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What To Expect When You’re Birthing At Home: A Hospital C-Section (Possibly)

Screen shot 2015-03-20 at 9.07.11 AM

By Ananda Lowe
Guest Contributor

The term “homebirth cesarean” didn’t exist before 2011, when Oregon mother and student midwife Courtney Jarecki coined it. But now, a Google search returns almost 2,000 entries on the topic.

The term refers to a small but emerging community of mothers who have experienced the extremes of birth: They’d planned to have their babies at home, but ended up in a hospital, most often in the operating room having a cesarean section, major abdominal surgery. Needless to say, the effect of such a dramatic course change takes a toll, and can often be overwhelming.

(“Homebirth cesarean” can also refer to births that were planned to occur at a freestanding birth center outside of a hospital, but eventually were transferred to the hospital for a cesarean.)

How often does this happen?

Home births, though a small fraction of the approximately 3.9 million births a year in the U.S., are on the rise. Based on the most recent birth data from the National Center for Health Statistics, “the 36,080 home births in 2013 accounted for 0.92% of all U.S. births that year, an increase of 55% from the 2004 total.”

Eugene Declercq, a professor of community health sciences at Boston University School of Public Health, studies national birth trends. He said in an email that while there are no nationwide numbers on homebirth transfers to the hospital, “the studies that have been done usually report about a 12% intrapartum transfer rate.”

But beyond the numbers, what happens emotionally when your warm and fuzzy image of natural childbirth in the comfort of home suddenly morphs into the hard reality of a surgical birth under fluorescent lights?

A woman who'd planned a homebirth but ended up having a cesarean in the hospital. (Photo courtesy: Courtney Jarecki)

A woman who’d planned a homebirth but ended up having a cesarean in the hospital. (Photo courtesy: Courtney Jarecki)

Jarecki founded the homebirth cesarean movement to figure that out. She connected women who, like herself, shared the experience of giving birth through full surgical intervention, despite their original plans of having their babies at home or outside of the established medical system.

In Jarecki’s case, she labored at home for 50 hours until her midwives detected a rare complication known as a constriction ring, or a thickened band of tissue in her uterus that was impeding progress. Shortly after this, meconium appeared, and Jarecki knew it was time to go to the hospital. Her emotional response to the intensity of the situation, however irrational, was one of anger, shame and failure at her ability to give birth normally. A cesarean followed.

Over the next several years, Jarecki began helping other homebirth cesarean mothers emerge from the silence and shame they felt confronting their unexpected surgeries. Some of these women also report that their postpartum recovery was tougher because their unique needs were not adequately addressed by their home birth midwives or their hospitals.

Jarecki started by launching a (now busy) Facebook page as a support group for these mothers and their health care providers.

Childbirth Expectations vs. Reality

Rule number one in childbirth is that it rarely unfolds as you expect. Continue reading

In Memory: A Fat Kid’s Love For Mr. Spock

By Steven Schlozman, M.D.

I remember the exact moment I realized that I could be Mr. Spock.

I was 9 years old, trapped in the “Husky” jeans section of the local Macy’s department store. Looking around at the selection of very big pants, I understood viscerally what I had known intellectually for years.

“Husky” meant “fat.” It meant that I was fat.

Not super fat, but fat enough to be in the Husky section.

I was awkward, developing in that tortured way that evolution see’s fit to make us endure. Staring at the mirror while my Mom gathered trousers for me try on, I was pissed off that because of this shopping trip, I was missing the rerun of “Star Trek” that aired on weekday afternoons.

(Daniel Arrhakis/Flickr)

(Daniel Arrhakis/Flickr)

“What would Spock think about the ‘Husky’ designation?” That’s what I was pondering. I was wondering how the master of logic would justify and make sense of the clearly derogatory way I was feeling about myself.

“Fascinating,” I imagined him saying, and he would raise that patented eyebrow.

Then I looked in the mirror, furrowed my brow, took note of the barely present peach fuzz growing under my nose, and with all the power of a Vulcan mind meld, I imagined that my right eyebrow was being pulled by a thread towards the stars. That one eyebrow was to boldly go where no eyebrow of mine had ever gone before.

And I did it. I raised that eyebrow.

“Fascinating,” I muttered. And then I did it again, and again. It was like a teeny Bar Mitzvah moment. “Today, I am a Vulcan.”

Spock meant that much to me. Spock could be friends with a tough guy like Kirk. Spock was unfazed by McCoy’s insults. Spock tolerated with admirable self-control the romantic advances of Nurse Chapel. Spock would, I was certain, be emotionally impervious to the Husky section of Macy’s.

“Fascinating,” I said, and again I raised my right eye brow.

I share the world’s sadness for Leonard Nimoy’s passing. I am grateful that he stuck around so long after he began his “five year mission.” I feel like a kid every time I hear his voice in the Imax theater at Boston’s Museum of Science. Every time I hear his voice, I am wearing Husky jeans but feeling OK about it.

These days I’m still raising one eyebrow on an almost daily basis. I even had a patient’s parent give me Vulcan ears for Christmas a few years ago.

“They’re not because you’re emotionally cold,” she explained.

No, I thought, Spock wasn’t cold.

“They’re because you’re not freaked out by our child. They’re because you’re interested.” Continue reading

10 Bits Of Blizzard Therapy From Laura Ingalls Wilder’s ‘The Long Winter’

A train stuck in snow in 1881, the ferocious winter Laura Ingalls Wilder wrote about. Note the man standing on top for scale. (Minnesota Historical Society on Wikimedia Commons)

A train stuck in snow in 1881, the ferocious winter Laura Ingalls Wilder described. Note the man standing on top for scale. (Minnesota Historical Society on Wikimedia Commons)

I pulled Laura Ingalls Wilder’s “The Long Winter” from my son’s bookshelf with the very explicit intention of helping myself feel better about this epic weather.

It worked.

Of course, any reading of the vivid “Little House on the Prairie” accounts of laborious pioneer life will always work to induce a great surge of gratitude for our modern comforts. Friends of mine call it “The Brutal Series.” (Wilder is back on the bestseller list, I see, with a never-before-published autobiography written in 1930.)

But “The Long Winter” offers, I would argue, the best of all antidotes to feelings that this is a horrible, awful, nasty winter. The trick is to compare our current winter woes not to our usual milder weather but to a dire prairie winter: the kind of winter when young Laura would wake, shivering, to a frigid house buffeted by blizzard, spend the dreary day twisting hay for heat and grinding wheat for the coarse brown bread that was her family’s last remaining food, crawl back into a cold bed and shiver until the shivering itself made her warm enough to fall asleep.

“There were no more lessons. There was nothing in the world but cold and dark and work and coarse brown bread and winds blowing.”

Suddenly, the Boston winter of 2015 feels more like a season of relative ease and mild inconvenience.

There’s nothing like reading the whole book, but here are 10 boons of modernity that “Long Winter” passages cast into gratitude-inducing relief:

1. Weather forecasts

“Heap big snow come.” That’s the closest thing Laura’s family gets to a forecast, from “a very old Indian.” The more detailed forecast: “Heap big snow, big wind.”

Much as we may sometimes curse the messengers who bring us dire forecasts, life without them meant that Laura’s Pa took his life into his hands every time he ventured the couple of miles back to their claim land to load the hay he carted to their house in the tiny town of De Smet. A blizzard could hit at any time, and he’d be unable to make his way home.

Author Laura Ingalls Wilder (Wikimedia Commons)

Author Laura Ingalls Wilder (Wikimedia Commons)

2. Powerful plows

A major element of “The Long Winter’s” plot is the snow blockade (see photo above) that stops all train traffic to the town for months, cutting it off from supplies. The “cut” around the tracks repeatedly fills with 20 feet of snow and ice, beyond the snowplow engine’s power to remove.

Even driving a horse and cart over such deep snow becomes a dangerous ordeal when the horse steps on a snow surface with air pockets beneath and falls, panicked, into a deep snow pit. It then falls to the driver to dig the horse out.

3. Stronger houses

Early in the winter, Laura wakes to find that “ice crackled on the quilt where leaking rain had fallen.”

…Her teeth chattered while she pulled on her clothes. Ma was dressing too, behind the curtain, but they were both too cold to say anything. They met at the stove where the fire was blazing furiously without warming the air at all. The window was a white blur of madly swirling snow. Snow had blown under the door and across the floor and every nail in the walls was white with frost.

4. Heat Continue reading

A Miracle Drug For Binge Eating? Not So Fast, Says Therapist

(Bloody Marty/Flickr)

(Bloody Marty/Flickr)

By Jean Fain
Guest Contributor

For more than 20 years, my binge-eating patients have wished for a magic wand. And for all that time I told them there is no wand — there are only strategies that require awareness and effort to get a handle on their eating.

Last week, when the FDA announced it had approved Vyvanse for the treatment of binge eating disorder (BED), I found myself at an uncharacteristic loss for words. With headlines touting a magical cure for this most common adult eating disorder, I feared there was nothing I could say to stop the stampede for this next, new drug.

The news, in and of itself, is hopeful. Vyvanse (lisdexamfetamine dimesylate) has been the subject of rigorous research, first for ADHD, and now for BED. In two good-sized studies with more than 700 adult participants diagnosed with moderate to severe binge eating, this central nervous system stimulant proved more effective at reducing binge days per week than placebo for three months.

What’s more, the FDA’s approval has proven a good opportunity for a drugmaker, U.S-based Shire, and leading eating disorder associations — the National Eating Disorder Association and Binge Eating Disorder Association — to coordinate a nationwide educational campaign. If even a fraction of the estimated 2.8 million Americans diagnosed with the disorder get help as a result of the campaign’s public service announcements and new website, there’s reason to be hopeful.

There’s also reason to be cautious. Consider some of the issues before you take tennis great and Shire spokesperson Monica Seles’ advice to “talk with your doctor.” To help you do that, here are the pros and cons in my clinical experience and that of my colleagues.

But first, if you’re unclear on what constitutes binge eating disorder, here’s how the Binge Eating Disorder Association defines it:

“Routinely eating far more food than most adults would in a similar time period under similar circumstances.” Binge eaters typically feel out of control during a binge, and afterward, they’re consumed with guilt, self-disgust and embarrassment. Other hallmarks of the disorder: eating extremely fast, in secret, to the point of uncomfortable fullness, even when not hungry. Unlike other eating disorders, people with BED don’t try to “undo” excessive eating by throwing up, taking laxatives and other excessive actions.

OK, so here are a few points to consider…

Pros:

•More Treatment Options

With the FDA’s first and only approved medication for BED, patients now have another way into treatment: their family doctor. Rather than seeking out a psychotherapist or a nutritionist, which many are reluctant to do, they might feel more comfortable asking their physician about a prescription and other treatment options for this lesser-known eating disorder, which was only recognized two years ago as a distinct disorder by the American Psychiatric Association.

•Fewer Binge Days

Vyvanse has been shown to markedly reduce, if not eliminate, binge episodes in two studies, both funded by Shire. According to last month’s JAMA Psychiatry study, participants who got a daily dose of 50-70 mg, reduced the frequency of binge days per week from about five to less than one over the course of 12 weeks. By comparison, those taking placebo continued to binge more than two days per week. What’s more, half the participants taking the 70 mg dose stopped binging after four weeks, compared to one fifth of those taking placebo.

•Possible Weight Loss

Because Vyvanse has yet to be studied as a weight loss aid, it’s approved only in the treatment of binge eaters, not the overweight or the obese. That said, study subjects who took Vyvanse lost about 10 pounds. The potential weight loss may come as welcome news to bingers taking an off-label prescription for an antidepressant or anti-seizure medication. A common side effect of most antidepressants is weight gain. While binge eaters are often thrilled with the weight loss that the anti-seizure drug Topomax can facilitate, they’re none too pleased by the mental impairment.

Cons:

•Greater Risk of Abuse/Dependency

There’s a reason Vyvanse is a controlled substance with a black box warning. The potential for abuse and dependence is a real risk. Take it from psychiatrist Daniel Carlat, editor in chief of The Carlat Psychiatry Report, who expressed his reservations in a recent email exchange:

“I’m concerned that the FDA’s approval of Vyvanse for binge eating disorder is going to worsen our problems with stimulant abuse,” Carlat says. Continue reading

Rich Get Richer, Poor Get More Stress: Report Finds Growing Gap In Levels

Source: “Stress in America,” American Psychological Association

Click to enlarge. Source: “Stress in America,” American Psychological Association

File under: “Growing inequality.”

The American Psychological Association issues its regular report on stress today, “Stress in America: Paying With Our Health,” and the good news is that overall, stress is down a bit from 2007. The bad news is that the relative share of stress appears to have tipped more toward people with less money. Which makes sense, given that our finances tend to be our biggest source of stress. But still, back in 2007, stress appeared to be doled out with odd fairness.

No more, according to this latest report.

Says Dr. David Ballard, the assistant executive director for organizational excellence at the American Psychological Association:

When we go back to the early years of the survey, back to 2007, stress levels were consistent regardless of income levels. People with lower income, people with higher income — their stress levels were pretty much the same. What we’re finding now is that people in the lower income groups are reporting higher levels of stress. So the gap seems to be widening between people with lower and higher incomes — which makes sense given that people with lower incomes are facing pressures and stress related to meeting their basic needs — foods, shelter, clothing, taking care of their families. But it’s interesting that we didn’t use to see that gap, and that gap has emerged.

The report can only report correlations rather than explanations, he says, so he can’t cast further light on that growing gap. But the report does highlight a sort of a double or triple whammy that can hit poorer people: Stress, including financial stress, can be bad for health in general. Other research has suggested that when people are under financial stress, “that can affect their decision making skills,” Ballard says. And stress also makes people “more likely to turn to unhealthy behaviors to manage that stress. So it in fact compounds the problem.”

More from the association’s press release:

The survey, which was conducted by Harris Poll on behalf of APA among 3,068 adults in August 2014, found that 72 percent of Americans reported feeling stressed about money at least some of the time during the past month. Continue reading

How Art Can Re-Order A Harsh, ‘Deformed’ Childhood

Artist Evelyn Berde was born with congenital scoliosis in 1950 and spent many years in and out of Massachusetts General Hospital, confined to a bed for months at a time.

Her art, she says, is informed by her experience living with her “deformity,” as it was referred to back then, and her childhood growing up in the old West End of Boston, a low-income neighborhood near MGH and the Charles River, which was razed in the late 1950s, displacing many residents.

It wasn’t an easy childhood: Alcoholism ran in the family and Evelyn’s brother drowned in the Charles River when he was nine and she was just six. Evelyn was subjected to numerous surgeries and procedures for her scoliosis — some that now seem barbaric.

But art, she says, “has the ability to lift us out of one place and take us to another.”

Here, you can listen to Evelyn talk about five of her paintings and tell the stories that helped shape them.

Artist Evelyn Berde's "Shame" (Courtesy Berde)

Artist Evelyn Berde’s “Shame” (Courtesy Berde)

Artist Evelyn Berde's "July 12, 1956" (Courtesy Berde)

Artist Evelyn Berde’s “July 12, 1956″ (Courtesy Berde)

Continue reading

Beyond Carb-Cutting: Resolutions After A Trauma — Sleep, Play, Love

(katiebordner/Flickr)

(katiebordner/Flickr)

By Rachel Zimmerman

A friend, trying to cheer me up over the holidays, suggested I find comfort in this fact: “The worst year of your life is coming to an end.”

In 2014 I became a widow, and my two young children lost their father. Needless to say our perspective and priorities have shifted radically.

Last year at this time, my New Year’s resolutions revolved around carbs, and eating fewer of them. This year, carbs are the least of my worries. My resolutions for 2015 are all about trying to let go of any notion of perfection and seek what my mother calls “crumbs of pleasure” — connection, peace and actual joy on the heels of a life-altering tragedy that could easily have pushed me into bed (with lots of comforting carbs) for a long time.

As a mom I know with stage 4 cancer put it, when your world is shaken to its core, your goals shift from things you want to “do” —  spend more time exercising, learn Italian, make your own clothes — to ways you want to “be,” knowing that your life can shift in an instant.

So, with that in mind, here are my five, research-backed, heal-the-trauma resolutions for 2015:

A Restful Sleep

Yes, at the top of my list of lofty life goals is a very pedestrian one: sleep. Lack of sleep can devastate a person’s mental health and without consistent rest, the line between emotional stability and craziness can be slim. (See postpartum depression, for one example.) In my family at least, to ward off depression and anxiety, we need good sleep and lots of it; more Arianna Huffington and less Bill Clinton.

Play, Sing, Dance

The beautiful thing about children is that despite tragedy and loss, they remain kids; they are compelled to play, climb, run and be active. Resilience, as the literature says. In their grief, they can still cartwheel on the beach, play tag or touch football in the park. Shortly after my husband died, I tried very hard to play the games my kids liked, which often felt like that scene in the “Sound of Music” where the baroness pretends to enjoy a game of catch with the children. Soon I learned to broaden my definition of play — really anything, physical, or not — that serves no other purpose other than to elicit pure joy. Continue reading

Boundary Crossing: When Doctors And Patients Get Personal For Better Health

A diabetes patient and her doctor sit down to talk as part of a novel program aimed at improving the patient-provider relationship.

A diabetes patient and her doctor sit down to talk as part of a novel program aimed at improving the patient-provider relationship.

By Dr. Annie Brewster and Jonathan Adler
Guest Contributors

As a patient you’ve no doubt had moments when you feel like your doctor just doesn’t get you, or, that you don’t get your doctor.

If you’ve never felt rushed, ignored, overlooked or vulnerable during the course of your medical care, you’ve probably never been a patient in the U.S. health care system.

And if you’re a doctor, or another type of health care provider, you’ve probably felt hassled, frustrated, and powerless to help your patient, despite your best intentions.

In today’s medical system, the patient-doctor relationship is often challenged, in large part because there’s no room for us to actually engage with each other as people, to hear each other’s stories.

In medicine, there are unspoken but clear rules about what is appropriate behavior within the context of the patient-doctor relationship: doctors should never reveal intimate details about their own lives, and patients should never ask. Patients, meanwhile, should stick to the facts of whatever is ailing them, giving their provider the data for diagnosis and treatment planning, without superfluous anecdotal detail.

Professional boundaries are certainly important. There is validity to the argument that doctors need to keep distance in order to make clear medical decisions, striving to minimize the biasing impact of emotion. And perhaps it is also true that patients benefit from some distance, in thinking of their doctor as an authority figure rather than a friend.  But this obsession with boundaries has conspired with the pressures of efficiency and economy that constrain the health care system to remove some very personal (and important) elements of the patient-provider relationship.

We are far from the small town medicine of the past, when patients and doctors knew the details  of each other’s lives because their worlds intersected outside of the exam room.

Nowadays, in the 15-20 minute appointments that we are alloted, the patient-provider relationship can feel sterile and robotic. At its worst, it can feel antagonistic. Doctors are over-loaded and time constrained, with fear of litigation and the rules of HIPAA pressing in on them, and a payment model that rewards quantity over quality.

Patients often feel hurried and neglected; overwhelmed by the task of presenting the frightening aspects of their health in the right way to get answers and treatment. Physician burnout is ubiquitous, as is patient dissatisfaction.

It is our belief that by highlighting the humanity of both individuals in the relationship, the patient-doctor bond can be strengthened, with increased satisfaction all around.

Taking it one step further, we believe that reviving the humanity in this relationship will ultimately lead to better health outcomes.

So, here at Health Story Collaborative we’ve designed a program in which a patient and a doctor come together to share and listen to one another’s personal narratives. This new patient-provider model is a variation of our already existing Healing Story Sessions program. In short, our goal is to create a space where both patient and provider can be human.

We recently launched this project in collaboration with the Cambridge Health Alliance, with a grant from the Arnold P. Gold Foundation. We met on a Tuesday evening recently with Tracey Pratt, a woman with diabetes and her health care provider of many years, Dr. David Baron. As they shared their stories, an audience, including other diabetes patients, Dr. Baron’s wife and other medical providers, listened on.

We worked with both speakers in advance to craft their narratives, encouraging personal refection as well as their thoughts about the their mutual relationship.

Tracey talked about her passion for teaching, her travel to the Great Wall of China, and about learning Merengue in Havana, Cuba. She also detailed some of the difficulties she had managing her diabetes.

David told stories about growing up in rural Ohio, picking corn in the fields as a teenager, about his time in the Peace Corps in the Dominican Republic, and his journey to becoming a doctor. Continue reading

New Year’s Resolutions: How To Keep Them Alive

(anomalily/Compfight)

(anomalily/Compfight)

By Jessica Alpert

You know the drill. Lose weight. Save more money. Keep in better touch. Or as one of my Facebook friends recently announced “make a new piece of clothing every month.”

I hate the gym in January since it’s crowded to the gills with exercise hopefuls.  By February, the regulars reign again and the wait for the treadmill is nonexistent.

A study published in the Journal of Clinical Psychology from researchers at the University of Scranton found that 45 percent of us made New Year’s Resolutions in 2014–and almost 90 percent of us failed at keeping them.

Maybe not a huge surprise but what can we do to maintain those good intentions?

Dr. Philip Levendusky, Associate Professor of Psychology at Harvard Medical School and Director of the Psychology Department at McLean Hospital, recently shared some tips.

First, is change even necessary?  Do you already work out three days a week and now you’re promising to do six? It’s a worthwhile goal but acknowledge what you already do. “We don’t always have to be striving for perfection or feel like we’re a work in progress,” Levendusky writes.

Next, remember that small changes can make a big impact.  Do you want to be a better partner? Instead of creating a list of 10 promises, start with something actionable and attainable–like being a better listener during dinner.  According to Levendusky, “building goals that can have an immediate and positive response,” may actually help keep you on track beyond the month of January.

Continue reading

Embrace The Eggnog, And Other Tips To Curb Holiday Eating (And Guilt)

(Theen Moy/Flickr)

(Theen Moy/Flickr)

It’s peak season for overeating — and then beating yourself up for doing it.

Clearly, you’re not the only one treating yourself to pumpkin and pecan pie, egg nog and, yes, fruitcake. Yet it’s no comfort that everyone else and their Weight Watchers’ leader is also riddled with guilt and enduring a personal thrashing for the extra calories and potential weight gain. While this self-flagellation goes on, you’re missing out on enjoying the holidays.

If only there were a better approach to holiday eating, maybe then you’d be able to stop beating yourself up, enjoy eating what you love and savor everything else you really do love about this season.

Happily, you don’t need an emergency gastric bypass to stop the vicious cycle: putting an end to both overeating and self-criticism might be easier than you think. It might be as easy as reviewing some research-based strategies honed from a group training I lead for people with eating issues. It revolves around practicing a variety of mindful eating and self-compassion meditations.

Here are five proven tips for happier, healthier holiday eating:

1. Redefine Holiday Eating

You’ll need a better working definition of “normal holiday eating” if your definition sounds anything like my esteemed colleague and family eating expert Ellyn Satter’s:

Most people get caught up in what they should and shouldn’t eat. They’re anxious and ambivalent about eating. They might try to resist at holiday parties, but the table is laden with ‘forbidden food,’ and they throw away all control and overdo it. Many times they’re over-hungry because they’re trying to restrict themselves and lose weight. So the standard definition of holiday eating becomes eating way too much.

If you’d prefer to take fewer bites and ease the anxiety and ambivalence, now’s the time to do the exact the opposite, starting with eating regular meals and snacks. Then, come party-time, permit yourself to eat the foods you enjoy. You’re probably going to eat them anyway, so you might as well as enjoy them, without the guilt and other uncomfortable emotions that predictably fuel emotional eating.

2. Go Easier On Yourself

If, like most dieters, you’re hoping that feeding yourself a steady diet of self-criticism will inspire you to rein in your eating, think again. You’ve actually got it backward. Self-criticism — calling yourself fat, disgusting and other mean, nasty names — is really a recipe for emotional overeating and holiday weight gain. Continue reading