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The Miscarriage Manual: Coping with the Emotional Aspects of Pregnancy Loss by Elizabeth Carney

Miracles and Memories Family-Building Pins

Miracles and Memories Family-Building PinsFourteen years ago I gave birth to a baby girl. Four hours later she died because of an internal malformation that was undetectable during my pregnancy. During my short hospital stay, nurses and doctors seemed to avoid me and my questions. What they did say was about the same as what my friends and family were saying. "You're young. You'll have other babies. Try to forget." 

I didn't want any other baby; I wanted that one! Forget? How could I forget? Instead I was overwhelmed with crushing, breathtaking grief. I remember how empty I felt the day I left the empty womb and empty arms. I never really knew her but I missed her and ached for her so desperately. 

Soon after I returned home, everyone acted as if they had already forgotten her, as if they expected me to also. Someone had removed all the baby items I had acquired before coming home, hoping to spare me the pain. Instead, it felt like a further denial of her existence. When I tried to talk about her everyone became very quiet, or changed the subject, or left the room. Friends were very careful not to say anything that might remind me of my experience. Baby shower invitations didn't come in the mail. Birth announcements didn't come in the mail. Many stayed away because they simply did not know what to say. My husband had three days to "get over it" before he was expected back at work. The world kept on spinning as if nothing had happened. I remember thinking that I must have lost my mind. I thought that if my baby had lived for a while, if people had gotten to know and love her, maybe then I would have been given the affirmation to grieve the way I needed to. But I was the only one with any memory of her, the only one who had the chance to love her. I had no one to share that with, not even my husband. Most of his grief was for me and for the dreams we had shared for this child. I felt all alone as I began my mourning. 

Over the years, after much healing, I have had the opportunity to speak with other parents who have had experiences which were similar to mine. As a result of that, and also as a result of my search for answers to all those unanswered questions, I have compiled a list of several "truths and non-truths" concerning the grieving process as it relates to perinatal bereavement. 

This is not intended to be the absolute word on the subject, but rather a gauge for the unexpected emotions felt by parents who have suffered this type of loss. Most of the parents I have spoken to agreed that the uncertainty of their grief was frightening and may have been alleviated had they known what to expect. 

Friends and family may also benefit from reading this over so they might understand the special kinds of pain and emotions involved in this type of loss and allow them to be expressed. 

The Truth Is...

1. The truth ISN'T that you will feel "all better" in a couple of days, or weeks, or even months. 

The truth IS that the days will be filled with an unending ache and the nights will feel one million sad years long for a while. Healing is attained only after the slow necessary progression through the stages of grief and mourning. 

2. The truth isn't that a new pregnancy will help you forget. 

The truth is that, while thoughts of a new pregnancy soon may provide hope, a lost infant deserves to be mourned just as you would have with anyone you loved. Grieving takes a lot of energy and can be both emotionally and physically draining. This could have an impact upon your health during another pregnancy. While the decision to try again is a very individualized one, being pregnant while still actively grieving is very difficult. 

3. The truth isn't that pills or alcohol will dull the pain. 

The truth is that they will merely postpone the reality you must eventually face in order to begin healing. However, if your doctor feels that medication is necessary to help maintain your health, use it intelligently and according to his/her instructions. 

4. The truth isn't that once this is over your life will be the same. 

The truth is that your upside-down world will slowly settle down, hopefully leaving you a more sensitive, compassionate person, better prepared to handle the hard times that everyone must deal with sooner or later. When you consider that you have just experienced one of the worst things that can happen to a family, as you heal you will become aware of how strong you are. 

5. The truth isn't that grieving is morbid, or a sign of weakness or mental instability. 

The truth is that grieving is work that must be done. Now is the appropriate time. Allow yourself the time. Feel it, flow with it. Try not to fight it too often. It will get easier if you expect that it is variable, that some days are better than others. Be patient with yourself. There are no short cuts to healing. The active grieving will be over when all the work is done. 

6. The truth isn't that grief is all-consuming. 

The truth is that in the midst of the most agonizing time of your life, there will be laughter. Don't feel guilty. Laugh if you want to. Just as you must allow yourself the time to grieve, you must also allow yourself the time to laugh. Viewing laughter as part of the healing process, just as overwhelming sadness is now, will make the pain more bearable. 

7. The truth isn't that one person can bear this alone. 

The truth is that while only you can make the choices necessary to return to the mainstream of life a healed person, others in your life are also grieving and are feeling very helpless. As unfair as it may seem, the burden of remaining in contact with family and friends often falls on you. They are afraid to "butt in," or they may be fearful of saying or doing the wrong thing. This makes them feel even more helpless. They need to be told honestly what they can do to help. They don't need to be told, "I'm doing fine" when you're really NOT doing fine. By allowing others to share in your pain and assist you with your needs, you will be comforted and they will feel less helpless. 


8. The truth isn't that God must be punishing you for something. 

The truth is that sometimes these things just happen. They have happened to many people before you, and they will happen to many people after you. This was not an act of any God; it was an act of Nature. It isn't fair to blame God, or yourself, or anyone else. Try to understand that it is human nature to look for a place to put the blame, especially when there are so few answers to the question, "Why?" Sometimes there are answers. Most times there are not. Believing that you are being punished will only get in the way of your healing. 

9. The truth isn't that you will be unable to make any choices or decisions during this time. 

The truth is that while major decisions, such as moving or changing jobs, are better off being postponed for now, life goes on. It will be difficult, but decisions dealing with the death of your baby (seeing and naming the baby, arranging and/or attending a religious ritual, taking care of the nursery items you have acquired) are all choices you can make for yourself. Well-meaning people will try to shelter you from the pain of this. However, many of us who have suffered similar losses agree that these first decisions are very important. They help to make the loss real. Our brains filter out much of the pain early on as a way to protect us. Very soon after that, we find ourselves reliving the events over and over, trying to remember everything. This is another way that we acknowledge the loss. Until the loss is real, grieving cannot begin. Being involved at this early time will be a painful experience, but it will help you deal with your grief better as you progress by providing comforting memories of having performed loving, caring acts for your baby. 

10. The truth isn't that you will be delighted to hear that a friend or other loved one has just given birth to a healthy baby. 

The truth is that you may find it very difficult to be around mothers with young babies. You may be hurt, or angry, or jealous. You may wonder why you couldn't have had that joy. You may be resentful, or refuse to see friends with new babies. You may even secretly wish that the same thing would happen to someone else. You want someone to understand how it feels. You may also feel very ashamed that you could wish such things on people you love or care about, or think that you must be a dreadful person. You aren't. You're human, and even the most loving people can react this way when they are actively grieving. If the situations were reversed, your friends would be feeling and thinking the same things you are. Forgive yourself. It's OK. These feelings will eventually go away. 

11. The truth isn't that all marriages survive this difficult time. 

The truth is that sometimes you might blame one another, resent one another, or dislike being with one another. If you find this happening, get help. There are self-help groups available or grief counselors who can help. Don't ignore it or tuck it away assuming it will get better. It won't. Actively grieving people cannot help one another. It is unrealistic, like having two people who were blinded at the same time teach each other Braille. Talking it out with others may help. It might even save your marriage. 


12. The truth isn't that eventually you will accept the loss of your baby and forget all about this awful time. 

The truth is that acceptance is a word reserved for the understanding you come to when you've successfully grieved the loss of a parent, or a grandparent, or a beloved older relative. When you lose a child, your whole future has been affected, not your past. No one can really accept that. But there is resolution in the form of healing and learning how to cope. You will survive. Many of us who have gone through this type of grief are afraid we might forget about our babies once we begin to heal. This won't happen. You will always remember your precious baby because successful grieving carves a place in your heart where he or she will live forever.


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Avoiding Toxins During Pregnancy

Illustration of 6 different ethnic pregnant women

Pregnancy is what we strive for but with a history of infertility and miscarriage, it can be one of the scariest times in a couple's life. Environmental factors play a big role in the development of the baby. Here are some toxins to avoid and some tips on how to avoid them

Please feel free to share this simple infographic: Avoiding Toxins During Pregnancy. Click each icon to find more information and tips to avoid toxins during pregnancy.




Can Acupuncture Ease Labor Pains?

Dr. Marc Sklar is an INCIID Professional Member. In this Video Clip he explains how Acupuncture can ease labor pains.

Benefits of Breast-Feeding for Baby and Mother

There are many benefits to breastfeeding. Even if you are able to do it for only a short time, your baby's immune system can benefit from breast milk. Here are many other benefits of breast milk for a mother, her baby, and others:


Health Risks of Not Breastfeeding
Breast milk has agents (called antibodies) in it to help protect infants from bacteria and viruses. Recent studies show that babies who are not exclusively breastfed for 6 months are more likely to develop a wide range of infectious diseases including ear infections, diarrhea, respiratory illnesses and have more hospitalizations. Also, infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S.

Some studies suggest that infants who are not breastfed have higher rates of sudden infant death syndrome (SIDS) in the first year of life, and higher rates of type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's disease, overweight and obesity, high cholesterol and asthma. More research in these areas is needed (American Academy of Pediatrics, 2005).

Babies who are not breastfed are sick more often and have more doctor's visits.

Also, when you breastfeed, there are no bottles and nipples to sterilize. Unlike human milk straight from the breast, infant formula has a chance of being contaminated.
Breast milk is the most complete form of nutrition for infants. A mother's milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. Most babies find it easier to digest breast milk than they do formula.

As a result, breastfed infants grow exactly the way they should. They tend to gain less unnecessary weight and to be leaner. This may result in being less overweight later in life.

Premature babies do better when breastfed compared to premature babies who are fed formula.

Breastfed babies score slightly higher on IQ tests, especially babies who were born pre-maturely.


Nursing uses up extra calories, making it easier to lose the pounds of pregnancy. It also helps the uterus to get back to its original size and lessens any bleeding a woman may have after giving birth.

Breastfeeding, especially exclusive breastfeeding (no supplementing with formula), delays the return of normal ovulation and menstrual cycles. (However, you should still talk with your doctor or nurse about birth control choices.)

Breastfeeding lowers the risk of breast and ovarian cancers, and possibly the risk of hip fractures and osteoporosis after menopause.

Breastfeeding makes your life easier. It saves time and money. You do not have to purchase, measure, and mix formula. There are no bottles to warm in the middle of the night!

A mother can give her baby immediate satisfaction by providing her breast milk when her baby is hungry.

Breastfeeding requires a mother to take some quiet relaxed time for herself and her baby.

Breastfeeding can help a mother to bond with her baby. Physical contact is important to newborns and can help them feel more secure, warm and comforted.

Breastfeeding mothers may have increased self-confidence and feelings of closeness and bonding with their infants.


Breastfeeding saves on health care costs. Total medical care costs for the nation are lower for fully breastfed infants than never-breastfed infants since breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations.

Breastfeeding contributes to a more productive workforce. Breastfeeding mothers miss less work, as their infants are sick less often. Employer medical costs also are lower and employee productivity is higher.

Breastfeeding is better for our environment because there is less trash and plastic waste compared to that produced by formula cans and bottle supplies.


Current as of October 2005


Good Habits for Pregnant and Nursing Mothers from the Danish Government

Good Chemistry

To all pregnant and nursing mothers:

During pregnancy or when you are breast feeding, you and your child are particularly sensitive. During this period you should, therefore, pay special attention to chemicals which you and your child are exposed to. The Environmental Protection Agency has formulated 9 good habits for pregnant and nursing mothers regarding chemicals in cosmetics, in products for children and in toys. If you follow them, you will be well on your way to creating good chemistry for you and for your child.



For pregnant and nursing mothers:

Good chemistry for you and for your child

1. Use as little cosmetics and lotions as possible while you are pregnant and as long as you are breast feeding

- Certain cosmetics and lotions contain allergenic chemicals or are suspected of being hormone disruptors. By using as little cosmetics and lotions as possible you lessen the effect of chemicals on you and on your child.

2. Always choose unscented products, and stop using perfume during pregnancy and as long as you are breast feeding.

- Perfume can cause allergies, skin irritation, rashes or breathing difficulty.

3. Buy products with environmental labels whenever possible – look for the Swan label and The Flower

- The swan and the flower are environmental logos you can see on products made with special consideration for health and the environment – for instance by containing fewer problematic chemicals.

4. Don’t color your hair during pregnancy and as long as you are breast feeding

- Certain chemicals in hair dye can cause serious allergenic reactions or are suspected of being hormone disruptors. Also "natural hair dyes" like Henna can contain harmful chemicals.

5. Avoid using products that come in spray cans and do not paint while you are pregnant or as long as you are breast feeding

- If you paint or use spray cans you inhale chemicals that can be absorbed by your body and transmitted to your child. Avoid painting during this period and be sure to air out newly painted rooms properly.



Good chemistry for your baby

6. Wash everything before using it for your baby – also clothes and toys made of cloth or plastic

- New clothing, toys, nursing bottles etc. made of cloth or plastic can contain chemical residues. If you wash everything in hot water, most of the chemicals will be removed.

7. Avoid daily use of lotion, soap, etc. for your baby

- Bathe your baby in clean water and limit the use of lotions after bathing and after diaper changes. If your child has very dry or red and irritated skin or other skin problems, speak with your doctor or health visitor.

8. Always buy unscented products for your baby – also toys

- Perfume can give your baby an allergy. Therefore, always buy unscented grooming products for your baby and avoid scented toys.

9. Only use toys especially designed for babies. Toys for children older than 3 years may contain ftalates.

- Ftalates are used to soften plastics. Certain ftalates are hormone disruptors. In Denmark, the use of ftalates in toys for children under 3 years old is forbidden.


Download this fact sheet as a PDF


If you wish to read more about good chemistry for your baby see:

For information on nutrition for pregnant women see the website of the Ministry of Family and Consumer Affairs: For products containing environmental labels see the ecolabel website:


Breastfeeding is best for babies

Breast-Feeding Best Bet for Babies
by Rebecca D. Williams


New parents want to give their babies the very best. When it comes to nutrition, the best first food for babies is breast milk.

More than two decades of research have established that breast milk is perfectly suited to nourish infants and protect them from illness. Breast-fed infants have lower rates of hospital admissions, ear infections, diarrhea, rashes, allergies, and other medical problems than bottle-fed babies.

"There are 4,000 species of mammals, and they all make a different milk. Human milk is made for human infants and it meets all their specific nutrient needs," says Ruth Lawrence, M.D., professor of pediatrics and obstetrics at the University of Rochester School of Medicine in Rochester, N.Y., and spokeswoman for the American Academy of Pediatrics.

The academy recommends that babies be breast-fed for six to 12 months. The only acceptable alternative to breast milk is infant formula. Solid foods can be introduced when the baby is 4 to 6 months old, but a baby should drink breast milk or formula, not cow's milk, for a full year.

"There aren't any rules about when to stop breast-feeding," says Lawrence. "As long as the baby is eating age-appropriate solid foods, a mother may nurse a couple of years if she wishes. A baby needs breast milk for the first year of life, and then as long as desired after that."

In 1993, 55.9 percent of American mothers breast-fed their babies in the hospital. Only 19 percent were still breast-feeding when their babies were 6 months old. Government and private health experts are working to raise those numbers.

The U.S. Food and Drug Administration is conducting a study on infant feeding practices as part of its ongoing goal to improve nutrition in the United States. The study is looking at how long mothers breast-feed and how they introduce formula or other foods.

Health experts say increased breast-feeding rates would save consumers money, spent both on infant formula and in health-care dollars. It could save lives as well.

"We've known for years that the death rates in Third World countries are lower among breast-fed babies," says Lawrence. "Breast-fed babies are healthier and have fewer infections than formula-fed babies."


Human Milk for Human Infants

The primary benefit of breast milk is nutritional. Human milk contains just the right amount of fatty acids, lactose, water, and amino acids for human digestion, brain development, and growth.

Cow's milk contains a different type of protein than breast milk. This is good for calves, but human infants can have difficulty digesting it. Bottle-fed infants tend to be fatter than breast-fed infants, but not necessarily healthier.

Breast-fed babies have fewer illnesses because human milk transfers to the infant a mother's antibodies to disease. About 80 percent of the cells in breast milk are macrophages, cells that kill bacteria, fungi and viruses. Breast-fed babies are protected, in varying degrees, from a number of illnesses, including pneumonia, botulism, bronchitis, staphylococcal infections, influenza, ear infections, and German measles. Furthermore, mothers produce antibodies to whatever disease is present in their environment, making their milk custom-designed to fight the diseases their babies are exposed to as well.

A breast-fed baby's digestive tract contains large amounts of Lactobacillus bifidus, beneficial bacteria that prevent the growth of harmful organisms. Human milk straight from the breast is always sterile, never contaminated by polluted water or dirty bottles, which can also lead to diarrhea in the infant.

Human milk contains at least 100 ingredients not found in formula. No babies are allergic to their mother's milk, although they may have a reaction to something the mother eats. If she eliminates it from her diet, the problem resolves itself.

Sucking at the breast promotes good jaw development as well. It's harder work to get milk out of a breast than a bottle, and the exercise strengthens the jaws and encourages the growth of straight, healthy teeth. The baby at the breast also can control the flow of milk by sucking and stopping. With a bottle, the baby must constantly suck or react to the pressure of the nipple placed in the mouth.

Nursing may have psychological benefits for the infant as well, creating an early attachment between mother and child. At birth, infants see only 12 to 15 inches, the distance between a nursing baby and its mother's face. Studies have found that infants as young as 1 week prefer the smell of their own mother's milk. When nursing pads soaked with breast milk are placed in their cribs, they turn their faces toward the one that smells familiar.

Many psychologists believe the nursing baby enjoys a sense of security from the warmth and presence of the mother, especially when there's skin-to-skin contact during feeding. Parents of bottle-fed babies may be tempted to prop bottles in the baby's mouth, with no human contact during feeding. But a nursing mother must cuddle her infant closely many times during the day. Nursing becomes more than a way to feed a baby; it's a source of warmth and comfort.


Benefits to Mothers

Breast-feeding is good for new mothers as well as for their babies. There are no bottles to sterilize and no formula to buy, measure and mix. It may be easier for a nursing mother to lose the pounds of pregnancy as well, since nursing uses up extra calories. Lactation also stimulates the uterus to contract back to its original size.

A nursing mother is forced to get needed rest. She must sit down, put her feet up,and relax every few hours to nurse. Nursing at night is easy as well. No one has to stumble to the refrigerator for a bottle and warm it while the baby cries. If she's lying down, a mother can doze while she nurses.

Nursing is also nature's contraceptive--although not a very reliable one. Frequent nursing suppresses ovulation, making it less likely for a nursing mother to menstruate, ovulate, or get pregnant. There are no guarantees, however. Mothers who don't want more children right away should use contraception even while nursing. Hormone injections and implants are safe during nursing, as are all barrier methods of birth control. The labeling on birth control pills says if possible another form of contraception should be used until the baby is weaned.

Breast-feeding is economical also. Even though a nursing mother works up a big appetite and consumes extra calories, the extra food for her is less expensive than buying formula for the baby. Nursing saves money while providing the best nourishment possible.


When Formula's Necessary

There are very few medical reasons why a mother shouldn't breast-feed, according to Lawrence.

Most common illnesses, such as colds, flu, skin infections, or diarrhea, cannot be passed through breast milk. In fact, if a mother has an illness, her breast milk will contain antibodies to it that will help protect her baby from those same illnesses.

A few viruses can pass through breast milk, however. HIV, the virus that causes AIDS, is one of them. Women who are HIV positive should not breast-feed.

A few other illnesses--such as herpes, hepatitis, and beta streptococcus infections--can also be transmitted through breast milk. But that doesn't always mean a mother with those diseases shouldn't breast-feed, Lawrence says.

"Each case must be evaluated on an individual basis with the woman's doctor," she says.

Breast cancer is not passed through breast milk. Women who have had breast cancer can usually breast-feed from the unaffected breast. There is some concern that the hormones produced during pregnancy and lactation may trigger a recurrence of cancer, but so far this has not been proven. Studies have shown, however, that breast-feeding a child reduces a woman's chance of developing breast cancer later.

Silicone breast implants usually do not interfere with a woman's ability to nurse, but if the implants leak, there is some concern that the silicone may harm the baby. Some small studies have suggested a link between breast-feeding with implants and later development of problems with the child's esophagus. Further studies are needed in this area. But if a woman with implants wants to breast-feed, she should first discuss the potential benefits and risks with her child's doctor.


Possible Problems

For all its health benefits, breast-feeding does have some disadvantages. In the early weeks, it can be painful. A woman's nipples may become sore or cracked. She may experience engorgement more than a bottle-feeding mother, when the breasts become so full of milk they're hard and painful. Some nursing women also develop clogged milk ducts, which can lead to mastitis, a painful infection of the breast. While most nursing problems can be solved with home remedies, mastitis requires prompt medical care (see accompanying article).

Another possible disadvantage of nursing is that it affects a woman's entire lifestyle. A nursing mother with baby-in-tow must wear clothes that enable her to nurse anywhere, or she'll have to find a private place to undress. She should eat a balanced diet and she might need to avoid foods that irritate the baby. She also shouldn't smoke, which can cause vomiting, diarrhea and restlessness in the baby, as well as decreased milk production.

Women who plan to go back to work soon after birth will have to plan carefully if they want to breast-feed. If her job allows, a new mother can pump her breast milk several times during the day and refrigerate or freeze it for the baby to take in a bottle later. Or, some women alternate nursing at night and on weekends with daytime bottles of formula.

In either case, a nursing mother is physically tied to her baby more than a bottle-feeding mother. The baby needs her for nourishment, and she needs to nurse regularly to avoid getting uncomfortably full breasts. But instead of feeling it's a chore, nursing mothers often cite this close relationship as one of the greatest joys of nursing. Besides, nursing mothers can get away between feedings if they need a break.

Finally, some women just don't feel comfortable with the idea of nursing. They don't want to handle their breasts, or they want to think of them as sexual, not functional. They may be concerned about modesty and the possibility of having to nurse in public. They may want a break from child care to let someone else feed the baby, especially in the wee hours of the morning.

If a woman is unsure whether she wants to nurse, she can try it for a few weeks and switch if she doesn't like it. It's very difficult to switch to breast-feeding after bottle-feeding is begun.

If she plans to breast-feed, a new mother should learn as much as possible about it before the baby is born. Obstetricians, pediatricians, childbirth instructors, nurses, and midwives can all offer information about nursing. But perhaps the best ongoing support for a nursing mother is someone who has successfully nursed a baby.

La Leche League, a national support organization for nursing mothers, has chapters in many cities that meet regularly to discuss breast-feeding problems and offer support.

"We encourage mothers to come to La Leche League before their babies are born," says Mary Lofton, a league spokeswoman. "On-the-job training is hard to do. It's so important to learn how to breast-feed beforehand to avoid problems."


Interested women or couples are welcome to attend La Leche League meetings without charge. League leaders offer advice by phone as well. To find a convenient La Leche League chapter, call (1-800) LA-LECHE.

Rebecca D. Williams is a writer in Oak Ridge, Tenn.



Tips for Breast-Feeding Success
It's helpful for a woman who wants to breast-feed to learn as much about it as possible before delivery, while she is not exhausted from caring for an infant around-the-clock. The following tips can help foster successful nursing:


Get an early start: Nursing should begin within an hour after delivery if possible, when an infant is awake and the sucking instinct is strong. Even though the mother won't be producing milk yet, her breasts contain colostrum, a thin fluid that contains antibodies to disease. 
Proper positioning: The baby's mouth should be wide open, with the nipple as far back into his or her mouth as possible. This minimizes soreness for the mother. A nurse, midwife, or other knowledgeable person can help her find a comfortable nursing position. 
Nurse on demand: Newborns need to nurse frequently, at least every two hours, and not on any strict schedule. This will stimulate the mother's breasts to produce plenty of milk. Later, the baby can settle into a more predictable routine. But because breast milk is more easily digested than formula, breast-fed babies often eat more frequently than bottle-fed babies. 
No supplements: Nursing babies don't need sugar water or formula supplements. These may interfere with their appetite for nursing, which can lead to a diminished milk supply. The more the baby nurses, the more milk the mother will produce. 
Delay artificial nipples: It's best to wait a week or two before introducing a pacifier, so that the baby doesn't get confused. Artificial nipples require a different sucking action than real ones. Sucking at a bottle could also confuse some babies in the early days. They, too, are learning how to breast-feed. 
Air dry: In the early postpartum period or until her nipples toughen, the mother should air dry them after each nursing to prevent them from cracking, which can lead to infection. If her nipples do crack, the mother can coat them with breast milk or other natural moisturizers to help them heal. Vitamin E oil and lanolin are commonly used, although some babies may have allergic reactions to them. Proper positioning at the breast can help prevent sore nipples. If the mother's very sore, the baby may not have the nipple far enough back in his or her mouth. 
Watch for infection: Symptoms of breast infection include fever and painful lumps and redness in the breast. These require immediate medical attention. 
Expect engorgement: A new mother usually produces lots of milk, making her breasts big, hard and painful for a few days. To relieve this engorgement, she should feed the baby frequently and on demand until her body adjusts and produces only what the baby needs. In the meantime, the mother can take over-the-counter pain relievers, apply warm, wet compresses to her breasts, and take warm baths to relieve the pain. 
Eat right, get rest: To produce plenty of good milk, the nursing mother needs a balanced diet that includes 500 extra calories a day and six to eight glasses of fluid. She should also rest as much as possible to prevent breast infections, which are aggravated by fatigue. 


Medicines and Nursing Mothers
Most medications have not been tested in nursing women, so no one knows exactly how a given drug will affect a breast-fed child. Since very few problems have been reported, however, most over-the-counter and prescription drugs, taken in moderation and only when necessary, are considered safe.

Even mothers who must take daily medication for conditions such as epilepsy, diabetes, or high blood pressure can usually breast-feed. They should first check with the child's pediatrician, however. To minimize the baby's exposure, the mother can take the drug just after nursing or before the child sleeps. In the January 1994 issue of Pediatrics, the American Academy of Pediatrics included the following in a list of drugs that are usuallycompatible with breast-feeding:

  • acetaminophen
  • many antibiotics
  • antiepileptics (although one, Primidone, should be given with caution)
  • most antihistamines
  • alcohol in moderation (large amounts of alcohol can cause drowsiness, weakness, and abnormal weight gain in an infant)
  • most antihypertensives
  • aspirin (should be used with caution)
  • caffeine (moderate amounts in drinks or food)
  • codeine
  • decongestants
  • ibuprofen
  • insulin
  • quinine
  • thyroid medications



Drugs That Are NOT Safe While Nursing
Some drugs can be taken by a nursing mother if she stops breast-feeding for a few days or weeks. She can pump her milk and discard it during this time to keep up her supply, while the baby drinks previously frozen milk or formula.

Radioactive drugs used for some diagnostic tests like Gallium-69, Iodine-125, Iodine-131, or Technetium-99m can be taken if the woman stops nursing temporarily.

Drugs that should never be taken while breast-feeding include:

Bromocriptine (Parlodel): A drug for Parkinson's disease, it also decreases a woman's milk supply.

Most Chemotherapy Drugs for Cancer: Since they kill cells in the mother's body, they may harm the baby as well.

Ergotamine (for migraine headaches): Causes vomiting, diarrhea, convulsions in infants.

Lithium (for manic-depressive illness): Excreted in human milk.

Methotrexate (for arthritis): Can suppress the baby's immune system.

Drugs of Abuse: Some drugs, such as cocaine and PCP, can intoxicate the baby. Others, such as amphetamines, heroin and marijuana, can cause a variety of symptoms, including irritability, poor sleeping patterns, tremors, and vomiting. Babies become addicted to these drugs.

Tobacco Smoke: Nursing mothers should avoid smoking. Nicotine can cause vomiting, diarrhea and restlessness for the baby, as well as decreased milk production for the mother. Maternal smoking or passive smoke may increase the risk of sudden infant death syndrome (SIDS) and may increase respiratory and ear infections.


This article comes from the FDA


Thatcher's Thoughts Age related increase in uterine dysfunction during labor

Index for entries posted 11/21/00:

Lower cholesterol -- lower dementia
Age related increase in uterine dysfunction during labor
Worrisome ovarian cysts

Lower cholesterol -- lower dementia
Title: Statins and the risk of dementia
Author: H. Jick, et al.
Address: Lexington, MA 
Source: The Lancet 356:1627-1631 (November) 2000 
Summary: It is estimated that dementia affects 10% of the population older than 65 years and vascular and lipid-related mechanisms are thought to have a role in the pathogenesis of Alzheimer's disease and vascular dementia. Thus, researchers conducted a study of the potential effect of HMG CoA (3 hydroxy-3menthylglutaryl-coenzyme A) reductase inhibitors (statins) and other lipid-lowering agents on dementia. The study population initially included 3 groups who were 50 years and older. Group 1 consisted of all individuals who had received lipid-lowering agents; group 2 included all individuals with a clinical diagnosis of untreated hyperlipidaemia; and group 3 was a randomly selected group of other individuals. From these three groups, all cases with a computer recorded clinical diagnosis of dementia were identified. Each case was matched with as many as four controls derived from the base population on age, sex, practice, and index date of case. Included in the study were 284 subjects with dementia and 1,080 controls. 13% of the controls had untreated hyperlipidaemia, 11% were prescribed statins, 7% other LLAs, and 69% had no hyperlipidaemia or LLA exposure. Researchers found that individuals 50 years and older who were prescribed statins had a substantially lower risk of developing dementia, independent of the presence or absence of untreated hyperlipidaemia or exposure to non-statin LLAs. However, the available data do not distinguish between Alzheimer's disease and other forms of dementia. 
Comment: This reminds me of a cartoon of a physician looking over his desk and telling a perimenopausal patient, "I'm going to take you off additives and put you on preservatives." An interesting comparison might be made with HRT. Both are needed because of our extended life expectancy and to help extend it. Both have benefits greater than the reason for which they are indicated. Both are associated with unwanted side-effects. It is too early to know the impact of lipid lowering agents on large populations over many years. The frontier of pharmaceutical research is drugs to acclimate our genetic predispositions into our 21st century lifestyle. 

Age related increase in uterine dysfunction during labor
Title: The relationship between maternal age and uterine dysfunction: A continuous effect throughout reproductive life 
Author: D. Main, et al. 
Address: San Francisco, CA
Source: American Journal of Obstetrics and Gynecology 183:1312-1320 (November) 2000 
Summary: This study was undertaken to determine whether there is a continuous effect of maternal age on uterine function. Using a comprehensive computerized database and medical record system, researchers identified 8496 low risk patients who were nulliparous and in spontaneous term labor with singleton fetuses in vertex presentation. Subjects were analyzed according to maternal age for measures of labor dysfunction and rates of operative delivery. The use of oxytocin, duration of second stage of labor, cesarean delivery, cesarean delivery for failure to progress and operative vaginal delivery rates were significantly increased with advancing maternal age. These increases appeared to be continuous functions beginning during the early 20s instead of a new phenomenon beginning after age 35. Researchers concluded that among nulliparous patients with uncomplicated labor there is a continuously increasing risk of uterine dysfunction related to maternal age. 
Comment: On analysis of a large number of studies on the adverse effects of aging on pregnancy and labor, there are three risks that seem to stand out as incontrovertible. There is an increased risk of spontaneous abortion / chromosomal abnormalities and there is an increased risk of C-section. Some have stated this is because of the increased incidence of fibroids and anatomic abnormalities. Others have proposed that there is a greater propensity for the obstetrician to intervene because of perceived risk. When both of these are excluded, C-section rates are still higher and seem to be related to uterine dysfunction. 

Worrisome ovarian cysts
Title: Worrisome ovarian cysts 
Author: W. Gotlieb, et al.
Address: Tel Hashomer, Israel 
Source: American Journal of Obstetrics and Gynecology 183:541-546 (September) 2000 
Summary: Researchers performed a retrospective analysis of ultrasonographic characteristics and CA 125 levels in 91 patients with ovarian tumors of borderline malignancy. In 75% of the patients, serous tumors of borderline malignancy were associated with elevated CA 125 levels, compared with 30% of mucinous tumors. In stage IA serous tumors, CA 125 was elevated in 35% of patients, compared with 89% of tumors that had spread beyond the ovary. Mucinous tumors were larger on ultrasonography than serous tumors. Mucinous tumors were also multilocular in half the patients and contained papillations in 40%. Serous tumors were multilocular in 30%, but presented with solid or papillary patterns in 78%. A resistance index of less than 0.4 was found in 36% of mucinous tumors and half the cases of serous tumors. In 13%, ultrasonographic traits were compatible with a simple cyst, including 1 patient with microinvasion and 1 patient with stage IIIB disease. Sensitivity of gray-scale ultrasonography was 87% that of CA 125 measurement was 62%, and that of flow was 55%. At least 1 diagnostic test result was abnormal in 93%, 2 were abnormal in 69%, and all 3 were abnormal in 21%. A high proportion of borderline tumors of the ovary, particularly of the serous type, were associated with elevated CA 125 levels and abnormal ultrasonographic characteristics, although some tumors presented as simple cysts. 
Comment: The great fear is that a cyst found on ultrasound is cancerous. While this is rare in the woman of reproductive age, it does occur. This study was particularly distressing because some of the borderline tumors and 2 cancers were associated with "simple cysts," i.e. those with a thin wall and none of the usual signs that raise suspicion. Persistent cysts should not be dismissed and a CA 125 seems to be a relatively good 2nd step. 

Thatcher's Thoughts Diabetes & Maternal Age

Index for entries posted 09/15/00:

1. Birth weight and risk of type 2 diabetes 
2. Obesity gene
3. Maternal age and risk of type 1 diabetes

Birth weight and risk of type 2 diabetes
Title:The fetal and childhood growth of persons who develop type 2 diabetes
Author: T. Forsen, et al.
Address: Helsinki, Finland
Source: Annals of Internal Medicine 133: 176-182 (August) 2000
Summary:Because type 2 diabetes is linked to low birthweight followed by obesity in adulthood, researchers speculated that those who develop the disease might have a particular pattern of growth from birth through childhood. Thus, they examined the relation of type 2 diabetes to size at birth and childhood growth. Researchers identified 471 men and women born in Helsinki between 1924 and 1933, and still lived in Finland in 1971, who developed type 2 diabetes. The cumulative incidence of type 2 diabetes was 7.9% in men and 5.4% in women. The incidence increased with decreasing birthweight, birth length, ponderal index, and placental weight. The odds ratio for type 2 diabetes was 1.38 for each 1 kg decrease in birthweight. The mean weights and heights of the children at 7 years of age who later developed type 2 diabetes were about average. Thereafter, their growth in weight and height was accelerated until 15 years of age. Children of both sexes whose mothers had a high body mass index in pregnancy had more rapid growth during childhood and an increased incidence of type 2 diabetes. Researchers concluded that their findings are consistent with the hypothesis that type 2 diabetes is programmed in utero in association with low rates of fetal growth. 
Comment: The relationship between low birthweight and insulin resistance is clearly established. There has been less information on birthweight and diabetes. There also seems to be an association between low birthweight and premature adrenarche (pubic hair development). One hypothesis is that stress related to growth restriction results in a premature activation of the adrenal axis. This same effect could contribute to the development of PCOS. A potential outcome of the additional possible effect is the development of PCOS, possibly a non-genetic cause of PCOS. To the contrary, large babies are sometimes associated with gestational diabetes, also a known risk factor for later development of type 2 diabetes. 

Obesity gene
Title:Independent confirmation of a major focus for obesity on chromosome 10
Author: A. Hinney, et al.
Address:Marburg, France
Source:The Journal of Clinical Endocrinology & Metabolism 85:2962-2965 (August) 2000
Summary: Linkage of obesity to chromosome 10p12 with a maximal multipoint LOD score of 4.85 was reported upon use of an affected sib-pair approach including nuclear families in which the adult index case had a BMI greater than or equal to 40kg/m2 and at least one further sibling had a BMI greater than or equal to 27 kg/m2. In an effort to reproduce this linkage finding, researchers genotyped 11 markers spanning approximately 23 cm from 10p13 to 10q11 in a total of 386 individuals stemming from 93 nuclear families with two or more young obese offspring with a BMI greater than or equal to the 90th age percentile. The highest multipoint maximum likelihood binomial LOD score using the extreme concordant sib-pair approach in which one sib had a BMI greater than or equal to the 95th percentile, and other sibs a BMI less than or equal to the 90th percentile was 2.32. Six markers yielded nominal p-values less than 0.05, the highest two point MLB-LOD score of 2.45 was obtained for the marker TCF8. Transmission disequilibrium tests for the most frequent parental allele yielded no nominal p-value less than 0.05. The linkage results confirm the presence of a major susceptibility locus for obesity in a region near the centromere on chromosome 10. 
Comment: Once the (a) gene is found, can it be fixed? 

Maternal age and risk of type 1 diabetes
Title:Influence of maternal age at delivery and birth order on risk of type 1 diabetes in childhood: prospective population based family study
Author: P. Bingley, et al. 
Address: Bristol, England
Source:British Medical Journal 321: 420-424 (August) 2000
Summary: In a prospective population based family study, researchers studied the impact of parental age at delivery and birth order on subsequent risk of childhood diabetes. Subjects were 1375 families in which one child or more had diabetes. Of 3221 offspring, 1431 had diabetes and 1790 remained non-diabetic at a median age of 16.1 years. It was discovered that maternal age at delivery was strongly related to the risk of type 1 diabetes in the offspring. The risk increased by 25% for each five year increase of maternal age, so that maternal age at delivery of greater than or equal to 45 years was associated with a relative risk of 3.11 when compared with a maternal age of less than 20 years. Paternal age was also associated with a 9% increase for each five year increase in paternal age. However, the relative risk of diabetes, adjusted for parental age at delivery and sex of offspring, decreased with increasing birth order. The overall effect was a 15% risk reduction per child born. Researchers speculated that the increase in maternal age at delivery in the United Kingdom over the past two decades could partly account for the rise in incidence of childhood diabetes over this period.
Comment: A curious association, but a mechanism is still lacking. 

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INCIID’s Beta HCG Chart

INCIID's Pregnancy hCG Beta Chart

Human Chorionic Gondaotropin (hCG) is often referred to as the "pregnancy hormone" because it signals the ovary that an egg has been fertilized and the cells are dividing. In response, the ovary continues producing progesterone which fosters the continued growth and development of the embryo. hCG is the first hormone to herald pregnancy, first appearing when an embryo has as few as 6-8 cells. As the number of cells increases, the amount of hCG produced increases as well. Home Pregnancy Tests (HPTs) can detect this hormone in your urine a few days before your expected menstrual bleeding begins, providing advanced notice of a pregnancy. An hCG-beta blood test is much more sensitive than an HPT, and can detect pregnancy as early as 8-10 days after fertilization.

More important than the hCG value is how it changes over time. Although most people expect the hCG to double every two days during the early weeks of pregnancy, an increase of as little as 60% is still very reassuring that all is going well. If you have received an hCG injection (Profasi, Pregnyl) to trigger ovulation or to lengthen the luteal phase of your cycle, trace amounts can remain in your system as long  as one week after your last injection; resulting in a false positive on a pregnancy test, or, creating a misleading trend in hCG production. To confirm a pregnancy related increase in hCG compare two or more consecutive quantitative hCG beta blood tests, preferably done by the same lab. If your level increases progressively, you have an on-going pregnancy. .

An hCG level of less than 5 mIU/ml generally indicates you are not pregnant.

Week from the Last Menstrual Period (LMP) Amount of hCG in mIU/ml
3 5 - 50
4 4 - 426
5 19 - 7,340
6 1,080 - 56,500
7 - 8 7,650 - 229,000
9 - 12 25,700 - 288,000
13 - 16 13,300 - 254,000
17 - 24 4,060 - 165,400
25 - 40 3,640 - 117,000


Pregnant women usually attain serum concentrations of 10 to 50 mIU in the week following conception. The hCG level will rise progressively during the first trimester—reflecting the rapid growth of the placenta that is producing it. These levels then plateau before they go down during the third trimester. This hormone will then disappear following delivery until the next pregnancy occurs.

Robert Greene, MD, FACOG (Read His Bio)

Ask Dr. Greene a early pregnancy question on the INCIID Pregnancy Forum
Medical Director (Email Dr. Greene through link below)
Sher Institute for Reproductive Medicine

Dr. Greene discusses HCG very thoroughly in his new and excellent book: PERFECT HORMONE BALANCE FOR FERTILITY

Every aspect of pregnancy—from your ability to conceive to your risk of a preterm delivery—is affected by your hormonal health. But if you’re like many women, you don’t know the critically important role hormones play at every stage of your pregnancy. In Dr. Robert Greene’s Perfect Hormone Balance for Pregnancy, Dr. Greene, a world-renowned hormone expert, incorporates his years of research into a practical plan for maintaining excellent hormone health throughout your pregnancy.

Balanced hormones are essential to a healthy pregnancy for you and for optimal brain development for your baby. Dr. Greene’s groundbreaking Perfect Balance Pregnancy Program, which follows all the guidelines recommended by the American College of Obstetricians and Gynecologists, shows you how to overcome and avoid common factors that create hormonal imbalance—including overeating, insufficient sleep, chronic stress, and the chemicals found in food, water, and cosmetics. With this easy-to-follow plan for maintaining proper hormone balance, you’ll understand:

• why your symptoms matter
• the importance of diet and exercise
• what is the appropriate weight gain for your body
• how to reduce tension and improve sleep
• why and how to avoid environmental toxins

The Perfect Balance Pregnancy Program arms you with the tools you need before, during, and after pregnancy to stay healthy and feel great.

Visit Dr. Greene's pregnancy blog