“Advanced Maternal Age” – What Are the Risks?

I recently was reading about advanced maternal age, and some commenters were ranting.  I can understand.  I *hope* to have another baby at some point, but likely after 30.  Yet my husband and I agree that at 35 he’s getting a vasectomy.  (He doesn’t like to talk about it, but yes, he says he wants to do it.  Just never to think about it.)

So why is “advanced maternal age” such a big deal?  And why age 35?  Age 35 is the cutoff used for all of my studies cited below, and is repeatedly given as an age where risks tend to increase when research is done.

1. Mothers of advanced maternal age have a higher incidence of c-section.  Wait…. doesn’t this just prove what some are ranting about?  We make women “high risk” and of COURSE they are going to have a higher c-section rate, because OB’s are “scalpel happy”.  Yet it’s important to also notice that the elective c-section rate was also higher in older mothers.  While some may argue this following statement, I stand behind it – OB’s see those who request c-sections as a higher risk, because there is a lot that can go wrong.  In fact, most OB’s I know would prefer you go into labor naturally, believe it or not.  While there are exceptions to every rule, elective c-sections are getting poorer and poorer reputations by the minute.

(Bayrampour H, Heaman M. Advanced Maternal Age and the Risk of Cesarean Birth: A Systematic Review. Birth: Issues In Perinatal Care [serial online]. September 2010;37(3):219-226. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

2. Higher neonatal mortality rates.  One study found that mothers of multiples at an increased maternal age had a significantly higher rate of neonatal mortality in pregnancy with multiples.  This is definitely something to consider at an advanced age.  Since often the risk of having multiples increases with age, it is important to know that there is also an increased risk of losing a baby or babies.  Another study found an increased risk of stillbirth among mothers of advanced age (greater than 35).

(Kristensen S, Salihu H, Keith L, Kirby R, Pass M, Fowler K. Impact of advanced maternal age on neonatal survival of twin small-for-gestational-age subtypes. Journal Of Obstetrics & Gynaecology Research [serial online]. June 2007;33(3):259-265. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.

Salihu H, Wilson R, Alio A, Kirby R. Advanced maternal age and risk of antepartum and intrapartum stillbirth. Journal Of Obstetrics & Gynaecology Research [serial online]. October 2008;34(5):843-850. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

3. Risk of Down Syndrome Increases.  Many studies support this finding.  In Norway, a population based study showed the significantly higher association of Down Syndrome and maternal age.  They also explain that the higher rates of Down Syndrome are related to our older maternal age overall when having children.  It’s also important to note that studies are now showing that advanced paternal age is also proving to be associated with an increased risk of Down Syndrome – so it’s not just moms we need to consider when looking at risk factors.

(Melve K, Lie R, Irgens L, et al. Registration of Down syndrome in the Medical Birth Registry of Norway: Validity and time trends. Acta Obstetricia Et Gynecologica Scandinavica[serial online]. August 2008;87(8):824-830. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.

Dzurova D, Pikhart H. Down syndrome, paternal age and education: comparison of California and the Czech Republic. BMC Public Health [serial online]. January 2005;5:69-10. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

4. Increased age and autism.  Again, we’re not just talking about mothers.  My cited study shows that maternal age is a bigger risk factor for autism, but paternal age is still a risk factor as well.

(King M, Fountain C, Dakhlallah D, Bearman P. Estimated Autism Risk and Older Reproductive Age. American Journal Of Public Health [serial online]. September 2009;99(9):1673-1679. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

5. Testing Increases Risks.  Often more testing will be done when a mother is of a higher age.  This includes amniocentesis and other tests that have risks associated with them. It’s also important to note, though, that research shows we don’t need to go crazy with the testing.  A study that began in 2006 shows that by changing policy from offering routine invasive screening to only offering when there was a positive screening result or an abnormality in an ultrasound the invasive testing was decreased significantly.  I cite this so you can go prepared, and be confident in your decision to test or not to test – as it can be an overwhelming decision to make!

(Tsz Kin L, Fung King L, Wing Cheong L, Wai Lam L, Lawrence Chang Hung T, Robert Kien Howe C. A new policy for prenatal screening and diagnosis of Down syndrome for pregnant women with advanced maternal age in a public hospital. Journal Of Maternal-Fetal & Neonatal Medicine [serial online]. August 2010;23(8):914-919. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

I hope that gives a little insight into why advanced maternal age is considered a risk.  There are other associated risks, and I encourage every mama to do research and know what she is facing when at an advanced maternal age (or paternal age!)

Questions?  Ask!  I’m happy to address and support any questions you might have in the effort to promote educated birth.  Go forth, ladies, and have FANTASTIC pregnancies, births, and babies!

MMR Vaccine + Autism

**First let me say that I am for INFORMED decisions.  I have my own vaccination schedule and beliefs about vaccines.  I personally am not going to argue that someone should or should not, just that they should be informed – and when I say informed, I don’t mean informed about what I believe.*

I recently found a thread where a mom was asking about the MMR vaccine and if it was truly linked to autism.  She asked for some research and evidence, and all she really seemed to get were strong opinions, but nothing backing it up.  I see this all too often.  Recently I was sent an article against vaccines, and the research behind the article was from 1950.  A lot has changed in the medical world since then.  So I decided to attempt to provide some information that is more recent, relevant, and reliable.  If anyone has some to add, leave a comment – I’m happy to consider anything and everything, but I really would prefer recent information!

“MMR and autism: further evidence against a causal association” by C.Paddy Farrington, Elizabeth Miller and Brent Taylor.  This article was written in 2007, and the study out of the UK initially was performed to determine if there was a short term association between the MMR vaccine and autism.  No association was found.  They then re-analyzed the information to determine if there was an association in a longer term interval between the MMR vaccine and autism, and again no association was found.  You can see the abstract and purchase the article here: http://www.sciencedirect.com/science/article/pii/S0264410X01000974

In “Association Between Thimerosal-Containing Vaccine and Autism” by Anders Hviid, et al., is from a study run in Denmark between 1990 and 1996.  The research found no correlation between thimerosal -containing vaccines and autism, nor was there a reaction association between autism and thimerosal.  You can see this article here:   http://jama.ama-assn.org/content/290/13/1763.short

“A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism” was again in Denmark between 1991 and 1998.  Again, they found no correlation between autism and the MMR vaccine.  The article can be seen here: http://www.nejm.org/doi/full/10.1056/NEJMoa021134

“Vaccines and Autism: A Tale of Shifting Hypotheses” is not necessarily one specific article, but I love it because it addresses three proposed reasons that vaccines cause autism and then supports with good evidence how they are not true or there is no evidence of such.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908388/

I did look for something showing an association between the MMR vaccine and autism, and I did not find anything reliable.  I refuse to acknowledge, cite, or support anything by Dr. Wakefield, as his studies were poorly done and even proven to not be truthful.  However, if someone has something not by Wakefield that they can cite or share here, I would really appreciate it!  I’m definitely not trying to only show one side of the issue.

One important thing to remember is that when autism tends to set in and is diagnosed, which is often between 18 months and 2 years… around the time that many children receive the MMR vaccine.  It’s also important to remember that autism isn’t really a new phenomenon – just a newly defined and diagnosed phenomenon.

 

I’m anxious to hear your thoughts!  More to add?  Please DO comment!  I want to hear it!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My Favorite Lactation Cookies

As an exclusive pumper, you get a little obsessive… about ounces.  So I thought I’d share with you this little gem that really did give me a boost – when I was able to get to them before my husband and son did.  I’m wondering if I should have hooked them pump up to them too, with as many as they ate!  :-)

Oatmeal Chocolate Chip Lactation Cookies

**Preheat oven to 350 degrees**

1 cup of butter

1 cup of sugar

1 cup of well packed brown sugar

4 tablespoons of water

2-3 tablespoons of flax seed meal (I liked 3)

2 eggs

1 tsp vanilla

2 cups flour

1 tsp baking soda

1/2 tsp of salt (sometimes I omitted the salt completely – I’m not a salt fan)

3 cups of oats

1 cup of chocolate chips (or a bit more, if they just happen to accidentally fall into the mix…)

4 tablespoons of brewer’s yeast (This is the only ingredient that is hard to find.  I live in a rural area, but I checked a Target, two Wal-Marts, and three grocery stores – to no avail.  I finally found it at my local food co-op, and I had to ask.  It was hiding in a fridge.)

Mix the flax seed meal and water together and let sit for 3-5 minutes, until water has been absorbed and flax is more like a gel.  Meanwhile you can beat together the butter, sugar and brown sugar.  Add eggs and mix well.  Then you can add the flax seed meal and vanilla and beat well.  Sift together the flour, brewer’s yeast, baking soda, and salt, and then add the dry ingredients to the butter mix.  Stir in the oats and chips, place on a baking sheet and bake for approximately 12 minutes.  Let sit for a few minutes and then remove from the cookie sheet.  Hide from your children and husband, or try to convince your husband that he will start lactating if he eats them.  Enjoy!  (I was eating about 4 a day and saw improvement in my supply)

I feel the need to retract a previous recommendation

I really do love everyone.  I think all of the birth oriented sites have some truth to them, and all mean well.  Ethically, we could take Kent’s view and say that since they mean well and really do have the desire to do good, they are performing ethically.  I also understand that there are a bazillion different ways to view ethics, and even Kent – we could also argue that if we were to use a blanket rule based on childbirth education, for example, and insist everyone have a homebirth, it would be unethical, as babies and mothers that are high risk would suffer.  Ethics is tricky, I get it – now I’m off track.

Anyway, as a blog and facebook page with a growing number of fans, I keep my rules simple – you can disagree with me, and that’s cool.  I really like back up to claims.  And I really can’t stand when other bloggers act unprofessionally.

Recently I endorsed The Mom: Informed in a blog post as a blog and page that I recommend following.  As I perused all the sites I follow tonight, I discovered blog posts written as personal attacks.  I don’t know the history of all of this drama, and I really can’t gather it all by quickly scanning the facebook page and blog, but that doesn’t matter to me – I shouldn’t have to hunt for the meaning behind a blog.

What I did see was an extreme level of unprofessionalism.  I know there are “trolls” out there.  I know that depending on who you are, what your beliefs are and what pages you follow you may have specific people or pages that come to mind.  I don’t care who they are – remember, I love everybody.

However, you will never see me compose a blog specifically as a personal attack against another person.  As I mentioned before, I do not know the history here, but I follow a wide range of viewpoints, and no matter what the views are, I do not find personal attacks acceptable, professional, or ethical – no matter which view of ethics I try to take.

So unfortunately I would like to add to this blog that I no longer encourage fans of MEB to follow The Mom: Informed.  I find that while TM:I has some view points that I really appreciate and some blog posts that are great, I cannot endorse a blogger who is personally attacking someone else.  I hope that everyone can understand why I feel that I need to do this – it is not personal by any means, but as a professional I do not feel that I can support and endorse someone who acts this way.

I will be removing TM:I from the list on my previous blog.

I hope everyone understands, and I thank you for following me.

Why I Love Everybody (My Birth Education Cup is Half Full)

There are a lot of birth support/education/discussion groups out there, and they get a lot of good and bad feedback.  Some people dispise one, others may love them.  Here’s what I think of some specific groups/people/mindsets.

Birth Without Fear - While January and I may not always agree, she has her heart in a good place.  I can’t say that I ever DIDN’T feel empowered by giving birth.  But I also can’t imagine what it would have been like to sit in a room waiting for labor to progress with just my husband rather than walking the halls for FOUR HOURS with my CNM by my side the whole way (except for a quick refill of coffee!).  I might be a little more science minded and personally not crazy about the idea of UC’s or birthing at home, I would support someone’s decision to do so AS LONG AS THEY WERE INFORMED.  While January provides a lot of support for these situations, she really deep down has one goal – women to feel empowered after giving birth.  I agree.  I think every single woman should feel supported and then have that after-labor high where they look in the mirror (okay, maybe not that day, exactly…) and say “I DID IT.  I am amazing.  I made a beautiful baby, I brought him/her into the world (no matter HOW), and while I have some stretch marks here and some saggy stuff there, I am BEAUTIFUL.”  Unfortunately in my experience that high only lasts about a month and a half before you’re back to “OMGSTRETCHMARKSFLABBYYUCKYMYBODYISSOGROSS”.  If I could bottle that feeling postpartum and distribute it, not only would I be rich, but we would have some incredibly powerful women in the world.  Yet we can’t.  So January tries to encourage that confidence in other ways – and I’m down with that. 

The Skeptical OB – Sure, sometimes Dr. Amy can come off a little gruff, but she’s got some AMAZINGLY good information on her blog.  If it’s something that seems like it’s not supportive or raises doubt, I do my research and move on.  But there are some great citations and awesome learning opportunities.  While she takes a stance on some issues that are currently hot topics, like homebirth, I believe that you should always research both sides of a debate before coming to your own conclusion.  This is a great place to put together the “other side”, and find some contrasting information and view points.   

Academic OB/GYN –  First off I have to say that Dr. Fogelson does not post enough.  Yes, I said it.  If you’re reading this, I know you are busy with being an OB/GYN and all, but I find your posts to be like crack…. I’m so addicted and I can’t stop.  (Although I’ve never actually tried any recreational drugs, so I guess your blog is as close as I’m getting!)  While some of it may be over your head, if you take a little extra time to figure out what you don’t understand you will be SO informed.  He’s certainly not the scary evil OB type that many people fear – in fact he recently posted this on facebook: “Advancements in hospital birth have created all kinds of reasons to get the baby somewhere other than to the mother, probably for the worse in most cases”.  He’s an OB, scientifically minded, but also so smart and so well-balanced.  I find it hard to believe that someone would have an issue with him.

I think I kind of covered the whole spectrum, didn’t I?  And I certainly didn’t purposely leave anyone out – I just can’t write that long of a blog!

I think what is REALLY important in this crazy mom-blogger-childbirth-blogging world is that we remember to support one another and remember that essentially we are working towards the same goal – patient education.  Just like two Gastroenteronologists may not agree on a treatment or diagnosis, neither will a variety of people with different educational levels and beliefs.  Yet what we do agree is that sometimes things are done wrong, and sometimes birth is perfect – and our goal is to make birth perfect for as many people as we can.  And that, ladies and gentlemen, is something to respect and give credit for.

Some thoughts on Pitocin from M.E.B.

I recently read “Little Known Facts About Pitocin” over on Birth Faith’s blog.  I was pretty pleased at first, nodding in agreement.  A lot of points were made that are good, or just needed a little clarification.  So with complete respect and the hope that I don’t offend Ms. Birth Faith, I wanted to add a bit of information to what she wrote.

“Pitocin is not approved by the FDA for elective inductions or elective stimulation of labor”.  Yes, Pitocin is not indicated by the FDA for elective inductions – this is true.   It just might be good to have the terminology right.  This by no means says that the FDA Gods will come riding through the streets on steeds to take away a provider who does use Pitocin for elective inductions – they just never recommend it, because frankly, they don’t know enough about it. 

“Pitocin generally produces contractions that are much longer, more intense, and more painful than normal contractions”.  Well this is pretty much true – thus why they use it in labor!  Yet I agree with Birth Faith – I’m not going to go sign up for a Pitocin party voluntarily!

“The intense contractions caused by Pitocin can abnormally restrict oxygen supply to the fetus”.  Ehhhh…. based on what I know, this is possible, but under extreme circumstances – like high dosage.  FDA’s risks to the fetus are:

  • Bradycardia
  • Premature ventricular contractions and other arrhythmias
  • Permanent CNS (central nervous system) or brain damage
  • Fetal death
  • Neonatal seizures have been reported with the use of Pitocin
  • Low APGAR scores at five minutes
  • Neonatal jaundice
  • Neonatal retinal hemorrhage

“Pitocin has the potential of causing tetanic contractions”.  Yep, but again, most likely in dosages well above what most providers use or need to use.

“When Pitocin is introduced to the labor process, oxytocin receptors in the body tell the brain to stop producing natural oxytocin”.  Okay, dead stop.  Anything that involves labor and hormones (and natural feedback loops!) I’m a nut for.  This is all of the above.  This is again more about wording, but yes, oxytocin receptors are throughout the body.  However, your brain is not being told to STOP production completely, but it may SLOW production. Oxytocin, because it is a natural feedback loop (in labor) means that oxytocin = contraction = more oxytocin.  If anything, you are most likely helping your body to keep producing, if for some reason you had slowed.  (Or stopped dead at 9 cm… which is no fun – trust me.)

“Pitocin does not act like the oxytocin produced by a woman’s own body.  Oxytocin is a “feel good” hormone which causes the body to be bathed in coping chemicals, reducing anxiety and stress, which helps a woman to handle labor more effectively.  Pitocin does not do this, which partly explains why contractions produced by Pitocin are more painful.”  This one I also have some things to add.  The (only) way that Pitocin doesn’t “act” the same is that it doesn’t cross the blood-brain barrier.  So it is still rocking that uterus, keeping it going – but it is not helping you with bonding, that is absolutely true.  Now at this point you need to keep in mind what I mentioned above – your oxytocin production didn’t just freeze in time and quit completely, so bonding can happen just fine.  Besides, your body after birth still has some work for oxytocin to do, and every time you breast feed, contract, and even snuggle, you’re likely improving that oxytocin production.  Also, I think the increased pain is due to stronger contractions than you were/would normally have, not lack of oxytocin.  The lack of memory after birth is oxytocin’s fault, but in the moment? Not so much.

“Pitocin has a long and disturbing list of possible side-effects”.  We were just discussing side effects of “natural” (loosely defined) birth over on my facebook.  While some are a little concerning (subarachnoid hemorrhage), some are possible side effects of pretty much any birth (vomiting, hemorrhage, nausea, uterine rupture).  More frightening are the risks with excessive dosage – those give me reason to be concerned.  I guess what I fear is not Pitocin, but providers that are giving too much of it. 

Do you have any additional knowledge of Pitocin to add?  Have you experienced Pitocin?  Better yet, are you like me and find pharmaceutical labels fascinating?  No?  Huh…. guess I am kind of weird.  :-)