde6Oxs8db0XHptmoUp0uLupJRCksl0/s200/buffmama.jpg" width="106" /></a></div>
<b><span style="color: blue;">The most important message from this review of studies is that exercise in pregnancy may be very helpful in people of size in lowering the risk for GD. </span></b><br />
<br />
If GD does occur, exercise plays an important role in managing the GD and minimizing its risks. So does careful consideration of food intake and timing. Getting a glucometer so you can monitor your results at home helps you manage things based on your own needs and responses. Although it's a pain to test, it really does allow you more control over the whole process and outcome.<br />
<br />
Since doctors tend to get all uptight about gestational diabetes in higher weight women and a GD diagnosis is the beginning of many interventions, anything women can do to lower their risk for GD is potentially very helpful. Exercise is one of the most powerful interventions women can make on their own behalf.<br />
<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">References</span></b><br />
<br />
Birth. 2018 Sep 21. doi: 10.1111/birt.12396. [Epub ahead of print] <b><span style="color: purple;">Effects of physical exercise during pregnancy on maternal and infant outcomes in overweight and obese pregnant women: A meta-analysis. </span></b>Du MC, Ouyang YQ, Nie XF, Huang Y, Redding SR. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/30240042" target="_blank">30240042</a><br />
<blockquote class="tr_bq" style="-webkit-text-stroke-width: 0px; color: black; font-family: "Times New Roman"; font-size: medium; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; letter-spacing: normal; orphans: 2; text-align: left; text-decoration-color: initial; text-decoration-style: initial; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;">
<div style="margin: 0px;">
...The purpose of this meta-analysis was to assess the effect of physical exercise on maternal and infant outcomes in overweight and obese pregnant women... RESULTS: Thirteen studies involving 1439 participants were included. Physical exercise reduced gestational weight gain (mean difference = -1.14 kg, 95% CI = [-1.67 to -0.62], P < 0.0001) and the risk of gestational diabetes (RR = 0.71, 95% CI = [0.57-0.89], P = 0.004) in overweight and obese pregnant women. There were no significant differences in other outcomes such as gestational hypertension, preeclampsia, cesarean delivery, birthweight, large for gestational age, small for gestational age, macrosomia, and preterm birth. CONCLUSIONS: <b>Prenatal exercise interventions reduced gestational weight gain and the risk of gestational diabetes for overweight and obese pregnant women, which reinforced the benefits of exercise during pregnancy.</b> However, no evidence was found with respect to benefits and/or harm for infants. Consideration should be taken when interpreting these findings as a result of the relative small sample size in this meta-analysis. Further larger well-designed randomized trials may be helpful to assess the short-term and long-term effects of prenatal exercise on maternal and infant outcomes.</div>
</blockquote>
<i>*For more information on troubleshooting high blood sugar numbers with GD, read my <a href="http://www.plus-size-pregnancy.org/gd/gd_highreadings.htm" target="_blank">article</a> on it. Be aware it's from my old website (which I can no longer update), so some information is outdated, but most of it is still valid. </i></div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-35950968604223994962018-09-20T01:21:00.000-07:002018-09-20T01:21:10.531-07:00Weight-Neutral PCOS Series: A Quick Guide<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIXebe8NRdVV9yZVTG_I_Pp9EoSxRx7HvSoBdxwFqYubn6FD4alSw7kg0AGxyBa5ZlG7c3oxQB-UpoG3wt2xe-RW0rD_nHCOrUILupdxfTuzpAsck__B2L9fgiGHSlFIhO-B_ysQET4y4/s1600/PCOS+awareness+clean.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIXebe8NRdVV9yZVTG_I_Pp9EoSxRx7HvSoBdxwFqYubn6FD4alSw7kg0AGxyBa5ZlG7c3oxQB-UpoG3wt2xe-RW0rD_nHCOrUILupdxfTuzpAsck__B2L9fgiGHSlFIhO-B_ysQET4y4/s320/PCOS+awareness+clean.jpg" width="320" /></a></div>
<br />
This blog has an ongoing series on Polycystic Ovarian Syndrome (PCOS). Because so much information has been gathered about it, I am putting up this Quick Guide to the PCOS Series so the information is more searchable and easier to use. Keep checking back periodically. More posts will be added as they are finished.<br />
<br />
<b>This PCOS series is unique on the internet because it is weight-neutral. </b><br />
<br />
There are many other sites with information on PCOS, but most emphasize weight loss or strict dietary restrictions as cornerstones of treatment. (<i>More on that below.</i>) This series does not push weight loss or a particular diet as a treatment, but rather discusses approaches that are not weight-centric. Weight loss as an approach <i>is </i>mentioned on occasion because doctors recommend it so often, but it is not promoted, and its pros and cons are critically examined. No one is shamed because they do or do not choose weight loss as a treatment.<br />
<br />
I encourage you to review many different sites on PCOS and to think critically about the information you find from them. Ultimately your treatment choices are up to <i>you</i>.<br />
<br />
In this PCOS series so far you will find an introduction to PCOS as a health concern:<br />
<ul style="text-align: left;">
<li>The <a href="http://wellroundedmama.blogspot.com/2011/09/pcos-condition-every-person-of-size.html">definition and symptoms</a> of PCOS</li>
<li>The <a href="http://wellroundedmama.blogspot.com/2011/09/pcos-how-does-pcos-affect-women.html" target="_blank">typical presentation</a> of PCOS</li>
<li>The <a href="http://wellroundedmama.blogspot.com/2011/10/pcos-testing-and-diagnosis.html">testing and diagnosis</a> of PCOS </li>
<li>The <a href="http://wellroundedmama.blogspot.com/2011/10/pcos-possible-causes.html">possible causes</a> of PCOS </li>
<li><a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-options-overview.html" target="_blank">Common treatment protocols</a> for PCOS and their pros and cons</li>
</ul>
Many people with PCOS have high levels of insulin, so one of the mainstays of treatment is to lower insulin levels. You will find a mini-series on insulin-sensitizing medications here, including:<br />
<ul style="text-align: left;">
<li><a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-metformin.html" target="_blank">Metformin</a> (Glucophage)</li>
<li>The <a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-tzds-and-other-glucose.html" target="_blank">TZDs</a> (Actos, etc.)</li>
<li>The <a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-inositols.html" target="_blank">Inositols</a></li>
<li>Other <a href="http://wellroundedmama.blogspot.com/2013/11/pcos-and-diabetes-glucose-lowering.html" target="_blank">glucose-lowering medications</a> if you have developed overt diabetes</li>
</ul>
<div>
Other hallmarks of PCOS include high levels of androgens (male hormones) and irregular periods. Therefore I also have information on medications for these things, including:<br />
<ul style="text-align: left;">
<li><a href="http://wellroundedmama.blogspot.com/2015/09/pcos-treatment-anti-androgen-medications.html" target="_blank">Anti-androgenic medications</a> for treating various PCOS symptoms</li>
<li><a href="http://wellroundedmama.blogspot.com/2013/12/pcos-treatment-of-irregular-cycles.html" target="_blank">Progesterone supplements</a> for menstrual irregularity</li>
<li>A 3-part <a href="http://wellroundedmama.blogspot.com/2014/09/pcos-and-birth-control-pills-part-1.html" target="_blank">mini-series</a> on <a href="http://wellroundedmama.blogspot.com/2014/10/pcos-and-birth-control-pills-part-2.html" target="_blank">birth control pills</a> for <a href="http://wellroundedmama.blogspot.com/2014/10/pcos-and-birth-control-pills-part-3-use.html" target="_blank">PCOS</a></li>
</ul>
In addition, there are articles that discuss specific conditions associated with PCOS and the treatments available for them. This includes:<br />
<ul style="text-align: left;">
<li>The risk for <a href="http://wellroundedmama.blogspot.com/2017/09/pcos-and-endometrial-cancer-risk.html" target="_blank">endometrial cancer</a> with PCOS and the weight loss dilemma</li>
<li><a href="https://wellroundedmama.blogspot.com/2018/09/pcos-and-hirsutism-treatment-options.html" target="_blank">Hirsutism</a> (facial and body hair in PCOS women in typically "male" patterns) </li>
</ul>
One of the least-discussed conditions associated with PCOS is Alopecia Androgenetica (AGA, also called female-pattern hair loss or FPHL). I did a 3-part mini-series on it:<br />
<ul style="text-align: left;">
<li><a href="http://wellroundedmama.blogspot.com/2017/09/pcos-and-hair-loss-part-1-prevalence.html" target="_blank">PCOS Hair Loss: Part One</a> - what alopecia is, diagnosis, causes</li>
<li><a href="https://wellroundedmama.blogspot.com/2017/10/pcos-and-hair-loss-part-2-medical.html" target="_blank">PCOS Hair Loss: Part Two</a> - medical treatments for alopecia</li>
<li><a href="https://wellroundedmama.blogspot.com/2017/10/pcos-and-hair-loss-part-3-cosmetic.html" target="_blank">PCOS Hair Loss: Part Three</a> - cosmetic treatments for women's hair loss</li>
</ul>
The blog also has an occasional post reviewing recent research studies on PCOS, like one on i<a href="https://wellroundedmama.blogspot.com/2018/09/inositol-for-pcos-anovulation-2018.html" target="_blank">nositols for ovulation</a>, <a href="https://wellroundedmama.blogspot.com/2015/01/recent-studies-on-inositol-for-pcos.html" target="_blank">inositols</a> in <a href="https://wellroundedmama.blogspot.com/2015/12/2015-studies-on-d-chiro-inositol.html" target="_blank">general</a>, or inositols for <a href="https://wellroundedmama.blogspot.com/2016/03/can-inositol-prevent-gestational.html" target="_blank">preventing gestational diabetes</a>. Sometimes I publish an opinion piece/rant about <a href="https://wellroundedmama.blogspot.com/2013/11/sixth-annual-turkey-awards-pcos-isnt.html" target="_blank">weight bias</a> and <a href="https://wellroundedmama.blogspot.com/2018/08/the-turkey-awards-obesity-eugenics-via.html" target="_blank">fertility treatment discrimination</a> and how it impacts people with PCOS.<br />
<br />
As more posts are added to the series, this list will be updated. Please feel free to share a link to this series on your social media platforms or on PCOS forums. As always, you may read this information for free. However, if you quote an article or use its information elsewhere, you <i>must </i>give credit to me and link back to the original article. I do <i>not </i>give permission for these articles to be reposted elsewhere. Just give a brief comment and link back to the original article with proper citation.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">PCOS Sites: Caution Needed</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmTqZNztc-WgatvgTxflfPR_LyMAL_3V-5_b6uVP6INe97Q3c2B1iC-_Wdw8hPyiqS7u4ioD0v6Fc5ki5liuH1FU7WFnsXc74Jn2bId4Ve34YAEuGGki_kr9ACmkUp9UKW5uamPTY24j8/s1600/PCOS+awareness+butterfly.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="225" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmTqZNztc-WgatvgTxflfPR_LyMAL_3V-5_b6uVP6INe97Q3c2B1iC-_Wdw8hPyiqS7u4ioD0v6Fc5ki5liuH1FU7WFnsXc74Jn2bId4Ve34YAEuGGki_kr9ACmkUp9UKW5uamPTY24j8/s200/PCOS+awareness+butterfly.jpg" width="200" /></a></div>
Polycystic Ovarian Syndrome (PCOS) affects many higher weight women, but sadly many don't know they have it. Among those who do know about PCOS, there are many gaps in knowledge. Even among medical professionals who treat people with PCOS, there is a great deal of misinformation and mismanagement due to ignorance and weight stigma. There is a pressing need for good, research-based information about treating PCOS.<br />
<br />
There are now many resources online about PCOS but unfortunately, not all of them are very evidence-based. Some do quote research but only selectively, without giving a full picture of the pros and cons of a particular treatment. Others promote all kinds of alternative treatments as if they are proven, but with only anecdotal evidence to support it.<br />
<br />
This PCOS series is designed to take an evidence-based look at PCOS and its various treatments, both traditional and alternative. Links to research are placed in each blog post, and the most important studies are summarized at the bottom of most posts. Anecdotal stories are not immaterial so they are considered too, but they are not seen as proof.<br />
<br />
Financial conflicts of interest contaminate many PCOS resources. Remember that the weight loss and diet business is <i>highly</i> lucrative, and many scientific researchers and doctors are biased by grants and ties to obesity treatment programs and drug companies. They are often not even aware of their own biases and conflicts of interest. Even consumer-run PCOS resources often promote and make money off a particular dietary approach, supplement, or personal health coaching business. Therefore, when researching PCOS, look for conflicts of interest and question conclusions.<br />
<br />
Every source of information is subject to bias, even when no financial incentive exists. Be aware of the bias of the sites you read. That includes this resource. Its weight-neutral approach makes it unique among PCOS resources, but some would charge it might be biased against weight loss. On the other hand, unlike many PCOS resources, this series has no financial incentive towards any particular treatment. I make no money from the blog and do not benefit from people choosing non-weight loss treatments. I consider evidence for weight loss and try to be as fair as I can in its evaluation, but I won't pull punches about when it doesn't measure up. It's up to you to decide if I'm writing about it fairly and what the right course is for yourself.<br />
<br />
If you are new to this site, I strongly suggest reading the <a href="https://wellroundedmama.blogspot.com/p/terminology.html" target="_blank">Terminology Page</a> and the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041737/" target="_blank">Health At Every Size®</a> information to understand the language and philosophy of a weight-neutral approach.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">A Weight-Neutral Emphasis</span></b><br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjd3g-Wgr9RVWgEvd74c5QyRRHr9adZefKP5FUnbrt4wljOk__cNgVwFKj4gId4pS_8JKfYphudX53qOxOdkqcPIbrQ-azq6XL0VjDpIeTOM9q-45gJtH0OUehdwNXZquW0VinM__IAmc4/s1600/HAES2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="88" data-original-width="152" height="115" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjd3g-Wgr9RVWgEvd74c5QyRRHr9adZefKP5FUnbrt4wljOk__cNgVwFKj4gId4pS_8JKfYphudX53qOxOdkqcPIbrQ-azq6XL0VjDpIeTOM9q-45gJtH0OUehdwNXZquW0VinM__IAmc4/s200/HAES2.jpg" width="200" /></a>As noted, most PCOS websites have a tremendous weight-loss emphasis. Some are run by people who are selling "lifestyle coaching" or various supplements for PCOS and are profiting from their PCOS connections. In essence, they have monetized their diagnosis. There is nothing necessarily wrong with this, but it does inherently bias the information they have available and the treatments they promote.<br />
<br />
The strong weight loss emphasis on many sites also alienates people who have moved beyond dieting and embrace a size acceptance point of view. People like this often avoid typical PCOS sites because of the weight emphasis and so miss important information about treating the condition. There is a strong need for good, in-depth information without pushing weight loss as the cornerstone of all treatment, something that is very missing in most PCOS resources.<br />
<br />
Of course, the weight-centric paradigm is very strong in PCOS circles, both among consumers and medical professionals. Even the mere suggestion that dieting could be counter-productive is heresy to some. The idea of a PCOS resource that does not promote weight loss will immediately discredit this series in some eyes.<br />
<br />
But remember, <i>you are your own boss</i>. No one is telling you what to do. It doesn't hurt you to consider an weight-neutral point of view. If you decide it's nonsense, you can certainly pursue weight loss as a treatment for your PCOS. No one is going to stop you. Certainly, there is some research that weight loss can be helpful for some things in PCOS, though I would point out it's usually temporary. If you want to pursue that, go ahead. There are plenty of PCOS resources friendly to that approach and no shortage of weight loss advice online.<br />
<br />
The problem is that PCOS and weight loss research, like <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916886/" target="_blank">most research on weight loss</a>, is <a href="http://www.pubmed.gov/15997250" target="_blank">short in duration</a> (usually <a href="http://www.slate.com/articles/health_and_science/medical_examiner/2015/03/diets_do_not_work_the_thin_evidence_that_losing_weight_makes_you_healthier.html" target="_blank">less than</a> 24 months), has <a href="http://www.pubmed.gov/23429925" target="_blank">very poor long-term success</a>, and completely ignores the <a href="http://www.pubmed.gov/9080261" target="_blank">risks</a> that <a href="https://www.ncbi.nlm.nih.gov/pubmed/28678345" target="_blank">can</a> be <a href="http://www.pubmed.gov/23183902" target="_blank">associated</a> with weight loss/weight cycling. Does a 5-10% (or larger) weight loss really benefit your health if you <a href="http://mann.bol.ucla.edu/files/Diets_don%27t_work.pdf" target="_blank">end up</a> heavier <a href="http://www.pubmed.gov/26354535" target="_blank">afterwards</a> and with more <a href="https://www.ncbi.nlm.nih.gov/pubmed/17324664" target="_blank">eating-disordered</a> <a href="http://www.pubmed.gov/8655907" target="_blank">behaviors</a>? Or if you end up with <a href="http://www.pubmed.gov/10075614" target="_blank">gallstones</a>, <a href="https://academic.oup.com/aje/article/166/7/752/94606/Body-Size-Weight-Cycling-and-Risk-of-Renal-Cell" target="_blank">kidney cancer</a>, or <a href="http://www.pubmed.gov/28069684" target="_blank">endometrial cancer</a> from weight cycling?<br />
<br />
Given the overwhelming <a href="http://wellroundedmama.blogspot.com/p/weight-loss-and-weight-cycling.html" target="_blank">evidence</a> of poor long-term success with weight loss and the significant harms that can come from yo-yo dieting, it's important to know that there is an alternative. You <i>can </i>treat your PCOS without having to go on yet another diet that is likely to fail. That doesn't mean that lifestyle is irrelevant to treating PCOS, but simply that an emphasis on weight loss is not required. This blog examines lifestyle as an intervention for PCOS, but without an emphasis on guilt or pressure for any particular approach. Nor do we measure success by the scale.<br />
<br />
This series does not ignore the possibility of weight loss as treatment, but promoting weight loss is not its focus, unlike most other PCOS resources. The decision on whether or not to lose weight is left up to the individual.<br />
<br />
As with any medical situation, readers will have to carefully consider the pros and cons of all their choices and decide what is right for themselves. That might involve intentional weight loss, but it might mean choosing a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041737/" target="_blank">Health At Every Size® paradigm</a> instead, which emphasizes healthy habits guided by lab results and symptoms instead of the scale. Whatever you decide on the weight loss question for you is fine; just make that decision from an informed place.<br />
<br />
Please remember that this blog is meant to be a safe space. If you decide on weight loss, that's fine, but respect other people's right to have a diet-free space. Do not promote diets, weight loss surgery, eating-disordered behaviors, or body-shaming on this site, and treat everyone politely. You are allowed to disagree with my point of view if it's done respectfully. I can and <i>do </i>restrict comments when necessary. No fat hate is allowed.<br />
<br />
This series exists because it's important that people know that there are evidence-based treatment approaches that can help mitigate the risks of PCOS without adding in the risks and emotional roller-coaster of weight loss. The decision about how to approach your weight, however, is entirely up to you.<br />
<br />
Remember, you <i>can </i>have a good life, even with health challenges like PCOS. But it pays to be proactive and learn as much as you can about the condition and your treatment choices.<br />
<div>
<br /></div>
<br /></div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-19324534281590560722018-09-14T19:07:00.001-07:002018-09-14T19:07:57.848-07:00PCOS and Hirsutism: Treatment Options<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-sX2WUTL5chVK5KyALt0kIrgWpkEvSUoNZ1X7-Pqb_mx8VKxBNLhRIGURjkVCeDz8W7F-k-DbLVmp6AKFcw8jtCBFF0R3jPr9YLYOl90UmOJ64uD39oZLS72Rz8_kXkpxQD4BeWL22_o/s1600/Hirsutism-9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-sX2WUTL5chVK5KyALt0kIrgWpkEvSUoNZ1X7-Pqb_mx8VKxBNLhRIGURjkVCeDz8W7F-k-DbLVmp6AKFcw8jtCBFF0R3jPr9YLYOl90UmOJ64uD39oZLS72Rz8_kXkpxQD4BeWL22_o/s320/Hirsutism-9.jpg" width="320" /></a></div>
<br />
Every September, we discuss Polycystic Ovarian Syndrome (PCOS) in honor of PCOS Awareness Month. Today we discuss PCOS and abnormal facial and body hair (hirsutism).<br />
<br />
To review, in our PCOS series so far you will find an introduction to PCOS as a health concern:<br />
<ul style="text-align: left;">
<li>The <a href="http://wellroundedmama.blogspot.com/2011/09/pcos-condition-every-person-of-size.html">definition and symptoms</a> of PCOS</li>
<li>The <a href="http://wellroundedmama.blogspot.com/2011/09/pcos-how-does-pcos-affect-women.html" target="_blank">typical presentation</a> of PCOS</li>
<li>The <a href="http://wellroundedmama.blogspot.com/2011/10/pcos-testing-and-diagnosis.html">testing and diagnosis</a> of PCOS </li>
<li>The <a href="http://wellroundedmama.blogspot.com/2011/10/pcos-possible-causes.html">possible causes</a> of PCOS </li>
<li><a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-options-overview.html" target="_blank">Common treatment protocols</a> for PCOS and their pros and cons</li>
</ul>
You will also find a mini-series on insulin-sensitizing medications, including:<br />
<ul style="text-align: left;">
<li><a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-metformin.html" target="_blank">Metformin</a> (Glucophage)</li>
<li>The <a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-tzds-and-other-glucose.html" target="_blank">TZDs</a> (Actos, etc.)</li>
<li>The <a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-inositols.html" target="_blank">Inositols</a></li>
<li>Other <a href="http://wellroundedmama.blogspot.com/2013/11/pcos-and-diabetes-glucose-lowering.html" target="_blank">glucose-lowering medications</a> for overt diabetes</li>
</ul>
<div>
There is a mini-series on other medications for PCOS, including:<br />
<ul style="text-align: left;">
<li><a href="http://wellroundedmama.blogspot.com/2015/09/pcos-treatment-anti-androgen-medications.html" target="_blank">Anti-androgenic medications</a> for treating various PCOS symptoms</li>
<li><a href="http://wellroundedmama.blogspot.com/2013/12/pcos-treatment-of-irregular-cycles.html" target="_blank">Progesterone supplements</a> for menstrual irregularity</li>
<li>A 3-part <a href="http://wellroundedmama.blogspot.com/2014/09/pcos-and-birth-control-pills-part-1.html" target="_blank">mini-series</a> on <a href="http://wellroundedmama.blogspot.com/2014/10/pcos-and-birth-control-pills-part-2.html" target="_blank">birth control pills</a> for <a href="http://wellroundedmama.blogspot.com/2014/10/pcos-and-birth-control-pills-part-3-use.html" target="_blank">PCOS</a></li>
</ul>
In addition, we discuss specific conditions associated with PCOS and have an occasional post reviewing recent research studies on PCOS:<br />
<ul style="text-align: left;">
<li>The risk for <a href="http://wellroundedmama.blogspot.com/2017/09/pcos-and-endometrial-cancer-risk.html" target="_blank">endometrial cancer</a> with PCOS and the weight loss dilemma</li>
<li>Research review on <a href="https://wellroundedmama.blogspot.com/2018/09/inositol-for-pcos-anovulation-2018.html" target="_blank">inositols for anovulation</a>. </li>
</ul>
We also have a mini-series on the least-discussed symptom associated with PCOS, Alopecia Androgenetica (AGA, also called female-pattern hair loss or FPHL):<br />
<ul style="text-align: left;">
<li><a href="http://wellroundedmama.blogspot.com/2017/09/pcos-and-hair-loss-part-1-prevalence.html" target="_blank">PCOS Hair Loss: Part One</a> - what alopecia is, diagnosis, causes</li>
<li><a href="https://wellroundedmama.blogspot.com/2017/10/pcos-and-hair-loss-part-2-medical.html" target="_blank">PCOS Hair Loss: Part Two</a> - medical treatments for alopecia</li>
<li><a href="https://wellroundedmama.blogspot.com/2017/10/pcos-and-hair-loss-part-3-cosmetic.html" target="_blank">PCOS Hair Loss: Part Three</a> - cosmetic treatments for women's hair loss</li>
</ul>
</div>
<ul>
</ul>
<div>
Now it's time to address the topic of hirsutism (excess facial and body hair) and various medical and cosmetic treatment options for it.<br />
<br /></div>
<b><span style="color: #cc0000; font-size: large;">What is Hirsutism?</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwpHmnN48uRwIRPVeKjN_IwWBkQiBUTgempr8CBPmFic0M8h2UZxMKAOjcmfbdfeSp4PYyimJ0J2Ay5qLkvpMsxjqAnOYMkpQiFYYaipKEiSZ8aUeXsXoholy2R2oV0JnjT7X6ZK0pq_w/s1600/side-face-day-36%252C+hairyfairyweymouth+dot+com.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="420" data-original-width="560" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwpHmnN48uRwIRPVeKjN_IwWBkQiBUTgempr8CBPmFic0M8h2UZxMKAOjcmfbdfeSp4PYyimJ0J2Ay5qLkvpMsxjqAnOYMkpQiFYYaipKEiSZ8aUeXsXoholy2R2oV0JnjT7X6ZK0pq_w/s320/side-face-day-36%252C+hairyfairyweymouth+dot+com.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Images from <a href="https://audioboom.com/posts/2374123-weymouth-s-hairy-fairy-talks-about-ditching-the-razor-and-going-au-naturel" target="_blank">Karen Figgett</a>, 2014<br />originally posted at hairyfairyweymouth.com</i></td></tr>
</tbody></table>
Hisutism is excess facial or body hair growth in women that occurs in a so-called male pattern. In other words, it occurs on parts of women's bodies where <a href="http://en.wikipedia.org/wiki/Terminal_hair" target="_blank">terminal hair growth</a> (long, dark, thick hairs) is not expected or is normally very minimal.<br />
<br />
If the hair growth is all over everywhere, it is called <a href="https://en.wikipedia.org/wiki/Hypertrichosis" target="_blank">hypertrichosis</a>. This is very rare and quite different from hirsutism, which is hairiness limited to "male" areas (like the upper lip, the chin, the chest).<br />
<br />
Many women with PCOS have hair above their lips, like a mustache, as well as fine hair growing on their chin, cheeks, or neck. Some have just a few hairs sprouting on the face, while others can have quite a bit. Excess hair can also grow on the abdomen, chests, back, upper legs, and arms of women with PCOS. <br />
<br />
Women with PCOS tend to have high rates of hirsutism. Although not all women with PCOS experience hirsutism, it is considered one of the most classic symptoms of PCOS.<br />
<b><span style="color: #cc0000; font-size: large;"><br /></span></b>
<b><span style="color: #cc0000; font-size: large;">Possible Causes and Diagnosis</span></b><br />
<br />
Hirsutism from PCOS is usually caused by an endocrine (hormonal) imbalance involving the over production of male hormones (androgens). It may also result from an increased sensitivity of the hair follicles to these hormones. Most of the time the source of the increased male hormones is from the ovaries, the adrenal glands, or the brain.<br />
<br />
Hirsutism most commonly results from:<br />
<ul>
<li>Polycystic ovary syndrome (PCOS) (cysts on the ovaries giving off androgens)</li>
<li>Insulin resistance, which increases testosterone production</li>
<li>Congenital adrenal hyperplasia, mostly caused by 21-α hydroxylase deficiency</li>
<li>Adrenal problems like Cushing's Syndrome, adrenal gland cancer, non-classical adrenal hyperplasia</li>
<li>Hyperprolactinemia</li>
<li>Thyroid dysfunction</li>
<li>Growth hormone excess (acromegaly, gigantism) from benign tumors near the pituitary gland</li>
<li>Ovarian tumors</li>
<li>Menopause, which decreases female hormones but continues to produce male hormones</li>
</ul>
Every woman with significant hirsuitism should seek out a medical evaluation to determine the cause. At their appointment, they should undergo a complete physical exam and have some blood labs run. These may include DHEA-S, testosterone, androstenedione, various thyroid levels, blood sugar, insulin, prolactin, and 17α-hydroxyprogesterone.<br />
<br />
A medical history should also be taken, including menstrual regularity and development of hirsutism. A critical question is how fast the hirsutism developed. If it is sudden and marked, it's more likely to be related to adrenal problems such as a tumor on the adrenal gland. If this is the cause, it needs immediate follow-up.<br />
<br />
If the hirsutism has been slow to develop, it's more likely due to high androgen levels from PCOS or insulin resistance. If it's associated with irregular menstrual cycles, it is most likely tied to PCOS. Most cases of hirsutism are caused by PCOS or are idiopathic (cause unknown) and are not alarming, just annoying.<br />
<br />
A full discussion of hirsutism in all its forms is beyond the scope of this blog. This blog post discusses only PCOS and hirsutism.<br />
<br />
<b><i><span style="color: #38761d;">Ferriman-Gallwey Score</span></i></b><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPJCNluJ3FvUdPul5m9OWMm3cBkZ_DAd8ByY6fITa-eve_CPtNnLJKlO3-ZC5VVVhjDyv2_Yhv2MXCT-JNEXZt9Ngd2Z0WA8mkzE5baOWmeWeHYpfpj6hzU7EVS0neP8VEa104IENySTs/s1600/Ferriman-Gallwey+scale%252C+darker.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="418" data-original-width="605" height="276" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPJCNluJ3FvUdPul5m9OWMm3cBkZ_DAd8ByY6fITa-eve_CPtNnLJKlO3-ZC5VVVhjDyv2_Yhv2MXCT-JNEXZt9Ngd2Z0WA8mkzE5baOWmeWeHYpfpj6hzU7EVS0neP8VEa104IENySTs/s400/Ferriman-Gallwey+scale%252C+darker.jpg" width="400" /></a></div>
<br />
Doctors use the <a href="https://en.wikipedia.org/wiki/Ferriman%E2%80%93Gallwey_score" target="_blank">Ferriman-Gallwey score</a> to evaluate and quantify body hair growth. Although other measures are available, this remains the standard of care in most practices for evaluating hirsutism in women.<br />
<br />
In the original method, 11 body areas were assessed for hair growth, including upper lip, chin, chest (especially along the midline), upper back, lower back, upper abdomen, lower abdomen, thighs, forearms (not used anymore), and legs (not used anymore).<br />
<br />
According to <a href="https://en.wikipedia.org/wiki/Hirsutism" target="_blank">Wikipedia</a>, forearms and legs were deleted in the modified version of this scale. Some medical professionals use a further modification of the scale to consider 19 total locations, including spots like sideburns, neck, buttocks, feet, and fingers. However, most seem to still use the 9-location scale.<br />
<br />
Hair growth is graded on a scale from 0 (no excessive growth of terminal hair) to 4 (extensive terminal hair growth). If the 9-location version of the scale is used, that means that there is a maximum score of 36 points.<br />
<br />
Ethnicity plays a role in how much hair is expected. Each patient's ethnic background should be considered in the scale evaluation. In Caucasian women, a score of 8 or more is considered hirsutism, although some care providers use 6 as a diagnostic threshold instead.<br />
<br />
There is great <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419030/" target="_blank">debate</a> about the proper diagnostic levels for other ethnicities; this discussion is beyond the scope of this blog post but rest assured, hirsutism happens in every ethnic group. If in doubt, look at others of the same group around you. If your symptoms seem worse than theirs, you probably have some degree of hirsutism.<br />
<br />
<b>The most <a href="http://www.hirsutism.com/" target="_blank">common ways</a> to treat hirsutism include:</b><br />
<ul style="text-align: left;">
<li><b>Oral contraceptive pills (OCPs) </b>to regulate androgen production</li>
<li><b>Gonadotrophin Releasing Hormone analogs (GnRHa)</b> to regulate androgens by suppressing ovulation</li>
<li><b>Anti-androgen drugs</b> like spironolactone or flutamide </li>
<li><b>5 alpha-reductase suppressants </b>like finasteride</li>
<li><b>Insulin-sensitizing agents</b> like metformin or pioglitazone</li>
<li><b>Epilation (removal of hair by the roots) with cosmetic methods </b>like bleaching or chemical depilation, plucking, waxing, shaving and more permanent methods like laser, electrolysis etc.</li>
<li><b>Topical treatment with medications</b> like Eflornithine 11.5% or 13.9% cream etc.</li>
</ul>
<div>
Let's take a look at each of these and a quick overview of their pros and cons. </div>
<div>
<br /></div>
<b><span style="color: #cc0000; font-size: large;">Oral Contraceptive Pills for Hirsutism</span></b><br />
<div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsqr7L1doAwXMiHmdBhm7vgXzjoDt83cS8QYwIV671TIyvqnnsaDL7_2-a8BQRaI0rJukBxArl-OPE9veCvfXP35zUwkQiYTYGiiF2UHRpn3QWBQPcAS4g4JRVSq_lTYIIDCCo20neFT4/s1600/Yasmin.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="240" data-original-width="300" height="160" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsqr7L1doAwXMiHmdBhm7vgXzjoDt83cS8QYwIV671TIyvqnnsaDL7_2-a8BQRaI0rJukBxArl-OPE9veCvfXP35zUwkQiYTYGiiF2UHRpn3QWBQPcAS4g4JRVSq_lTYIIDCCo20neFT4/s200/Yasmin.jpg" width="200" /></a></div>
Some birth control pills can have a major anti-androgenic effect and lessen many PCOS symptoms, which is why they are the most commonly prescribed medication for PCOS. However, there are some drawbacks.</div>
<br />
Not all oral contraceptives have an anti-androgenic effect, and some significantly worsen androgens. Combined oral contraceptives, especially the ones that lessen androgenic effects, also increase the risk for blood clots, and may have lower birth control efficacy in high-BMI women. Some argue that OCPs merely put a band-aid on symptoms while not adequately addressing the underlying causes of PCOS issues.<br />
<br />
<b><i><span style="color: #38761d;">Combined Oral Contraceptives (Dianette, Yasmin, etc.)</span></i></b><br />
<br />
As we have discussed before, certain combination oral contraceptives (using both estrogen and progestin) have strong anti-androgen effects. As a result, they are often the first-line treatment for PCOS and for hirsutism in general. One OB <a href="http://www.obgmanagement.com/home/article/polycystic-ovary-syndrome-cosmetic-and-dietary-approaches/3cb861d829fb000d1a47246a4548cd27.html">website</a> sums up the mechanism of action:<br />
<blockquote class="tr_bq">
Oral contraceptives...suppress pituitary production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn suppress ovarian androgen production. OCs also may reduce adrenal androgen production, although the mechanism of action is unclear.</blockquote>
The estrogen component in OCs increases hepatic production of sex hormone-binding globulin (SHBG), thereby decreasing free testosterone levels. The progestin component antagonizes 5α-reductase and the androgen receptor; it also may increase hepatic metabolism of testosterone and can increase SHBG when the OC has low androgenic activity. However, the strength of anti-androgenic effect in oral contraceptives varies. Some birth control pills (second generation, especially those involving levonorgestrel) have strong androgenic effects, which can make symptoms worse in some women with PCOS.<br />
<br />
Many of the later oral contraceptives (third- and fourth-generation) have a stronger anti-androgenic effect. These can be used on their own or in combination with other anti-androgenic drugs (usually spironolactone) to treat hirsutism and acne.<br />
<br />
Unfortunately, the oral contraceptives with the strongest anti-androgenic effects tend to have the strongest risk of blood clots, particularly for women of size and/or women with PCOS. Each woman's unique medical history and risk factors must be considered very carefully before use of these oral contraceptives. You can read more about these risks <a href="http://www.wellroundedmama.blogspot.com/2014/09/pcos-and-birth-control-pills-part-1.html">here</a>, <a href="http://www.wellroundedmama.blogspot.com/2014/10/pcos-and-birth-control-pills-part-2.html">here</a>, and <a href="http://www.medscape.com/viewarticle/769687">here</a>.<br />
<br />
Here are further details of two of the most commonly-prescribed anti-androgenic oral contraceptives, those using droperinone and those using cyproterone acetate.<br />
<br />
<div>
<b><i><span style="color: #38761d;">Drospirenone </span></i></b>(brand names: Yasmin, Yaz, Angeliq)</div>
<div>
<br />
Drospirenone (also known as 1,2-dihydrospirorenone) is a synthetic steroidal progestin which has weak anti-androgenic properties. Structurally, it is similar to spironolactone.<br />
<br />
When combined with ethinyl estradiol, it becomes the combination birth control pill called Yasmin, sometimes called a "fourth-generation" oral contraceptive. It has a modest effect against hirsutism and acne. It was marketed as a treatment for acne. (In a slightly different formulation, drosperinone plus estradiol is called Angeliq, and is sometimes used for menopausal symptoms.)<br />
<br />
Yasmin is contraindicated in people with a history of liver, kidney, or adrenal insufficiency. Potassium levels must be carefully monitored in anyone on this medication.<br />
<br />
People with a history of depression or family depression might want to avoid this OCP because anxiety and depression are possible side effects. Migraine is another possible side effect.<br />
<br />
The biggest concern, however, is blood clots. Research <a href="http://news.health.com/2015/05/27/newer-birth-control-pills-may-slightly-raise-blood-clot-risk/">suggests</a> that the risk for blood clots is <a href="https://www.marieclaire.com.au/yasmin-side-effects" target="_blank">significantly increased</a> in people on Yasmin, both compared to those not on any birth control pills at all, and in those on other types of birth control pills. Certain risk factors (obesity, high blood pressure, family history of blood clots, diabetes, etc.) may raise the risk even more.<br />
<br />
Still, doctors point out that the absolute risk remains relatively low, and certainly lower than the risk of blood clots during pregnancy. And it reportedly does a good job of lessening hirsutism.<br />
<br />
<b><i><span style="color: #38761d;">Cyproterone Acetate</span></i></b> (CPA; in oral contraceptives, Dianette or Diane-35)<br />
<br />
CPA is another progestin that has anti-androgenic properties and may be used alone or as part of certain birth control pills. It inhibits production of androgens in ovarian theca cells, and also competes with androgens at receptor sites.<br />
<br />
From its <a href="http://en.wikipedia.org/wiki/Cyproterone_acetate">Wikipedia entry</a>:<br />
<blockquote class="tr_bq">
Cyproterone Acetate...is a synthetic steroidal antiandrogen drug with additional progestogen and antigonadotropic properties. Its primary action is to suppress the activity of the androgen hormones such as testosterone and its more potent metabolite dihydrotestosterone (DHT) in the body, effects which it mediates via competitive antagonism of the androgen receptor and inhibition of enzymes in the androgen biosynthesis pathway.CPA is most often used as an anti-androgen treatment for men with prostate cancer. In PCOS women, it is an effective treatment for significant hirsutism and acne. It may be even more effective for this when combined with metformin.</blockquote>
In the U.K. and Canada, CPA has been combined into the oral contraceptives known as Dianette and Diane-35. CPA and the Diane birth control pills are <a href="http://www.medscape.com/viewarticle/572203_2">not available</a> in the U.S.<br />
<br />
The amount of CPA in most birth control pills is fairly small, and has only a modest effect on hirsutism. Higher doses of CPA tend to have more impact on hirsutism. However, it takes quite a while for the CPA in birth control pills to affect hirsutism; <i>a trial of at least 6 months is needed</i>, and often the maximum effect is not attained until 2-3 years later.<br />
<br />
CPA can have significant liver toxicity. Liver enzymes, cortisol and electrolyte levels must be monitored when on CPA. A woman's ability to absorb vitamin B12 may also be impaired, while iron-binding abilities may be enhanced. B12 and ferritin levels should be monitored when on this medication long-term.<br />
<br />
Nausea, vomiting, headache, depression, weight changes, edema, increased blood pressure, gallstones, and skin spots are potential side effects. Again, birth defects can occur with this drug, so effective birth control is needed, which is why it is usually administered in oral contraceptive form.<br />
<br />
Blood clots are also a significant risk; women on birth control pills with CPA have a <a href="http://pcosdiva.com/2013/06/dianette-worth-the-risk/">higher risk</a> for blood clots than women on certain other types of the Pill, but some <a href="http://sogc.org/media_updates/position-statement-diane-35-and-risk-of-venous-thromboembolism-vte/">OB organizations</a> feel that they can be worth the risk. Like Yasmin, the absolute risk of a blood clot is fairly low, but may be increased in women with certain risk factors.<br />
<br />
If you consider use of CPA, a CPA oral contraceptive (like Dianette), or a drosperinone oral contraceptive (Yasmin), be sure to consult with your care providers carefully about your health history, risk factors, and the benefit/risk ratio of these medications. Generally speaking, on their own, OCPs are not that effective for hirsutism, but combined with other medications like an anti-androgen they are far more effective. Still, they often involve significant side effects and must be considered carefully.<br />
<br />
You can read more about Dianette oral contraceptives <a href="http://www.netdoctor.co.uk/sex-and-relationships/medicines/dianette.html">here</a> and the newer oral contraceptives in general <a href="http://news.health.com/2015/05/27/newer-birth-control-pills-may-slightly-raise-blood-clot-risk/">here</a>.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Gonadotrophin Releasing Hormone analogs (GnRHa) </span></b></div>
<br />
GnRHa medications work by suppressing ovulation, which in turn lowers the androgens in the body. According to <a href="http://www.hirsutism.com/hirsutism-treatments/grh-analogs-hirsutism.shtml" target="_blank">one source</a>:<br />
<blockquote class="tr_bq">
Gonadotrophin Releasing Hormone Analogs suppress gonadal hormone synthesis by imitating GnRH and attaching to target pituitary receptors with ‘high affinity’. The commonly used analogs are potent GnRH agonists (GnRHa). A long-term treatment with a GnRHa like leuprolide acetate acts against ovarian steroidogenesis by inhibiting pituitary LH and FSH production. This in turn reduces the concentration of circulating testosterone and androstenedione, but without affecting adrenal androgens.</blockquote>
These medications tend to work better for PCOS hirsutism than oral contraceptives alone. However, long-term use brings lots of side effects, so this medication is typically only used in women who have very serious hirsutism and only minimal success with other hirsutism medications.<br />
<br />
This medication needs to be injected. It is done about once a month, and is quite expensive. It is viewed as a short-term solution only and is not generally used long-term. It may provide a short-term clearing of excess hair that then can be sustained with an oral contraceptive but generally speaking most doctors prefer other choices first.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Anti-Androgens for Hirsutism</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikU0L46XQUFjaI-cNi1OHGfqU6kcxvVYoaI1RdBtmJf4FWVYCWLzY9FO0a_eNpJZg5c6Onwh1CflhgzrpcxZeKtMSjWv20gs0iJ_iUwQ7T4rwrMoj7lviuPKPXTbYE9MYPSXMZXyMfC-Y/s1600/spironolactone-25mg-100-count-7_387x705.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="705" data-original-width="387" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikU0L46XQUFjaI-cNi1OHGfqU6kcxvVYoaI1RdBtmJf4FWVYCWLzY9FO0a_eNpJZg5c6Onwh1CflhgzrpcxZeKtMSjWv20gs0iJ_iUwQ7T4rwrMoj7lviuPKPXTbYE9MYPSXMZXyMfC-Y/s200/spironolactone-25mg-100-count-7_387x705.jpg" width="109" /></a></div>
<br />
One of the most effective treatments for hirsutism is an anti-androgen medication, either by itself or combined with an oral contraceptive. Since PCOS results in androgen excess, treatments aim to reduce the levels of androgens ─ or at least to reduce their effects.<br />
<br />
An anti-androgen prevents the body from making as many androgens, or it may limit the activities and effects of androgens. Treatment with anti-androgenic medications can help lower androgen levels, reduce hirsutism, reduce acne, and perhaps even minimize hair loss issues.<br />
<div>
<br />
While anti-androgens can reduce some PCOS symptoms, they can also cause birth defects and <i>must</i> be taken with an extremely reliable form of birth control, even in women with fertility issues. Occasional spontaneous ovulation does happen even in those struggling with infertility, and the chance of birth defects is high in women who take anti-androgen medications. As a result, anti-androgens are usually taken with oral contraceptives in order to make sure pregnancy is prevented. Sometimes the combination works even better on PCOS than alone, giving it an added bonus.<br />
<br />
Anti-androgens are not FDA-approved for the treatment of PCOS. Research reviews note the poor quality of research on these drugs, so the best anti-androgen for treating PCOS symptoms is not yet known, nor is the best combination of anti-androgen and oral contraceptive. Women who want to use any of these drugs should discuss all pros and cons thoroughly with their medical professional.<br />
<br />
<b>It is important to note that it takes a long trial of treatment (6-18 months) before it is clear whether a particular anti-androgen drug is impacting your symptoms.</b> Because the hair growth cycle is long, improvement is generally slow and gradual. You must be patient before you decide whether or not an anti-androgen drug is helping.<br />
<br />
And remember, the drug's benefits last only as long as you are taking the drug, and the risk of side effects with some drugs is substantial. If the drug's benefits are only modest, some people may feel they are not worth the long-term risk of side effects.<br />
<div>
<br /></div>
<div>
<b><i><span style="color: #38761d;">Spironolactone </span></i></b>(brand name: Aldactone)<br />
<br />
<a href="https://en.wikipedia.org/wiki/Spironolactone" target="_blank">Spironolactone</a> is the most common anti-androgen drug used for women with PCOS. It is a potassium-sparing diuretic, usually prescribed for treating edema (excess fluid) or high blood pressure. It is also an aldosterone antogonist. Its use for PCOS symptoms is off-label but has been going on for years.<br />
<br />
Spironolactone is thought to <a href="http://pcos.about.com/od/pcos101/a/pcostreatment_2.htm">help</a> in the following way:<br />
<blockquote class="tr_bq">
Spironolactone inhibits the testosterone secreted by the body, and also competes for hormone receptors in the hair follicles. Receptors are sites on cells which allow hormones or chemical to bind to them, creating a reaction. If another chemical is in the receptor site, androgens cannot bind to them and stimulate the reaction causing hair growth.</blockquote>
Spironolactone has been shown to significantly lessen facial hirsutism in women with PCOS. A recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/25918921">Cochrane meta-analysis</a> suggests that 100 mg daily is quite effective against hirsutism, although it noted that the quality of this evidence was low and more research is needed. Other <a href="http://www.obgmanagement.com/home/article/polycystic-ovary-syndrome-cosmetic-and-dietary-approaches/3cb861d829fb000d1a47246a4548cd27.html">OB guidelines</a> have suggested that higher doses may be needed in some women, but that it's best to build dosage up slowly over time.<br />
<br />
For many women with significant hirsutism, spironolactone is the medication of choice when used with a form of extremely reliable birth control in women who have even the smallest chance of becoming pregnant. This usually means the Oral Contraceptive Pill. The combination of the Pill and spironolactone can be <i>particularly </i>effective for many women with PCOS. However, not all find it helpful.<br />
<br />
Because spironolactone is a diuretic, you will need to be monitored to make sure you don't build up too much potassium in the blood. Frequent urination is the most common side effect. Nausea, fatigue, headache, lightheadedness, indigestion, thirst, electrolyte imbalances, and abnormal bleeding or menstrual disturbances are other potential side effects. Heart arrhythmias can occur if potassium levels spike; this is most common in the elderly or those with kidney disease but can occur in younger patients. Liver enzymes must also be monitored regularly for signs of hepatotoxicity.<br />
<br />
The good news is that spironolactone is an extremely affordable drug that is generally quite effective for PCOS hirsutism, especially when used in combination with other drugs. If PCOS-related acne is a problem for you, it often works well for both hirsutism and acne, and possibly for alopecia (hair loss on the head) too. You can read more about the uses, side effects, and cautions for spironolactone <a href="http://drugs.webmd.boots.com/drugs/drug-440-spironolactone.aspx?drugid=440&drugname=spironolactone&istictac=false">here</a> and <a href="http://www.obgmanagement.com/home/article/polycystic-ovary-syndrome-cosmetic-and-dietary-approaches/3cb861d829fb000d1a47246a4548cd27.html">here</a>. </div>
<div>
<br /></div>
<div>
<b><i><span style="color: #38761d;">Flutamide </span></i></b><br />
<br />
Another medication that works similarly to spironolactone is flutamide. From one <a href="http://www.androgeneticalopecia.com/hair-loss-treatments/systemic-flutamide-antiandrogen-pattern-baldness.shtml">website</a>:<br />
<blockquote class="tr_bq">
Flutamide is a non-steroidal antiandrogen that is devoid of other hormonal activity. It most likely acts after converting to 2-hydroxyflutamide, which is a potent competitive inhibitor of dihydrotestosterone (DHT) binding to the androgen receptor.</blockquote>
A few studies have <a href="http://www.ncbi.nlm.nih.gov/pubmed/23327685">found</a> that flutamide helps restore regular menstrual cycles and ovulation in women with PCOS, but it is most useful against <a href="http://www.hirsutism.com/hirsutism-treatments/flutamide-hirsutism.shtml" target="_blank">hirsutism</a>. It is available in the United States, but is usually prescribed for men with prostate cancer, not women with PCOS. As a result, most of the hirsutism research on it is European.<br />
<br />
Flutamide can have significant <a href="http://livertox.nih.gov/Flutamide.htm">liver toxicity</a>, so some organizations recommend against it use. Flutamide can also result in significant gastrointestinal upset, as well as issues with dry skin. Because of these side effects, flutamide is generally considered <a href="http://dermnetnz.org/treatments/antiandrogens.html">unsuitable</a> for the treatment of acne and other skin problems where its benefit is only minimal.<br />
<br />
Because it is more effective for hirsutism, the benefit/risk ratio for this is more controversial. A recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/25918921">Cochrane meta-analysis</a> suggests that flutamide (250 mg, twice daily) is "effective and safe" against hirsutism, although it noted that the quality of this evidence was low. Another recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/24889738">meta-analysis</a> disagreed, stating:<br />
<blockquote class="tr_bq">
Due to its risk for hepatotoxicity, flutamide is not considered a first-line therapy. If used, the lowest effective dose should be administered with careful monitoring of liver enzymes.</blockquote>
Some care providers feel that flutamide is relatively safe with careful monitoring of liver function. The chance for birth defects is quite high with Flutamide, so again, a very reliable form of birth control must be used, or it may be prescribed only for women with no childbearing potential.<br />
<br />
You can read more about Flutamide <a href="http://pcos.about.com/od/callingyourdoctor/p/flutamide.htm">here</a>, <a href="http://www.obgmanagement.com/home/article/polycystic-ovary-syndrome-cosmetic-and-dietary-approaches/3cb861d829fb000d1a47246a4548cd27.html">here</a>, and <a href="https://en.wikipedia.org/wiki/Flutamide">here</a>.</div>
<div>
<br /></div>
<div>
<b><span style="color: #cc0000; font-size: large;">5 Alpha-Reductase Inhibitors for Hirsutism</span></b></div>
<div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhV5rx4EzABGg1bq1U6jieDRHlB9i3AiijI7YM7uQHEnkvu-ueYMDIbBe2eywc7jQSY4t5Aaqwlg2XUOGwWZ5W5rXq5JVkxY2vYJWLY81NctSbp3uf0_nImFzSKdD_wyZn3Ak5vGzQr-o/s1600/propecia-300x300+%25281%2529.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhV5rx4EzABGg1bq1U6jieDRHlB9i3AiijI7YM7uQHEnkvu-ueYMDIbBe2eywc7jQSY4t5Aaqwlg2XUOGwWZ5W5rXq5JVkxY2vYJWLY81NctSbp3uf0_nImFzSKdD_wyZn3Ak5vGzQr-o/s200/propecia-300x300+%25281%2529.jpeg" width="200" /></a></div>
Another way to reduce hirsutism is by lessening the effect of androgens on skin cells. 5 alpha-reductase inhibitors are very effective at doing this. <i>[Note: "alpha" may be written out or the greek letter used - "5 α-reductase inhibitor"]</i><br />
<br />
<b><i><span style="color: #38761d;">Finasteride </span></i></b>(brand name: Propecia or Proscar)<br />
<br />
Finasteride is a 5 alpha-reductase inhibitor. It is FDA-approved for the treatment of baldness and/or Benign Prostatic Hyperplasia (BPH) in men. It has a relatively good safety profile and is well tolerated by most men, but it is quite expensive. It is not approved for use with PCOS or with women.<br />
<br />
Finasteride has been shown in some <a href="http://www.ncbi.nlm.nih.gov/pubmed/12724020">research</a> to be effective against hirsutism, though <a href="https://www.ncbi.nlm.nih.gov/pubmed/24039457">not</a> for hair loss in women. It works by preventing the androgens from getting into the cells. However, the recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/25918921">Cochrane meta-analysis</a> notes that the research on finasteride is inconsistent and therefore conclusions cannot be reached. It does not appear to be effective against hair loss in women.<br />
<br />
Finasteride can cause headaches and depression. It is associated with a very high risk of birth defects (pregnancy drug category X), so it is not used in women who have even the smallest chance of becoming pregnant. Some doctors consider it an option, however, for women who have no childbearing potential anymore (beyond menopause, tubal ligation, hysterectomy, etc.).<br />
<br />
You can read more about finasteride <a href="http://www.obgmanagement.com/home/article/polycystic-ovary-syndrome-cosmetic-and-dietary-approaches/3cb861d829fb000d1a47246a4548cd27.html">here</a>.</div>
<div>
<br /></div>
<div>
<div>
<b><i><span style="color: #38761d;">Bicalutamide </span></i></b>(brand name: Casodex, Calutide)</div>
<br />
A fairly new option for hirsutism is bicalutamide. It is a 5 alpha-reductase inhibitor, like finasteride. It was developed to treat prostate cancer in men. Its <a href="http://www.obgmanagement.com/home/article/polycystic-ovary-syndrome-cosmetic-and-dietary-approaches/3cb861d829fb000d1a47246a4548cd27.html">mechanism of action</a> is as follows:<br />
<blockquote class="tr_bq">
Bicalutamide acts as a pure antiandrogen by binding to the androgen receptor and preventing its activation and subsequent upregulation of androgen-responsive genes by androgenic hormones. In addition, bicalutamide accelerates the degradation of the androgen receptor. </blockquote>
<div>
Bicalutamide is considered to be about as effective as finasteride, but with fewer side effects. Although it can impact liver function, bicalutamide is less likely to cause damage than some other anti-androgen drugs, which is a big advantage. Another advantage is its price, as it is a comparatively cheap medication. A generic version is available. </div>
<div>
<br /></div>
<div>
Like finasteride, it is associated with a high risk of birth defects and is contraindicated in women with any chance of becoming pregnant. However, there is some minimal <a href="http://www.ncbi.nlm.nih.gov/pubmed/11915584">research</a> on its use in women. A recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/29211888" target="_blank">study</a> found that an oral contraceptive pill plus bicalutamide was very effective and well-tolerated. </div>
<br />
You can read more about bicalutamide <a href="https://en.wikipedia.org/wiki/Bicalutamide">here</a>.<br />
<div>
<br /></div>
</div>
<div>
<b><span style="color: #cc0000; font-size: large;">Insulin-Sensitizing Medications for Hirsutism</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj084JlXeDjTqPmG4Zb40QcgUTq1Pip97chSgl3TFLyKy8aMi0URCIAhDR4v8Fv6sp32J1auydxsqPgR1BVfL1bcPdIMmC-DGDowjiFOTozVwfALuUcSWm8Nkd1R6PvcCe7ewV4pOeemjA/s1600/790px-Metformin_500mg_Tablets.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="790" height="151" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj084JlXeDjTqPmG4Zb40QcgUTq1Pip97chSgl3TFLyKy8aMi0URCIAhDR4v8Fv6sp32J1auydxsqPgR1BVfL1bcPdIMmC-DGDowjiFOTozVwfALuUcSWm8Nkd1R6PvcCe7ewV4pOeemjA/s200/790px-Metformin_500mg_Tablets.jpg" width="200" /></a></div>
Another option for treating hirsutism is an insulin-sensitizing medication. Since many women with PCOS have strong insulin resistance and this may result in higher androgen levels, treating the insulin resistance may be helpful in treating mild hirsutism.<br />
<br />
Insulin-sensitizing medications may have some anti-androgenic effects and can be <a href="http://www.ncbi.nlm.nih.gov/pubmed/12153743">somewhat effective</a> against hirsutism or acne. Since they have the distinct advantage of being effective against multiple PCOS symptoms at the same time, some providers will prescribe insulin sensitizers first in women with PCOS. These include TZDs, inositols, and most commonly, metformin.<br />
<br />
TZDs like Actos<i> </i>and Avandia<i> </i>may be somewhat effective against hirsutism but because of concerns over their safety, they are not usually used for hirsutism. However, they may be part of an overall PCOS treatment program with some medical professionals. You can read more about TZDs <a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-tzds-and-other-glucose.html">here</a>.<br />
<br />
The <a href="http://www.wellroundedmama.blogspot.com/2013/10/pcos-treatment-inositols.html" target="_blank">inositols</a> (myo-inositol and d-chiro-inositol) are insulin-sensitizing supplements that many people with PCOS find more tolerable than metformin or TZDs. They are effective for lessening insulin resistance, but the research on whether they <a href="https://www.ncbi.nlm.nih.gov/pubmed/18854115" target="_blank">help</a> with <a href="https://www.ncbi.nlm.nih.gov/pubmed/19551544" target="_blank">symptoms</a> like <a href="https://www.ncbi.nlm.nih.gov/pubmed/27808588" target="_blank">hirsutism</a> is <a href="https://www.ncbi.nlm.nih.gov/pubmed/28092404" target="_blank">mixed</a>. More data is needed.<br />
<br />
Metformin (brand name Glucophage) is the most commonly used insulin-sensitizing medication in PCOS. It is an old drug that has been in use for a very long time and has an <i>impressive </i>safety record compared to other insulin sensitizers. In diabetics, it has been shown to lower the risk for heart disease and death <a href="https://www.ncbi.nlm.nih.gov/pubmed/29144162" target="_blank">significantly</a>, a claim few drugs can make. It has also been shown to <a href="https://www.ncbi.nlm.nih.gov/pubmed/30126667" target="_blank">delay the development of diabetes</a> in those with strong risk factors.<br />
<br />
However, metformin is known for its GI side effects in some people. Diarrhea, gas, and bloating are common. Using the extended release formulation can lessen this for many people, but GI side effects can still happen and lead some people to discontinue its use.<br />
<br />
Metformin also has been known to <a href="https://www.ncbi.nlm.nih.gov/pubmed/24959880" target="_blank">impact</a> vitamin B12 levels in some patients so B12 levels should be checked periodically. Rarely, metformin can result in lactic acidosis, a severe complication that can be fatal. To lessen the risk, many doctors recommend temporarily discontinuing metformin during times of significant acute illness or surgery. Liver and kidney labs should be run before starting metformin and periodically during its use. You can read much more about metformin <a href="https://wellroundedmama.blogspot.com/2013/10/pcos-treatment-metformin.html" target="_blank">here</a>.<br />
<br />
Metformin has been shown in some past research to be <a href="http://www.ncbi.nlm.nih.gov/pubmed/19012104">as good as</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/12970273">somewhat better</a> than oral contraceptives alone in reducing hirsutism in women with PCOS. A <a href="http://www.aafp.org/afp/2009/0415/p671.html">2009 literature review</a> for the American Academy of Family Physicians notes that past research showed that metformin was as effective for treatment of hirsutism as many oral contraceptives, although later research did not confirm its effectiveness.<br />
<br />
Nowadays, metformin alone is not considered to be a first-line drug for use against hirsutism. However, it may increase the effectiveness when used <i>with </i>other hirsutism medications. One <a href="https://www.ncbi.nlm.nih.gov/pubmed/24889738">recent review</a> said:<br />
<blockquote class="tr_bq">
Monotherapy with an insulin sensitizer does not significantly improve hirsutism. While insulin sensitizers improve important metabolic and endocrine aberrations in polycystic ovary syndrome, they are not recommended when hirsutism is the sole indication for use. More recent research <a href="http://www.jfponline.com/the-publication/past-issue-single-view/what-therapies-alleviate-symptoms-of-polycystic-ovary-syndrome/b516291a857fc229d697494c5174a4f1.html">suggests</a> that metformin modestly increases the effectiveness of other anti-hirsutism medications, particularly oral contraceptives and spironolactone. In other words, while metformin probably shouldn't be prescribed by itself for hirsutism, it may well be prescribed in combination with an anti-androgen medication (probably spironolactone) or an oral contraceptive.</blockquote>
<b><span style="color: #cc0000; font-size: large;">Herbs for Hirsutism</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQTee-6eAQl06kPFNvrVbBve9Pr-W3a6zYaFHrgcIRawFUG_EDWTZH67hoKxSWRfeBYkdPJK9bNNGbJQaZKme1vGrKaJVv-_QKwSwivaN7XYN1lAX9MTPlFRO0fzle6NLGZHuzm-SFAUk/s1600/spearminttea.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="525" data-original-width="700" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQTee-6eAQl06kPFNvrVbBve9Pr-W3a6zYaFHrgcIRawFUG_EDWTZH67hoKxSWRfeBYkdPJK9bNNGbJQaZKme1vGrKaJVv-_QKwSwivaN7XYN1lAX9MTPlFRO0fzle6NLGZHuzm-SFAUk/s200/spearminttea.jpg" width="200" /></a></div>
In addition to traditional medicines, there are herbs that are reputed to have anti-androgenic effects.<br />
<br />
For example, herbal spearmint tea has long been used as an anti-hirsutism treatment in Middle Eastern cultures. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19585478">Research</a> suggests that spearmint tea may have mild anti-androgenic effects and may be helpful with hirsutism, but longer studies are needed to evaluate this.<br />
<br />
Other possible herbal agents may include red reishi (a mushroom used in Chinese medicine), licorice root, Chinese peony, green tea, black cohosh, and saw palmetto extract. I am not aware of any studies on these herbs for hirsutism; their inclusion is based only on anecdotal evidence from some PCOS sites.<br />
<div>
<br /></div>
<div>
Many women with PCOS use chaste tree/vitex in particular. More information on the (rather sparse) research behind these possibilities can be found <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693613/">here</a>.<br />
<br />
<div>
<b><span class="Apple-style-span" style="color: #cc0000; font-size: large;">Cosmetic Treatments for Hirsutism</span></b><br />
<b><br /></b>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvSlv9s_WuBfMgb97PJTZnsB0QOhGXZWzhr1Qyd456MpoX1ole880CWMX9WFY7TtnS73P_ph-P9hLKNuX7GBHBQFJiJR78aoW8Acvk2yUtEV07Q9WFqLTDAxQPdEXt7Z6SDvYuhWRAWWc/s1600/woman+shaving+face.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="270" data-original-width="618" height="139" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvSlv9s_WuBfMgb97PJTZnsB0QOhGXZWzhr1Qyd456MpoX1ole880CWMX9WFY7TtnS73P_ph-P9hLKNuX7GBHBQFJiJR78aoW8Acvk2yUtEV07Q9WFqLTDAxQPdEXt7Z6SDvYuhWRAWWc/s320/woman+shaving+face.jpg" width="320" /></a></div>
<br />
There are a number of <a href="http://pcos.about.com/od/callingyourdoctor/p/flutamide.htm" target="_blank">cosmetic treatments</a> that can help with PCOS symptoms like hirsutism. None are 100% satisfactory, but most women find them preferable to risky drugs, especially during their childbearing years. Over time they develop a routine that works for them, even if it's not as ideal as they'd like.<br />
<br />
<b><i><span style="color: #38761d;">Mechanical Hair Removal or Disguise</span></i></b><br />
<br />
To deal with bothersome facial and body hair, most women employ <a href="http://www.hirsutism.com/hirsutism-treatments/cosmetic-hair-removal.shtml" target="_blank">cosmetic remedies</a> like shaving, plucking, waxing, epilators, and depilatory creams. Bleaching may also help by making the facial hair less noticeable.<br />
<br />
If the degree of hirsutism is mild, then shaving is the easiest way to take care of it. Keep in mind that it has to be done often or stubble will show. Shaving does <i>not </i>make the hair grow back darker and thicker; the stubble left over just appears that way. Using an electric shaver may result in less skin irritation than a blade. One woman <a href="http://fattiesunited.wordpress.com/2013/06/24/my-fine-fuzzy-fat-face/" target="_blank">reports</a> that an electric eyebrow shaver was the best solution for her.<br />
<blockquote class="tr_bq">
Eyebrow shavers are the best to use for fuzzy face because the blade is much finer and it cuts the hair at an angle that doesn't result in the hair looking darker/thicker as it comes back in.</blockquote>
Lots of people use plucking or tweezing if the hirsutism is mild and just results in a few stray hairs. Waxing is a faster version of plucking. Epilators are <a href="https://www.amazon.com/Best-Sellers-Beauty-Hair-Removal-Epilators/zgbs/beauty/234944011" target="_blank">small mechanical devices</a> that basically work the same as waxing or tweezing; they pull the hair out by the root. Under ideal conditions this leaves smooth soft skin and lasts several weeks.<br />
<br />
However, plucking, tweezing, etc. can permanently damage the hair follicle. Sometimes this is good as the hair follicle might stop producing hair. Sometimes it is bad because the hair follicle may respond by growing a bigger, thicker, and darker hair. You never know which result you are going to get. Also, tweezing, plucking, epilators, and waxing can sometimes lead to major skin irritation and damage. And they <i>hurt</i>!<br />
<br />
Bleaching can work well if you are very light-skinned as it reduces the contrast between hair and skin. However, bleaching can lead to major skin irritation and damage. For many women of color, bleaching is not a good option.<br />
<br />
Depilatory (hair removal) creams can be used at times. These creams use very alkaline formulations that weaken the hair shaft so that the hair breaks off below the surface, leading to very smooth skin. One advantage of depilatories is that their results tend to last longer than shaving; however, many women find that depilatory creams cause significant skin irritation and redness. They do fine for a while but eventually many women become too sensitive to use these regularly.<br />
<br />
Most women with PCOS use multiple cosmetic measures to deal with visible hirsutism. For example, women may start by waxing off the excess hair, then using an epilator as it grows back. Or they may rotate their approach to lessen the sensitivity of the area.<br />
<br />
However, for some women cosmetic measures are not enough. As a result, they may turn to procedures like electrolysis or laser therapy.<br />
<br />
<b><i><span style="color: #38761d;">Electrolysis</span></i></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpNDiht5hR150PDCijORbKe4zB05oHNcctDxwtewJtPphOFTFDSIN4XyCYHip9E0qY5KW_nciviSKJ6kYl3htDChQSo8rKRuG06P4kw36CoFGAKgmheMCVum1Pzdr-0mj9NiSNmJeNX-w/s1600/Article-4-Electrolysis-Procedure-687x400.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="687" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpNDiht5hR150PDCijORbKe4zB05oHNcctDxwtewJtPphOFTFDSIN4XyCYHip9E0qY5KW_nciviSKJ6kYl3htDChQSo8rKRuG06P4kw36CoFGAKgmheMCVum1Pzdr-0mj9NiSNmJeNX-w/s400/Article-4-Electrolysis-Procedure-687x400.jpg" width="400" /></a></div>
In order to destroy the offending hair follicles and hopefully achieve permanent hair loss, electricity is another tool. Basically, it's an epilator with the addition of a small electrical current to destroy the hair root. Here is a <a href="http://www.hirsutism.com/hirsutism-treatments/electrolysis-hair-removal.shtml" target="_blank">description</a> of the procedure:<br />
<blockquote class="tr_bq">
Electrolysis is defined as the electrochemical destruction of the hair follicle. In electrolytic epilation a fine, disposable wire needle is inserted into the hair follicle. Through this needle, a regulated electric current, either direct or alternating, is transmitted from a highly state-of-the art instrument known as an epilator to destroy the germinative hair bulb. It can be correctly performed only by expert professionals. </blockquote>
<blockquote class="tr_bq">
The frequency of the electric current (as regulated by the FDA) is generally 13.56 MHz. The current may be either low power and administered for 3 to 20 seconds, or high power and given for less than a second (the commonly known flash technique).</blockquote>
There are several types of electrolysis available, including galvanic electrolysis, thermolysis, and the blend method. Descriptions of these can be found <a href="https://en.wikipedia.org/wiki/Electrology" target="_blank">here</a> and <a href="http://www.hirsutism.com/hirsutism-treatments/electrolysis-hair-removal.shtml" target="_blank">here</a>.<br />
<br />
Some people have very good results with electrolysis but it is a long process. Even when seen once a week, treatment for significant PCOS hirsutism may take months or even years. Redness and swelling often result after a session. Infections and scarring may occur. Treatments are expensive and painful and may not result in permanent removal of hair.<br />
<br />
Therefore, electrolysis seems most useful for women with small localized patches of hirsutism.<br />
<br />
<b><i><span style="color: #38761d;">Laser Therapy</span></i></b><br />
<br />
Some women with hirsutism choose to try <a href="http://www.hirsutism.com/hirsutism-treatments/laser-hair-removal.shtml" target="_blank">laser therapy</a>:<br />
<blockquote class="tr_bq">
Laser treatment employs a method called selective photothermolysis in order to destroy the hair follicle selectively. The laser is passed through the skin and specifically targets a chromophore called melanin, a natural pigment present in the hair follicle. Melanin absorbs the laser light at a specific wavelength and converts the laser into heat energy for destroying the hair tissue. Since melanin is located in the hair follicle but not the adjoining dermis, targeting it ensures selective damage of the follicle without harming neighboring tissues. However, melanin is present in the epidermis. Hence, laser methods must ensure that the skin is cooled off to prevent thermal damage of the epidermis.</blockquote>
Laser therapy can be used on larger areas of the body, unlike electrolysis. Treatment does not result in permanent hair loss, but the results do last much longer than other forms of treatment, usually several months. Treatment is often done in threes; one initial dose, another dose when hair regrowth appears several months later, and then a final dose when hair regrowth appears again. A lot depends on the type of laser used; see the article linked above for more specifics.<br />
<br />
Laser treatment can be somewhat painful and side effects like swelling and redness are quite common. Less common are more serious side effects like scarring and dyspigmentation. Although longer wave lengths can be used for people of color, laser therapy may cause scarring and damage in people with darker skin.<br />
<br />
<b><i><span style="color: #38761d;">Other Medications</span></i></b><br />
<b><i><br /></i></b>
Besides the anti-androgens listed above, another medication that may help with hirsutism is Vaniqa<span style="color: #38761d; font-weight: bold;"> (</span><a href="http://www.hirsutism.com/hirsutism-treatments/eflornithine-hirsutism.shtml" target="_blank">Eflornithine</a><b><span style="color: #38761d;">, </span></b>pronounced EE-floor-nih-theen). This cream is used to slow growth of unwanted hair, especially on the face. It's not a depilatory cream but rather an enzyme blocker.<br />
<br />
The drug works by blocking an enzyme (putrescine) needed for hair to grow. If the patient stops using the cream, the hair will grow back, so a long-term management plan is needed. Eflornithine is FDA-approved for the treatment of facial hirsutism and is considered safe to use during pregnancy.<br />
<br />
Like other medications and treatments, it can cause redness and irritation in the area being treated. It must be used for at least 8 weeks to be effective. Discontinuing it for substantial lengths of time would stop its effect.<br />
<br />
Although it is known to work successfully in women with facial hirsutism, its specific effectiveness at treating women with PCOS is currently unknown.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">To Treat or Not to Treat</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNS8yGVz-SWkQCkpLO0OA_vsjdvGYH7-pwQi6Sml_D250AA_SzMbFolokZc3QdgQuHdKL5mU8qr6NMgbfOptLKbYfhQriPWeySOI01YBxdx1pYckvSiqtJna7FOLNPmaIt9jtp3sOWt8k/s1600/hirsutism.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="137" data-original-width="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNS8yGVz-SWkQCkpLO0OA_vsjdvGYH7-pwQi6Sml_D250AA_SzMbFolokZc3QdgQuHdKL5mU8qr6NMgbfOptLKbYfhQriPWeySOI01YBxdx1pYckvSiqtJna7FOLNPmaIt9jtp3sOWt8k/s1600/hirsutism.jpg" /></a></div>
<br />
Of course, it is also a choice <i>not </i>to treat your cosmetic PCOS symptoms. Just because society says that women should look a certain way doesn't mean that we have to do so. After all, facial hair and thinning hair on the head is accepted in men, so why is it considered so unacceptable in women? It results from sexist double-standards, the idea that it is our main duty as women to be as sexually attractive as possible, and that this sexual attractiveness is measured by extremely narrow standards that very few women actually meet.<br />
<br />
Some women struggle for years to deal with cosmetic symptoms, find few treatments that work well for them, and in the end decide to opt out of even trying to treat these cosmetic symptoms. For some women, it can be a tremendously freeing to finally get off the merry-go-round of cosmetic treatments and trying to hide what is happening to them, just to meet some sexist standard of what women "should" look like. There is NO obligation to treat cosmetic symptoms if you don't want to do so.<br />
<br />
On the other hand, societal pressure causes most women to want to treat distressing cosmetic symptoms, and that's fine too. Although it is not fair that women are subjected to appearance double-standards, it is a fact of life that social judgment can have significant impacts on self-esteem, dating, and work opportunities. If a woman wants to treat her androgenic symptoms, this is also normal and understandable.<br />
<br />
The point is that each woman gets to decide on her own what she will and won't treat. There is no symptom that you <i>have </i>to treat. There is nothing wrong if you <i>want </i>to treat certain symptoms, and there is nothing wrong with opting <i>out </i>of treating those symptoms either. It's your choice.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Conclusion</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEialBwy0HEFrpcTcyaRXX07aCosgLSUx7aOj8fPUmMkAKhQPGuco83P0FEdMGdrAx_C2jR4l4tDjqJVCE-JJDhrdhrC8ZelXJ9kTyIiNHgf_dNCDx_5xMVYkK7YHOWWGnen9jD7T9ZcdGk/s1600/pcos+stronger+than.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="97" data-original-width="150" height="128" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEialBwy0HEFrpcTcyaRXX07aCosgLSUx7aOj8fPUmMkAKhQPGuco83P0FEdMGdrAx_C2jR4l4tDjqJVCE-JJDhrdhrC8ZelXJ9kTyIiNHgf_dNCDx_5xMVYkK7YHOWWGnen9jD7T9ZcdGk/s200/pcos+stronger+than.jpg" width="200" /></a></div>
Hirsutism is one of the more difficult and disheartening PCOS symptoms to deal with. There is no magical cure for it, only ways to manage it, each with its own trade off.<br />
<br />
Most women choose a variety of methods to deal with it. They may use medications to decrease the amount of hirsutism, while also using cosmetic removal methods. A lot depends on the degree of hirsutism and whether the woman is planning on having children anytime soon.<br />
<br />
If you are in your childbearing years, sexually active, and have any chance of conceiving, your best choice is probably cosmetic treatments, with the possible addition of metformin. Used carefully, this is pretty effective, especially in those with mild to moderate hirsutism.<br />
<br />
If you are not interested in or not ready to conceive and you have moderate to significant hirsutism, one of the most effective treatments is an Oral Contraceptive Pill <i>plus </i>spironolactone. Recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/29878857" target="_blank">research</a> shows that this is highly effective for many women with PCOS. Another choice is metformin plus an Oral Contraceptive Pill, which can be effective for mild to moderate cases.<br />
<br />
For those women who do not have childbearing capacity anymore (due to hysterectomy, tubal ligation, menopause, etc.), treatment can include metformin plus spironolactone, or an alpha-reductase inhibitor for very significant cases of hirsutism.<br />
<br />
Most women with mild hirsutism find all they need is cosmetic treatments. Those with significant hirsutism find they have to combine some form of medication with some form of cosmetic treatment in order to get the appearance they want.<br />
<br />
Whatever treatment you choose, there's no doubt that dealing with excess facial and body hair is <i>hard</i>. It strikes right at the heart of a woman's perceptions of her own femininity, and it affects how others view her as well.<br />
<br />
But you are not alone. There are many PCOS support groups available. These can provide invaluable emotional support when dealing with the emotional angst or social stigma of some of the cosmetic and medical side effects of PCOS.<br />
<br />
<b><span style="color: purple;">Remember, your symptoms do not define you.</span></b><br />
<br />
Cosmetic symptoms are distressing and you have every right to be upset and angry about them, but in the end, <i>they do not define who you are or what kind of life you can have. </i>Only YOU can do that.<br />
<br />
Women can have symptomatic PCOS and still have good, happy lives, regardless of what they do about their hirsutism. Half the battle is being determined to have a good life, regardless of whatever challenges you are handed.<br />
<br />
This is the only life you get; make the most of it! Don't let PCOS or its symptoms keep you from happiness.<br />
<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">References</span></b><br />
<b><br /></b>
<b><i><span style="color: #38761d;">General Information about Hirsutism</span></i></b><br />
<ul style="text-align: left;">
<li><a href="http://www.hirsutism.com/">www.hirsutism.com</a> - website with information about hirsutism</li>
<li><a href="http://dermnetnz.org/treatments/antiandrogens.html">http://dermnetnz.org/treatments/antiandrogens.html</a> - information about anti-androgen treatment for conditions including hirsutism</li>
<li><a href="https://www.pcosdietsupport.com/lifestyle/hairy-pcos-and-hirsutism/">https://www.pcosdietsupport.com/lifestyle/hairy-pcos-and-hirsutism/</a> - info about PCOS and hirsutism; lots of diet talk</li>
<li><a href="https://en.wikipedia.org/wiki/Hirsutism">https://en.wikipedia.org/wiki/Hirsutism</a> - Wikipedia entry about hirsutism</li>
<li><a href="https://www.aafp.org/afp/2012/0215/p373.html">https://www.aafp.org/afp/2012/0215/p373.html</a> - American Academy of Family Practice article on hirsutism and its treatment</li>
<li><a href="https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/booklet_hirsutism_and_pcos.pdf" target="_blank">https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/booklet_hirsutism_and_pcos.pdf </a>- info from reproductive society about hirsutism and its treatments, 2016</li>
</ul>
<div>
<b><i><span style="color: #38761d;">Information about Ferriman Gallwey Score</span></i></b></div>
<ul style="text-align: left;">
<li><a href="http://en.wikipedia.org/wiki/Ferriman%E2%80%93Gallwey_score">http://en.wikipedia.org/wiki/Ferriman%E2%80%93Gallwey_score</a> - Wikipedia entry </li>
<li><a href="http://www.hirsutism.com/hirsutism-biology/ferriman-gallwey-score.shtml">http://www.hirsutism.com/hirsutism-biology/ferriman-gallwey-score.shtml</a></li>
</ul>
<b><i><span style="color: #38761d;">Study Reviews</span></i></b><br />
<b><i><br /></i></b>
Am J Clin Dermatol. 2014 Jul;15(3):247-66. doi: 10.1007/s40257-014-0078-4. <b><span style="color: purple;">Hirsutism: an evidence-based treatment update. </span></b>Somani N, Turvy D. PMID: <a href="http://www.pubmed.gov/24889738" target="_blank">24889738</a><br />
<blockquote class="tr_bq">
...Four recently published RCTs met criteria for inclusion in our review. In addition, one meta-analysis and one systematic review/treatment guideline were identified in the recent literature. Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments. Evidence supports the use of electrolysis for permanent hair removal in localized areas and lasers (particularly alexandrite and diode lasers) for permanent hair reduction. Topical eflornithine can be used as monotherapy for mild hirsutism and as an adjunct therapy with lasers or pharmacotherapy in more severe cases. Combined OCPs as a class are superior to placebo; however, antiandrogenic and low-dose neutral OCPs may be slightly more efficacious in improving hirsutism compared with other types of OCPs. Antiandrogens are indicated for moderate to severe hirsutism, with spironolactone being the first-line antiandrogen and finasteride and cyproterone acetate being second-line antiandrogens. Due to its risk for hepatotoxicity, flutamide is not considered a first-line therapy. If used, the lowest effective dose should be administered with careful monitoring of liver enzymes. Monotherapy with an insulin sensitizer does not significantly improve hirsutism. While insulin sensitizers improve important metabolic and endocrine aberrations in polycystic ovary syndrome, they are not recommended when hirsutism is the sole indication for use. Lifestyle modification counseling is recommended. Gonadotropin-releasing hormone analogs and glucocorticoids are only recommended in specific circumstances. Additional therapies without sufficient supportive evidence of efficacy are ovarian surgery, statins (HMG-CoA reductase inhibitors), and vitamin D supplementation...CONCLUSIONS: Risks and benefits of treatment must be carefully considered and discussed with the patient. Expectations for efficacy should be appropriately set. <b>A minimum of 6 months is required to see benefit from pharmacotherapy and lifelong treatment is often necessary for sustained benefit.</b></blockquote>
Cochrane Database Syst Rev. 2015 Apr 28;(4):CD010334. doi: 10.1002/14651858.CD010334.pub2. <b><span style="color: purple;">Interventions for hirsutism (excluding laser and photoepilation therapy alone). </span></b>van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N. PMID: <a href="http://www.pubmed.gov/25918921" target="_blank">25918921</a><br />
<blockquote class="tr_bq">
Hirsutism occurs in 5% to 10% of women of reproductive age when there is excessive terminal hair growth in androgen-sensitive areas (male pattern). It is a distressing disorder with a major impact on quality of life. The most common cause is polycystic ovary syndrome. There are many treatment options, but it is not clear which are most effective... AUTHORS' CONCLUSIONS: Treatments may need to incorporate pharmacological therapies, cosmetic procedures, and psychological support. For mild hirsutism there is evidence of limited quality that OCPs are effective. Flutamide 250 mg twice daily and spironolactone 100 mg daily appeared to be effective and safe, albeit the evidence was low to very low quality. Finasteride 5 mg daily showed inconsistent results in different comparisons, therefore no firm conclusions can be made. As the side effects of antiandrogens and finasteride are well known, these should be accounted for in any clinical decision-making. There was low quality evidence that metformin was ineffective for hirsutism and although GnRH analogues showed inconsistent results in reducing hirsutism they do have significant side effects.Further research should consist of well-designed, rigorously reported, head-to-head trials examining OCPs combined with antiandrogens or 5α-reductase inhibitor against OCP monotherapy, as well as the different antiandrogens and 5α-reductase inhibitors against each other. Outcomes should be based on standardised scales of participants' assessment of treatment efficacy, with a greater emphasis on change in quality of life as a result of treatment.</blockquote>
<b><i><span style="color: #38761d;">Treatment of Hirsutism</span></i></b><br />
<ul style="text-align: left;">
<li><a href="http://www.endo-society.org/guidelines/final/upload/Hirsutism_Guideline.pdf">http://www.endo-society.org/guidelines/final/upload/Hirsutism_Guideline.pdf</a> - Endocrine Society's guideline to treating hirsutism in pre-menopausal women </li>
<li><a href="http://pcos.about.com/od/relatedconditions/a/hirsutism.htm">http://pcos.about.com/od/relatedconditions/a/hirsutism.htm</a> - about.com summary of dealing with hirsutism</li>
<li><a href="http://www.obgmanagement.com/home/article/polycystic-ovary-syndrome-cosmetic-and-dietary-approaches/3cb861d829fb000d1a47246a4548cd27.html">http://www.obgmanagement.com/home/article/polycystic-ovary-syndrome-cosmetic-and-dietary-approaches/3cb861d829fb000d1a47246a4548cd27.html</a> - article for OBs about using anti-androgens for treating PCOS hirsutism [<i>trigger warning: weight loss talk]</i></li>
<li><a href="https://wellroundedmama.blogspot.com/2015/09/pcos-treatment-anti-androgen-medications.html">https://wellroundedmama.blogspot.com/2015/09/pcos-treatment-anti-androgen-medications.html</a> - My article on anti-androgen medications for various symptoms; lots of references</li>
</ul>
</div>
</div>
</div>
</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-18845981439072432722018-09-07T13:38:00.002-07:002018-09-07T13:38:56.930-07:00Inositol for PCOS anovulation: 2018 Review<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgX5aVbnEFfNGk5O643gTUybkxI7g4-NxnfIyQTRvASAYmnZ2E0lwYL01GsC-_44yrA5r2dcdUuWFypHmdao6Y-68Y1WfzV3pNQDomi-rZinMK3UYQnZkyqf__oyMdleklQfE0IxnjTznM/s1600/inositol+bottle2.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgX5aVbnEFfNGk5O643gTUybkxI7g4-NxnfIyQTRvASAYmnZ2E0lwYL01GsC-_44yrA5r2dcdUuWFypHmdao6Y-68Y1WfzV3pNQDomi-rZinMK3UYQnZkyqf__oyMdleklQfE0IxnjTznM/s320/inositol+bottle2.JPG" width="320" /></a></div>
It's September, and that means it's time for PCOS Awareness Month. We have a continuing <a href="https://wellroundedmama.blogspot.com/search/label/PCOS" target="_blank">series</a> on Polycystic Ovarian Syndrome (PCOS) that looks at various PCOS issues from a weight-neutral point of view.<br />
<br />
One of the most exciting treatments on the horizon for Polycystic Ovarian Syndrome (PCOS) is inositol, either myo-inositol or d-chiro-inositol, or a combination of both. We've <a href="https://wellroundedmama.blogspot.com/2013/10/pcos-treatment-inositols.html" target="_blank">discussed</a> it before, but now there is a recent meta-analysis of the literature.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">New Review of Inositol for Fertility</span></b><br />
<br />
Here is a review of the best research we have so far on inositol for fertility issues in women with PCOS. There are other studies, but these studies met high enough standards for quality to be considered for this analysis.<br />
<br />
The good news is that the results so far are quite encouraging. The bad news is that it's clear we still need better-designed trials.<br />
<br />
Let's start with the bad news. There was little uniformity in the protocols. Some studies used myo-inositol, some studies used d-chiro-inositol. Some studies compared inositols with metformin, others did not. Trials are also fairly small, which makes it harder to know how reliable the data is. Most importantly, no trials reported on live birth rates, which is the most important outcome.<br />
<br />
The good news is that overall, the review was quite positive. <b>The review's authors found that use of inositol improved ovulation rates and regularity of menstrual cycles. </b><br />
<br />
The review found that inositol was better than placebo (sugar pill), and was also more effective than metformin. In one study, it also increased pregnancy rates (3.3x compared to placebo, 1.5x compared to metformin), but we don't know how many of these ended up as live births. The authors concluded:<br />
<blockquote class="tr_bq">
Inositol appears to regulate menstrual cycles, improve ovulation and induce metabolic changes in polycystic ovary syndrome; however, evidence is lacking for pregnancy, miscarriage or live birth. A further, well-designed multicentre trial to address this issue to provide robust evidence of benefit is warranted. </blockquote>
So there are reasons to be cautiously optimistic about inositols, but a lot more research is needed. Come on, researchers, get this work going! Inositol's preliminary results look very promising so far, but we need much more data before it becomes standard of care. In particular, we need to know whether it improves the live birth rate in people with PCOS, which is the ultimate measure of successful treatment.<br />
<br />
Still, it's another tool in the toolbox that can be considered for women with PCOS who don't ovulate regularly. And on the whole, that's good news.<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">Reference</span></b><br />
<br />
BJOG. 2018 Feb;125(3):299-308. doi: 10.1111/1471-0528.14754. Epub 2017 Jul 14. <b><span style="color: purple;">Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials.</span></b> Pundir J, Psaroudakis D, Savnur P, Bhide P, Sabatini L, Teede H, Coomarasamy A, Thangaratinam S. PMID: <a href="http://www.pubmed.gov/28544572" target="_blank">28544572</a><br />
<blockquote class="tr_bq">
...Systematic review and meta-analysis of randomised controlled trials (RCT) that evaluated the effects of inositol as an ovulation induction agent... We included ten randomised trials. A total of 362 women were on inositol (257 on myo-inositol; 105 on di-chiro-inositol), 179 were on placebo and 60 were on metformin. Inositol was associated with significantly improved ovulation rate (RR 2.3; 95% CI 1.1-4.7; I2 = 75%) and increased frequency of menstrual cycles (RR 6.8; 95% CI 2.8-16.6; I2 = 0%) compared with placebo. One study reported on clinical pregnancy rate with inositol compared with placebo (RR 3.3; 95% CI 0.4-27.1), and one study compared with metformin (RR 1.5; 95% CI 0.7-3.1). No studies evaluated live birth and miscarriage rates. Inositol appears to regulate menstrual cycles, improve ovulation and induce metabolic changes in polycystic ovary syndrome; however, evidence is lacking for pregnancy, miscarriage or live birth. A further, well-designed multicentre trial to address this issue to provide robust evidence of benefit is warranted. </blockquote>
<blockquote class="tr_bq">
Tweetable abstract: <b>Inositols improve menstrual cycles, ovulation and metabolic changes in polycystic ovary syndrome.</b></blockquote>
<br /></div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-35260610676634498372018-08-31T21:36:00.003-07:002018-08-31T21:36:51.568-07:00Keep Children in Rear-Facing Car Seats Longer<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnvK1ELIkdECv6tKooSnxQ12dyj586OuX5Wl2daM-kNeZ-qAOLEibkId6nJ0pebV9hU5ABdGRZemJHW6p2RLoOzEJVVI7X_jVsTGE3jfRFzqpyBP357nFQAsxYiX7OBucB8IN3oe3BrLY/s1600/CR-Cars-InlineHero-Child-in-Rear-Facing-Seat-8-18.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="674" data-original-width="1199" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnvK1ELIkdECv6tKooSnxQ12dyj586OuX5Wl2daM-kNeZ-qAOLEibkId6nJ0pebV9hU5ABdGRZemJHW6p2RLoOzEJVVI7X_jVsTGE3jfRFzqpyBP357nFQAsxYiX7OBucB8IN3oe3BrLY/s400/CR-Cars-InlineHero-Child-in-Rear-Facing-Seat-8-18.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Image from Consumer Reports article cited below</i></td></tr>
</tbody></table>
As we head into the new school year and the holiday weekend, it is a good time to remind parents and guardians to double-check their car seat usage.<br />
<br />
<b>The American Academy of Pediatrics (AAP) has issued new guidelines suggesting that parents keep their young children in rear-facing car seats until they reach the height or weight limits of that seat. </b><br />
<br />
In other words, don't be so eager to get those children front-facing because children really are safer rear-facing. <br />
<br />
In the past, AAP recommendations were age-based. Generally they recommended that children become front-facing at <a href="https://www.consumerreports.org/car-seats/new-rear-facing-car-seat-recommendations-remove-age-milestone/" target="_blank">age two</a>. But there is such a wide variation of size in children, even at the same age, that going only by age doesn't make sense. Also, research shows that rear-facing remains the safest position even for children older than two. Instead, parents should consult the height and weight limits of the car seat they use and use <i>those </i>to guide when to switch to front-facing.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Why Rear-Facing?</span></b><br />
<br />
It's important to keep children rear-facing as long as possible because it protects the child's head and neck more completely. If a young child is front-facing and an accident occurs, the child's body is restrained but the head is thrown forward, placing tremendous stress on the neck and spine at a time when they are not very strong or developed. If the child is rear-facing in the same scenario, most of the force pushes the child's head and back into the support of the car seat behind them, lessening the stress on the back and limiting extension of the neck.<br />
<br />
Research clearly shows that children are <a href="https://www.sciencedaily.com/releases/2018/04/180403085051.htm" target="_blank">safer</a> in rear-facing car seat positions whether the impact is from a head-on collision, a side-impact collision, or a rear-impact collision. This really is a no-brainer.<br />
<br />
From the Consumer Reports article on car seat safety:<br />
<blockquote class="tr_bq">
“Parents and caregivers should never be in a rush to move kids along to the next seat type or orientation,” says Emily Thomas, Ph.D., auto safety engineer at Consumer Reports’ <a href="https://www.consumerreports.org/cars-how-consumer-reports-tests-cars/">Auto Test Center</a>. “Each move to the next step can actually be a step down in terms of a child’s overall safety. In this case, making the transition to forward-facing too early exposes your child to head and spine injuries during a crash.”</blockquote>
<b><span style="color: #cc0000; font-size: large;">General Car Seat Guidelines</span></b><br />
<br />
Most parents do a pretty good job these days of using infant car seats correctly when babies are young. However, there is a distinct <a href="https://www.ncbi.nlm.nih.gov/pubmed/24167033" target="_blank">drop-off</a> of proper use as the child gets older.<br />
<br />
Car seat safety doesn't end when the child becomes a toddler or goes to preschool. Research <a href="https://www.ncbi.nlm.nih.gov/pubmed/26308122" target="_blank">shows</a> that during routine car seat inspections, about one-third of children over 4 years of age were "suboptimally restrained." There's a lot of room for improvement here.<br />
<br />
Consumer Reports suggests:<br />
<div>
<blockquote class="tr_bq">
<b><span style="color: blue;">Parents can expect to need a minimum of three seats to best protect their children through the car-seat years: a rear-facing infant seat, a convertible seat (used rear-facing first, then transitioned to forward-facing when appropriate) and a booster seat.</span></b></blockquote>
</div>
Here are some suggestions for safer car seat use:<br />
<ul style="text-align: left;">
<li><b>Start with a rear-facing infant seat or convertible car seat.</b> Always place it in the rear seat. The middle of the back seat is the safest spot in the car for a child</li>
<li><b>Switch from a rear-facing infant seat to a rear-facing convertible seat "<a href="https://www.consumerreports.org/convertible-car-seats/why-you-should-buy-a-convertible-car-seat-sooner-rather-than-later/" target="_blank">no later than your child's first birthday</a>"</b> This is because most babies outgrow their infant seat due to height, not weight, so be sure you pay attention to the height limits as well as weight limits</li>
<li><b>Get the best convertible car seat you can afford, one that goes up to the highest height/weight limits you can find</b>. Children really are safer rear-facing when they are young so find the car seat that will let you keep them rear-facing the longest</li>
<li><b>Children should remain rear-facing until they have reached the height or weight limit</b> <b>for rear-facing children in that seat</b>. At that point, switch to forward-facing in the convertible seat</li>
<li><b>Stay in the forward-facing convertible seat until the height or weight limit is exceeded</b> <b>for the forward-facing position</b>. Only then should you switch to a booster seat</li>
<li><b>Use a booster seat until the child outgrows the height or weight limits of that seat and a lap/shoulder belt fits them properly</b>. Most resources <a href="https://www.cdc.gov/features/passengersafety/index.html" target="_blank">advise</a> that children should be at least 4'9" tall and weigh at least 80 lbs. before they transition out of the booster seat. In some areas, 20% of child injuries under age 8 in car accidents resulted from <a href="https://www.ktvz.com/news/do-you-know-oregons-new-child-passenger-seat-law/620141389" target="_blank">using adult restraints instead of booster seats</a></li>
<li><b>Keep children in the back seat until the teenage years</b> (<a href="https://saferide4kids.com/blog/can-children-sit-in-the-front-seat-car/" target="_blank">at least 13</a>; in some states it is 14). Air bags in the front are rated for adults and can seriously injure or kill children. Older children may look fairly grown but their skeletal systems are still more vulnerable to force injuries. Restrained children in the front seat are <a href="https://www.ncbi.nlm.nih.gov/pubmed/15741356">about 40% more likely</a> to sustain an injury than restrained children in the rear seat</li>
</ul>
<div>
There are so many car seats brands and types; each has its own height/weight guidelines.<i> When in doubt, follow the guidelines that came with your car seat.</i><br />
<br />
Always keep the car seat's guidelines <u>with</u> the seat so they are easily found for reference. Tape them to the back or side of the seat. Some experts also <a href="https://www.thebump.com/news/car-seat-hack-write-vital-info" target="_blank">recommend</a> writing or attaching an ID tag to the car seat with the child's name, parent names, and pediatrician's name/number. That way if there is a significant accident and a relative is unable to give information or medical contacts, first responders have a lead on who the child is, their medical professional, and a way to find medical history. If your child has special needs, this is particularly important.<br />
<br />
Remember that there are many car seat safety inspection clinics <a href="https://www.safekids.org/events/field_type/check-event" target="_blank">available in the community</a>. Please use them. You can be very well-educated and still make mistakes that could be deadly.<br />
<br />
Many hospitals host car seat clinics regularly, and many fire departments and police departments sponsor them as well. Many parents go to these inspections when their kids are babies, but do not attend them once the child reaches pre-school or school age, thinking that they now know what to do. Yet frequent errors are found in children between ages four to twelve, and faulty restraint is a <a href="https://www.ncbi.nlm.nih.gov/pubmed/28552450" target="_blank">major cause of trauma and mortality</a> for children of that age. Don't assume you have it all down; rules change at times and it's easy to overlook a recalled seat or a change in guidelines.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Dealing with Pressure About Restraints</span></b><br />
<br />
One reason parents don't restrain their children optimally is due to a misunderstanding of the current guidelines. Guidelines do change over time as a result of research, but they represent the best current science on car seat safety that we have. As the research evolves, so do the guidelines.<br />
<br />
Unfortunately, many family members and community members aren't familiar with the latest research or minimize its importance. Many parents give in to pressure from family members or peers about car seat rules or simply get lax about them as children grow older.<br />
<br />
I know that car seat safety was a continuing source of discord in our family as we raised our children. My husband and I are in agreement on most parenting issues, but not always on safety issues. He and his family felt that many car seat safety guidelines were excessive and unnecessary.<br />
<br />
Front-facing vs. rear-facing was one of our biggest ongoing arguments. My husband and his family felt that I was being way too cautious by keeping my children rear-facing, especially once in a convertible seat. They wanted that child front-facing sooner than later. This was probably one of the most contentious parenting battles we had.<br />
<br />
It certainly was very tempting to turn the seat forward so I could see the child better when I was driving. I hated not being able to see what was going on with my infant when it was just the baby and me in the car. Also, once they were a little older, the children themselves <i>wanted </i>to be forward-facing so they could feel like Big Kids. It became like a rite of passage emotionally, both to the kids and to other family members. These are understandable reasons why parents ignore the guidelines ─ but the safety of the child should be the top priority. Rear-facing <i>is </i>safer.<br />
<br />
The fight over car seat safety didn't end there. My husband and his family also strongly pressured me to switch my children to a booster seat long before they outgrew the height/weight guidelines on the convertible seat. They felt I was being too much of a worrywart and the current safety recommendations were excessive. They also felt the children would be more comfortable in a booster. Still, I didn't give in. I knew the children were safer in a 5-point restraint than using an adult seat belt on a booster.<br />
<br />
Then of course, as the children got well into grade school, the family thought it was ridiculous to still have the kids in a booster. They pointed out how much more convenient it would be not to deal with boosters when carpooling or going on field trips. This argument resonated with me because not having boosters would certainly be easier, and I saw many of my children's peers starting to go without boosters. But again, boosters were safer and that's what really mattered. I gritted my teeth and held strong.<br />
<br />
The battle continued as the children became pre-teens. They were no longer in boosters, but now they wanted to ride in the front seat instead of the back. My husband was particularly susceptible to this argument. We had to have this discussion multiple times until the law mandated that pre-teens had to be in the back. Then he had no choice but to follow the rules or risk a ticket.<br />
<br />
He and his family always had good intentions and they were loving, supportive relatives, but they had a real blind spot about car seat safety. They simply refused to believe the guidelines. <i>However, this was one thing I would not compromise on. </i><br />
<br />
The safety of my children was always the MOST important thing and I knew the research. So I put my foot down on this battle and would not budge, but let me tell you it wasn't easy sometimes. In the end, it was a battle worth sustaining.<br />
<br />
Before you head out to school or on family trips, take a moment now to review the guidelines, review the height/weight limits on your current car seats, write in your children's IDs, and make sure they are properly restrained. Better safe than sorry.<br />
<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">Resources</span></b><br />
<br />
<ul style="text-align: left;">
<li><a href="https://www.consumerreports.org/car-seats/new-rear-facing-car-seat-recommendations-remove-age-milestone/" target="_blank">https://www.consumerreports.org/car-seats/new-rear-facing-car-seat-recommendations-remove-age-milestone/ </a> - Consumer Reports summary of new car seat guidelines. Easy to read and understand</li>
<li><a href="https://www.cdc.gov/features/passengersafety/index.html">https://www.cdc.gov/features/passengersafety/index.html</a> - Center for Disease Control (CDC) guidelines on using car seats and when to switch. <i>Note</i>: Still has outdated guidelines on age</li>
<li><a href="https://www.consumerreports.org/convertible-car-seats/why-you-should-buy-a-convertible-car-seat-sooner-rather-than-later/">https://www.consumerreports.org/convertible-car-seats/why-you-should-buy-a-convertible-car-seat-sooner-rather-than-later/</a> - when to switch from an infant seat to a convertible (but still stay rear-facing). <i>Note</i>: Older article, so it refers the outdated guidelines about ages for switching</li>
<li><a href="https://www.sciencedaily.com/releases/2018/04/180403085051.htm">https://www.sciencedaily.com/releases/2018/04/180403085051.htm</a> - rear-facing car seats are safest for head-on crashes, side impact crashes, and rear-impact crashes</li>
<li><a href="https://saferide4kids.com/blog/can-children-sit-in-the-front-seat-car/">https://saferide4kids.com/blog/can-children-sit-in-the-front-seat-car/</a> - when can kids right in the front seat of the car and why </li>
<li><a href="https://www.ncbi.nlm.nih.gov/pubmed/21422088">https://www.ncbi.nlm.nih.gov/pubmed/21422088</a> - The old AAP guidelines with specific ages</li>
</ul>
<br />
J Trauma Acute Care Surg. 2015 Sep;79(3 Suppl 1):S48-54. doi: 10.1097/TA.0000000000000674. <b><span style="color: purple;">Car seat inspection among children older than 3 years: Using data to drive practice in child passenger safety. </span></b>Kroeker AM, Teddy AJ, Macy ML. PMID: <a href="http://www.pubmed.gov/26308122" target="_blank">26308122</a><br /><blockquote class="tr_bq">
BACKGROUND: Motor vehicle crashes are the leading cause of unintentional death and disability among children 4 years to 12 years of age in the United States. Despite the high risk of injury from motor vehicle crashes in this age group, parental awareness and child passenger safety programs in particular may lack focus on this age group. METHODS: This is a retrospective cross-sectional analysis of child passenger safety seat checklist forms from two Safe Kids coalitions in Michigan (2013) to identify restraint type upon arrival to car seat inspections... Just 10.8% of the total seats inspected were booster seats. Child safety seats for infant and young children were more commonly inspected (rear-facing carrier [40.3%], rear-facing convertible [10.2%], and forward-facing [19.3%] car seats). Few children at inspections used a seat belt only (5.4%) or had no restraint (13.8%). <b>Children 4 years and older were found to be in a suboptimal restraint at least 30% of the time.</b> CONCLUSION: Low proportions of parents use car seat inspections for children in the booster seat age group. The proportion of children departing the inspection in a more protective restraint increased with increasing age. This highlights an area of weakness in child passenger safety programs and signals an opportunity to strengthen efforts on The Booster Age Child.</blockquote>
J Pediatr. 2017 Aug;187:295-302.e3. doi: 10.1016/j.jpeds.2017.04.044. Epub 2017 May 25. <b><span style="color: purple;">Factors Associated with Pediatric Mortality from Motor Vehicle Crashes in the United States: A State-Based Analysis.</span></b> Wolf LL, Chowdhury R, Tweed J, Vinson L, Losina E, Haider AH, Qureshi FG. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/28552450" target="_blank">28552450</a><br /><blockquote class="tr_bq">
...Using the 2010-2014 Fatality Analysis Reporting System, we identified passengers <15 years of age involved in fatal MVCs, defined as crashes on US public roads with ≥1 death (adult or pediatric) within 30 days. We assessed passenger, driver, vehicle, crash, and state policy characteristics as factors potentially associated with MVC-related pediatric mortality. Our outcomes were age-adjusted, MVC-related mortality rate per 100 000 children and percentage of children who died of those in fatal MVCs. Unit of analysis was US state... RESULTS: Of 18 116 children in fatal MVCs, 15.9% died. The age-adjusted, MVC-related mortality rate per 100 000 children varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate of 0.94). <b>Predictors of greater age-adjusted, MVC-related mortality rate per 100 000 children included greater percentage of children who were unrestrained or inappropriately restrained (P < .001) </b>and greater percentage of crashes on rural roads (P = .016)... For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1100 pediatric deaths averted over 5 years....</blockquote>
<br /></div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-72816783342114609312018-08-24T15:14:00.002-07:002018-08-24T15:14:50.551-07:00Study: Pre-Conception Screening with Higher Weight Women<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaUX6oY6QWuIFHg1fqIeuZxfhPKGv_Psrfqhtm1ZhLQSBO9J9ooyDqkjYlz6YAkCmPjDJxtRWkrCIN6Cn2AVTIG9BnGPA_bIS44Oi0TloC4OzkzSXjZMWiuuMo8TQr9WSKzJxOAJPRPy0/s1600/stethoscope_2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="520" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaUX6oY6QWuIFHg1fqIeuZxfhPKGv_Psrfqhtm1ZhLQSBO9J9ooyDqkjYlz6YAkCmPjDJxtRWkrCIN6Cn2AVTIG9BnGPA_bIS44Oi0TloC4OzkzSXjZMWiuuMo8TQr9WSKzJxOAJPRPy0/s400/stethoscope_2.jpg" width="346" /></a></div>
In 2017, researchers from Harvard Medical School and the Brigham & Women's Hospital published a <a href="http://www.pubmed.gov/28620542" target="_blank">study</a> on pre-conception consults with "obese" women and the outcomes of those consults. This study pointed out a couple of glaring problems with pre-conception consults for women of size, but as always, the authors ended up <i>focusing on the wrong problem. </i><br />
<b><span style="color: #cc0000; font-size: large;"><br /></span></b>
<b><span style="color: #cc0000; font-size: large;">Study Details</span></b><br />
<br />
The consults were mostly done for women with fertility concerns who were seeking fertility treatment. 28% had a pre-existing diagnosis of Polycystic Ovarian Syndrome (PCOS), which often leads to sub-fertility in women of size. These consults were not with regular OBs or midwives; these consults were with Maternal-Fetal Medicine (MFM) specialists, who mainly see complicated or extra risky pregnancies. If anyone should have gotten pre-conception counseling right, it should have been these docs. But what researchers found were significant problems.<br />
<br />
The researchers reviewed the charts of 162 consults between 2008 and 2014. They were looking for 3 main things in the records:<br />
<ol style="text-align: left;">
<li>Documentation of discussion of obesity-related risks and complications</li>
<li>Documentation that lab tests were performed to be sure blood pressure and blood sugar were normal</li>
<li>Whether doctors advised weight loss before pregnancy, whether people took the weight loss advice via consults with the hospital's Weight Management Program, bariatric surgery, or other programs, and if so, how much weight was lost</li>
</ol>
<b><span style="color: #cc0000; font-size: large;">Discussion of Obesity-Related Risks</span></b><br />
<br />
Unsurprisingly, doctors talked about obesity-related risks in 96% of the MFM consults. With all the emphasis in the media and in the research about the risks of obesity in pregnancy, that's to be expected. We can only hope this was done in a neutral and fair way, rather than through scare-mongering and exaggeration, but there's not much information on how the risks were presented.<br />
<br />
Discussion of potential risks is part of a medical professional's job, so no one is suggesting that this should not have been covered. But <i>how </i>they discuss risk matters. Is it done in a gloom-and-doom way, is it shaming or condescending, or is it simply information provided without judgment? Do doctors emphasize ways to mitigate risk beyond losing weight? Are risk ratios the only method used (which tends to inflate the perception of risk) or are actual numerical incidences used? Do doctors acknowledge that complications are not a foregone conclusion and that many women of size can have normal pregnancies and healthy babies?<br />
<br />
Risk discussions about weight are difficult and can be fraught with emotions. Shaming and scolding backfire because most people stop listening and tune out. Most people of size have experienced such negative contacts with healthcare professionals that they have learned to block out the gloom-and-doom predictions. Exaggerating the risk results in people not taking the discussion seriously and not listening to the important advice that might be given on prevention.<br />
<br />
We need a different way to discuss risk surrounding weight in pregnancy. Couch the discussion in neutral terms without being judgmental. Use actual incidence figures to give numerical context to risk ratios, and make sure patients understand the difference. Acknowledge that positive outcomes are possible, and suggest ways (beyond just focus on the scale) to mitigate the risk. This is much more empowering to women and more likely to be heard and heeded. Potential complications can be discussed, but with explanations of how such problems would be addressed whenever possible. Don't center the entire discussion around weight; encourage good habits like regular exercise without tying it to the scale.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Screening for Diabetes and High Blood Pressure</span></b><br />
<br />
Part of every preconception consult for people of size should be measuring blood sugar and blood pressure. High blood sugar in early pregnancy is strongly <a href="https://www.ncbi.nlm.nih.gov/pubmed/20042435" target="_blank">tied</a> to birth defects. High blood pressure issues in pregnancy often <a href="https://www.ncbi.nlm.nih.gov/pubmed/29914278" target="_blank">lead</a> to too-small babies, premature births, and sometimes even death for mother or baby. Discovering these conditions before pregnancy and getting them under control before conception can definitely improve outcomes.<br />
<br />
<b>Shockingly, only about <i>half </i>of obese women were screened for diabetes and high blood pressure at the MFM consult:</b><br />
<blockquote class="tr_bq">
Screening for diabetes and hypertension occurred in 48% and 51% of consults, respectively. </blockquote>
This is very surprising, and a <i>tremendous </i>missed opportunity. While most obese women do not have diabetes or blood pressure issues before pregnancy, some certainly do, and those pregnancies are responsible for much of the less ideal outcomes from high BMI pregnancies.<br />
<br />
A preconception consult is the perfect time to discover whether there are pre-existing problems, take action, and hopefully prevent some of the worst-case scenarios. Therefore it's stunning that MFM specialists screened only <i>half </i>of the people of size for these conditions ahead of time.<br />
<br />
This is the most important finding of this study, in my opinion. Medical professionals need to be sure to test for these conditions before pregnancy whenever possible. People of <i>all </i>sizes should have their blood pressure taken (with the <a href="https://wellroundedmama.blogspot.com/2009/03/importance-of-blood-pressure-cuff-size.html" target="_blank">correct-sized cuff</a>) and a medical history taken. People who are at increased risk for diabetes (such as higher-weight people, people with PCOS, people with a strong family history of diabetes, etc.) should also have their blood sugar tested pre-conception if possible.<br />
<br />
If your care provider does not order these tests in your regular check-ups, then you need to take matters in your own hands and arrange for them to be done. Even if you are not planning a pregnancy, many pregnancies occur unplanned. Getting regular monitoring of your blood sugar levels and blood pressure if you are sexually active is simply common sense. So is taking a prenatal vitamin regularly.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Weight Loss Advice and Follow-Through</span></b><br />
<br />
Because most doctors are taught that weight loss is the main way to prevent complications in high BMI women, advice to lose weight before pregnancy is common. The authors state:<br />
<blockquote class="tr_bq">
Ideally, an MFM consult should not only inform an obese woman of the impact of her weight on fertility and pregnancy, but also equip her with strategies for weight loss.</blockquote>
In fact, it is that hospital's policy that all women with a BMI over 40 who are seeking fertility treatment should be automatically referred to the hospital's Weight Management program, "which includes calorie-controlled diet and liquid diet programs in addition to other medical treatments for obesity."<br />
<br />
With a protocol like this in place, it's understandable that the researchers were disappointed that weight loss referrals weren't universally given in the consults. Just over half of participants were documented as having received advice on diet and exercise. As BMI went up, more were given such advice, as well as referrals to bariatric surgery, but it was by no means universal even at the largest sizes.<br />
<br />
Researchers were shocked by how few women took active measures to lose weight. In the study,<br />
<blockquote class="tr_bq">
27% of patients saw a nutritionist, 6% saw a provider for a medically supervised weight loss program, and 6% underwent bariatric surgery... The median weight change was a loss of 2.0 lb, or 0.6% body weight, over a median of 12 months.... Rates of any pregnancy and of ongoing pregnancy were not associated with whether women lost ≥5% body weight.</blockquote>
The authors of the study acknowledge that most women, especially those facing fertility challenges, don't want to delay treatment for the elusive dream of losing weight, and that this likely was why most patients did not opt into the Weight Management or bariatric surgery programs. Most began fertility treatments within a month or so after their MFM consult.<br />
<br />
It should also be pointed out that the median weight change was TWO POUNDS... not exactly outstanding results. Those who waited and lost more than 5% of body weight did not have more pregnancies, calling into question whether weight loss is as effective for fertility as doctors assume.<br />
<br />
But of course doctors ignored these findings and just called for more weight loss emphasis in pre-conception consults. The authors state:<br />
<blockquote class="tr_bq">
...the consults were unsuccessful in meaningfully effecting pre-pregnancy weight loss. In this study, only 19% of the participants with follow-up weights achieved ≥5% loss, and only 5% achieved ≥10% loss. We believe that increased emphasis is needed on weight loss resources, including discussion of lifestyle modification and referrals to specialty obesity treatment services, e.g. bariatric surgery. In addition, MFM providers and referring REI providers must be allied in counseling women to delay fertility treatment and conception to focus on weight loss. This recommendation is more nuanced in the case of women of advanced maternal age, when postponing fertility treatment may result in loss of the fertile window and may therefore be untenable. ...More emphasis is needed on weight loss resources and delaying pregnancy to achieve weight loss goals. </blockquote>
Here we go, back to the same old medical mentality. It's all about losing weight before pursuing pregnancy, even when they can see that most women are not interested in that, even when most women lost very little weight despite trying, and even when such weight loss may not make <a href="https://www.ncbi.nlm.nih.gov/pubmed/27192672" target="_blank">a difference</a> in <a href="https://wellroundedmama.blogspot.com/2018/08/the-turkey-awards-obesity-eugenics-via.html" target="_blank">live birth rates</a>.<br />
<div>
<br /></div>
It's like doctors are incapable of thinking outside the box. They know the colossal failure of weight loss programs but are in such denial they cannot admit that these basically useless. Instead, their answer is MORE emphasis on weight loss programs, with a fallback to bariatric surgery if all else fails.<br />
<br />
It is telling that no acknowledgement was made of many people's long history of dieting ups and downs and the tremendous frustration of yo-yo dieting. Many patients are just <i>done </i>with radical weight loss programs because they know that they are not effective long-term and they are not willing to live like that.<br />
<br />
Like most in the weight loss field, these researchers remained determinedly obtuse. It's weight loss above everything else, at any cost. And while some higher weight people are interested in this, many are not.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Discussion of Study</span></b><br />
<br />
It's clear from the summary at the end of the paper that the main result of this study is going to be an increased pressure on MFM specialists to push weight loss before treatment. More pressure will be brought on doctors to refer patients to the hospital's Weight Management and bariatric surgery programs. The question is whether women will be free to accept or decline these programs at will.<br />
<br />
It's one thing to offer someone access to weight management programs; some want this and that's their choice. It's another thing to browbeat women into these programs, and it's a completely different thing to <i>require </i>them. While this center did not deny higher BMI women access to fertility treatment without weight loss first, that seems to be the direction they are heading, and that's alarming.<br />
<br />
Although these hospitals deny a profit motive, let's not forget that weight loss programs are big money-makers for hospitals, so financial incentives may also play a role. The weight loss industry is BIG BUSINESS and many doctors are utterly compromised by their ties to these programs. They may be unconsciously biased and not even recognize it. Ties to the pharmaceutical industry are treated with far more caution than ties to the weight loss industry, but money talks in the bariatric field as loudly as any other.<br />
<br />
<b>The biggest take-away from this study should not be that more emphasis on weight loss before pregnancy is needed. </b><br />
<b><span style="color: blue;"><br /></span></b>
<b><span style="color: blue;">Instead, the most important take-away SHOULD be the fact that medical professionals are not adequately testing to make sure the woman is in reasonable health before pregnancy. </span></b><br />
<br />
The fact that only HALF of the women were not even tested for blood pressure and blood sugar issues, yet the study authors conclude that weight loss referral is the most pressing issue shows that medical professionals are too narrowly focused on the scale. They have blinders on and cannot see anything else.<br />
<br />
Weight should not be used as a surrogate for whether a person is healthy. Instead, documentation of blood pressure and blood sugar and other labs should be done, and treatment of any problems initiated or adjusted if needed. <i>That </i>will likely have more downstream improvement of outcome than trying to ensure that all the women lose at least 10% of their bodyweight first.<br />
<br />
That doesn't mean that lifestyle and health habits should be ignored. Instead, people's individual habits should be evaluated in a non-judgmental manner, and suggestions for improvements can be gently made to people of <i>all </i>sizes. Advice about nutrition doesn't have to be about restricting calories; combining proteins with carbs and limiting high glycemic index carbs may help prevent some complications without necessarily resulting in weight loss. Exercise can strongly improve outcomes, even if it doesn't lead to weight loss. Lab tests can be run to see if any particular nutrients are deficient and need boosting. Nutritional consults can be very useful if they are done right.<br />
<br />
In the study, 27% of women were willing to see a nutritionist before pregnancy, while only 6% were willing to enroll in a Weight Management program. That means there is an opportunity here for a <a href="https://wellroundedmama.blogspot.com/2008/07/health-at-every-size-paradigm.html" target="_blank">Health At Every Size</a>® approach instead, which would emphasize healthy habits and food, regular exercise, and lab tests as measures of health instead of the scale. This may do more to improve outcome than trying to get women to lose 10% or more of their bodyweight.<br />
<br />
<b>Doctors need more tools in their maternal obesity toolbox besides weight loss</b>. They need to think about prevention <i>beyond </i>just losing weight before pregnancy.<br />
<br />
Testing for pre-existing conditions before pregnancy is a cornerstone of the toolbox. Too bad these researchers missed the bus on emphasizing this as their main message.<br />
<br />
<br />
<br />
<b><span style="color: #cc0000; font-size: x-large;">Reference</span></b><br />
<br />
Fertil Res Pract. 2017 Jan 13;3:3. doi: 10.1186/s40738-016-0030-9. eCollection 2017.<b><span style="color: purple;"> Preconception consultations with Maternal Fetal Medicine for obese women: a retrospective chart review. </span></b>Page CM, Ginsburg ES, Goldman RH, Zera CA. PMID: <a href="http://www.pubmed.gov/28620542" target="_blank">28620542</a> Full text <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424381/" target="_blank">here</a>.<br />
<blockquote class="tr_bq">
...The purpose of this study was to evaluate the quality and effectiveness of Maternal Fetal Medicine (MFM) preconception consults for obese women. METHODS: We performed a retrospective chart review examining 162 consults at an academic medical center from 2008 to 2014. The main outcome measures included consultation content - e.g. discussion of obesity-related pregnancy complications, screening for comorbidities, and referrals for weight loss interventions - and weight loss. RESULTS: <b>Screening for diabetes and hypertension occurred in 48% and 51% of consults, respectively. </b>Discussion of obesity-related pregnancy complications was documented in 96% of consults. During follow-up (median 11 months), 27% of patients saw a nutritionist, 6% saw a provider for a medically supervised weight loss program, and 6% underwent bariatric surgery. The median weight change was a loss of 0.6% body weight. CONCLUSIONS: <b>In this discovery cohort, a large proportion of MFM preconception consultations lacked appropriate screening for obesity-related comorbidities. </b>While the vast majority of consultations included a discussion of potential pregnancy complications, relatively few patients achieved significant weight loss. More emphasis is needed on weight loss resources and delaying pregnancy to achieve weight loss goals.<br />
<div>
<br /></div>
</blockquote>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-38877207907670756442018-08-12T17:50:00.001-07:002018-08-12T17:50:58.863-07:00The Turkey Awards: Obesity Eugenics via Fertility Treatment Denial<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDX9mIqG9HDgjitoyDAkKHdmM9hikFUNdIql4V5qRJTdlV3un246uKK8Fdi-DJtGiuRSmJ6dTOPdZgddiUVvVrC0BQ8Ij6TLeXWIL1L4eh3m3RcSMawdsFsNHZWE2MAuB3SB3NUCb6Z0k/s1600/Royal-palm-turkey-tom%252C+mother+earth+news.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="450" data-original-width="500" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDX9mIqG9HDgjitoyDAkKHdmM9hikFUNdIql4V5qRJTdlV3un246uKK8Fdi-DJtGiuRSmJ6dTOPdZgddiUVvVrC0BQ8Ij6TLeXWIL1L4eh3m3RcSMawdsFsNHZWE2MAuB3SB3NUCb6Z0k/s400/Royal-palm-turkey-tom%252C+mother+earth+news.jpg" width="400" /></a></div>
<br />
We've been talking about Obesity Eugenics, when authorities try to keep people of size from reproducing through negative media campaigns, scare tactics, risk hyperbole, apocryphal stories, push for normal BMI before conception, and pressure for sterilization or termination. This incredibly insensitive and discriminatory movement is the winner of not one, but <i>two</i> Turkey Awards. It's time to call out these egregious practices.<br />
<br />
If you aren't familiar with them, the Turkey Awards are the "prizes" I hand out to highlight fat-phobic treatment of people of size from care providers, biased attitudes or studies from researchers, or troubling trends in the care of fat pregnant women these days.<br />
<br />
Last year's Turkey Award was delayed so I'm doing two years in a row now. I've already done the first half; attention to the <a href="https://wellroundedmama.blogspot.com/2018/07/9th-turkey-awards-obesity-eugenics.html" target="_blank">Obesity Eugenics Media Campaign</a>. Now it's time to highlight the egregious lack of access to fertility treatment for people of size.<br />
<br />
In past years, we've talked about:<br />
<ul style="text-align: left;">
<li>#1: <a href="http://www.wellroundedmama.blogspot.com/2008/11/first-annual-turkey-awards.html">fat-phobic care providers</a></li>
<li>#2: <a href="http://www.wellroundedmama.blogspot.com/2009/11/second-annual-turkey-awards.html" target="_blank">scare-mongering and shaming tactics</a></li>
<li>#3: <a href="http://www.wellroundedmama.blogspot.com/2010/11/third-annual-turkey-awards-jumping-to.html">jumping to conclusions about risks</a></li>
<li>#4: <a href="http://www.wellroundedmama.blogspot.com/2011/12/fourth-annual-turkey-awards-leaps-of.html">scorched earth tactics</a></li>
<li>#5: <a href="http://www.wellroundedmama.blogspot.com/2013/01/fifth-annual-turkey-awards-prenatal.html">prenatal weight gain extremism</a></li>
<li>#6: <a href="http://www.wellroundedmama.blogspot.com/2013/11/sixth-annual-turkey-awards-pcos-isnt.html">fat-phobic attitudes around treatment of PolyCystic Ovarian Syndrome</a>(PCOS)</li>
<li>#7: <a href="http://www.wellroundedmama.blogspot.com/2015/04/seventh-annual-turkey-awards.html">astronomically high cesarean rates in women of size</a></li>
<li>#8: <a href="http://wellroundedmama.blogspot.com/2016/02/eighth-annual-turkey-awards-weight-bias.html" target="_blank">weight bias in the treatment of lipedema</a> </li>
<li>#9: <a href="https://wellroundedmama.blogspot.com/2018/07/9th-turkey-awards-obesity-eugenics.html" target="_blank">obesity eugenics media campaigns</a></li>
<li>#10: obesity eugenics via fertility treatment denial</li>
</ul>
We've already seen in the previous Turkey Award that many care providers believe that "obese" women have no business being pregnant. As a result, there has been a concerted public health campaign in recent years to reduce pregnancies in high BMI women. Today we talk about one of the most widely accepted and insidious ways the medical establishment promotes Obesity Eugenics ─ by denying access to fertility treatment.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Lack of Access to Fertility Treatment</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj92Iwn39kbaKUZiSxA-1d9CEVNMfrfRs17ynkm1BwKgOf4XtuWXHsTdgJRhqBeqEMUCvr6XF4Kz22vBLBomW5gE5j6qfmb9iGrDDRnkkukZR9GntYhOumDNrPZKBrkmf29D9zrAzIEYtU/s1600/Should+obese+women+be+denied+fertility+treatments+Hamilton+Spectator+2011.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="759" data-original-width="802" height="377" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj92Iwn39kbaKUZiSxA-1d9CEVNMfrfRs17ynkm1BwKgOf4XtuWXHsTdgJRhqBeqEMUCvr6XF4Kz22vBLBomW5gE5j6qfmb9iGrDDRnkkukZR9GntYhOumDNrPZKBrkmf29D9zrAzIEYtU/s400/Should+obese+women+be+denied+fertility+treatments+Hamilton+Spectator+2011.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from <a href="https://www.dailytelegraph.com.au/news/nsw/concerns-about-obese-women-getting-ivf-despite-health-risks-for-mums-and-bubs/news-story/1ad8a9029ec9a30067b09bbd2aee23ce" target="_blank">The Hamilton Spectator, 2011</a></i></td></tr>
</tbody></table>
Denying access to fertility treatment via BMI restrictions is a widely-accepted practice in the medical community. It is driven by risk hyperbole, economics, and weight bias.<br />
<blockquote class="tr_bq">
<b><span style="color: purple;">“Fat women only have babies because we can’t stop them; we’re certainly not going to help you conceive.”</span></b> <i>– Family Practice doctor to woman dealing with infertility</i></blockquote>
In many fertility clinics these days, women above a certain BMI are not permitted to access fertility treatments. In many clinics the cutoff is a BMI of 35, but in the U.K., the limit is usually a BMI of 30. Here is <a href="https://fathealth.wordpress.com/2011/05/23/too-fat-to-get-pregnant-need-wls-ob-gyn-doesnt-believe-patient/" target="_blank">one story</a> of a woman denied fertility treatment and pressured for bariatric surgery because of her weight.<br />
<blockquote>
The first thing out of the gynaecologist's mouth was “How much do you weigh”. 135kg <i>[297 lbs</i>]. “Do you realise how obese you are?” I then told her I have been working hard to lose weight through diet and exercise, thinking to cut her off before she got into her fat-bashing rant. As I explained that I had lost 15kg since January, was doing 90 minutes of cardio at the gym 5 times a week, and eating a low GI, low-fat, low-carb diet. She rolled her eyes at me in disbelief. Her reply was, “You are too fat for a baby. You need to get down to 65kg <i>[143 lbs.</i>] before I will help you”. At that point I should have stood up, told her to go f*** herself and walked out but I was stunned. I guess she took the stunned silence as agreement because then she whipped out the lapbanding pamphlet and told me I had to have weight loss surgery. </blockquote>
Stories abound of women denied fertility treatment because of weight. One woman was <a href="https://fathealth.wordpress.com/2007/07/19/it-would-be-unethical-to-help-a-fat-woman-get-pregnant/#more-16" target="_blank">told</a> by her Reproductive Endocrinologist (RE):<br />
<blockquote class="tr_bq">
Pregnancy is supposed to be beautiful and natural and it can be neither at your weight. I suggest you lose 100 pounds then come back.</blockquote>
Here is a story from the comments section of the defunct blog, <a href="http://myobsaidwhat.com/2013/04/19/fat-women-only-have-babies-because-we-cant-stop-them/" target="_blank">My OB Said What</a>?!?:<br />
<blockquote class="tr_bq">
I...had an amazing RE last time, but she has since retired and the only one in town will not treat me due to my weight. He will not do any infertility treatment on you unless you have a BMI under 30!! Really? Because last time I got pregnant with injections and IUI [<i>Intrauterine Insemination</i>] I was 330!!! I had an amazing pregnancy and a healthy baby! Why is okay that...because I have a medical issue and disease I do not deserve to have children. UGH! I can’t even start on how this way of thinking pisses me off!!</blockquote>
Another woman in the same story wrote in the comments section:<br />
<blockquote class="tr_bq">
We have a good ob/gyn...but we cannot find a reproductive endocrinologist who will even agree to see us.</blockquote>
BMI limits on fertility treatment is one of the most accepted ways doctors try to keep obese women from reproducing. It's another step on the path towards Obesity Eugenics.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">The PCOS Conundrum</span></b><br />
<b><br /></b>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLJp3pbEOTc_55ZdI7EnJwPT9qv04w-7JfnOIU4iUoI_1y1Mv_j76p0K_KciXt70s8lovFIdm44x5QFw_wji649qFUH6JsY6f5Q6G4qF7qIFEnT-Xmc_jEE7fXKibEcwNPGQEs_QTzHgI/s1600/pcos-christi-infertility.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="690" data-original-width="491" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLJp3pbEOTc_55ZdI7EnJwPT9qv04w-7JfnOIU4iUoI_1y1Mv_j76p0K_KciXt70s8lovFIdm44x5QFw_wji649qFUH6JsY6f5Q6G4qF7qIFEnT-Xmc_jEE7fXKibEcwNPGQEs_QTzHgI/s400/pcos-christi-infertility.jpg" width="283" /></a></div>
<b><br /></b>
It's true that heavier women have higher rates of fertility problems. However, it's important to note that just because you are larger, it doesn't mean you will have trouble having a baby. Lots of plus-size women have babies without help. That includes me; I was told I would probably not conceive without fertility help, but conceived four children naturally with no problems. So don't just assume (or let your doctors tell you) that if you are fat you probably won't be able to have kids.<br />
<br />
But it's important to acknowledge that some high BMI women do have more difficulty conceiving a pregnancy. Doctors often blame higher levels of estrogen, but the bottom line is that many fertility issues in women of size can be traced back to PolyCystic Ovarian Syndrome (PCOS), which <i>leads</i> to higher levels of estrogen.<br />
<br />
In PCOS, women have a hormonal imbalance, probably because of underlying insulin resistance due to impaired insulin signaling. They have too much estrogen and testosterone, but not enough progesterone. As a result, the body ovulates sporadically, weakly, or sometimes only rarely. Ovarian follicles containing eggs either don't finish ovulating or ovulate only weakly. The ovarian cysts that are a byproduct of this process give off excess hormones, and can cause distressing symptoms like excess facial and body hair, thinning scalp hair, cystic acne, body tags, darkened skin around the back of the neck, armpits, etc. It also leads to reduced fertility.<br />
<br />
In PCOS, the woman often experiences erratic menstrual cycles, which make it difficult to become pregnant. She may not ovulate regularly, or if she does, she may ovulate only weakly. If she does manage to conceive, she may have difficulty sustaining the pregnancy because of low levels of progesterone to support the the early weeks of pregnancy. In other words, the problem may be conceiving a pregnancy, or a high miscarriage rate afterwards, or both. While there are some women with PCOS who have the ovulatory phenotype and <a href="https://www.romper.com/p/im-fat-i-have-pcos-i-got-pregnant-i-know-im-not-alone-19019" target="_blank">do not have problems conceiving</a> (I'm one of these), many women with PCOS have fertility issues.<br />
<br />
PCOS is one of the most common cause of fertility issues. Australian research <a href="https://www.ncbi.nlm.nih.gov/pubmed/25654626" target="_blank">suggests</a> that up to 72% of women with PCOS have fertility issues, and PCOS often leads to <a href="https://www.ncbi.nlm.nih.gov/pubmed/23818329" target="_blank">long-term weight gain</a> due to insulin resistance. While <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861983/" target="_blank">many people</a> with PCOS are <a href="https://academic.oup.com/humupd/article/18/6/618/628147" target="_blank">heavy</a>, not all are, but the fertility effects of PCOS are independent of BMI. Thin women with PCOS experience fertility problems too, but they are able to access fertility help more easily than their heavier sisters.<br />
<br />
There is an erroneous belief among <a href="https://www.telegraph.co.uk/news/uknews/1569222/Deny-obese-women-fertility-treatment.html" target="_blank">some doctors</a> that being fat or gaining weight can <i>cause </i>PCOS. This is an <a href="https://wellroundedmama.blogspot.com/2013/11/sixth-annual-turkey-awards-pcos-isnt.html" target="_blank">unproven assumption based on fatphobia</a> and allows doctors to blame women with PCOS for their condition. It is far more likely to be the opposite ─ PCOS is most likely an <a href="https://www.ncbi.nlm.nih.gov/pubmed/16728382" target="_blank">inherited</a> underlying <a href="https://www.ncbi.nlm.nih.gov/pubmed/14516934/" target="_blank">metabolic condition</a> that then triggers weight gain. One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861983/" target="_blank">review</a> states:<br />
<blockquote class="tr_bq">
Familial aggregation of PCOS strongly supports a genetic susceptibility to this disorder.</blockquote>
Weight gain does tend to make PCOS symptoms worse, but it is likely the underlying condition that causes weight gain in the first place. Although it is not impossible to lose weight with PCOS, it is <i>much </i>harder. And <a href="https://fatheffalump.wordpress.com/2009/09/03/pcos-in-the-fatosphere/" target="_blank">not everyone</a> who loses weight with PCOS finds that it helps their symptoms. Many people spend years yo-yo dieting because it is so difficult to lose weight with PCOS.<br />
<br />
It is a cruel irony to then deny heavy women with PCOS access to fertility treatment. It is a double blow because they are the very ones <i>who need help the most</i>. It's simply a <a href="https://www.ncbi.nlm.nih.gov/pubmed/15380142" target="_blank">genetic condition</a> that is inherited through no fault of their own, but they are being punished for that genetic inheritance.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Treatment Success Rates</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhclQqHzp9KaQngZOmp3cczX7ncMvXQ3KavgFkW5GzNEEp8_JrLz2yKlrpwicidr5gg-PECOLs41CPNdcSatyHL51SJMhAVNZwCKUIxjvuTAv5o-pdECSX46jBTfeHjbpEg1UdHM6aVJp4/s1600/Canadian+MDs+Consider+Denying+Fertility+Treatments+to+Obese+Women+The+Globe+and+Mail%252C+2011+crop+2.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="621" data-original-width="1030" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhclQqHzp9KaQngZOmp3cczX7ncMvXQ3KavgFkW5GzNEEp8_JrLz2yKlrpwicidr5gg-PECOLs41CPNdcSatyHL51SJMhAVNZwCKUIxjvuTAv5o-pdECSX46jBTfeHjbpEg1UdHM6aVJp4/s400/Canadian+MDs+Consider+Denying+Fertility+Treatments+to+Obese+Women+The+Globe+and+Mail%252C+2011+crop+2.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from <a href="https://www.theglobeandmail.com/life/health-and-fitness/canadian-mds-consider-denying-fertility-treatments-to-obese-women/article595016/" target="_blank">The Globe and Mail, 2011</a></i></td></tr>
</tbody></table>
Many infertility doctors justify denying fertility treatment to obese people because they contend it is less likely to succeed at high BMIs, and the risk for complications if pregnancy occurs is too high. Let's take a look at these arguments and see if they hold up.<br />
<br />
To be fair, there is considerable <a href="https://www.ncbi.nlm.nih.gov/pubmed/29486787" target="_blank">research</a> that suggests <a href="https://www.ncbi.nlm.nih.gov/pubmed/27242175" target="_blank">lower</a> rates of Assisted Reproductive Technology (ART) ) <a href="https://www.ncbi.nlm.nih.gov/pubmed/28190215" target="_blank">success</a> in heavier women and a higher rate of <a href="https://www.ncbi.nlm.nih.gov/pubmed/29636081" target="_blank">miscarriage</a> after fertility treatment, although <a href="https://www.ncbi.nlm.nih.gov/pubmed/28609272" target="_blank">not</a> all <a href="https://www.ncbi.nlm.nih.gov/pubmed/29808381" target="_blank">studies</a> agree. These results seem to confirm that health issues like PCOS play a strong role in infertility in obese women. But it doesn't mean that these women should be penalized for their genetic vulnerabilities.<br />
<br />
It's probably true that a higher BMI has a generally lower success rate of fertility treatment to regulate menstrual cycles and help ovulation occur, but that doesn't always translate to actual live birth rates. When looking at live birth rates, some research has found very similar rates of ART success in obese women. One recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/28531369" target="_blank">Israeli study</a> found similar pregnancy and live-birth rates between all BMI groups and concluded:<br />
<blockquote>
The results of our relatively large retrospective study did not demonstrate a significant impact of BMI on the ART cycle outcome. Therefore, BMI should not be a basis for IVF [<i>In Vitro Fertilization</i>] treatment denial.</blockquote>
When funds are limited, doctors argue that fertility treatment should be limited to those most likely to achieve a pregnancy. However, even when funds are available or people pay for their own treatment, many fertility doctors withhold treatment for people of size. It's not just about saving money.<br />
<br />
<b>Most tellingly, doctors do not deny fertility treatments to other groups (like older women) who may have lower success rates. Only obese people are penalized like this. </b><br />
<br />
This is a form of selective discrimination. If older women have access to fertility treatment, so should high BMI people.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">What About Weight Loss Before Fertility Treatment?</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh2TlhcKHNrK0fyOMGIl1BZ9ZD__bq2tSjbsbujLflduYzuCkN7NnXL3kC48Z_9_nkf9mox5DOj7LT0VSb3YdVfpcrSFWj11HlHEbJwS79GNS14OpOrBeO7sH05WN0FhUvVUwxjuTnwls/s1600/no-parking-bmi%252C+unnecesarean.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="328" data-original-width="216" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh2TlhcKHNrK0fyOMGIl1BZ9ZD__bq2tSjbsbujLflduYzuCkN7NnXL3kC48Z_9_nkf9mox5DOj7LT0VSb3YdVfpcrSFWj11HlHEbJwS79GNS14OpOrBeO7sH05WN0FhUvVUwxjuTnwls/s200/no-parking-bmi%252C+unnecesarean.jpg" width="130" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Image from <a href="http://www.cesareanrates.org/" target="_blank">The Unnecessarean</a></i></td></tr>
</tbody></table>
One of the arguments for BMI limits in fertility treatment is that losing weight first improves outcomes. The British NHS Guidelines <a href="https://www.telegraph.co.uk/news/uknews/1569222/Deny-obese-women-fertility-treatment.html" target="_blank">state</a> that "<i>most overweight women would only need to lose 5 to 10 per cent of their body weight before they would be able to conceive without needing treatment</i>." The advantage of this is that it could save lots of money and increase success rates. However, the evidence is not so clear.<br />
<br />
Some <a href="https://www.ncbi.nlm.nih.gov/pubmed/27172435" target="_blank">research</a> does suggest <a href="https://www.ncbi.nlm.nih.gov/pubmed/28961722" target="_blank">higher rates</a> of <a href="https://www.ncbi.nlm.nih.gov/pubmed/26401593" target="_blank">ovulation</a> in obese women with PCOS who <a href="https://www.ncbi.nlm.nih.gov/pubmed/27172435" target="_blank">lose weight</a> before <a href="https://www.huffingtonpost.com/entry/exercise-and-weight-loss-pcos_us_560e999ae4b0dd85030ba630" target="_blank">fertility treatment</a>. This is why many doctors require that high BMI people lose weight before treatment is permitted. They figure a low-cost intervention like this is worth trying before resorting to high-cost ones. That is a logical argument.<br />
<br />
However, while weight loss <i>may </i>improve ovulation and pregnancy rates, does it really result in more babies? What is most important is the final outcome, i.e. live-birth rates. <b>And not all studies agree that weight loss improves actual live-birth rates. </b>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28366412" target="_blank">2017 review </a>found:<br />
<blockquote class="tr_bq">
The existing data from randomized trials...have failed to document improved live-birth rates after the [<i>weight loss</i>] intervention compared with control groups.</blockquote>
A study in infertility clinics across several <a href="https://www.ncbi.nlm.nih.gov/pubmed/28854592" target="_blank">Nordic countries</a> found statistically similar live birth rates among obese women (BMI 30-35) who were subjected to a very-low-calorie liquid diet for 3 months before In Vitro Fertilization (IVF). Another study <a href="http://www.pubmed.gov/16750829" target="_blank">found</a> that an intensive weight loss intervention before IVF actually resulted in decreased IVF success.<br />
<div>
<br /></div>
An important <a href="https://www.ncbi.nlm.nih.gov/pubmed/27192672" target="_blank">2016 study</a> in the New England Journal of Medicine found that live birth rates were actually slightly <i>better </i>in the non-weight loss group that proceeded directly to fertility treatment than in the group subjected to a 6 month "lifestyle intervention" program (i.e. weight loss) before treatment:<br />
<blockquote class="tr_bq">
...The primary outcome <i>[live births]</i> occurred in 27.1% of the women in the intervention <i>[weight loss] </i>group and 35.2% of those in the control group..In obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization<span style="background-color: white; font-family: "arial" , "helvetica" , "clean" , sans-serif; font-size: 1.04em;">.</span></blockquote>
A <a href="https://www.ncbi.nlm.nih.gov/pubmed/27798042" target="_blank">follow-up</a> of this study found that the lifestyle intervention in anovulatory women resulted in more spontaneous conceptions but made no difference in live birth rates.<br />
<br />
The benefits of weight loss before fertility treatment are mixed. While some people of size do find increased success with spontaneous conception with a modest weight loss, other people of size do not. To blithely suggest that a 5-10% weight loss is all it takes to conceive is insensitive and unrealistic. It may help some; for others it may be a waste of valuable time. Weight loss can be offered to larger women if they are interested since it helps some achieve pregnancy, but <i>the choice must be left up to them, not mandated.</i><br />
<br />
Furthermore, time is a complicating issue. If women put off pregnancy to pursue weight loss, they are losing some of their most fertile years. It can take a long time to lose weight down to required BMI cutoffs. As one critic <a href="http://www.pubmed.gov/20129994" target="_blank">noted</a>:<br />
<blockquote class="tr_bq">
Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity...<b>Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women.</b></blockquote>
Surveys <a href="https://www.ncbi.nlm.nih.gov/pubmed/29221938" target="_blank">suggest</a> that very few women in their 30s are willing to delay seeking fertility treatment in order to pursue weight loss. They know that advancing age is a far more important risk factor than weight.<br />
<br />
Others are unwilling to pursue weight loss because even a small loss often results in long-term weight gain rebound and they are unwilling to risk that, especially in pregnancy. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/23427235" target="_blank">high drop-out rate</a> in weight-loss-for-fertility programs is an additional problem, suggesting that many of these programs are not sustainable or practical.<br />
<br />
As a result, there are some doctors who suggest an <a href="https://www.ncbi.nlm.nih.gov/pubmed/28366410" target="_blank">emphasis</a> on good nutrition and exercise a few months before treatment is more effective than a weight loss emphasis.:<br />
<blockquote class="tr_bq">
Lifestyle modifications, in particular a healthy diet and exercise during the 3-6 months before conception and during treatment, should result in better outcomes than requiring weight loss before fertility treatments.</blockquote>
This is compatible with a <a href="https://www.sizediversityandhealth.org/content.asp?id=76" target="_blank">Health At Every Size® approach</a>. Focus on lifestyle and habits, not the scale. Healthy habits are very important before pregnancy but they doesn't necessarily result in weight loss.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Perceived Risks of Obese Pregnancies</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAQ8PF0VYoGRJ8p5bvoxHLJrFxqFf_RDESCv61bw4FQHNVFAzIdLW6Jm1DuWC6yM7sDsTvg29GBqD10e4GUmHqcSjKhE29EwJCTEu258d6PTa0MQSbV0gr7Yfa4HHr4Fq9boezRciByRI/s1600/Sensationalized+risk+-+Canadian+article.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="193" data-original-width="815" height="93" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAQ8PF0VYoGRJ8p5bvoxHLJrFxqFf_RDESCv61bw4FQHNVFAzIdLW6Jm1DuWC6yM7sDsTvg29GBqD10e4GUmHqcSjKhE29EwJCTEu258d6PTa0MQSbV0gr7Yfa4HHr4Fq9boezRciByRI/s400/Sensationalized+risk+-+Canadian+article.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from <a href="https://nationalpost.com/health/while-health-risks-are-real-much-of-the-risk-talk-telling-obese-women-they-are-dangerous-potential-mothers-sensationalized-research" target="_blank">The National Post, 2016</a></i></td></tr>
</tbody></table>
Many fertility docs justify denying treatment to high BMI women because of the perceived risks of pregnancy at larger sizes. They are concerned that the risks of an Assisted Reproduction Technology pregnancy will magnify the risks of a high BMI pregnancy, creating an extremely unhealthy outcome. However, research <a href="https://www.ncbi.nlm.nih.gov/pubmed/29982477" target="_blank">shows</a> that the two risks are generally not synergistic.<br />
<br />
Some doctors believe that fat women are at SUCH high risk that they can't <i>possibly </i>have a healthy pregnancy or a healthy baby. While that's simply not true, it is a strongly held belief of many fertility doctors. Toronto fertility specialist Dr. Carl Laskin <a href="http://news.nationalpost.com/health/should-there-be-a-weight-cutoff-for-ivf-firestorm-of-debate-over-denying-fertility-treatments-to-obese-women?__lsa=eb29-de5c" target="_blank">says</a>:<br />
<blockquote class="tr_bq">
“To me, it’s a medical issue. It is not a discrimination issue. [Obese] women are running risks in pregnancy, and if they’re running risks in pregnancy, why should you be helping them get pregnant?” Dr. Laskin has a BMI cut off of 35. “Mine is a brick wall,” he said. "Other clinics will go as high as 40. Some have no cut off."</blockquote>
Bill Ledger, a <a href="https://www.theguardian.com/science/2007/nov/13/sciencenews.medicalresearch" target="_blank">professor</a> of Reproductive Medicine at Sheffield University in the U.K., reflects the extremism of some doctors' beliefs:<br />
<blockquote class="tr_bq" style="text-align: left;">
Doctors shouldn't be helping women have a pregnancy that's at a high risk of going horribly wrong. </blockquote>
Many reproductive endocrinologists (REs) feel that "it would be <a href="https://fathealth.wordpress.com/2007/07/19/it-would-be-unethical-to-help-a-fat-woman-get-pregnant/#more-16" target="_blank">unethical</a> to help a fat woman get pregnant." From a comment left on my blog in a <a href="http://wellroundedmama.blogspot.com/2010/07/limiting-fertility-treatment-access-for.html" target="_blank">past post</a>:<br />
<blockquote class="tr_bq">
I just went to a gynecologist this past week ...I was told, quite directly, that she would not and nor would any doctor in my HMO take me on since my BMI would make the pregnancy too high risk to myself and a fetus.</blockquote>
An <a href="https://nationalpost.com/health/while-health-risks-are-real-much-of-the-risk-talk-telling-obese-women-they-are-dangerous-potential-mothers-sensationalized-research?__lsa=eb29-de5c/" target="_blank">article from 2016</a> has the doctor throwing down the Fat Death Card <i>(if you get pregnant you'll probably die so we mustn't help you)</i>:<br />
<blockquote class="tr_bq">
One woman recounted a fertility doctor telling her, “Gals your size, OK, mortality rates are higher. So I go ahead and intervene, help you get pregnant here. Then you go down to (a birthing ward). And then, boom! Pulmonary embolism.”</blockquote>
Again, this goes back to risk hyperbole. People of size <i>are </i>more at risk for blood clots, some of which can go to the lung (pulmonary embolism), and that is potentially lethal. But the actual incidence of such incidents is quite low. Furthermore the risk can be lowered with good care by using blood thinners when indicated, not doing cesareans unless truly needed, keeping women as mobile as possible all throughout pregnancy and afterwards, and increasing postpartum surveillance for blood clots in women at increased risk.<br />
<br />
<b>Furthermore, the argument about risk is a spurious argument because it is not applied equally. </b><br />
<br />
Doctors justify denying fertility treatment because women of size do have a higher rate of pregnancy and birth complications, but they weaken their argument by <a href="https://academic.oup.com/hropen/article/2017/2/hox009/4049574" target="_blank">not applying it equitably</a>:<br />
<blockquote class="tr_bq">
...the objection is that it excludes a specific patient category on grounds that are not applied to treatment of others with comparable risks.</blockquote>
In other words, there are many other groups (like older women, people with certain medical conditions) that have similar or higher risks for complications but these groups are NOT denied access to fertility treatment. <i>Only fatness is penalized in such an across-the-board way. </i>As one <a href="https://academic.oup.com/hropen/article/2017/2/hox009/4049574" target="_blank">review</a> put it:<br />
<blockquote class="tr_bq">
...a higher risk than the mean IVF population does not mean that it is irresponsible to take that risk. It is a question of proportionality: a higher risk can still be acceptable in light of the gain a woman can expect from treatment. Through the same reasoning IVF is thought acceptable in other women who are at increased risk of pregnancy complications because of medical conditions. Women with diabetes mellitus have an increased risk of hypertensive disorders and congenital abnormalities, macrosomia, stillbirth and premature labour...Diabetes mellitus is, however, not an exclusion criterion for fertility treatment.</blockquote>
Another recent review <a href="https://academic.oup.com/hropen/article/2017/2/hox009/4049574" target="_blank">agreed</a>:<br />
<blockquote class="tr_bq">
Given that patients with, for example, diabetes or previous pre-eclampsia, who are at higher risks than many obese women, are allowed treatment on the basis of individualized and well-informed decision-making, we think there is no justification for taking a different line with regard to BMI.</blockquote>
<span style="color: blue;"><b>Although fertility doctors like to pretend that denial of treatment is based on their concern for risks, they don't apply these rules equally among groups. The same standards are not applied to other women at higher risk for complications; only the obese are targeted. </b></span><br />
<br />
Research also shows that while some risks are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19067282" target="_blank">increased</a> in people of size, the increase in risk is <a href="https://www.scienceandsensibility.org/blog/maternal-obesity-a-view-from-all-sides" target="_blank">moderate</a>, and many women of size actually have perfectly healthy pregnancies and births. Furthermore, group statistics cannot predict any one person's outcome. Denying fertility treatment based only on weight limits or BMI means that <i>many pregnancies that would have had normal and healthy outcomes will never occur.</i><br />
<i><br /></i>
Some experts <a href="https://www.theglobeandmail.com/life/health-and-fitness/canadian-mds-consider-denying-fertility-treatments-to-obese-women/article595016/?service=mobile" target="_blank">refute</a> the idea that BMI should be used as a surrogate for unacceptable risk levels:<br />
<blockquote class="tr_bq">
Dr. Cheung plans to argue that studies also show IVF does not pose unacceptable risks for heavy women, and that BMI alone is not a good measure of which patients face the highest risks. Age, he said, is "by far the strongest indicator" of success and dangers.</blockquote>
An article <a href="https://www.thestar.com/life/health_wellness/2011/09/22/should_obese_women_be_denied_fertility_treatments.html" target="_blank">highlighting</a> the Canadian debate agrees:<br />
<blockquote class="tr_bq">
But to Dr. Yoni Freedhoff, a specialist in weight control at the Ottawa Bariatric Medical Institute, that’s part of an “insidious” health care practice. </blockquote>
<blockquote class="tr_bq">
“It would seem to me that this ‘you’re too fat to have IVF’ policy probably is in part started as patient safety, but ultimately it reflects weight bias,” he said. </blockquote>
<blockquote class="tr_bq">
Freedhoff, who’s advised assisted reproduction patients needing to lose weight, doesn’t dispute that excess pounds can cause additional risks. What he doesn’t understand is why weight might exclude women from fertility treatment, but other factors that have been shown to adversely affect pregnancy — such as smoking or advanced age — are not perceived as equally damaging.</blockquote>
<b><span style="color: #cc0000; font-size: large;">Ethics and Eugenics Questions</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4RQ8nfHa1BzTuQ3JTaoKjUBXhYvdAT7zo9tBoX8jRFkcW5IDRnUrA2X5nwCty7wluUyZQDXxKR1t5AFboy7qTZeeTEBcVi2OAUrG6eKeFXjijy8NO4-kLKeBPghDRRJ7r-7l9l46SE24/s1600/Women+with+obese+male+partners+will+be+denied+IVF+treatment+Independent+2018.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="841" data-original-width="1010" height="332" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4RQ8nfHa1BzTuQ3JTaoKjUBXhYvdAT7zo9tBoX8jRFkcW5IDRnUrA2X5nwCty7wluUyZQDXxKR1t5AFboy7qTZeeTEBcVi2OAUrG6eKeFXjijy8NO4-kLKeBPghDRRJ7r-7l9l46SE24/s400/Women+with+obese+male+partners+will+be+denied+IVF+treatment+Independent+2018.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from <a href="https://www.independent.co.uk/news/health/women-obese-men-denied-ivf-treatment-bmi-30-bath-north-east-somerset-ccg-a8248061.html" target="_blank">The Independent, 2018</a></i></td></tr>
</tbody></table>
Infuriatingly, in some areas, helping an obese woman with fertility is seen as malpractice and authorities forbid or strongly discourage allowing fertility docs to treat women of size. According to <a href="https://www.theguardian.com/science/2007/nov/13/sciencenews.medicalresearch" target="_blank">guidelines</a> in the UK:<br />
<blockquote class="tr_bq">
Fertility clinics should defer treating obese women until they have lost weight through dieting, exercise or surgery, according to guidelines published today. Under the recommendations, clinics are advised to begin treatment on severely overweight women only once they have reduced their body mass index (BMI) to below 35. Women under 37 years of age should reduce their weight further, to a BMI of less than 30, the guidelines state.</blockquote>
Here's a story from a woman in Australia:<br />
<blockquote class="tr_bq">
I’ve been to two fertility specialists and neither of them will give us any fertility treatment until I have a BMI of under 35 (99kg). Nothing to do with my chances of getting pregnant; they say it’s an ethical matter, that obesity itself is enough of a health challenge for the body without adding the impact of pregnancy. Getting an obese woman pregnant would be seen as doing harm. The second OBGYN informed me it’s a state-wide guideline according to the Fertility Council which covers public & private health.</blockquote>
Although there <i>are </i>fertility docs out there who believe that it's <a href="http://www.thefertilitydoc.com/infertility-and-the-overweight-woman/" target="_blank">wrong</a> to deny fertility treatment to fat women, BMI restrictions are common in many fertility practices and some government healthcare.<br />
<br />
<b><span style="color: blue;">In New Zealand, Australia, and Canada, there are guidelines in place/ being proposed to prevent women over a BMI of 35 from accessing fertility treatment. In the U.K., women under the age of 37 must have a BMI of no more than 30. In the U.S., guidelines are more individualized, but many clinics have policies in place that bar fertility treatment above a certain BMI, usually 35.</span></b><br />
<br />
And now things are going even further. Some areas of the U.K. are <a href="https://www.independent.co.uk/news/health/women-obese-men-denied-ivf-treatment-bmi-30-bath-north-east-somerset-ccg-a8248061.html" target="_blank">proposing limiting fertility treatments</a> to women whose <i>male</i> <i>partners</i> have a BMI over 30. The woman can have a "normal" BMI which would ordinarily get her IVF, but if her partner is fat, she doesn't qualify anymore. So not only can they deny treatment to fat women, but to fat men and any woman with a fat male partner.<br />
<br />
Some fertility experts recognize the major ethical problems with denying heavier people access to fertility treatment. An <a href="https://www.theglobeandmail.com/life/health-and-fitness/canadian-mds-consider-denying-fertility-treatments-to-obese-women/article595016/?service=mobile" target="_blank">article</a> about proposed BMI limitations on fertility treatment in Canada notes:<br />
<blockquote class="tr_bq">
...It's ethically troubling," said the University of Manitoba's Arthur Schafer, director of the Centre for Professional and Applied Ethics. "In our society, the decision to procreate is left to the individual – so why would it be appropriate for the doctors to usurp those rights for women who are obese." </blockquote>
<blockquote class="tr_bq">
Doctors would only be justified, he says, if they could "honestly, hand-on-heart say," that the safety risks are so great "that no reasonable fat woman would want to conceive a baby in this way." </blockquote>
<blockquote class="tr_bq">
"I'm not sure the fertility industry or association can really defend a blanket exclusion on obese women having access to assisted reproduction."</blockquote>
Intersectional stigma applies here too. Another <a href="http://www.abc.net.au/news/2017-03-17/ivf-guidelines-for-obese-woman-should-be-reviewed/8364956" target="_blank">article</a> from Australia notes that the impact of these policies is often discriminatory towards various racial groups and poorer people:<br />
<blockquote class="tr_bq">
"They need to recognise that there's harm in doing nothing. Women who are unable to have children, there's a much higher risk of depression and anxiety and a doubling in the suicide rate. So doing nothing is not necessarily doing the best thing." </blockquote>
<blockquote class="tr_bq">
The guidelines, he claims, can be classified as discrimination."Especially when you consider the low socio-economic group," he said. </blockquote>
<blockquote class="tr_bq">
"The Indigenous patients have a lot higher incidents of obesity than the general population, so you're almost discriminating against those two disadvantaged groups in this particular policy. "Obviously that wasn't the original intent, but that is a potential end product of that."</blockquote>
Here is what one group of experts <a href="https://www.ncbi.nlm.nih.gov/pubmed/28299785" target="_blank">argues in response</a> to the usual excuses for denying fertility treatment based on BMI (my emphasis):<br />
<blockquote class="tr_bq">
Obesity is associated with a reduction in fertility treatment success and increased risks to mother and child. Therefore guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) suggest that a body mass index exceeding 35 kg/m2 should be an absolute contraindication to assisted fertility treatment such as in vitro fertilisation IVF. </blockquote>
<blockquote class="tr_bq">
In this paper we challenge the ethical and scientific basis for such a ban. Livebirth rates for severely obese women are reduced by up to 30%, but <i>this result is still far better than that observed for many older women who are allowed access to IVF.</i> This prohibition is particularly unjust when IVF is the only treatment capable of producing a pregnancy, such as bilateral tubal blockage or severe male factor infertility. </blockquote>
<blockquote class="tr_bq">
<span style="color: blue;"><b>Furthermore, the absolute magnitude of risks to mother or child is relatively small, and while a woman has a right to be educated about these risks, she alone should be allowed to make a decision on proceeding with treatment.</b> </span>We do not prohibit adults from engaging in dangerous sports, nor do we force parents to vaccinate their children, despite the risks. Similarly, we should not prohibit obese women from becoming parents because of increased risk to themselves or their child. </blockquote>
<blockquote class="tr_bq">
Finally, prohibiting obese women's access to IVF to prevent potential harms such as 'fetal programing' is questionable, especially when compared to that child never being born at all. As such, we believe the RANZCOG ban on severely obese women's access to assisted reproductive treatment is unwarranted and should be revised.</blockquote>
Amen to that. Now if only the health authorities would listen. Unfortunately, they seem to be going in the opposite direction, getting more stringent in their weight-related restrictions, as seen in the U.K. limits on male partners too.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Summary</span></b><br />
<b><br /></b>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHT4rbXPv_HimLP9AWtxKE33k_oX6rC4-OjC4SMGgViyxpB85Z4YX7_PqflhrqYAq_L-AtrkpP39M-esfDDIqvPwUymERAXIMgNFZw_TBmyeIOXrQtB_p6WmD6CVb-rUPVfBirPo5svsk/s1600/Revise+ANZOG+Guidelines+on+IVF+and+Obesity+2017.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="410" data-original-width="725" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHT4rbXPv_HimLP9AWtxKE33k_oX6rC4-OjC4SMGgViyxpB85Z4YX7_PqflhrqYAq_L-AtrkpP39M-esfDDIqvPwUymERAXIMgNFZw_TBmyeIOXrQtB_p6WmD6CVb-rUPVfBirPo5svsk/s400/Revise+ANZOG+Guidelines+on+IVF+and+Obesity+2017.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from <a href="http://www.abc.net.au/news/2017-03-17/ivf-guidelines-for-obese-woman-should-be-reviewed/8364956" target="_blank">abc.news.au, 2017</a></i></td></tr>
</tbody></table>
A few brave medical professionals are speaking out about the discrimination happening in fertility treatment despite tremendous pressure from their colleagues. There have been a number of articles published recently in OB journals questioning the ethics of BMI restrictions but so far, none of the national guidelines have changed. And as noted in the U.K., things seem to have gotten even worse.<br />
<br />
Bottom line, denying fat people access to fertility treatment is another form of keeping fat people from having children, but many doctors resist acknowledging the implications of these restrictions. They tell themselves they are protecting their patients with these guidelines. They tell themselves it's all about the risks, yet other groups with similar risks are not penalized. They refuse to acknowledge that they are infantilizing larger-bodied people and taking away their personal autonomy over crucial life decisions.<br />
<br />
Authorities think that they are doing fat women a favor by insisting they lose weight before pregnancy, yet by insisting on such weight loss they deny women timely intervention when fertility treatments are most likely to succeed. The number of people who lose weight to a "normal" BMI and keep it off is quite small. When authorities insist on a much lower BMI as a requirement for treatment, they basically are keeping fat people from having children. Intentional or not, this is Eugenics.<br />
<br />
Denial of treatment is based on weight bias, the assumption that all fat people voluntarily brought on their weight through poor health habits, sloth, and gluttony, and would perpetuate those bad habits to the next generation. Doctors assume that fatness is easily solved through altering health habits and exercising a little more willpower, but this argument does not hold up under scrutiny.<br />
<br />
Research is very clear that most people are unable to <a href="http://www.pubmed.gov/20646282" target="_blank">lose weight</a> and <a href="http://mann.bol.ucla.edu/files/Diets_don%27t_work.pdf" target="_blank">keep it off long-term</a>, so denying treatment until someone reaches an "ideal BMI" or even a 5-10% reduction is unrealistic and delays fertility treatment until it may be too late. As some <a href="https://www.mdedge.com/obgynnews/article/55807/gynecology/impact-ivf-success-may-not-be-so-hefty-after-all" target="_blank">experts</a> note;<br />
<blockquote class="tr_bq">
Age trumps everything, so if your plan is going to make these women lose weight, the time that might take them if they’re older is going to be way more significant than any potential benefit in terms of weight loss.</blockquote>
Weight loss surgery does reduce BMI, but research shows significant trade-offs. There are reduced risks for <a href="https://www.ncbi.nlm.nih.gov/pubmed/22353952" target="_blank">gestational diabetes</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23241580" target="_blank">large babies</a>, but also <a href="https://www.ncbi.nlm.nih.gov/pubmed/29454871" target="_blank">increased risks</a> of <a href="https://www.ncbi.nlm.nih.gov/pubmed/24222480" target="_blank">prematurity</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/23467053" target="_blank">too-small babies</a>, and possibly <a href="https://www.ncbi.nlm.nih.gov/pubmed/25714159" target="_blank">neonatal mortality</a>. There are no easy answers here.<br />
<br />
Potential health complications is a red herring argument. The underlying reason weight has been made an automatic disqualifier is because doctors see people of size as unfit parents who will create more fat people. Sure, there are some fat people who do have poor health habits but so do many thinner women, yet <i>they </i>are not kept from fertility treatment. If health habits were the main concern then EVERY patient should be screened for this and used as a barrier to treatment for all sizes, yet it's only targeted to obese people.<br />
<br />
Furthermore, many fat people have medical causes for their weight such as Polycystic Ovarian Syndrome, lipedema, hypothyroidism, etc., and these conditions can impact fertility as well. To deny people with conditions like PCOS treatment is to penalize them for their genetics. <i>People should not be punished for their genetic vulnerabilities.</i><br />
<br />
People of size should be informed of the potential risks of pregnancy at larger sizes, but in a realistic way, not through scare tactics. People of ALL sizes should be encouraged to practice healthy habits and have great nutrition, and should be counseled about their individual risks. In most cases, though, the decision on whether to proceed with fertility treatment must be the person's. The government or a group of doctors has no business controlling whether or not a person has children. It infantilizes women and takes away personal autonomy to impose such rigid guidelines.<br />
<br />
<b>Denying fertility treatment based on weight basically keeps a whole group of people from having children and that's <i>always</i> a suspicious restriction that smacks of eugenics.</b><br />
<br />
Those who would deny fertility treatment based on BMI are trying to be the gatekeepers of who are "allowed" to reproduce; this is another insidious form of eugenics and must STOP.<br />
<br />
<br />
<span style="color: #cc0000; font-size: large;"><b> Resources</b></span><br />
<br />
If you are experiencing fertility issues, here is a brief set of links to resources that might be helpful:<br />
<ul style="text-align: left;">
<li><a href="https://www.fertilityplus.com/faq/bbwfaq.html">https://www.fertilityplus.com/faq/bbwfaq.html</a> - an older document and website that has many tips for fertility treatment in women of size. Not entirely diet-free but generally balanced </li>
<li><a href="https://www.fertilityplus.com/faq/bbt/bbt.html">Basal Body Temperature Chart</a> - Chart your cycle to see when you are ovulating </li>
<li><a href="https://www.amazon.com/dp/B00QFOP45Q/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1">Taking Charge of Your Fertility</a> by Toni Weschler, an excellent book about using fertility awareness techniques to either conceive or avoid conception, depending on your intent </li>
<li><a href="http://www.tcoyf.com/">www.tcoyf.com</a> - Website of the above book; tons of excellent information and aids </li>
<li><a href="http://www.fertilityfriend.com/">www.fertilityfriend.com</a> - Other fertility aid charts and information</li>
</ul>
<div class="p3" style="background-color: white; box-sizing: border-box; margin-bottom: 26px; padding: 0px;">
<ul style="text-align: left;">
</ul>
</div>
<div>
<b><span style="color: #cc0000; font-size: x-large;">References</span></b><br />
<br />
<span style="color: purple;">*The full list of references for this post are far too long to include. Instead, here are a few key references and quotes. The other references are scattered throughout the article and have links to the original sources and studies.</span><span style="color: #444444;"> </span><br />
<br />
<b><i><span style="color: #38761d;">Studies Critical of BMI Limits on Fertility Treatment</span></i></b><br />
<br />
<i>Should obese women's access to assisted fertility be limited? A scientific and ethical analysis. </i>Tremellen et al. 2017 Aust N Z J Obstet Gynaecol <a href="https://www.ncbi.nlm.nih.gov/pubmed/28299785">https://www.ncbi.nlm.nih.gov/pubmed/28299785</a><br />
<blockquote class="tr_bq">
Quote: "The absolute magnitude of the risks to mother or child is relatively small, and while a woman has a right to be educated about these risks, she alone should be allowed to make a decision on proceeding with treatment...we should not prohibit obese women from becoming parents because of the increased risk to themselves or their child...."</blockquote>
<i>Should access to fertility treatment be determined by female body mass index? </i>Pandey et al., 2010 Human Reproduction. <a href="http://www.pubmed.gov/20129994">www.pubmed.gov/20129994</a><br />
<blockquote class="tr_bq">
Quote: "Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity...Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women."</blockquote>
<i>It is not justified to reject fertility treatment based on body mass index.</i> Koning et al., 2017. Human Reproduction Open. <a href="https://academic.oup.com/hropen/article/2017/2/hox009/4049574">https://academic.oup.com/hropen/article/2017/2/hox009/4049574</a><br />
<blockquote class="tr_bq">
Quote: "Given that patients with, for example, diabetes or previous pre-eclampsia, who are at higher risks than many obese women, are allowed treatment on the basis of individualized and well-informed decision-making, we think there is no justification for taking a different line with regard to BMI."</blockquote>
<i>Should overweight or obese women be denied access to ART?: Comment by: Ahmed Badawy,</i> Middle East Fertility Society Journal, 2013. <a href="https://www.sciencedirect.com/science/article/pii/S1110569013001106">https://www.sciencedirect.com/science/article/pii/S1110569013001106</a><br />
<blockquote class="tr_bq">
Quote: "Those who are choosing to postpone childbearing for the weight reduction should balance the negative effects of aging versus obesity on fertility and perinatal outcomes... there is no strong evidence for the association between obesity and live birth in infertile women. Thus, there is insufficient proof to refute women fertility treatment on grounds of BMI."</blockquote>
<i>We need to stop discriminating against plus-size pregnant women. </i>Raina Delisle, Today's Parent, 2017. <a href="https://www.todaysparent.com/pregnancy/pregnancy-health/we-need-to-stop-discriminating-against-plus-size-pregnant-women/">https://www.todaysparent.com/pregnancy/pregnancy-health/we-need-to-stop-discriminating-against-plus-size-pregnant-women/</a><br />
<br />
<i>Women with obese male partners will be denied IVF treatment, rules NHS group. </i>Tom Embury-Dennis. Independent, 2018. <a href="https://www.independent.co.uk/news/health/women-obese-men-denied-ivf-treatment-bmi-30-bath-north-east-somerset-ccg-a8248061.html">https://www.independent.co.uk/news/health/women-obese-men-denied-ivf-treatment-bmi-30-bath-north-east-somerset-ccg-a8248061.html</a><br />
<br /></div>
<div>
<i>Should high BMI be a reason for IVF treatment denial?</i> Friedler et al., 2017 Gynecological Endocrinology <a href="https://www.ncbi.nlm.nih.gov/pubmed/28531369">https://www.ncbi.nlm.nih.gov/pubmed/28531369</a> </div>
<blockquote class="tr_bq">
Quote: "The results of our relatively large retrospective study did not demonstrate a significant impact of BMI on the ART cycle outcome. Therefore, BMI should not be a basis for IVF treatment denial."</blockquote>
<i>Randomized Trial of a Lifestyle Program in Obese Infertile Women.</i> Mutsaerts et al., 2016 New England Journal of Medicine <a href="https://www.ncbi.nlm.nih.gov/pubmed/27192672">https://www.ncbi.nlm.nih.gov/pubmed/27192672</a><br />
<blockquote class="tr_bq" style="margin-bottom: 0.5em;">
...The primary outcome <i>[live birth rate]</i> occurred in 27.1% of the women in the intervention <i>[weight loss] </i>group and 35.2% of those in the control group (rate ratio in the intervention group, 0.77; 95% confidence interval, 0.60 to 0.99). CONCLUSIONS: In obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization<span style="background-color: white; font-family: "arial" , "helvetica" , "clean" , sans-serif; font-size: 1.04em;">.</span></blockquote>
<i>Mr. Fertility Authority, Tear Down That Weight Wall! </i>Hum Reproduction 2016 Dec;31(12):2662-2664. Epub 2016 Oct 19. Legro RS1. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/27798043" target="_blank">27798043</a> Full text <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193329/" target="_blank">here</a><br />
<div>
<blockquote class="tr_bq">
<i>Discussion of the 2016 NEJM study above and subsequent subanalysis.</i> Quote: "The impression from these epidemiologic studies and the smaller interventional trials is that obese women are damned if they do lose weight prior to pregnancy and damned if they don't. As the LIFEstyle study indicates, dropout rates with lifestyle modification are high (20%), the average amount of weight lost is modest (4.4 kg) and most women will not achieve the targeted weight loss (62%). Furthermore, women who participate, regardless of age, initial BMI and ovulatory status, will experience cumulative lower rates of a healthy baby... pending further studies,<b> these cumulative data suggest that weight limits used to deny women access to fertility care are not only arbitrary, but discriminatory, and clearly not evidence-based.</b></blockquote>
<span style="background-color: white; color: #575757; font-family: "arial" , "helvetica" , "clean" , sans-serif; font-size: 0.8465em;"> </span> </div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0tag:blogger.com,1999:blog-4738062031052371885.post-11326531521472661392018-07-31T02:25:00.002-07:002018-07-31T02:25:41.504-07:009th Turkey Awards: Obesity Eugenics Media Campaigns<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVW72Q_3oR5OJmIv_0s8_TrvpkS18vzT_ePppg7OQPsO6yMlOKi6a8dgvuFOqnZs5MA4A8KUaVmkRe6zcMfFUJ9j7pfwSaT2VDf0FuLA8uk6rA2mN5_vb3KCbGYqfPsOVSm8M9Smo01b8/s1600/BourbonRedTurkey440.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="389" data-original-width="440" height="352" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVW72Q_3oR5OJmIv_0s8_TrvpkS18vzT_ePppg7OQPsO6yMlOKi6a8dgvuFOqnZs5MA4A8KUaVmkRe6zcMfFUJ9j7pfwSaT2VDf0FuLA8uk6rA2mN5_vb3KCbGYqfPsOVSm8M9Smo01b8/s400/BourbonRedTurkey440.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
A fairly recent <a href="http://thenewdaily.com.au/life/wellbeing/2016/10/13/obesity-and-pregnancy/" target="_blank">article</a> in an Australian newspaper ─ October 2016 ─ had the inflammatory headline, "<b>Call to stop obese women from having babies.</b>" The picture below it featured a woman with a slight double chin and said, "<i>Experts warn obese women should not have children.</i>"<br />
<br />
Well, here we go again with the Obesity Eugenics Wars. This incredibly discriminatory movement is the winner of not one but two Turkey Awards. It's time to call these egregious practices out.<br />
<br />
If you aren't familiar with them, the Turkey Awards are the "prizes" I hand out to highlight fat-phobic treatment of people of size from care providers, biased attitudes or studies from researchers, or troubling trends in the care of fat pregnant women these days.<br />
<br />
In past years of the Turkey Awards, we've talked about:<br />
<ul style="text-align: left;">
<li>#1: <a href="http://www.wellroundedmama.blogspot.com/2008/11/first-annual-turkey-awards.html">fat-phobic care providers</a></li>
<li>#2: <a href="http://www.wellroundedmama.blogspot.com/2009/11/second-annual-turkey-awards.html" target="_blank">scare-mongering and shaming tactics</a></li>
<li>#3: <a href="http://www.wellroundedmama.blogspot.com/2010/11/third-annual-turkey-awards-jumping-to.html">jumping to conclusions about risks</a></li>
<li>#4: <a href="http://www.wellroundedmama.blogspot.com/2011/12/fourth-annual-turkey-awards-leaps-of.html">scorched earth tactics</a></li>
<li>#5: <a href="http://www.wellroundedmama.blogspot.com/2013/01/fifth-annual-turkey-awards-prenatal.html">prenatal weight gain extremism</a></li>
<li>#6: <a href="http://www.wellroundedmama.blogspot.com/2013/11/sixth-annual-turkey-awards-pcos-isnt.html">fat-phobic attitudes around treatment of PolyCystic Ovarian Syndrome</a>(PCOS)</li>
<li>#7: <a href="http://www.wellroundedmama.blogspot.com/2015/04/seventh-annual-turkey-awards.html">astronomically high cesarean rates in women of size</a></li>
<li>#8: <a href="http://wellroundedmama.blogspot.com/2016/02/eighth-annual-turkey-awards-weight-bias.html" target="_blank">weight bias in the treatment of lipedema</a> </li>
</ul>
I haven't done a Turkey Award in quite a while, so I'm doing two years in a row now. To make it easier to read, I'm splitting one giant post up into two. Today's post is about attention to the Obesity Eugenics Media Campaign and its impact on women. In the future, we will highlight the egregious lack of access to fertility treatment for high BMI women and how this plays into Obesity Eugenics.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Obesity Eugenics: The Media Campaign</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBb-AFlzKYNpawaNVosF3rgOmfpM10Zgh9jYoqLGdXA3TqITsR36Q6Gz8ONrqYS4NRvYmWjzuY1-N-d0PReT6saOFSCzMOLiFLjnlXk2LKc_cpEFjJSISA1HfxIA6EpDVUlywkdG96Ess/s1600/Call+to+stop+obese+women+from+having+babies+-with+picture%252C+no+text.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="745" data-original-width="1054" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBb-AFlzKYNpawaNVosF3rgOmfpM10Zgh9jYoqLGdXA3TqITsR36Q6Gz8ONrqYS4NRvYmWjzuY1-N-d0PReT6saOFSCzMOLiFLjnlXk2LKc_cpEFjJSISA1HfxIA6EpDVUlywkdG96Ess/s400/Call+to+stop+obese+women+from+having+babies+-with+picture%252C+no+text.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from 2016 Australian <a href="https://thenewdaily.com.au/life/wellbeing/2016/10/13/obesity-and-pregnancy/" target="_blank">news article</a></i></td></tr>
</tbody></table>
<br />
There has been a concerted public health campaign in recent years to vilify fat pregnant women, scare them away from pregnancy via risk hyperbole, and present only negative stories about fat pregnancy in the media.<br />
<br />
<div>
This is because many doctors seem to believe that fat people have no business having children. Here's a <a href="https://myobsaid.wordpress.com/2014/11/21/obese-women-shouldnt-even-get-pregnant/" target="_blank">recent comment</a> from one OB:</div>
<div>
<blockquote class="tr_bq">
<b style="color: blue;">Obese women shouldn't even get pregnant. </b></blockquote>
This is a common opinion among some healthcare providers. While having a miscarriage, one women of size was scolded for being upset. She was <a href="http://wellroundedmama.blogspot.com/2014/03/a-woman-your-size-has-no-business-being.html" target="_blank">told</a>:<br />
<blockquote class="tr_bq">
Why are you crying? It’s not like you lost anything. A woman your size has no business being pregnant anyway.</blockquote>
The caption under the picture for the above news headline is<br />
<blockquote class="tr_bq">
<b>Experts warn obese women should not have children. </b></blockquote>
</div>
<ul style="text-align: left;">
</ul>
<div>
Although these experts justify their actions by saying it's for the sake of the children to get around criticism, that's baloney. This is nothing more than weight bias, pure and simple, combined with the arrogant belief that doctors should be the gatekeepers to who is allowed to reproduce. </div>
<div>
<br /></div>
<div>
And that is <i>completely unacceptable</i>.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Objective Reporting?</span></b></div>
<div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhteBpmYBOuQWxrGoL1sTgAYxZf5vGp7b59XRmUHojXGOoheDhafEG9mAHqUGLSlVeb2_Bo2isJAnwTE9YtBpita8qDTfoUTXegYScYG1iB-3KYRCXfVaWMOYhvVeHjL5rgjtCZoOINqq8/s1600/Pregnant+Obese+and+In+Danger+NYT+2015.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="672" data-original-width="827" height="325" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhteBpmYBOuQWxrGoL1sTgAYxZf5vGp7b59XRmUHojXGOoheDhafEG9mAHqUGLSlVeb2_Bo2isJAnwTE9YtBpita8qDTfoUTXegYScYG1iB-3KYRCXfVaWMOYhvVeHjL5rgjtCZoOINqq8/s400/Pregnant+Obese+and+In+Danger+NYT+2015.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Article from the <a href="https://www.nytimes.com/2015/03/29/opinion/sunday/pregnant-obese-and-in-danger.html" target="_blank">New York Times, 2015</a></i></td></tr>
</tbody></table>
There have been a series of media articles in recent years designed to discourage obese women from having children unless they reach a "normal" BMI first. These articles have hardly been objective. They use scary headlines, cite worst-case scenarios, use emotionally manipulative language, and rarely represent any other point of view.<br />
<br /></div>
<div>
Because of our society's dogged belief that obesity is all about willful <a href="http://www.ncbi.nlm.nih.gov/pubmed/18068203">sloth and gluttony</a>, communication about pregnancy in people of size has taken on an <a href="http://www.sscnet.ucla.edu/soc/faculty/saguy/saguyandgruys.pdf">ominous moral overtone</a>. The implication is that if the mother would only show a little <a href="https://theawl.com/real-america-with-abe-sauer-fat-fetuses-and-felonies-11013c2a5cc3#.uyagh7opi" target="_blank">self control</a>, she could stop irresponsibly putting her baby at risk. Some imply that <a href="http://www.naturalnews.com/001415.html">obesity during pregnancy is equivalent to child abuse</a>.<br />
<br />
Some articles portray fat mothers as despicable food addicts, akin to drug addicts and alcoholics, endangering their babies with their addiction. In the U.K., National Health Services health chief Jonathan Sher <a href="http://metro.co.uk/2016/05/27/dont-have-babies-health-chief-tells-addicts-and-obese-5908216/">recommended</a> in 2016 that certain women should be advised <i>not </i>to have children:<br />
<blockquote class="tr_bq">
He wrote that “health professionals, pharmacists and community workers” should all take part in giving the advice to these groups of women, who include the obese, drug addicts, domestic violence victims, and women who suffer from depression.</blockquote>
Lovely. So now fat people are looked at the same as drug addicts? A <a href="http://www.realclearscience.com/blog/2015/06/its_time_to_make_obesity_the_new_pregnancy_taboo.html" target="_blank">2015 article</a> trumpets that it's time to "<b><span style="color: purple;">make obesity the new pregnancy taboo.</span></b>"<br />
<br /></div>
<div>
Well, we are certainly well on our way towards doing that. Look at the titles of a number of recent articles or books about obesity and pregnancy.<br />
<ul style="text-align: left;">
<li><a href="http://commonhealth.legacy.wbur.org/2011/11/scary-reasons-obesity-pregnancy" target="_blank">10 Scary Reasons to Fight Obesity Before Pregnancy</a> <i>(2011)</i></li>
<li><a href="https://www.nytimes.com/2015/03/29/opinion/sunday/pregnant-obese-and-in-danger.html" target="_blank">Pregnant, Obese, and in Danger</a> <i>(New York Times, 2015)</i></li>
<li><a href="https://www.mirror.co.uk/lifestyle/health/miriam-stoppard-obese-mums-to-be-risking-1474430" target="_blank">Obese Mums-to-be Risking Their Own and Their Babies' Health</a> <i>(The Mirror, UK, 2012)</i></li>
<li><a href="https://www.realclearscience.com/blog/2015/06/its_time_to_make_obesity_the_new_pregnancy_taboo.html" target="_blank">Obese and Pregnant: Bad for Mother and Baby</a> <i>(Real Clear Science blog, 2015)</i></li>
<li><a href="https://www.nytimes.com/2010/06/06/health/06obese.html" target="_blank">Growing Obesity Increases Perils of Childbearing</a> (<i>New York Times, 2010)</i></li>
<li><a href="https://www.amazon.com/Obesity-Ticking-Reproductive-Elsevier-Insights/dp/012416045X" target="_blank">Obesity: A Ticking Time Bomb for Reproductive Health</a> <i>(ebook, Elsevier, 2013)</i></li>
<li><a href="https://thenewdaily.com.au/life/wellbeing/2016/10/13/obesity-and-pregnancy/" target="_blank">Call to Stop Obese Women from Having Babies</a> <i>(The New Daily, 2016)</i></li>
<li><a href="https://metro.co.uk/2016/05/27/dont-have-babies-health-chief-tells-addicts-and-obese-5908216/" target="_blank">Don't Have Babies, Health Chief Tells Addicts and Obese</a> <i>(Metro News, 2016)</i></li>
<li><a href="https://health.spectator.co.uk/dont-call-it-fat-shaming-there-are-good-reasons-obese-women-shouldnt-get-pregnant/" target="_blank">Don't Call It Fat-Shaming - There are Good Reasons Obese Women Shouldn't Get Pregnant</a> - <i>The Spectator, 2017</i></li>
</ul>
These are not the titles of objective pieces. These articles don't just raise awareness about risks. These articles have an obvious overt agenda, and that is to strongly discourage fat women from having children <i>at all</i>.<br />
<br />
<b>These articles are not meant to inform, but rather to scare, shame, and intimidate women of size. </b>They're meant to promote a climate of hostility towards high BMI women among healthcare providers and society in general. It's meant to paint people of size as irresponsible and out of control. It's fat-shaming and scare-mongering, pure and simple.<br />
<br />
Often, these articles feature an apocryphal <a href="http://www.nytimes.com/2010/06/06/health/06obese.html?adxnnl=1&emc=eta1&adxnnlx=1307355101-XRbzrRQ+bFL/k/Go8IiKoA">story of an obese woman with severe complications</a> as a cautionary tale. This is often a woman of color, accelerating the stigma even further. These stories imply that fat women are all at equal risk for such a dire outcome, and that anyone who dares to be Pregnant While Fat is the ultimate Bad Mother. Or as one blogger puts it, "<a href="http://www.historiann.com/2010/03/24/fat-is-the-new-crack/">fat is the new crack</a>" in bad-mother blaming.<br />
<br />
Anyone reading these articles might well conclude that virtually no fat woman has EVER had a healthy pregnancy or a healthy baby, that the ONLY way to have a healthy pregnancy is to lose vast quantities of weight first, and that the vast majority of fat women experience MAJOR complications and bear only deformed or doomed babies. And that simply doesn't jibe with the experiences of most fat mothers.<br />
<br /></div>
<div>
<b><span style="color: #cc0000; font-size: large;">Exaggerated Scare Tactics</span></b><br />
<div>
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfTA1Tdi1lnsDMeLB0SKbLnH_B2W9MbuxfkSq1MB0WbENNwpPGbN6wQgs_-macPYV740olH85LS5GUF6YMZ8T83rUE-VZO7BrQo3SP_g4VZK2WcKxaVVnWY0zZ4eRrTgOB-R_HjbsTYF8/s1600/Don%2527t+call+it+fat+shaming%252C+good+reasons+obese+women+shouldn%2527t+get+pregnant.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="669" data-original-width="858" height="311" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfTA1Tdi1lnsDMeLB0SKbLnH_B2W9MbuxfkSq1MB0WbENNwpPGbN6wQgs_-macPYV740olH85LS5GUF6YMZ8T83rUE-VZO7BrQo3SP_g4VZK2WcKxaVVnWY0zZ4eRrTgOB-R_HjbsTYF8/s400/Don%2527t+call+it+fat+shaming%252C+good+reasons+obese+women+shouldn%2527t+get+pregnant.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Article from <a href="https://health.spectator.co.uk/dont-call-it-fat-shaming-there-are-good-reasons-obese-women-shouldnt-get-pregnant/" target="_blank">The Spectator</a>, 2017</i></td></tr>
</tbody></table>
One of the main ways the media and some doctors discourage childbearing in fat women is by using exaggerated scare tactics. We've talked about scare tactic hyperbole before in our 2nd Annual Turkey Awards on <a href="http://www.wellroundedmama.blogspot.com/2009/11/second-annual-turkey-awards.html" target="_blank">Scaremongering and Shaming Tactics</a>. But of course, this tactic is still alive and kicking, as demonstrated in the above articles.<br />
<div>
<br />
This is where "experts" get to pretend that they only have the best interests of women and children at heart when they publish inflammatory articles like these. It's not weight bias, oh no! After all, pregnancy while obese has risks, right?<br />
<br />
The <a href="https://health.spectator.co.uk/dont-call-it-fat-shaming-there-are-good-reasons-obese-women-shouldnt-get-pregnant/" target="_blank">2017 article</a> article above claims it's not stigma, it's just their <i>concern </i>for you. In other words, it's the medical version of Health Concern Trolling.<br />
<blockquote class="tr_bq">
Don't call it fat shaming ─ there are good reasons obese women shouldn't get pregnant. Some will say that this is ‘fat shaming’, but it’s just what we do in the medical profession; the identification of risk and its amelioration. We can’t sacrifice the health of mothers and babies on the altar of political correctness.</blockquote>
The article then goes on to recite in scary language how obese women have higher risks for various poor outcomes, <i>without giving any context to those risks, </i>and without acknowledging that only fat people are targeted in this way.<br />
<br />
Yes, women of size have <a href="https://www.babycenter.com/0_plus-size-and-pregnant-understanding-and-managing-health-ris_1504842.bc" target="_blank">increased risks</a> of some outcomes, such as gestational diabetes, blood pressure issues, certain birth defects, and stillbirth. It serves no one to pretend otherwise, and I believe firmly that women of size should understand the potential risks. I <a href="https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=327" target="_blank">write about these potential risks</a> so that women of size can come from an educated and empowered point of view, and decide for themselves what to do about them.<br />
<br />
<b>However, it is important to have context to any discussion of risk. </b><br />
<br />
For example, a recent <a href="http://onlinelibrary.wiley.com/doi/10.1111/obr.12288/abstract;jsessionid=8347A3B79E42BB06B06AA5C68BD3DE67.f02t02" target="_blank">2015 article</a> is a meta-analysis of the risks of obesity and pregnancy. Again, as so many of these scare tactic articles do, it distorts risks by using relative risk ratios without any actual numerical risks. This makes the risks sound far more grave and life-threatening than they are.<br />
<div>
<br /></div>
For example, past <a href="https://www.ncbi.nlm.nih.gov/pubmed/27155922" target="_blank">research</a> has suggested that obese women have an increased risk for certain birth defects such as Neural Tube Defects (NTDs). Scare-mongering articles always highlight the birth defects risk in particular in media campaigns because it holds so much emotional resonance. <i>Fat women are giving birth to deformed babies! If they weren't so selfish, these birth defects could be prevented!</i><br />
<br />
It's true that obese women have an increased risk for NTDs; some <a href="http://www.ncbi.nlm.nih.gov/pubmed/19211471">studies</a> have <a href="https://www.ncbi.nlm.nih.gov/pubmed/16463272" target="_blank">found</a> 2-4 times the <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/bdra.23113" target="_blank">risk</a> for Neural Tube Defects (NTDs) in obese and very obese women. Sounds scary, doesn't it? Yet rarely do the articles mention that double or even quadruple a <a href="http://www.fetalscreening.com/other_conditions.php">very small risk</a> (about 1-2 per thousand) is <i>still a very small risk</i>. Do the math. Even if there is an increased risk, less than 1% of obese women will probably have a baby with a NTD.<br />
<br />
Expressing it in relative risk (<i>Two times the risk! Four times the risk!</i>) makes it sound scarier and provides a juicier sound bite for the media. But what high BMI people really need to know is what the <i>absolute </i>numerical risk is and what they can do to <a href="https://www.babycenter.com/0_plus-size-and-pregnant-understanding-and-managing-health-ris_1504842.bc" target="_blank">lower their risk</a> for a NTD. [Answer: To lower the risk for NTDs be sure your blood sugar is normal before pregnancy, stays normal during pregnancy, and possibly take a higher dose of folic acid before and during early pregnancy.]<br />
<br />
Gestational diabetes (GD) is another risk that is frequently mentioned in these articles. The risk for GD is about 3-5% among the general population, but it <a href="http://www.wbur.org/commonhealth/2011/11/18/scary-reasons-obesity-pregnancy" target="_blank">increases</a> to around 15% or so in <a href="https://www.ncbi.nlm.nih.gov/pubmed/27275800" target="_blank">high BMI women</a>. This is definitely a substantial increase and a potential cause for concern because it may lead to other complications.<br />
<br />
However, reverse the statistics and you realize that <i>about 85% of high BMI women do NOT get gestational diabetes</i>. The risk is definitely increased but it is hardly overwhelming. Do you come away from articles on obesity and pregnancy with the impression that more than three-fourths of very fat women will NOT be diagnosed with gestational diabetes? Nor do most articles point out that even if someone develops GD, it is a very manageable condition. Most people with GD are able to control it and have healthy babies.<br />
<br />
<b>Yes, women of size are at increased risk for some complications, but being at increased risk does not mean that complications <i>will </i>happen. </b>Many women of size have healthy pregnancies and healthy babies, a fact conveniently ignored by these media articles. They only feature stories of scary complications in order to frighten people of size out of considering pregnancy. You don't scare people away from pregnancy with stories of normal pregnancies and good outcomes.<br />
<br />
<b>Nor should facing potential risk disqualify you from motherhood. </b>All kinds of women are at increased risk for complications due to various factors (age, family history, racial or ethnic status, various health conditions) but are rarely told that they have "no business being pregnant." Their risk status is acknowledged and counseling toward risk mitigation is given. The same can be done for women of size.<br />
<br />
In dealing with women with risk factors, the focus should be on helping them have the healthiest pregnancy possible, while acknowledging possible complications ─ not trying to keep them from ever having a baby.<br />
<br />
It's deeming people with some types of risk factors (like type 1 diabetes) as worthy of having babies despite the risks, and people with other types of risk factors (obesity) as unworthy of having babies. This suggests a bias and stigma, a real implication of a eugenics agenda, even if it is an unconscious one.<br />
<br />
Many caregivers recognize that plenty of people of size will have perfectly fine pregnancies and healthy babies despite their size. They also know that in those who <i>do </i>experience complications, the emphasis should be on kind and empathetic care in helping that person towards the best possible outcome, not on scolding and judgment. Even complicated pregnancies can often have good outcomes with supportive care.<br />
<br />
It is NOT an irresponsible act to have a baby at a larger size. Yet many of these alarmist articles imply that it is. It's NOT up to doctors to decide which patients with which risk factors should procreate. Rather, it is up to the couple to look at their particular risks and make an informed decision about having children or not. </div>
<b><span style="color: blue;"><br /></span></b>
<b><span style="color: blue;">Reasonable risk counseling is appropriate, medical bullying through risk hyperbole is not.</span></b></div>
<br />
It's not that we cannot discuss possible risks. Of course we can; that's an important part of the healthcare conversation. However, public health discussions about weight have gone from discussing possible risks, to making sweeping generalizations and exaggerations of risk in the public's mind, to scapegoating, scaremongering, and suspension of basic rights by healthcare professionals.<br />
<br />
What these experts fail to realize is that weight stigma in public health campaigns often <a href="https://www.ncbi.nlm.nih.gov/pubmed/26627213" target="_blank">backfires</a> and leads to worse outcomes, not better ones. Stigma affects health negatively. Increasing stigma for people of size does <i>not </i>improve outcomes.<br />
<br />
When media coverage quotes "experts" who criticize women of size in inflammatory language for even considering pregnancy at a larger size, when it refuses to acknowledge that many women of size DO have healthy pregnancies and babies at higher weights, when it distorts risk, when it makes sweeping behavioral generalizations, and when it attempts to keep plus-size people from procreation through guilt and dire predictions, that IS indeed fat shaming.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Just Lose Weight First?</span></b><br />
<div style="font-family: "times new roman";">
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFSxT0fzaT4n8MNwaVRl30G3aYAKX0U-UM7iUEs4gAx9OMYyWqyWdyWi_IJCfxoxd-8NHyDCbbzd0dd_D8aP5HzeVsKOhOrzemULlSe7BxBxHHcLRO4iESG_bUq782LYewS-rOMGQBJlA/s1600/Obese+mums+risking+health%252C+UK+Mirror%252C+Getty+image.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="807" data-original-width="1024" height="315" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFSxT0fzaT4n8MNwaVRl30G3aYAKX0U-UM7iUEs4gAx9OMYyWqyWdyWi_IJCfxoxd-8NHyDCbbzd0dd_D8aP5HzeVsKOhOrzemULlSe7BxBxHHcLRO4iESG_bUq782LYewS-rOMGQBJlA/s400/Obese+mums+risking+health%252C+UK+Mirror%252C+Getty+image.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from 2012 <a href="https://www.mirror.co.uk/lifestyle/health/miriam-stoppard-obese-mums-to-be-risking-1474430" target="_blank">article</a> in The Mirror</i></td></tr>
</tbody></table>
Some doctors are very supportive of people of size, but others are uncompromising and <a href="https://www.sciencedaily.com/releases/2010/01/100120121558.htm" target="_blank">rigid about weight</a>. They believe that no one should get pregnant unless they are at a "normal" BMI. From a <a href="https://health.spectator.co.uk/dont-call-it-fat-shaming-there-are-good-reasons-obese-women-shouldnt-get-pregnant/" target="_blank">2017 article</a> from the U.K.:<br />
<blockquote class="tr_bq">
<b>It is imperative that women should be discouraged from trying to get pregnant until they have attended to any excess weight</b>.</blockquote>
These doctors just don't get it. Being fat and wanting children poses a difficult set of choices, and that it's not always as simple as "eat better and exercise and you'll magically lose weight and be healthy enough for a pregnancy."<br />
<br />
Getting to so-called "ideal" weight is simply not a realistic goal for most fat people before pregnancy. Even when eating well and exercising regularly, many people of size stay fat. Even the <a href="https://www.bionews.org.uk/page_90537" target="_blank">fall-back stance</a> of "lose just 5-10% of your weight" can have negative outcomes in real life too, as it often triggers a rebound to a weight greater than the starting point.<br />
<br />
Doctors want simple answers, but there are none. The fact is that nearly all fat people have <a href="http://www.pubmed.gov/15175598">tried</a> <a href="http://www.pubmed.gov/19709468">repeatedly</a> to lose weight, and <a href="http://www.pubmed.gov/11033978">rarely</a> is it lost permanently. Frankly, if there really were an easy, foolproof way to lose weight permanently, we'd all be skinny. It's NOT just a matter of willpower, and research shows that <a href="http://junkfoodscience.blogspot.com/2007/12/part-two-what-does-evidence-reveal-can.html">long-term weight loss</a> is very <a href="http://www.pubmed.gov/17469900">unlikely</a>.<br />
<br />
Most fat people have <a href="http://www.pubmed.gov/1918744">lost weight</a> time after time, only to see it <a href="http://www.pubmed.gov/11896497">come back</a> over <a href="http://www.pubmed.gov/12080451">time</a>. Many of us end up <a href="http://www.pubmed.gov/19328269">fatter after a weight loss attempt</a> than <a href="http://www.pubmed.gov/8651838">before</a> we began it. In fact, for many of us, <a href="http://www.pubmed.gov/11896497">yo-yo dieting</a> is what actually <a href="http://www.pubmed.gov/16648597">put us</a> in the "morbidly obese" category in the first place. For others, strong <a href="http://www.pubmed.gov/7674914">genetic</a> and <a href="http://www.pubmed.gov/17964914">hormonal</a> factors may be <a href="https://www.ncbi.nlm.nih.gov/pubmed/27757353" target="_blank">at work</a>, making reaching that "ideal" weight statistically extremely unlikely.<br />
<br />
When faced with people like this, doctors often suggest bariatric surgery. Weight loss surgery does reduce BMI, but research shows significant trade-offs. There are reduced risks for <a href="https://www.ncbi.nlm.nih.gov/pubmed/22353952" target="_blank">gestational diabetes</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23241580" target="_blank">large babies</a>, but also <a href="https://www.ncbi.nlm.nih.gov/pubmed/29454871" target="_blank">increased risks</a> of <a href="https://www.ncbi.nlm.nih.gov/pubmed/24222480" target="_blank">prematurity</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/23467053" target="_blank">too-small babies</a>, and possibly <a href="https://www.ncbi.nlm.nih.gov/pubmed/25714159" target="_blank">neonatal mortality</a>. Nutrient deficits are <a href="https://www.ncbi.nlm.nih.gov/pubmed/20363593" target="_blank">common</a> and there is an <a href="https://www.ncbi.nlm.nih.gov/pubmed/28383368" target="_blank">increased risk</a> for <a href="https://www.ncbi.nlm.nih.gov/pubmed/29875982" target="_blank">intestinal hernias</a>; pregnancies after bariatric surgery must be monitored closely. There are no easy answers here.<br />
<br />
Many people stop weight loss attempts because they recognize that all the yoyo-ing is hurting their health far more than it is helping it. When they do this, they are not "giving up" or "letting themselves go" but instead focusing on healthy habits instead of weight loss as a measure of health. These habits often do not lead to significant weight loss, but people are still <a href="http://www.medicalnewstoday.com/articles/25384.php">healthier</a> by simply emphasizing good habits and weight stability. This approach is called "<a href="http://www.ars.usda.gov/is/AR/archive/mar06/health0306.htm">Health At Every Size</a>" (HAES).<br /><br /><b>For some, the decision to have a pregnancy at a larger size is one chosen once we recognize that long-term weight loss is not likely to happen and if we wait to reach that "ideal" weight range, we may never have a baby.</b><br /><br />Don't think that experts don't realize that. They do. Either they are deliberately deluding themselves about the long-term success of weight loss, or they are subtly trying to take fat people out of the reproductive pool.<br /><br />Another factor to consider is that dieting before pregnancy may deplete the body's stores of vital nutrients (particularly <a href="http://www.pubmed.gov/18271402">iron</a>), just at the time they are needed most. Many "morbidly obese" people have <a href="http://www.pubmed.gov/18491197">significant</a> <a href="http://www.pubmed.gov/18258626">micronutrient deficiencies</a> already; repeated dieting may be part of that. Some consciously choose not to restrict intake or undergo malabsorptive surgeries before deciding to have a baby because of this concern. We do this out of love, not out of selfishness.<br />
<br />
Some people of size do choose to try and lose some weight before pregnancy; not necessarily down to "ideal weight" but at least a little bit in hopes of lowering risks. Everyone is an adult and gets to make their own choices. There is some research that it <i>might </i><a href="https://www.ncbi.nlm.nih.gov/pubmed/23246318" target="_blank">improve</a> some <a href="https://www.ncbi.nlm.nih.gov/pubmed/29866719" target="_blank">outcomes</a> modestly. But is that the effect of actual weight loss or an effect of a change in habits?<br />
<br />
On the other hand, weight loss before pregnancy can also backfire, even modest amounts. Many of these women find that once pregnant, the body rebounds with a vengeance, gaining far <a href="http://www.pubmed.gov/18926129">more weight</a> than "should" be gained in pregnancy as the body tries to store fat for the starvation period it thinks it is in. And gaining a great deal of weight in pregnancy is not ideal for anyone, mother or baby.<br />
<br />
There is also some research that suggests that <a href="https://www.ncbi.nlm.nih.gov/pubmed/14652296" target="_blank">dieting behaviors</a> or <a href="https://www.ncbi.nlm.nih.gov/pubmed/29024488" target="_blank">weight loss product use</a> just before or around the time of conception <a href="https://www.ncbi.nlm.nih.gov/pubmed/21512779" target="_blank">increases the risk</a> for birth defects. So while losing even "just a few pounds" before pregnancy may seem prudent, it could have unforeseen consequences too.<br />
<br />
The bottom line is that there are no simple solutions. The best thing a person of size can do is to focus on improving health habits before pregnancy. This doesn't have to center on weight loss. For example, regular exercise is one of the most <i>powerful </i>things people of all sizes can do to improve their health before pregnancy. Checking that you have normal blood sugar and blood pressure before conceiving is a very important way to improve outcomes. Starting a prenatal vitamin and extra folic acid before conception is also a good idea. Emphasizing good nutrition can also be helpful, regardless of whether it results in weight loss.<br />
<br style="background-color: whitesmoke; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;" />
Some people of size choose not to wait till we are "ideal weight" before having kids because we know that there are risks to getting older too. Age decreases fertility and increases some pregnancy risks. We may decide that it's better to act sooner than later. <br />
<br />
Some of us believe that having a child at our present weight makes more sense than putting off pregnancy for years in an effort to lose weight. It's better than gambling on losing weight and then trying to keep the resultant pregnancy weight gain to "acceptable" levels, or to start out a pregnancy nutritionally-compromised from recent weight loss attempts or bariatric surgery.<br />
<br />
Having a child at a higher weight does not mean we are ignorant about nutrition and exercise, that we are recklessly exposing children to potential risk because we are too lazy or stupid to "eat right." Many of us have very normal eating habits and do not fit the stereotypes of junk food, overconsumption, and gluttony.<br />
<br />
Ultimately, the final choice about whether or not to lose weight before pregnancy is up to each individual. Some may decide to, and that's their choice. However, choosing not to lose weight first doesn't mean we are ignorant, uncaring, or unhealthy. Instead, for many of us, it may represent what we think is our best chance for a healthy pregnancy and baby. This is not an act of selfishness but an act of love, hard as that may be for some critics to understand.<br />
<br />
<div>
<div style="margin: 0px;">
Researchers need to STOP trying to scare and shame fat women out of reproducing and pretending that they only have the noblest of intentions at heart. They need to STOP implying that fat women are irresponsible for considering reproducing, or that the only safe way for a fat woman to have a baby is if she loses weight first. The fact is that many fat women have healthy pregnancies and babies without losing weight. <i>Experts need to study those women and see what can be learned from them.</i><br />
<div style="font-family: "times new roman";">
<br /></div>
</div>
</div>
<div>
<span style="color: #cc0000; font-size: large;"><b>Intersectional Stigma</b></span></div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkqGPhWxT_OVhXl0yJxp3w9w3Y2gEKFS16LHoRl4Drz0gmO9Ds6HjFzbcfLiLTt0iEcvQWypF7Dshn-QspIuapcFLwoBQiZXg_400cAlNX7q3RdBNE4jwoQASUs5gBFVVmlJ8ASKs8KBM/s1600/Growing+obesity+increases+perils+of+childbearing+NYT+2010.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="602" data-original-width="806" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkqGPhWxT_OVhXl0yJxp3w9w3Y2gEKFS16LHoRl4Drz0gmO9Ds6HjFzbcfLiLTt0iEcvQWypF7Dshn-QspIuapcFLwoBQiZXg_400cAlNX7q3RdBNE4jwoQASUs5gBFVVmlJ8ASKs8KBM/s400/Growing+obesity+increases+perils+of+childbearing+NYT+2010.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from <a href="https://www.nytimes.com/2010/06/06/health/06obese.html" target="_blank">The New York Times, 2010</a></i></td></tr>
</tbody></table>
These media articles don't just stigmatize fatness; they often reflect other societal stigmas. This is intersectional eugenics, where women of color who are also women of size or disabled in some way are being stigmatized even more.<br /><br />In the <a href="https://www.nytimes.com/2010/06/06/health/06obese.html">New York Times article above</a>, the cautionary apocryphal story about obesity in pregnancy is a woman of color. Of course, it's an extreme story. The woman, in her 30s, was already diabetic with kidney issues when she became pregnant. She gained a lot of weight in pregnancy, had a stroke, and her baby was born prematurely. She is pictured mournfully sitting by her extremely small son, touching his tiny feet, in the Neonatal Intensive Care Unit (NICU), and looking regretful.<br /><br />Imagine what happens when people with multiple marginalized social identities present for pregnancy care. Stigma increases even more. And it's no mistake that people with multiple stigmas are used as the "bad examples" in media articles, especially in the U.S. It's an unconscious desire to increase the "othering" of people of size in the minds of the public. <br /><br />Weight stigma in pregnancy is already <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577669/">considerable</a>. Caregivers report being repulsed and having less respect for people of size, along with <a href="https://www.ncbi.nlm.nih.gov/pubmed/20381222/">concern</a> on how to deal with fat pregnant women. They often assume that fat people lack "necessary skills, awareness, or motivation to manage their weight." They may view people who have become pregnant at a higher weight as irresponsible. One <a href="https://www.todaysparent.com/pregnancy/pregnancy-health/we-need-to-stop-discriminating-against-plus-size-pregnant-women/">article</a> notes:<br /><blockquote class="tr_bq">
Weight stigma is widespread in healthcare and can lead to anxiety, stress, depression, low self-esteem and negative body image. It can be particularly harmful during pregnancy, when women are at an increased risk of developing mental health issues and their bodies are being scrutinized more than usual. And discussions about things like how extra weight can put the baby at risk can lead to intense feelings of guilt when not handled properly.</blockquote>
<div>
Various racial groups, particularly African-Americans, also often experience great stigma in pregnancy. This may help explain why they have a higher risk for some poor <a href="https://www.npr.org/2011/07/08/137652226/-the-race-gap">outcomes</a>. An excellent <a href="https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why">2017 article</a> from National Public Radio (NPR) explored black maternal health in pregnancy and found that blacks had <a href="https://www.ncbi.nlm.nih.gov/pubmed/29346121">far higher rates</a> of maternal death during and after birth. The NPR article summarized (my emphasis):<br /><blockquote class="tr_bq">
According to <a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html">the CDC</a>, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women's health...In a <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Tucker+MJ%2C+Berg+CJ%2C+Callaghan+WM%2C+Hsia+J">national study</a> of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.</blockquote>
According to the NPR article, the difference in maternal mortality between blacks and whites is not attributable to education, socioeconomic status, or access to healthcare. African-American women with every advantage still have poorer outcomes in general. Much of this is due to the stress of long-term exposure to racism and stigma.<br /><br />What has been surprising recently is the discovery that black women are particularly vulnerable after the birth. More than half of maternal deaths <a href="https://www.npr.org/2018/04/23/605006555/redesigning-maternal-care-ob-gyns-are-urged-to-see-new-mothers-sooner-and-more-o">occur postpartum</a>, and people who experienced high blood pressure or cesareans are particularly <a href="https://www.ncbi.nlm.nih.gov/pubmed/27829570">vulnerable</a>. Black women have <a href="https://www.ncbi.nlm.nih.gov/pubmed/29528919">higher rates</a> of <a href="https://www.ncbi.nlm.nih.gov/pubmed/29980155">both</a> blood pressure issues and cesareans. Add in chronic stress from racism and care models that chronically neglect women after birth and you have a recipe for poor outcomes.<br /><br />The <a href="http://www.atmch.org/sites/atmch.org/files/Syllabi//Understanding%20Obesity%20Stigma%20as%20a%20Stressor.pptx">intersection</a> of race and weight leads to even more stigma. The NPR article related the story of a young black Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. Getting providers to listen and take your concerns seriously is difficult, especially if you are a person of color and size.<br /><br />That's why it's even more shameful when articles about the dangers of obesity and pregnancy feature women of color as their bad-mother examples; it multiplies stigma. As Abigail Saguy and Kjerstin Guys of UCLA <a href="http://www.sscnet.ucla.edu/soc/faculty/saguy/saguyandgruys.pdf">note</a>, articles that feature a cautionary example of a poor person of color "reinforces social stereotypes of fat people, ethnic minorities, and the poor as out of control and lazy...In the contemporary United States, body size intersects with other dimensions of inequality."<br /><br />Most researchers and care providers do not consciously wish to stigmatize women of color or women of size. They want to improve outcomes, which is a good goal. But some are tone deaf. They refuse to understand that the public health campaigns they are waging around obesity and pregnancy are far MORE stigmatizing and have begun to venture into the eugenics realm.</div>
<div>
<br /><div>
<b><span style="color: #cc0000; font-size: large;">Direct Pressure for Sterilization or Termination </span></b><br />
<br />
<b></b></div>
<div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMkTsCPN3IjmpiJdNB_4tchLLVbS2sI9f2ZGqEv8ZPo1BbuCxROLY4nk2VBgYChVFcOGtCZkxNPQqEL60rd9s7RrPKPJ7kJfTq8rkmIV7Uyp0qXRueDcU7pvd1Xr-Nwh7fsdFu4yYOVUU/s1600/Another+Pregnancy+Could+Kill+You+Sterilize+Daily+Mail+2016+-cropped.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="126" data-original-width="654" height="76" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMkTsCPN3IjmpiJdNB_4tchLLVbS2sI9f2ZGqEv8ZPo1BbuCxROLY4nk2VBgYChVFcOGtCZkxNPQqEL60rd9s7RrPKPJ7kJfTq8rkmIV7Uyp0qXRueDcU7pvd1Xr-Nwh7fsdFu4yYOVUU/s400/Another+Pregnancy+Could+Kill+You+Sterilize+Daily+Mail+2016+-cropped.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Article from <a href="http://www.dailymail.co.uk/femail/article-3422748/Obese-mother-five-told-fat-pregnancy-kill-gets-sterilised-slims-size-10.html" target="_blank">The Daily Mail</a>, 2016</i></td></tr>
</tbody></table>
The attempt to limit who can procreate doesn't just stop with scary media campaigns, hyperbole about risk, and pressure to get to a "normal" BMI first. Pressure for sterilization or termination (abortion) is another way that providers try to limit family size in high-BMI women.</div>
<div>
<br />
We should be clear that most providers don't do this. However, it is real and it <i>has </i>happened. And that is inexcusable.<br />
<div>
<br />
In the U.K. <a href="http://www.dailymail.co.uk/femail/article-3422748/Obese-mother-five-told-fat-pregnancy-kill-gets-sterilised-slims-size-10.html" target="_blank">story</a> behind the above headline, pressure for sterilization was direct and over the top. Her 5th pregnancy was a surprise pregnancy with twins, conceived despite being on birth control (which may be less effective in larger women). She was diagnosed with gestational diabetes during the pregnancy, not an uncommon finding in twin pregnancies. She was told in no uncertain terms that another pregnancy could <i>kill</i> her and that she needed to strongly consider sterilization:<br />
<blockquote class="tr_bq">
'At 31 weeks pregnant the consultant sat me down and was blunt. Firstly he said the diabetes could cause the girls to grow quite large so I would need a C-section. And then he said another pregnancy would most likely kill me as even if I weren't pregnant, I was at a high risk of becoming a diabetic, ending up in a wheelchair and having a heart attack. As such doctors suggested I should not become pregnant again and I could be sterilised during the C-section.</blockquote>
And indeed, that's what this mother chose to do. The doctor was sufficiently scary in his predictions that she <i>permanently </i>ended her childbearing.<br />
<br />
Sometimes the pressure is subtle, as in refusing to remove birth control devices. One Canadian woman recounted the story of her doctor who <a href="http://news.nationalpost.com/health/while-health-risks-are-real-much-of-the-risk-talk-telling-obese-women-they-are-dangerous-potential-mothers-sensationalized-research?__lsa=eb29-de5c" target="_blank">refused to remove her IUD</a> because he felt it would be a "disaster" for her to become pregnant. Although this is not permanent irreversible sterilization, it is a de facto sterilization.<br />
<br />
Other fat women have been pressured to have their tubes tied when they have babies. <a href="http://www.wellroundedmama.blogspot.com/2008/06/gina-maries-story.html" target="_blank">Gina Marie's story</a> from my website shared the tale of a woman who was pressured for sterilization during labor. This is an ethical violation; <a href="https://www.opensocietyfoundations.org/voices/against-her-will-putting-end-forced-sterilization" target="_blank">ethics guidelines</a> state that women should never be pressured for sterilization when particularly vulnerable, such as during labor. But it happened to Gina Marie anyway.<br />
<br />
Her labor was induced early due to fear of a big baby, and not surprisingly, she ended up with a cesarean. The OB was very vocal about how she shouldn't be having children at her size, and <a href="http://wellroundedmama.blogspot.com/2008/06/gina-maries-story.html" target="_blank">pressured</a> her to agree to have her tubes tied during the cesarean. When she would not agree to having her tubes tied, they tried to frighten her by exaggerating the risk of complications during the cesarean and asking her and her partner about her <i>funeral plans</i> during consent for the cesarean. Then they punished her by doing a classical cesarean (a giant incision, up and down, far more risky than a side-to-side incision), blaming it on her obesity, and telling her that her uterus would "explode" if she had any more pregnancies. She never did. In this case they did not succeed in directly sterilizing her but they did succeed in a de facto steriilization.<br />
<br />
Although most care providers will not go this far or be this coercive, there is subtle pressure towards sterilization for fat women. We know there is a <a href="http://rockcenter.nbcnews.com/_news/2011/11/07/8640744-victims-speak-out-about-north-carolina-sterilization-program-which-targeted-women-young-girls-and-blacks">long and shameful history</a> of <a href="http://theconversation.com/forced-sterilization-programs-in-california-once-harmed-thousands-particularly-latinas-92324">forced sterilizations</a> or sterilizations <a href="https://asunow.asu.edu/20160330-solutions-making-sense-dark-chapter-americas-past">without consent</a> in the <a href="http://moazedi.blogspot.com/2017/10/mississippi-appendectomy-racism-and.html">United States</a>. This is just the latest version of that, dressed up as "concern" for your health. Eugenics policies were often <a href="https://www.cbc.ca/news/canada/saskatoon/report-indigenous-women-coerced-tubal-ligations-1.4224286">directed</a> at women of color, poor women, and "disabled" women because medical authorities thought they should not be reproducing. <br /><br />Although forced sterilization was not systematically applied to fat women across the board, there have certainly been stories of strong pressure for sterilization and even abortion. A number of women have written to me over the years and shared some of <a href="http://wellroundedmama.blogspot.com/2008/06/pressure-for-abortion-for-obese-women.html">their stories</a>. Care providers (or even family members) have implied that it's far too dangerous to be fat and pregnant, that they must terminate the pregnancy in order to save their own lives. Or they imply that the baby is sure to have health problems, birth defects, or be stillborn. Here are a few of the stories:</div>
<ul style="text-align: left;">
<li>"I also was told I could not have kids. Then when I got pregnant I was told by various doctors for various reasons that I should abort."</li>
<li>"[The doctor] even suggested that we consider having an abortion because the likelihood was great that [problems with the baby were] going to happen....We had 2 weeks to decide about the abortion because legally you have up to 24 weeks to abort the baby." </li>
<li>"[The doctor said:] 'No fat woman can ever have a healthy pregnancy. Besides, if you did get pregnant, I'd order you to have an abortion. But that's a moot point anyway, because you're too fat to get pregnant.' "</li>
</ul>
<div>
Another <a href="https://fathealth.wordpress.com/2013/02/03/too-old-and-too-fat-to-be-pregnant-ffs/" target="_blank">story</a> of a fat person pressured for abortion can be found on the blog, <a href="http://fathealth.wordpress.com/" target="_blank">First Do No Harm</a>:<br />
<blockquote class="tr_bq">
The doctor walked in holding my chart. The first thing she said was, “We all know you don’t want to be here.” ... She continued, “Thirty six years old and a third baby. Hmm. We all know your eggs aren’t any good any more.” [The OB] spoke on and on about why it probably wasn’t a good idea for me to have the baby and that time was running short for me to terminate the pregnancy. I finally held my hand up and said, “I am not terminating the pregnancy. Let’s just move on from there.”</blockquote>
</div>
Sometimes the pressure for abortion is not quite as direct. The <a href="http://wellroundedmama.blogspot.com/2010/07/you-will-probably-just-die-anyway.html" target="_blank">potential for death</a> for mother or baby is <a href="http://wellroundedmama.blogspot.com/2009/05/care-providers-vs-scare-providers.html" target="_blank">emphasized</a> and the parents are left to fill in the dots as to what their next action should be. Sometimes providers imply that fat women will die if they try to carry a pregnancy to term, that having a baby is committing "<a href="http://www.wellroundedmama.blogspot.com/2008/09/suicide-by-pregnancy.html" target="_blank">suicide by pregnancy</a>." They hope that the women will be <a href="http://www.wellroundedmama.blogspot.com/2008/06/fat-pregnancy-equals-death.html" target="_blank">too scared</a> to continue the pregnancy or try to conceive in the first place. Or they imply that the baby is likely to be deformed or die.<br />
<ul style="text-align: left;">
<li>"I went to see a doctor today...He basically made me feel my baby is a death sentence...In his "honest opinion" I am going to die during labor/delivery or recovery."</li>
<li>"I used to go to a really Fat phobic doctor; he was so awful he told me that I couldn't even consider the idea of having another baby or I would die for sure (due to my weight)."</li>
<li>"[My doctor] was appalled when she heard I was not on any form of BCP [birth control pills] and said that "at your age and with your size" that either the baby or I would die."</li>
<li>"According to him I'm probably going to die of a heart attack sometime during my pregnancy or shortly after."</li>
<li>A reproductive endocrinologist refused to help a high BMI woman get pregnant, saying it would be unethical to do so. He says if she did somehow manage to get pregnant,<i> "The baby would only have a 5% chance of survival."</i></li>
</ul>
<div>
One of the very first stories I heard years ago when I started my website was the woman who was told that she would "die on the table" while giving birth. Others have been told that they would surely have a heart attack during pregnancy or shortly after, or that they were "<a href="http://wellroundedmama.blogspot.com/2012/02/you-and-baby-are-about-85-likely-to-die.html" target="_blank">85% likely to die on the table</a>" during the birth.<br />
<br /></div>
<div>
Although these doctors didn't directly pressure the women to have an abortion, statements implying that death is practically inevitable for a fat mother or baby are certainly going to be interpreted as pressure to terminate a pregnancy. Here is a <a href="http://wellroundedmama.blogspot.com/2012/05/plea-for-help-in-uk.html" target="_blank">story</a> of a woman in the U.K. who was so frightened by the "obesity risk" talk" from her care providers that she was strongly considering termination of the pregnancy.<br />
<blockquote class="tr_bq">
Please please please, can someone help me. I am 10 weeks pregnant and currently have a BMI of 35...I have had my first midwife appointment today and was told that more than 50 percent of maternal deaths in pregnancy and childbirth are obese mothers and that I will have to have special monitoring and won't be allowed to have a natural birth at the birth centre and will have to be under consultant care and be constantly monitored throughout labour (meaning no water birth, no moving around, no getting into positive positions to birth). </blockquote>
<blockquote class="tr_bq">
I am so scared and disappointed, I feel like I am an unfit mother already and feel that the drs think I do not care about the health of my unborn baby. Now I know that this will not go down well with some people but I am considering a termination so that I can lose more weight before carrying a child (I have currently lost 70 pounds).</blockquote>
Here is another <a href="https://www.mumsnet.com/Talk/pregnancy/2104110-Feel-like-Im-too-fat-to-be-pregnant" target="_blank">similar story</a>. The woman was so scared by all the death talk around obesity and pregnancy that she was considering ending her pregnancy, even though she'd already had one successful pregnancy and healthy baby. She was particularly afraid of the risk for a blood clot (DVT).<br />
<blockquote class="tr_bq">
I am pg with my 2nd child. With my first I was overweight with a BMI of 37 but had a textbook perfect pregnancy with low blood pressure, blood sugar etc and a small baby, natural birth no issues etc and everything was hunky dory. </blockquote>
<blockquote class="tr_bq">
Fast forward 2 years and I have since suffered anxiety and depression, mostly directed towards my health. I have become a hypochondriac which is mental torture some days. I have gained a weight since I had my dd...I am so upset and disgusted with myself , I have beat myself up all day about this. I have done a lot of research the past few days and there's a lot of scary articles about how maternal death and infant death is linked to obesity, how overweight women have a much bigger chance of dying during pregnancy etc, developing DVTs (which is one of my massive hypochondriac fears).</blockquote>
<blockquote class="tr_bq">
I am terrified I am going to die during this pregnancy because of my weight that I am considering not going ahead with the pregnancy. I am losing sleep and every ache or pain I am worrying about a DVT. It has been mental torture so far and another 8 months of this seems unbearable.</blockquote>
Again, this speaks to the importance of presenting risk realistically. It's true that obesity is a risk factor for DVT, but the actual chances of having a blood clot are pretty small, even in a "morbidly obese" pregnant woman. Many women of similar size (including me) have had pregnancies without blood clots, but these are not the stories being promoted by the media or shared by the doctors. <br /><br />Furthermore, if she is really worried about a clot, she could speak to her provider about taking a low-dose aspirin prophylactically. Some providers do this regularly with obese women; while no research on its benefit for obese women has been done, it is a choice that can be considered if she is really worried or has a strong family history of clots. She also needs treatment for her anxiety so she can deal with her fears.<br /><br /><b>Doctors may not intend to be actively promoting eugenics but they cannot overlook what the real-world effects are of discriminatory scare tactics. And shamefully, some are fully aware of these effects and employ them deliberately.</b></div>
<div>
<b><br /></b></div>
<div style="font-family: "times new roman";">
<div style="margin: 0px;">
<b><span style="color: #cc0000; font-size: large;">Eugenics Towards People of Size</span></b></div>
</div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh15voWQUXjPHAPbFxs8UcEFSEvX8wM9F0kWtPzG2u2ta2rNgBTSdPBUiQtjXX5bLckPElQp_2spuKkLfnGg1f29GEZPxduDX3BCsuE48q8Kz7dsMwmfBV3K0RLhJdP1D8LK7OA79FoTS4/s1600/Don%2527t+have+babies%252C+health+chief+tells+addicts+and+obese.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="581" data-original-width="676" height="343" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh15voWQUXjPHAPbFxs8UcEFSEvX8wM9F0kWtPzG2u2ta2rNgBTSdPBUiQtjXX5bLckPElQp_2spuKkLfnGg1f29GEZPxduDX3BCsuE48q8Kz7dsMwmfBV3K0RLhJdP1D8LK7OA79FoTS4/s400/Don%2527t+have+babies%252C+health+chief+tells+addicts+and+obese.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Headline from <a href="https://metro.co.uk/2016/05/27/dont-have-babies-health-chief-tells-addicts-and-obese-5908216/" target="_blank">Metro.co.uk 2016</a></i></td></tr>
</tbody></table>
How many women of size have had their family size limited, directly or indirectly, through medical bullying? How many people of size have decided not to have children because of the over-the-top public health campaigns against obesity and pregnancy? How many have put off pregnancy until they get to a "normal" BMI, only to find that day never comes? How many have faced pressure for sterilization or de facto sterilization? How many have considered ending their pregnancies because their doctors told them they might die? How many have been pressured to abort a wanted pregnancy because of their size?<br />
<br />
There is more than a whiff of eugenics in these latest media campaigns, whether providers mean it to be that way or not. Some researchers have <a href="http://news.nationalpost.com/health/while-health-risks-are-real-much-of-the-risk-talk-telling-obese-women-they-are-dangerous-potential-mothers-sensationalized-research?__lsa=eb29-de5c" target="_blank">suggested</a> that such stories "hint at so-called soft eugenic practices to keep obese women from reproducing."<br />
<br />
From a National Post <a href="https://nationalpost.com/health/while-health-risks-are-real-much-of-the-risk-talk-telling-obese-women-they-are-dangerous-potential-mothers-sensationalized-research?__lsa=eb29-de5c/">article from 2016</a> by Sharon Kirkey:<br />
<blockquote class="tr_bq">
Canadian researchers say that amid a flurry of press about the dangers of excess fat during pregnancy, overweight and obese women are being made to feel they’re “disgusting” or “bad mothers” for putting their fetuses at risk.... </blockquote>
<blockquote class="tr_bq">
Doctors have legitimate reasons to warn women of the complications related to excess maternal weight, they acknowledge. However, much of the obesity “risk talk” is sensationalized, moralizing and shouldn’t position heavy women as “always-already diseased and dangerous to their child,” they write in the latest issue of Social Science & Medicine. Larger women, they argue, can have perfectly healthy, incident-free pregnancies and births. </blockquote>
<blockquote class="tr_bq">
“We’re certainly not trying to say that any of the healthcare providers that are referred to in the study is actually a eugenicist,” co-first-author, Andrea Bombak, an assistant professor at Central Michigan University said in an interview. </blockquote>
<blockquote class="tr_bq">
“What we’re trying to say is that anytime we refuse care in these areas, or potentially limit people’s care, we could be unintentionally and inadvertently echoing some of these histories that we’ve seen in the past about who is it that society would prefer to reproduce — and who they would prefer to not have reproduce,” she said... </blockquote>
<blockquote class="tr_bq">
Many women had positive experiences. But many others also described being made to feel as if they were “disgusting” or unfit to be mothers. </blockquote>
</div>
<div>
Bravo to these researchers for calling out the hyperbole and stigma in these media articles and public health campaigns. It's time for others to take up their call.<br />
<div>
<br /></div>
<div>
When obese women are counseled about pregnancy risks with scare tactics and judgment, when newspaper articles use hyperbole to scare high-BMI women away from pregnancy, when obesity in pregnancy is viewed as child abuse or treated as the equivalent of drug addiction, and when women are pressured towards sterilization or termination because of their size ─ then it cannot be denied that these things begin to cross over into the repulsive realm of eugenics. </div>
<br />
<b><span style="color: #cc0000; font-size: large;">Reproductive Policing is WRONG</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifNiPrtM3sXwbRLmC4pCP3uPzzyEg7IdPp-WHUqMovRxt0ZIV6Xf4wslYbpa70Dyzy3ulM4OPoUw0A9RxEYao3DZBVyZWA2WbfQj0WxwJvHu3r05JdzusSVLi6woZkPg_B-iqoFbEsvKo/s1600/Sensationalized+risk+-+Canadian+article.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="193" data-original-width="815" height="93" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifNiPrtM3sXwbRLmC4pCP3uPzzyEg7IdPp-WHUqMovRxt0ZIV6Xf4wslYbpa70Dyzy3ulM4OPoUw0A9RxEYao3DZBVyZWA2WbfQj0WxwJvHu3r05JdzusSVLi6woZkPg_B-iqoFbEsvKo/s400/Sensationalized+risk+-+Canadian+article.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Article from National Post, 2016, found <a href="https://nationalpost.com/health/while-health-risks-are-real-much-of-the-risk-talk-telling-obese-women-they-are-dangerous-potential-mothers-sensationalized-research" target="_blank">here</a></td></tr>
</tbody></table>
Sadly, some medical professionals would like to prevent ALL fat women from having babies if they could. Remember the media article that states starkly that "Obese women should not have children"? This comes directly from a public health campaign started in the U.K. and endorsed by leading "experts."<br />
<br />
Most of the time these days it's considered wrong to question a woman's basic right to motherhood, even in a mother at risk for complications. Yet reproductive policing and shaming does not seem to be equally applied among groups considered at risk for complications. It seems to be focused mostly on obese people, and worse yet, this practice is widely defended in medical circles.<br />
<br />
Many doctors want to be the gatekeeper of who gets to procreate and who does not, and many of them particularly want to keep fat women from procreating so they don't pass along their fat genes to the next generation. A <a href="https://www.realclearscience.com/blog/2015/06/its_time_to_make_obesity_the_new_pregnancy_taboo.html" target="_blank">2015 article</a> reveals the <i>real</i> concern about obesity and pregnancy ─ that it will lead to more fat people:<br />
<blockquote class="tr_bq">
The kicker of all these consequences is that obesity begets obesity. "Maternal obesity is the most significant factor leading to obesity in offspring and, coupled with excess weight gain in pregnancy, also results in long-term obesity for women," the reviewers write.</blockquote>
Although doctors tell themselves they are just looking out for their patients, the underlying agenda here is about ridding the world of fat people. What better way than to prevent as many fat pregnancies as you can?<br />
<br />
Because medical providers have have been taught that obesity only occurs because of sloth and gluttony, many care providers see fat people unworthy of procreating. They use whatever means they can to discourage fat women from having a family. This far exceeds their mandate as physicians, and worse, it smacks of eugenics.<br />
<div>
<br />
Sorry, but NO ONE has the right to forbid reproduction. The government, medical authorities ─ history has shown time and again that these people should NOT be the gatekeepers of reproduction. Whether to have a baby is a decision for the woman and her partner to make and no one else.<br />
<br />
Yes, women of size have higher risks in pregnancy as a group. So do many other groups. Fat people should not be singled out. People of size should be counseled (with compassion, not scare tactics) about their risk status and possible complications, and they should given information about how to mitigate or manage those risks. Whether or not they experience complications, they should be <i>always </i>be treated with dignity, respect, and support.<br />
<br />
<span style="color: blue;"><b>The ability to reproduce is one of the basic rights of people in society; the state and/or medical caregivers have NO business trying to govern that. </b></span><br />
<br />
People should never be subject to shaming or scolding for the simple act of wanting to have a family. That principle applies just as much to people of size as to those in any other group.</div>
<div>
<br /></div>
<div>
Thankfully, many care providers <i>are</i> supportive of women of size, but the fact that some resort to extreme tactics to prevent or discourage people of size from reproducing is a terrible stain on the medical profession. This is a unique and insidious form of obesity eugenics and IT MUST STOP.<br />
<br />
<br />
<br /></div>
</div>
</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com1tag:blogger.com,1999:blog-4738062031052371885.post-65085198737924481482018-06-29T22:53:00.002-07:002018-06-29T23:01:54.195-07:00Lipedema: My Story<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjm6Q2v3NfUP4mN0edFDvl3GW-h9qyCA7blOLm_dx60WTekS19ExduDWszIjOPvmUPG5lVsNWT2sTUlcSf07rDCnW-Dloqy3EfDbPIX4khA4R-z6z8mnznjAJvGu46pQVL9Tj2T_nDq2g/s1600/ask+me+about+lipedema%252C+smaller.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="286" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjm6Q2v3NfUP4mN0edFDvl3GW-h9qyCA7blOLm_dx60WTekS19ExduDWszIjOPvmUPG5lVsNWT2sTUlcSf07rDCnW-Dloqy3EfDbPIX4khA4R-z6z8mnznjAJvGu46pQVL9Tj2T_nDq2g/s400/ask+me+about+lipedema%252C+smaller.jpg" width="400" /></a></div>
<br />
June is Lipedema Awareness Month. In lipedema, a fat storage disorder, an abnormal accumulation of fat develops in the legs and lower body, sometimes extending to the arms and other body parts as well. It is sometimes known as "painful fat syndrome" or "big legs syndrome." Although no one knows its true incidence, it has been estimated to affect up to 11% of women.<br />
<br />
To raise awareness about this condition, we have been doing an periodic <a href="https://wellroundedmama.blogspot.com/2018/06/the-lipedema-series.html" target="_blank">series</a> about lipedema. Here is what we have covered so far:<br />
<div>
<ul style="text-align: left;">
<li><a href="http://www.wellroundedmama.blogspot.com/2015/06/lipedema-part-1-lipedema-vs-lymphedema.html">Part One</a> - Typical features of lipedema and how to differentiate between lipedema and lymphedema</li>
<li><a href="http://www.wellroundedmama.blogspot.com/2015/06/lipedema-part-2-stages-and-progression.html">Part Two</a> - How lipedema progresses, the different stages of progression, and why it's so important to be aware of lipedema</li>
<li><a href="http://www.wellroundedmama.blogspot.com/2015/06/lipedema-part-3-types-of-fat.html">Part Three</a> - Types of fat distribution patterns, pictures illustrating type and stage of lipedema, how lipedema is diagnosed</li>
<li><a href="http://www.wellroundedmama.blogspot.com/2015/07/lipedema-part-4-possible-causes-and.html">Part Four</a> - Possible causes of lipedema, medical conditions often associated with it</li>
<li><u>Part Five</u> - Possible treatments for lipedema, broken down into several sub-posts</li>
<li> <a href="http://www.wellroundedmama.blogspot.com/2015/07/lipedema-part-5a-traditional-treatment.html">Traditional Medicine Treatments</a></li>
<li> <a href="http://www.wellroundedmama.blogspot.com/2015/07/lipedema-treatment-part-5b-weight-and.html">"Weight Control" and Special Nutritional Approaches</a> (trigger warning)</li>
<li> <a href="http://www.wellroundedmama.blogspot.com/2015/08/lipedema-treatment-part-5c-tumescent.html">Tumescent Liposuction</a></li>
<li> <a href="http://www.wellroundedmama.blogspot.com/2015/08/lipedema-part-5d-alternative-medicine.html">Alternative Medicine Treatments</a> </li>
<li> <a href="http://www.wellroundedmama.blogspot.com/2015/08/lipedema-part-5e-treatment-options.html">Summary of Treatment Options</a></li>
<li><a href="http://www.wellroundedmama.blogspot.com/2015/09/lipedema-series-part-6-finding-clothing.html">Part Six</a> - Coping with clothing challenges</li>
<li><a href="http://www.wellroundedmama.blogspot.com/2016/02/eighth-annual-turkey-awards-weight-bias.html">Part Seven</a> - Weight bias in lipedema care</li>
<li><a href="http://wellroundedmama.blogspot.com/2016/06/lipedema-part-8-living-your-best-life.html" target="_blank">Part Eight</a> - Living your best life with lipedema</li>
</ul>
Today, I share some of my own story of dealing with lipedema and how it has influenced other health challenges.<br />
<div>
<br />
<b><span style="color: #cc0000; font-size: large;">My Story</span></b><br />
<div>
<div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTN9v3E9A3snot7ru9ROKWGbh7gQYsV7ydMyw2Kl-frrSdnDJeVbLXdIk22I1JR17qlw2g6kILjoOaKMWMhqVLvQ7zEhBCqLsRtIq6597IAl1LzMbs-EzYqhjB-gvtljcW31VyyWPtNpk/s1600/It+took+33+years+to+get+diagnosed.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1229" data-original-width="843" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTN9v3E9A3snot7ru9ROKWGbh7gQYsV7ydMyw2Kl-frrSdnDJeVbLXdIk22I1JR17qlw2g6kILjoOaKMWMhqVLvQ7zEhBCqLsRtIq6597IAl1LzMbs-EzYqhjB-gvtljcW31VyyWPtNpk/s400/It+took+33+years+to+get+diagnosed.jpg" width="272" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Lipedema Posters from LASS, <a href="http://www.lass.org.au/">www.lass.org.au</a>,<br />Lipoedema Australia Support Society</i></td></tr>
</tbody></table>
Like the woman above, I too have lipedema and went undiagnosed for <i>many </i>years, which probably made my lipedema worse. This is why I try to raise awareness of this condition. Far too many people of size have lipedema and aren't aware of it, thus missing out on possible treatments for it. I was one of them.<br />
<br />
I only learned about lipedema when I was around 50 ─ but I found out about it from the internet, not from any doctor. I fit the classic profile of lipedema perfectly, with all the symptoms and nearly all the complications of it, but no care provider had EVER mentioned lipedema to me. No care provider had ever once thought to look more deeply into my inability to lose weight long-term or to question whether my abnormally heavy legs might mean something. They just chalked it up to bad habits and tried to pressure me to continue to diet, despite its many past failures. <br />
<br />
Once I learned about lipedema, all kinds of light bulbs went off in my head. A-ha! So that's why I had that funny shape! So that's why I gained so much weight as a young adult, despite workng <i>incredibly</i> <i>hard </i>to try and lose weight. So that's why I had all those symptoms! <br />
<br />
But even once I learned about lipedema, I didn't do much about it. I didn't think that there were many treatment options, so I didn't really bring it up with my care providers. I was more focused on my PCOS (Polycystic Ovarian Syndrome) and hypothyroidism, both of which seemed more treatable. But while treating those did help my overall health, it didn't address my lipedema. <br />
<br />
When I finally did bring up lipedema at the doctor's, I had to educate my provider about it because she had never even HEARD of it. Once she read the articles I gave her, she agreed I definitely fit the classic pattern but was at a loss for what to do about it. It's in my medical record now as a sub-note under "obesity" but because there is no official international diagnostic code for lipedema yet (despite it having been <a href="https://en.wikipedia.org/wiki/Lipedema#History" target="_blank">known about since 1940</a>) that's all she can really do. Lack of insurance coverage for lipedema treatment is a major barrier and the first step is an official diagnostic code for it.<br />
<br />
I'm in <a href="http://wellroundedmama.blogspot.com/2015/06/lipedema-part-2-stages-and-progression.html">Stage 3 lipedema</a>, with the start of lipo-lymphedema (stage 4). I have the <a href="http://wellroundedmama.blogspot.com/2015/06/lipedema-part-3-types-of-fat.html">Type III classic "pantaloon" shape</a> of my legs, complete with the shouldered ankles and fat pads by the knees, and the lipedema is now in my abdomen and my upper arms as well. I look at lot like the lady in the poster above, but with more cankles and less knees.<br />
<br />
Sadly, my eldest daughter seems to have inherited my lipedema; she had the big gain in early adulthood too and is already Stage 2. I'm worried about what will happen with her in the future. On the other hand, my youngest daughter shows no signs of lipedema at all, so I'm hoping she avoided this genetic minefield. Time will tell as she's just a young teenager now.<br />
<br />
In the hope that it will help others with lipedema, here is my lipedema story. I've tried to be detailed in case others find those details helpful.<br />
<br />
<span style="color: #cc0000; font-size: large;"><b>Childhood</b></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTTgTMSItI6mjzTgwKQvBvExf-XvfN9nD7TUozrbs0qaCv3J0cTkgGtGiyO1Q-6D0JqheYP9xp4zAuMpE2Yxkhw4NA0nixkiFjUrah1KALUzHMVz7ohL8ySMFtLr5gqR9KdBp5PJLxeUs/s1600/pear-shaped-body.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTTgTMSItI6mjzTgwKQvBvExf-XvfN9nD7TUozrbs0qaCv3J0cTkgGtGiyO1Q-6D0JqheYP9xp4zAuMpE2Yxkhw4NA0nixkiFjUrah1KALUzHMVz7ohL8ySMFtLr5gqR9KdBp5PJLxeUs/s400/pear-shaped-body.jpg" width="400" /></a></div>
My childhood shape was very much like the pear above, except with thicker thighs. My lower legs and arms were mostly unaffected. That came later.<br />
<br />
I am adopted, so I have only limited family medical history available to me. From what little I do know, it doesn't seem like my birth mother had significant lipedema at the time I was born. She did have other medical issues but apparently not lipedema. I would like to know if there was any history of large legs on either side of my biological family but so far have not been able to discover this information.<br />
<br />
I was always "chubby" and pear-shaped to some degree as a child, even while eating the same healthy foods as my thin adoptive family. Although I am not athletic, I still rode my bike, played in the woods, swam competitively, took several years of dance and gymnastics, and played football and baseball with the neighborhood boys. While I preferred reading to running, I was a reasonably active kid. My chubbiness had nothing to do with poor eating habits or lack of exercise.<br />
<br />
When I took gymnastics, the teacher was quite amazed at how limber I was, especially my back. I was <i>much </i>more limber than the other girls. I was able to do a no-handed back bend and pick up a cup off the floor with my teeth; no one else could. Now I realize that this was probably a sign of hypermobility, something many people with lipedema have. I was not double-jointed, but I was definitely more limber than most by far.<br />
<br />
My adoptive mother was always bothered by my weight. She felt it was a negative reflection on her, and people would assume she was feeding me junk food. Being naturally quite thin, she simply didn't understand how I could be chubby, and she was afraid of how it would affect me. She was of the generation where a girl's looks were everything; she was afraid I'd never find a man, which in her worldview was the real measure of a woman's worth.<br />
<br />
She wanted to put me on a diet at 5 years old but the doctor wouldn't let her. He just encouraged her to make me be as active as possible, so she was always booting me out the door to play. Didn't make me thin. When I was nine, we moved to a new town and the new doctor agreed to put me on a diet. It was a "healthy" diet, nothing radical, just mildly hypocaloric. I did lose some weight for a little while ─ until it came back, as it usually does. (And not because I slacked off.) So then I dieted again, and again the weight came back. So then we did it <i>again</i>, only this time with a lower calorie count, etc.<br />
<br />
Thus began my many years of yo-yo dieting. I dieted off and on (mostly on) from the age of 9. Generally speaking, each diet was more rigorous as I got more and more desperate to lose weight.<br />
<br />
<span style="color: #cc0000; font-size: large;"><b>Teens</b></span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhywihfjHFqI_BPU0co-0aLIiIA70uUWxipC8NO7MWNqh8NuxSPjIx4Ku4It2oPoOpIv-b5cLkdr-OtLpbwbaqfdYUq41BeIkUcHRh4J-vpUkvwsret3WgzoPSux-QUuP4l_I3S_YEljsQ/s1600/by+Sarah+Bishop%252C+Australian+artist.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="429" data-original-width="426" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhywihfjHFqI_BPU0co-0aLIiIA70uUWxipC8NO7MWNqh8NuxSPjIx4Ku4It2oPoOpIv-b5cLkdr-OtLpbwbaqfdYUq41BeIkUcHRh4J-vpUkvwsret3WgzoPSux-QUuP4l_I3S_YEljsQ/s320/by+Sarah+Bishop%252C+Australian+artist.jpg" width="317" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Image by Sarah Bishop</i></td></tr>
</tbody></table>
Once I hit puberty at about 13, my weight increased quite a bit. Most of the gain was in my hips and legs; I became even more pear-shaped. I was smaller on top than on the bottom, but I did not have the extreme disproportion that some lipedema women have.<br />
<br />
I had great difficulty buying regular pants because my waist was so much smaller than my hips. This is typical of women with lipedema. My mom made many of my clothes for me when I was younger in order to give me elastic waists. It was the only way to get pants that didn't gap hugely at the waist.<br />
<br />
I wasn't extremely fat, though I was certainly perceived as fat by those around me. I can remember people staring at or remarking on my legs as a teen. One boy who was interested in me said, "Well, now I can see why you don't wear shorts!" (<i>Nope, he most certainly did not become my boyfriend.</i>)<br />
<br />
When I was 13, my adoptive father had a heart attack; heart problems ran strongly in his family. Although we had always eaten healthy, our diet got even more rigid after that. We ate low-fat, semi-vegetarian, and rarely had sugar ─ yet I still gained weight.<br />
<br />
So I continued to diet off and on via calorie restriction and carb restriction. My legs remained heavy even when the rest of me lost weight, but frankly I never become a "normal" size no matter what I did, and <i>the weight always came back with extra. </i><br />
<br />
I started skipping periods occasionally due to PCOS but the PCOS went undiagnosed. Around age 15-16 I did some serious time with Weight Watchers (WW) and did lose a bit of weight, but not not nearly what was expected for the amount of time I was on the program and I never got to a "normal" BMI. Despite the weight loss, I still had a definite pear-shape and my periods stayed irregular.<br />
<br />
I remember being treated suspiciously by the Weight Watcher leaders because I wasn't losing "enough" weight; they suspected me of lying about my intake. But I was <i>very </i>strict and carried a scale with me everywhere to weigh my food or carried my own healthy snacks with me when I went out in an effort to strictly control my calories. Still, the weight came back. Weight Watcher weigh-ins became a nightmare. I grew to really <i>loathe </i>weigh-ins because of the judgment I received at them.<br />
<br />
I got more and more desperate and began to develop some eating-disordered behaviors ─ nothing major, but still not healthy, mainly trying to manipulate weigh-in results. I eventually quit WW in disgust because I wasn't losing weight anymore despite my most dedicated efforts, and because I was concerned the neurotic food behaviors and attitudes of the people at meetings were encouraging me to become more eating-disordered. Far from being "healthy," it felt like a very unhealthy place to be. I also tried Overeaters Anonymous, but was even more put off by that program because the extreme eating behaviors the other members described did not fit my experience. Again, it felt like a very emotionally unhealthy place to be.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Late Teens and Early 20s</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhyphenhyphentml3ULck78czrrbGLQYggsjvC15JjuidIjc5MdmiaYWlSvN-9Ala4RtNNNz602poWGP2xdpOAtC9i5DGKVSh5lsBkQas6000Yrht86zuDNjiVBXnQ1TeY3yi_7fXesmSrwFZsiJWAo/s1600/blamed+and+shamed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="480" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhyphenhyphentml3ULck78czrrbGLQYggsjvC15JjuidIjc5MdmiaYWlSvN-9Ala4RtNNNz602poWGP2xdpOAtC9i5DGKVSh5lsBkQas6000Yrht86zuDNjiVBXnQ1TeY3yi_7fXesmSrwFZsiJWAo/s400/blamed+and+shamed.jpg" width="400" /></a></div>
<br />
<br />
During my senior year of high school, I started gaining weight like crazy ─ all while dieting and getting plenty of exercise, including biking, cross-country skiing, and even climbing a mountain, but none of that made any difference.<br />
<br />
The weight gain accelerated in college. I took a Fitness Class in an effort to stem the weight gain. I was jogging, running stairs, biking, swimming, and lifting weights. I remember the coach criticizing my "<b>HUGE</b> legs" (his words, with that amount of emphasis). I gained 25 lbs. in a semester <u>during</u> that Fitness class, <i>despite</i> being on Weight Watchers again and getting tremendous amounts of exercise during the class. I'm pretty sure the coach thought I was binge eating in a closet somewhere but I wasn't. I was simply in the middle of a significant lipedema "flare."<br />
<br />
My parents were horrified by my large weight gain. I moved out of the dorm so I could avoid "fattening dorm food" (even though my dorm-mates ate the same food and were skinny). I saw a number of doctors over the years, trying to figure out the weight gain, but found no answers. They noted that my thyroid TSH labs were borderline but because they were still within the "normal" range, they basically just told me to eat less and exercise more.<br />
<br />
Although I had always been a healthy eater as a kid, I started developing more unhealthy eating patterns in response to all of this. I began alternating between restrictive diets and overindulging in "unhealthy" foods (though I was never a true binge eater). In desperation, I went back to WW several times during my college years, but found little weight loss and lots of food neurosis. Again, I manipulated for weigh-ins. I was concerned about what I was starting to do but felt such pressure at those weigh-ins. The basic food plan wasn't bad but the attitudes around food and weight in the WW meetings were extremely toxic. I quit to save my own sanity and because I was concerned I was headed for an eating disorder. I saw women around me in college with true eating disorders and how difficult that was. I realized I was headed in that direction if I didn't stop, so I did.<br />
<br />
Over the course of several years, despite all the dieting and exercise, I gained about 100 pounds total, most of it in the lower body. I had a terrible time finding clothes to wear; there was no internet then and my college was in a fairly small town. Chain stores and Goodwill had nothing in my size. I lived in men's overalls because that's all I could find to fit.<br />
<br />
It was hard to be positive about my body, but I was fortunate to have a boyfriend who loved me as I was. Being away from my mother's well-meaning but neurotic weight focus also helped boost my self-esteem and confidence. I developed a can-do attitude, worked hard for top grades, and didn't let me weight keep me from what I wanted to do.<br />
<br />
Still, I was worried what my weight would do to my health. In desperation, eventually I joined a special medical weight loss clinic, following a low-calorie ketogenic diet. I lived on 500 CALORIES A DAY, far below starvation levels, in ketosis, for SIX MONTHS during my senior year of college. (This is slightly lower than the caloric intake of the Dutch famine victims in World War II, for about the same amount of time, and the Dutch famine is considered a severe famine exposure). I lost 50 lbs., but still had fat legs, hips, and arms, and never got remotely close to a "normal" size. By the end of the 6 months, I slowly began gaining weight back ─ <i>while on 500 calories a day. </i> And I still wasn't thin enough to suit my mother.<br />
<br />
That starvation diet was a real wake-up call. I saw how foolish such an extreme approach was and how awful I felt, so I stopped the program. That program made me realize that something else HAD to be going on physiologically and that it wasn't just about my intake and output. I quit blaming myself. I went back to eating normally. It didn't take long before I returned to my original weight plus a little more ─ but with much more abdominal fat than I'd had before. That's when the lipedema really began affecting my abdomen too.</div>
<div>
<br />
<b>In hindsight, I think I had a "perfect storm" combination of PCOS, hypothyroidism, and lipedema all hit me at once, </b>and this triple-whammy caused the massive weight gain. I had gained about 100 lbs. despite multiple bouts of Weight Watchers, fitness classes, a starvation diet, and a million other things to try to stop the weight gain. Every doctor I consulted told me I just needed to eat less and exercise more; that it was just a matter of adjusting the math of intake vs. output, and having strong willpower. One endocrinologist I went to for thyroid testing told me that I was "just looking for an excuse for being fat."<br />
<br />
I knew there <i>had </i>to be more to the story but eventually gave up going to doctors because my concerns weren't taken seriously and I was tired of the weight harassment. I just tried to live a reasonable life and accepted that I would always be fat.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Mid-20s to Early 30s</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsHKg6cfaCeUW2uRR7poQza1KY1CYjte4o2PyyT5bPkcXz89x6VbIlOIu4aHTc4o1KHasIYRByD7YXv2QQvaJoU3aQlhshCB0mmoZf9WGjQTNR7ASGP5sqYsWc2-ggtokuaAp1ntuqfdQ/s1600/assumptions+about+lipedema.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="236" data-original-width="236" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsHKg6cfaCeUW2uRR7poQza1KY1CYjte4o2PyyT5bPkcXz89x6VbIlOIu4aHTc4o1KHasIYRByD7YXv2QQvaJoU3aQlhshCB0mmoZf9WGjQTNR7ASGP5sqYsWc2-ggtokuaAp1ntuqfdQ/s320/assumptions+about+lipedema.jpg" width="320" /></a></div>
<br />
Eventually my weight stabilized in my mid-20s. I stopped dieting, which helped stop the weight yo-yos and probably also stopped a full-blown eating disorder from developing. Leaving dieting certainly boosted my self-esteem and improved my mental health!<br />
<br />
Of course, I still encountered weight bias in my career and in the world. I was "morbidly obese" and people didn't hesitate to let me know it. I had a boss verbally pressure me to lose weight, and it came up in my job performance reviews...but only unofficially, so he didn't get into trouble. Another boss looked for a replacement for me because I wasn't "pretty enough" (code for <i>too fat</i>), as if physical appearance had anything to do with competency in my field. Fortunately I was very skilled and kept the job.<br />
<br />
It was frustrating to have all kinds of assumptions made about me based on my size, but I didn't let it hold me back. I got married, achieved in my career, traveled a lot, acted on stage, and participated in many fun activities. I lived my life and was happy.<br />
<br />
In my late 20s, I finally found a doctor who was willing to consider my symptoms of subclinical hypothyroidism. We did a trial of thyroid meds, which improved my life <i>greatly</i>. I stopped skipping periods and my skin issues improved. I had other PCOS symptoms that didn't abate but the thyroid meds blunted the worst of them. I felt like a reasonably normal human being again. I felt SO much better once I started on the thyroid meds, even though it made little difference to my weight or body size.<br />
<br />
My lipedema did worsen in my 20s. My legs got larger, my arms got larger, and weirdly, my bust also got suddenly larger despite a stable weight. By my late 20s, it was quite hard to find clothes that worked for my body (large bust, small waist, very large hips).<br />
<br />
My legs were pretty heavy by my 30s; I couldn't wear boots or knee-high socks anymore. It was hard to find clothes that fit me, even with big-city clothing stores. Still, my legs didn't interfere with my life too much. I had no mobility issues and I was able to be active. I wasn't any kind of athlete but took periodic aerobics or yoga classes and did a lot of folk dancing, walking, dancing in plays, and just generally enjoyed my life.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Mid-30s and early 40s; Four Pregnancies</span></b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvoPY-h3Fkot6jVdHnGYEH4Z7-WIVpq5VzsnUCcdTlx3CnFeEAft-OfwnTqlLdFNSR_F7Di2dWP9LGbi1AVA02eG3j23_9CtO_UT-f1mrX7XATVCJGE4WtY7cm7nsnJ2LkRtCSgS2qF5M/s1600/as+a+mother.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="960" data-original-width="658" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvoPY-h3Fkot6jVdHnGYEH4Z7-WIVpq5VzsnUCcdTlx3CnFeEAft-OfwnTqlLdFNSR_F7Di2dWP9LGbi1AVA02eG3j23_9CtO_UT-f1mrX7XATVCJGE4WtY7cm7nsnJ2LkRtCSgS2qF5M/s400/as+a+mother.jpg" width="272" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Poster from LASS (see above)</i></td></tr>
</tbody></table>
My husband and I decided to start a family in our 30s. I was lucky to have the ovulatory PCOS phenotype, so once my thyroid issues were treated, I never had any trouble with my cycles again and had no trouble getting pregnant, even into my 40s. I'm so glad we waited to try until after my thyroid issues were addressed!<br />
<br />
I had four pregnancies between age 33 and 43, resulting in 2 girls and 2 boys. The first pregnancy was rough because there was <i>no </i>information on pregnancy at a larger size available then, and I encountered a lot of size bias in that pregnancy. I had a nightmare cesarean after a long hard induction and developed PTSD. Breastfeeding was rough at first because I got poor advice. Afterwards, I spent a lot of time educating myself about pregnancy and breastfeeding so I wouldn't go through anything like that again, and started my website to help other large moms get information and empowerment.<br />
<br />
I had much better experiences with my later pregnancies. I did have another cesarean after a long hard labor with #2, but in some ways it was healing, even if it wasn't the birth I wanted. With my last 2 children, I had VBACs (Vaginal Births After Cesarean), and they went a long way towards restoring my faith in my body. So did breastfeeding all four of my children long-term.<br />
<br />
Some women with lipedema find that pregnancy and birth worsen the lipedema. For the most part, my experiences were normal and I didn't experience the severe issues that some women with lipedema do in pregnancy. I didn't gain much weight and I didn't develop any serious complications.<br />
<br />
However, I did gain more lipedemic fat in my abdomen with each pregnancy and I really started to feel the fat nodules under the skin there. This wasn't the result of pregnancy weight gain; I gained less than the weight of my babies with each pregnancy and ended all four pregnancies at about the same weight I started them. But despite being the same weight, I had quite a bit more abdominal fat afterwards. Classic lipedema.<br />
<br />
Some women with lipedema find that pregnancy and birth result in secondary lymphedema. I did find I experienced severe swelling after the births of #1 and #4, but not the others. Why I had it with only some births but not others is not clear but it's interesting that I only experienced it with my daughters. Of course, birth interventions can also influence edema. It's my opinion that it takes a combination of factors to cause problems.<br />
<br />
One major negative thing was that I had a LOT of back pain and joint issues (pubic symphysis and sacro-iliac joint issues) in my pregnancies. I had a lot of pain until I finally started seeing a chiropractor in my 3rd pregnancy. Since lipedema is associated with joint laxity and hypermobility, that (plus my history of car accidents) may well have been the source of my joint issues.<br />
<br />
Seeing a chiropractor highly trained in pregnancy starting with #3 was extremely helpful in getting my back and pelvis aligned. It reduced my discomfort tremendously and helped the baby be in an easier position for birth. I strongly believe it was the reason I was able to have normal vaginal births (VBACs) with my last two children but not my first two. My last two babies were better-positioned and far easier to birth and I really credit that to the chiropractic care.<br />
<br />
Despite being nearly 43 and "morbidly obese," my last pregnancy was my best. Even the edema and lipedema flare I had postpartum was a relatively small blip on the radar. Don't let the fact that some women with lipedema experience difficult pregnancies put you off having a baby; some women with lipedema do just fine in pregnancy. It's probably sensible to try to avoid the big interventions like inductions and cesareans whenever possible because they predispose to edema and complications afterwards. Remember that lipedemic bodies can give birth just fine naturally with a truly size-friendly provider.<br />
<br />
Personally, I did not find that lipedema affected my pregnancies very strongly; my biggest difficulties were with weight bias/over-intervention by providers, and in dealing with hypermobile joints during pregnancy. However, I did find that pregnancy increased my abdominal lipedemic fat every time, despite almost no weight gain, and I did experience significant temporary edema after two of my births.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Perimenopause and Menopause</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNcoTsXgBWhJ2-J59JDSOsGJsZ95m_heEuVK0GDAFgePF23-eO0wCiCsO3IMpZG2Slr-OMPykW5u3A7fnIJgKDZid9G4-_6bXuYFGhJErgggGQCae4CI6vd4QJzSr9JjY8FMEkQ9KEdgo/s1600/facts+about+lipedema.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="532" data-original-width="480" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNcoTsXgBWhJ2-J59JDSOsGJsZ95m_heEuVK0GDAFgePF23-eO0wCiCsO3IMpZG2Slr-OMPykW5u3A7fnIJgKDZid9G4-_6bXuYFGhJErgggGQCae4CI6vd4QJzSr9JjY8FMEkQ9KEdgo/s400/facts+about+lipedema.jpg" width="360" /></a></div>
<br />
As I transitioned into middle age, I did find that my leg size increased quite a bit, especially as I went through perimenopause and menopause from my mid-40s to mid-50s.<br />
<br />
More than simply a size change, the <i>shape </i>of my legs changed. I developed major fat pads and "folds" just under my knees, and I got some major-league "cankles" (calf-ankles). My arms have also gotten much larger now. I now have a truly significant amount of fat on my hips, abdomen, legs, and arms, and people really do stare. Although I am pretty at peace with my body in general, it's not always easy.<br />
<br />
Clothing-wise, lipedema has made aging more challenging. Finding good clothing is always hit-and-miss due to my unique proportions. Cold weather outer gear and rain gear have been my biggest challenges, as I've <a href="http://wellroundedmama.blogspot.com/2011/01/score-winter-stuff-in-extended-sizes.html" target="_blank">written</a> about <a href="http://wellroundedmama.blogspot.com/2012/01/need-extra-layer-for-warmth.html" target="_blank">before</a>. I often have to buy men's gear, which goes to larger sizes than women's sizes but it is geared towards a big belly and no hips, which is not my shape. Still, it's better than nothing. I have found good coats in my size through <a href="https://www.columbia.com/mens-big-tall/" target="_blank">Columbia Sportswear</a> but I have yet to find a pair of rain boots, rain pants, or snow pants which really work well for me.<br />
<br />
In summer, I do wear shorts and go swimming and the heck with anyone who doesn't like it. Most of the rest of the year I wear pants, the comfortable kind in cotton-and-spandex stretch fabric. I found my tolerance for restrictive fabric has diminished. Now, I mostly care about whether my clothes are <i>comfortable</i>. I wear pants or long skirts at work or when speaking to help others focus on <i>me </i>instead of staring at my legs. It's hard enough for people in our society to take fat people seriously; it's even harder when you have lipedemic legs. So in certain situations, I do cover my legs and arms to be taken more seriously, but that doesn't mean I always dress that way.<br />
<br />
After some car accidents in my late 40s, I developed significant knee problems. I'm sure my weight didn't help the injuries, but I'd been at the same weight for many years without any problems so it wasn't all about my weight. Yet the orthopedic surgeon I consulted told me my knee pain could <i>only </i>have been caused by arthritis due to weight, despite an x-ray showing very little arthritis the year before the accident. He refused to do an MRI, saying it was pure coincidence that the pain developed after the accident. He was unwilling to treat my knee issues with anything other than weight loss or injections. We compromised on physical therapy but it didn't help. I haven't been back to an orthopedist since. I should have my knees replaced but am reluctant to risk having surgery cause a lipedema flare.<br />
<br />
The difficulty in finding a doctor who doesn't blame everything on weight is a source of continuing major frustration to me, especially as I age. It's hard to be taken seriously as a person of size when you are young: it's even harder as a middle-aged woman. We are virtually invisible in society and especially in medicine.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Cancer</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCiqC8lRXy7XGytuWpbam-YzvGbUucXusiGITbuz5chzoeiXE7NWnwGhz1dckS3jCFQvw1jgb_0Hyim9Od5leDiy36HKoPOeyP7kd_jmzZgR7ggA2GKxv5fMgt64WaWR4pAQIY_3vg7Qk/s1600/life5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="315" data-original-width="472" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCiqC8lRXy7XGytuWpbam-YzvGbUucXusiGITbuz5chzoeiXE7NWnwGhz1dckS3jCFQvw1jgb_0Hyim9Od5leDiy36HKoPOeyP7kd_jmzZgR7ggA2GKxv5fMgt64WaWR4pAQIY_3vg7Qk/s400/life5.jpg" width="400" /></a></div>
<br />
As if that wasn't enough, it gets harder. My lipedema was made worse by the fact that I was diagnosed with cancer in my mid-50s. Not any of the cancers that might be associated with weight, but lung cancer, a type of cancer that is <i>completely </i>unassociated with size. Talk about a shocker. I never smoked or had any other risk factors. The only possible risk was perhaps genetic ─ my birth father died of lung cancer in his late 50s ─ but doctors tell me this type of cancer is not directly inherited. Who knows why I got it.<br />
<br />
My cancer was largely silent at first. I had very few major symptoms until it was advanced. The subtle early symptoms were things like breathlessness, some hoarseness, lack of endurance, and weak legs. I blamed it on being anemic and getting out of shape. I kept trying to get back into shape but just could not sustain my exercise program because it made me so fatigued. Yet nothing felt really alarming.<br />
<br />
The first symptom that was really obvious and alarming was large lumps under my skin ─ subcutaneous tumors. At first I assumed they were lipedema nodules, but when they started appearing in areas not normally affected by lipedema (spine and shoulder) I thought they were lipomas (fatty benign tumors) or perhaps <a href="https://www.fatdisorders.org/dercums/" target="_blank">Dercum's Disease</a>, which some patients get in addition to lipedema. However, the lumps on my body were not painful, unlike Dercum's Disease, so it didn't fit perfectly. I made an appointment to see a doctor but for various reasons the appointment got put off.<br />
<br />
Eventually I developed severe respiratory symptoms. We thought it was pneumonia. I didn't see my normal care provider due to circumstances, and the other doctor didn't take it seriously. He should have done a chest X-ray but he didn't. He said it was just a sinus infection. We tried antibiotics but they didn't help. I kept going back to the doctor multiple times and he basically told me to tough it out and I probably just had asthma. (Cause you know, <i>fat</i>.) Due to all these delays, by the time my cancer was diagnosed, it had spread all over my body.<br />
<br />
How did lipedema affect my cancer diagnosis? It certainly made it more difficult to figure out because we thought the subcutaneous tumors were part of lipedema or Dercum's. And of course the weight that goes with lipedema meant that my doctor did not take my respiratory symptoms, weakness, and fatigue seriously, even though they were very serious and debilitating. By the time my cancer was diagnosed, I was nearly dead.<br />
<br />
I am lucky that my particular mutation of lung cancer does have some treatments available, and that means my prognosis is better than some. Many lung cancer patients die within the first year and I have already surpassed that. My targeted therapy treatments brought me back to life and made me mostly functional again. I'm not back to normal but I'm a lot better than I was! However, I am unlucky in that my cancer is not curable. It will likely kill me but the treatments are changing so rapidly that it's difficult to predict the future.<br />
<br />
The cancer treatments and related complications have triggered the development of lipo-lymphedema ─ lymphedema on top of the lipedema. This has been difficult. One of the side effects of my first cancer medication was severe ankle and foot edema. Although my feet had always been spared before (one of the defining aspects of lipedema), suddenly now I had massively swollen feet as well as legs. Eventually I changed medications and my foot swelling went away, but I still struggle with leg lymphedema.<br />
<br />
I have to be honest; the increase in leg size has been quite challenging. It makes it harder to get around and it's very tiring. Cancer often involves muscle wasting; a lot of food energy is diverted to the tumors and the cancer starts cannibalizing your own muscle for additional energy. To be a large person with lipedema and then experience muscle wasting means that mobility becomes a real issue. After a stay in Intensive Care, I had trouble walking for a while. I had to go to rehab and get physical therapy before I could return to my home. Now I am much improved, but walking is still definitely exhausting and I don't go all that far. I miss taking a nice walk but am trying to build that up to that again.<br />
<br />
<b><span style="color: #cc0000; font-size: large;">Dealing with Lipedema</span></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3zxEf-mPgllCDRANFQwAdI_Jj0RuvV37E7vWv0V-pgG9SxL-ZcVPfywWLtsDAHzzRE75JpiG1w9dv4CMC0_BUWGvHck2KU4TVLvqAKVdywI3AGcoWgm13d6jvVL9WtU1MEIHohaDPz3s/s1600/exercise+to+be+fit.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="680" data-original-width="501" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3zxEf-mPgllCDRANFQwAdI_Jj0RuvV37E7vWv0V-pgG9SxL-ZcVPfywWLtsDAHzzRE75JpiG1w9dv4CMC0_BUWGvHck2KU4TVLvqAKVdywI3AGcoWgm13d6jvVL9WtU1MEIHohaDPz3s/s400/exercise+to+be+fit.jpg" width="293" /></a></div>
<br />
Dealing with lipedema has not been easy over the years, but has definitely gotten more challenging as I have aged and other health challenges have arisen. When I was younger, it was more of an aesthetic problem and a problem with finding clothing than a real interference in my life. It didn't affect my mobility much and I did most things I wanted to do. However, lipedema plus cancer has now affected my mobility and I find that very difficult, though I try not to let it get me too down. I work hard not to let lipedema or cancer define my life, but it's not easy some days.<br />
<br />
<b>The things that I have <i>not </i>found helpful in my lipedema journey are dieting of any kind and rigid attitudes about food. </b>I don't follow either an anti-inflammatory diet nor a ketogenic diet; these approaches are simply <a href="https://wellroundedmama.blogspot.com/2018/06/ketogenic-diets-and-lipedema-apply.html" target="_blank">somebody's guess</a> at a treatment; there is absolutely NO proof that they help. At this point, nobody's even <i>tested </i>them so it bothers me to see them talked about in lipedema circles as if they are a proven treatment. They're not.<br />
<br />
Unfortunately, many people in the lipedema community are still stuck in the dieting mentality and weight loss emphasis. Food restriction is a strong thread in many lipedema and medical organizations' guidelines. That is very off-putting to many people of size who would otherwise involve themselves in the lipedema community. Many care providers try to be understanding about weight issues, but the one thing most cannot understand is clients not actively trying to lose weight. They have been taught the "good fatty/bad fatty" paradigm; you can be fat, but that's no excuse for not continuing to try to lose weight. But for me, trying to lose even the 5-10% doctors recommend means playing Russian Roulette with my body because weight loss always ends in a rebound for me. Furthermore, I refuse to be a famine victim anymore. I'm done trying to starve myself.<br />
<br />
Many women with lipedema, especially the more severe cases, choose weight loss surgery to try and cope with the physical effects of so much weight. This is a personal decision made by each woman and I am not here to judge it. However, from what I've seen, I don't believe it's very effective long-term for lipedema. Weight loss is mostly from other parts of the body and only minimally from lipedemic areas, and significant regain is <i>very </i>common after a few years. Personally, I am not interested in weight loss surgery of any kind because I have seen too many people with bad side effects after a few years. Lipedema is bad enough without adding malnutrition issues. But that's my choice; everyone gets to make their own choices about it.<br />
<br />
Of course, we don't want to add to our lipedema by being excessive. I try to be sensible about carb intake and not over-indulge, but neither do I abstain from carbs, including sugar. I just try to be reasonable. My motto is everything in moderation (including moderation!). I try to avoid getting neurotic over food or making "good food/bad food" judgments; that is eating-disordered thinking. Some food is healthier for you than others but that doesn't make you a better person for eating it, nor will it make you skinny. I hear friends trotting out the usual "it's-a-lifestyle-change" cliché but if it eliminates major food groups or is highly restrictive, it's still a diet. Food Police moralism isn't helpful. Food is just food; simply be sensible about it.<br />
<br />
I try to follow <a href="https://wellroundedmama.blogspot.com/2008/07/health-at-every-size-paradigm.html" target="_blank">Health At Every Size®</a> (HAES) paradigm instead of a weight-centric one. HAES is a health approach that de-emphasizes the scale, restrictive eating, and punitive exercise; it encourages intuitive eating and enjoyable movement. I aim for weight stability and reasonable eating habits, and use lab results to guide my health and nutrition decisions. I find my weight stays reasonably stable with that approach.<br />
<br />
The cancer has made nutrition more challenging because the meds change the sense of taste and food is often very unappealing. Muscle wasting and malnourishment from cancer is real even for fat people, an irony which is not lost on me. My oncologist has emphasized the importance of eating and getting enough calories, even if they are not "perfect" nutrition. It's hard to let go of all the pressure from people to eat this or avoid that to "fix" my cancer, but my doctor says it's more important to just <i>eat. </i>Your body needs energy to deal with the cancer.<br />
<br />
<b>The care practices I personally have found most helpful in my lipedema journey include chiropractic care, medical massage, and complete decongestive therapy. </b>The chiropractic care and massage helps address the hypermobility problems and muscle tightness than can occur. After I developed lipo-lymphedema from the cancer treatments, I found that <a href="https://wellroundedmama.blogspot.com/2017/05/manual-lymph-drainage-and-bandaging.html">Manual Lymph Drainage</a> (MLD) and <a href="https://www.compressionguru.com/solaris-readywrap-calf">compression</a> were immensely <a href="https://www.amazon.com/Sockwell-Incline-Moderate-Graduated-Compression/dp/B00GOJR2HK?ref=ast_p_ei">helpful</a> in preventing some of the skin complications. At one point in cancer treatment, my legs had such severe swelling, my skin cracked and leaked lymph fluid. I developed a mild cellulitis infection, which we were fortunately able to nip in the bud with antibiotics. I've had to become much more careful about caring for my legs and keeping down the swelling. With MLD and compression, they are doing okay.<br />
<br />
If I had unlimited money and no cancer, I would pursue <a href="https://wellroundedmama.blogspot.com/2015/08/lipedema-treatment-part-5c-tumescent.html" target="_blank">specialized liposuction</a> for the lipedema; it has to be done by specially trained doctors. Proper compression afterwards is critical. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28728329" target="_blank">Research</a> so far shows this type of liposuction to be quite <a href="https://www.ncbi.nlm.nih.gov/pubmed/26574236" target="_blank">helpful</a> for many people. Sadly, most insurance will not cover this and my budget does not allow it, but it may be a valid choice for some people with lipedema.<br />
<br />
<div>
Emotionally, I find it difficult to deal with the judgment heaped on people of size. When you say that you have lipedema, people think you are just making excuses. That I find <i>really </i>frustrating, especially when it comes from friends. I know some think I could lose weight if I tried harder, and that hurts. But I can't control what other people think, and anti-fat bias is so prevalent in our society it's no surprise they think that way. I try not to let those biases get in the way of friendship as long as they are respectful.<br />
<br />
While I can't honestly say I'm thrilled with the appearance of my legs or arms, I don't let it bother me too much because there's realistically very little I can do about it. I don't like being stared at, but I try to see it as the other person's issue, not mine. Remember that how people react to you often has more to do with their <i>own</i> fears and insecurities, not yours. Let condemnation and judgment roll off of you.<br />
<br />
I personally have been fortunate to have never struggled with depression the way that many people with lipedema have. That doesn't mean that dealing with lipedema and with cancer has not been frustrating or upsetting; it most certainly has! But depression is not one of my issues and I know that's lucky.</div>
<div>
<br />
However, anger is one of my issues. Sometimes it makes me SO angry that I've been saddled with PCOS <i>and </i>hypothyroidism <i>and</i> lipedema. Talk about a genetic triple whammy! That is incredibly frustrating. And now <i>cancer</i> on top of that?!??! So incredibly unfair!!!!!!!<br />
<br />
Having all of those conditions just <i>sucks </i>and I do sometimes indulge in the "Why me?" game. Sometimes I throw myself a really good pity party and let myself wallow in it for a while. I think that's reasonable and healthy ─ after all, having these conditions DOES suck and it is TOTALLY unfair. It's important to acknowledge and mourn your challenges and let yourself be angry. But spending too much time in anger is not healthy either; I don't want it to keep me from experiencing the positive things in life. So I pick myself up, brush off the negativity, and remind myself to count the blessings I do have. That helps counterbalance my pity party days.<br />
<br />
Being adopted has added to my emotional frustration; I would really like to know more about my birth parents' genetic heritage so I could see how genetic any of this really is. I know there is an <i>extremely </i>strong history of diabetes and autoimmune disease on my birth mother's side, which leads me to suspect an autoimmune component to lipedema. However, it's been difficult to get more detailed information. I know there's a strong history of cancer on my birth father's side, and that he died of lung cancer at about the same age as I am now. However, there's no way to know if it's the same type of lung cancer or not, and we'll <i>never </i>know. That's a difficult burden, because I don't know how concerned to be for my children.</div>
</div>
<div>
<br />
I try to remind myself that I also have good genes that balance these unfortunate ones, and I hope I passed on those good genes to my children. I try to remember the blessings I did inherit. Of course I have worries about my lipedema. How could I not? But now they've been supplanted by bigger worries, namely cancer. In the long run, lipedema is small potatoes compared to cancer. So while we have every right to be upset about our lipedema, remember to keep it in perspective. There are other challenges out there too. Keep it all in perspective.<br />
<br />
Some days it's hard to be positive but mostly I look at my children and my spouse and feel blessed.<br />
<br /></div>
</div>
<div>
<div style="margin: 0px;">
<div style="font-family: "times new roman";">
<b><span style="color: #cc0000; font-size: large;">Final Thoughts</span></b></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgq9eoqmW4mmk5fhILEXUVcFBBqB3a0RP1uxXC-lDYlPz9IXox4X7vvr597A-U1GOc02C7MAGQ4bBk7i28ThG-YL4TtwzCJYyVeqdNIWnSzrJ-dQ4lmaj3vizpMsJjBQbZjF3ym8IqrQGk/s1600/strength+and+courage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="500" height="383" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgq9eoqmW4mmk5fhILEXUVcFBBqB3a0RP1uxXC-lDYlPz9IXox4X7vvr597A-U1GOc02C7MAGQ4bBk7i28ThG-YL4TtwzCJYyVeqdNIWnSzrJ-dQ4lmaj3vizpMsJjBQbZjF3ym8IqrQGk/s400/strength+and+courage.jpg" width="400" /></a></div>
<br />
To summarize, I believe I've had lipedema my whole life, to one degree or another. I was never a "normal" size and I always had a pear shape, even as a young child. Puberty made it worse.<br />
<br />
However, the lipedema really kicked into high gear as a young adult and I gained a tremendous amount of weight despite doing everything I could to stop it. Lipedema probably acted synergistically with PCOS and hypothyroidism and that's why the weight gain was so severe.<br />
<br />
Dieting seemed to make the lipedema worse. The dieting made me gain weight rather than lose it over the long run, plus it took me close to an eating disorder. For me, it was much healthier to stop actively trying to lose weight. Instead, I follow the Health At Every Size approach and that has been incredibly helpful to me. <br />
<br />
The lipedema in my legs and especially my belly got mildly worse with all my pregnancies and I had significant foot/leg edema after two of my pregnancies. However, other than that, it really didn't affect my pregnancies too much. I was fortunate in that way.<br />
<br />
The lipedema got worse with peri-menopause and a major car accident but I was still mostly functional. My diagnosis of cancer threw a new wrench into the mix. The treatments for cancer made me develop lipo-lymphedema and I have struggled with that, but Manual Lymph Drainage and compression has helped. My mobility took a big hit; for a while I was in a wheelchair but I can now walk and climb stairs again. <br />
<br />
While lipedema and cancer give me significant challenges, I get on with my life and I don't let it derail my happiness. I don't let it silence my voice, my contributions, or my opinions. I will not let the lipedema or the cancer define me.<br />
<br />
I try to make sure that I continue to live my life with joy and purpose. Lipedema does interfere with my life, but I refuse to let it make me unhappy or to take away my pleasure in the important things of life. Cancer may take my life eventually but I will live as fully and as joyfully as I can until then.<br />
<br />
<i><span style="color: #444444;">How has lipedema affected you? And how do you try to handle it proactively?</span></i></div>
</div>
</div>
</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com5tag:blogger.com,1999:blog-4738062031052371885.post-31523095985227941262018-06-13T21:28:00.000-07:002018-06-29T23:18:32.385-07:00The Lipedema Series<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2G0On6cIt9NcmO1EQ5RpbQ8aWPngjU9oJx5zZibvT65G3CHcTqiddl3yunb7XKeBakHIqg5QIh1RUnGantlpblgFqYdgLaEnyiSqdxajxPJXdUPZoyaIDn7LbRtSCSOrnHgH5nHe2_UA/s1600/lipedema+community%252C+Marie+Madeleine+Gautier%252C+1956%252C+SculpLovers.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="410" data-original-width="512" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2G0On6cIt9NcmO1EQ5RpbQ8aWPngjU9oJx5zZibvT65G3CHcTqiddl3yunb7XKeBakHIqg5QIh1RUnGantlpblgFqYdgLaEnyiSqdxajxPJXdUPZoyaIDn7LbRtSCSOrnHgH5nHe2_UA/s400/lipedema+community%252C+Marie+Madeleine+Gautier%252C+1956%252C+SculpLovers.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Sculpture by Marie-Madeleine Gautier</i></td></tr>
</tbody></table>
Over the years I have written a series of blog articles on lipedema (also spelled lipoedema), sometimes known as "painful fat syndrome" or "big leg syndrome." These have become some of my most popular articles.<br />
<br />
Since June is Lipedema Awareness Month, I think it's time to add a link where you can find all of the series listed in one place.<br />
<br />
<span style="font-family: inherit;">Lipedema is a fat storage disorder. In lipedema, an abnormal accumulation of fat occurs in the legs and lower body. Over time, it may develop to include the arms and other parts of the body as well. It is usually progressive, though why it progresses severely in some and not in others is one of its great mysteries. </span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Here is what we have covered so far:</span><br />
<span style="font-family: inherit;"><br /></span>
<b style="font-family: inherit;"><a href="http://www.wellroundedmama.blogspot.com/2015/06/lipedema-part-1-lipedema-vs-lymphedema.html" target="_blank">Part One</a> - Typical features of lipedema</b><span style="font-family: inherit;"> and how to differentiate between lipedema and lymphedema</span><br />
<b style="font-family: inherit;"><br /></b>
<div>
<b style="font-family: inherit;"><a href="http://www.wellroundedmama.blogspot.com/2015/06/lipedema-part-2-stages-and-progression.html" target="_blank">Part Two</a> - Different stages of progression</b><span style="font-family: inherit;">, and why it's so important to be aware of lipedema</span><br />
<b style="font-family: inherit;"><br /></b></div>
<div>
<b style="font-family: inherit;"><a href="http://www.wellroundedmama.blogspot.com/2015/06/lipedema-part-3-types-of-fat.html" target="_blank">Part Three</a> - Types of fat distribution patterns</b><span style="font-family: inherit;">, pictures illustrating type and stage of lipedema, how lipedema is diagnosed</span><br />
<b style="font-family: inherit;"><br /></b></div>
<div>
<b style="font-family: inherit;"><a href="http://www.wellroundedmama.blogspot.com/2015/07/lipedema-part-4-possible-causes-and.html" target="_blank">Part Four</a> - Possible causes of lipedema</b><span style="font-family: inherit;">, medical conditions associated with it</span><br />
<b style="font-family: inherit;"><br /></b></div>
<div>
<b style="font-family: inherit;">Part Five - Possible treatments for lipedema</b><span style="font-family: inherit;">, broken down into several sub-posts</span></div>
<div>
<br />
<span style="font-family: inherit;"> </span><a href="http://www.wellroundedmama.blogspot.com/2015/07/lipedema-part-5a-traditional-treatment.html" style="font-family: inherit;" target="_blank"><b>Traditional Medicine Treatments</b></a><span style="font-family: inherit;"> - Manual Lymph Drainage, Compression</span><br />
<span style="font-family: inherit;"> </span><a href="http://www.wellroundedmama.blogspot.com/2015/07/lipedema-treatment-part-5b-weight-and.html" style="font-family: inherit;" target="_blank"><b>"Weight Control" and Special Nutritional Approaches</b></a><span style="font-family: inherit;"> (</span><i style="font-family: inherit;"><span style="color: red;">trigger warning</span></i><span style="font-family: inherit;">)</span><br />
<span style="font-family: inherit;"> </span><a href="http://www.wellroundedmama.blogspot.com/2015/08/lipedema-treatment-part-5c-tumescent.html" style="font-family: inherit;" target="_blank"><b>Tumescent Liposuction</b></a><span style="font-family: inherit;"> - Specialized liposuction to take out diseased fat cells</span><br />
<span style="font-family: inherit;"> </span><a href="http://www.wellroundedmama.blogspot.com/2015/08/lipedema-part-5d-alternative-medicine.html" style="font-family: inherit;" target="_blank"><b>Alternative Medicine Treatments</b></a><span style="font-family: inherit;"> - Acupuncture, herbs, etc.</span><br />
<span style="font-family: inherit;"> </span><b style="font-family: inherit;"> <a href="http://www.wellroundedmama.blogspot.com/2015/08/lipedema-part-5e-treatment-options.html" target="_blank">Summary of Treatment Options</a></b><span style="font-family: inherit;"> - Summary of all the various treatments</span><br />
<b style="font-family: inherit;"><br /></b></div>
<div>
<b style="font-family: inherit;"><a href="http://www.wellroundedmama.blogspot.com/2015/09/lipedema-series-part-6-finding-clothing.html" target="_blank">Part Six</a> - Coping with clothing challenges</b><br />
<b style="font-family: inherit;"><br /></b></div>
<div>
<b style="font-family: inherit;"><a href="http://www.wellroundedmama.blogspot.com/2016/02/eighth-annual-turkey-awards-weight-bias.html" target="_blank">Part Seven</a> - Weight Bias in Lipedema Care</b><span style="font-family: inherit;"> (Part of the </span><i style="font-family: inherit;">Turkey Awards</i><span style="font-family: inherit;"> Series)</span><br />
<b style="font-family: inherit;"><br /></b></div>
<div>
<b style="font-family: inherit;"><a href="https://wellroundedmama.blogspot.com/2016/06/lipedema-part-8-living-your-best-life.html" target="_blank">Part Eight</a> - Living Your Best Life with Lipedema</b><br />
<ul style="text-align: left;">
</ul>
<div>
<br />
In addition, there have been some other miscellaneous posts about lipedema. These include:</div>
<div>
<ul style="text-align: left;">
<li><a href="https://wellroundedmama.blogspot.com/2017/05/manual-lymph-drainage-and-bandaging.html" target="_blank"><b>Manual Lymph Drainage and Bandaging</b></a> - Does it work?</li>
<li><a href="https://wellroundedmama.blogspot.com/2015/10/lipedema-self-acceptance-and-trolls.html" target="_blank"><b>Lipedema, Self-Acceptance and Trolls</b></a> - Dealing with trolls online</li>
<li><a href="https://wellroundedmama.blogspot.com/2018/06/ketogenic-diets-and-lipedema-apply.html" target="_blank"><b>Ketogenic Diets and Lipedema: Apply Caution</b></a>- Caution about unproven diet recommendations in the trendy ketogenic diet</li>
<li><span style="font-family: inherit;"><b><a href="https://wellroundedmama.blogspot.com/2018/06/lipedema-my-story.html" target="_blank">My Lipedema Story</a> - </b>My personal story of lipedema over time and how it interacted with cancer</span></li>
</ul>
</div>
<div>
<br /></div>
<div>
<b style="font-family: "times new roman";"><span style="color: #cc0000; font-family: inherit; font-size: large;">References and Resources</span></b></div>
<div>
<b style="font-family: "times new roman";"><span style="color: #cc0000; font-family: inherit; font-size: large;"><br /></span></b></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDyXP9wFmgzmuQVM5gqmob1rOtfQYWsKfZ5PLpDBSPa_EECHKrWk5bLaqDHwjlpuP3Po5aKnTGucoeAswEWIha819oMXgcwpaMzzr39IfbXMqPBYV5-B93OxwgTzbl2ihFjydfhMQDGJk/s1600/3+in+a+row%252C+lipedema+and+lipolymphedema.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="530" data-original-width="701" height="301" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDyXP9wFmgzmuQVM5gqmob1rOtfQYWsKfZ5PLpDBSPa_EECHKrWk5bLaqDHwjlpuP3Po5aKnTGucoeAswEWIha819oMXgcwpaMzzr39IfbXMqPBYV5-B93OxwgTzbl2ihFjydfhMQDGJk/s400/3+in+a+row%252C+lipedema+and+lipolymphedema.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Statues by Rachel Stams, Suze, and Brigitta Custer</i></td></tr>
</tbody></table>
<div>
<br /></div>
<div>
<div style="font-family: "times new roman"; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
<b><span style="color: #38761d; font-family: inherit;"><i>Info About Lipedema and Support Groups</i></span></b><br />
<span style="font-family: inherit;"><b><span style="color: #38761d;"><i><br /></i></span></b><i>*Trigger Warning: Many of these sites are not fat-friendly or promote dieting behaviors</i></span></div>
<ul style="font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
<li style="font-family: "times new roman";"><span style="font-family: inherit;">Fat Disorders Research Society, Inc. <a href="http://www.fatdisorders.org/">http://www.fatdisorders.org/</a></span></li>
<li style="font-family: "times new roman";"><span style="font-family: inherit;">Cure Lipedema <a href="http://www.curelipedema.org/#">http://www.curelipedema.org/#</a></span></li>
<li style="font-family: "times new roman";"><span style="font-family: inherit;">Karen L. Herbst, PhD, MD <a href="http://www.lipomadoc.org/lipedema.html">http://www.lipomadoc.org/lipedema.html</a></span></li>
<li><span style="font-family: "times new roman";"><a href="https://lipoedemaaustralia.com.au/">https://lipoedemaaustralia.com.au/</a> - Australian Support Group</span></li>
<li><span style="font-family: "times new roman";"><a href="http://www.lipoedema.co.uk/">http://www.lipoedema.co.uk/</a> - United Kingdom Support Group</span></li>
<li style="font-family: "times new roman";"><span style="font-family: inherit;">United States National Library of Medicine, National Institutes of Health -<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309375/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309375/</a></span></li>
<li style="font-family: "times new roman";"><span style="font-family: inherit;">Wikipedia <a href="http://en.wikipedia.org/wiki/Lipedema">http://en.wikipedia.org/wiki/Lipedema</a></span></li>
<li style="font-family: "times new roman";"><span style="font-family: inherit;">Peninsula Medical <a href="http://www.lymphedema.com/lipedema.htm">http://www.lymphedema.com/lipedema.htm</a></span></li>
<li style="font-family: "times new roman";"><span style="font-family: inherit;">Lymphedema People <a href="http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema">http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema</a></span></li>
<li style="font-family: "times new roman";"><span style="font-family: inherit;">Lipoedema Ladies (U.K.) - <a href="http://www.lipoedemaladies.com/">http://www.lipoedemaladies.com/</a> </span></li>
<li style="font-family: "times new roman";"><span style="font-family: inherit;">WebMD article - <a href="http://www.webmd.com/women/guide/lipedema-symptoms-treatment-causes">http://www.webmd.com/women/guide/lipedema-symptoms-treatment-causes</a> </span></li>
<li><span style="font-family: "times new roman";"><a href="https://diseasetheycallfat.tv/">https://diseasetheycallfat.tv/</a> - Catherine Seo's website about Lipedema, including film clips</span></li>
<li>Numerous Facebook Groups. Just enter "lipedema" or "lipoedema" in the search field</li>
</ul>
<div>
<span style="font-family: "times new roman";"><br /></span></div>
<div>
<span style="font-family: "times new roman";"><br /></span></div>
<div style="font-family: "times new roman"; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;">
</div>
</div>
</div>
</div>
Well-Rounded Mamahttp://www.blogger.com/profile/04129621631406155340noreply@blogger.com0