women’s health

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The Medicated Woman: A Pill To Feel Better, Not Squelch Emotions

By Alicair Peltonen
Guest Contributor

I am a medicated woman. I take 50mg of Sertraline (the generic form of Zoloft) a day. I don’t take it to be more tolerable to my husband. I don’t take it because I’m embarrassed by my emotions. And I definitely don’t take it to quietly fit into a polite societal mold. I take an anti-depressant every day to quell my anxiety simply because it feels better. I feel better.

I grew up in a talk therapy household. My father began group therapy for anger management issues in 1984, when I was 10, breaking a cycle of rage and avoidance that tends to swallow people whole, particularly men. He would come home feeling calmer and then he would implore my sister and me to explore our feelings and talk about our problems. Begrudgingly at times, I learned to think analytically. And thankfully, I learned that asking for help is not only acceptable, it’s downright healthy.

I started seeing therapists here and there in my 20s and then regularly several months after my first daughter was born. Medication had never been suggested by any of my previous therapists but this time was different. I couldn’t shake the feelings of inadequacy, the certainty that my daughter didn’t like me and I was just a glorified dairy cow. Post-partum depression is a hell of a thing.

(Rachel Zimmerman/WBUR)

(Rachel Zimmerman/WBUR)

When my therapist suggested I see a psychiatrist to discuss the possibility of medication, I went home and cried for an hour. I felt ashamed, defeated, embarrassed, weak. Even though I had seen medication transform my father from a man who growled and dragged to one who laughed and hugged, it still stung to feel like I couldn’t pull myself together.

But, remembering my father’s bravery, I thought I should at least give it a try. If I didn’t like it, I could always stop taking it. The first pill was swallowed through tears. And each successive pill went down easier. For a full year, I could go days without yelling or wanting to break things and entire weeks without crying. And I felt better.

After a year, I decided to go off the medication. Things had been much better and I wanted to see if I could “go back to normal.” And things did go back to normal. But it turns out my normal wasn’t very comfortable.

There have been many discussions and articles recently asking if modern psychiatry is over-medicating women. A recent op-ed in the New York Times by psychiatrist Julie Holland suggested that many of the symptoms for which women are treated with antidepressants are natural and healthy. “We have been taught to apologize for our tears,” she writes, “to suppress our anger and to fear being called hysterical.”

Here’s the thing, though. Breaking down into uncontrollable tears because you stubbed your toe and it’s the straw that broke the stress-camel’s back doesn’t feel good. Continue reading

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

Lawsuits Move Forward, Brought By Women Hurt By Vaginal Mesh

With all of the complications related to vaginal mesh — which we reported on several years ago — the influential doctors group the American College of Obstetricians and Gynecologists recently issued an article, “What Is New in the Use of Mesh in Vaginal Surgery?” offering data published in the past year on the topic.

One notable point about the implants, used to lift sagging pelvic organs back into place, is that removing a vaginal mesh implant that has been causing problems doesn’t always fix the problems. The article, by John R. Fischer, M.D. of the Department of Obstetrics and Gynecology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, says:

Complications from placement of permanent synthetic mesh for vaginal prolapse repair are well-documented, but there is little to guide physicians regarding outcomes after surgical removal of trans-vaginal mesh. This is a retrospective review of patients who underwent excision of trans-vaginal mesh owing to complications. The most common issues were pelvic and vaginal pain, mesh exposure, and a bulge sensation…After removal, 51% of patients reported complete resolution of their symptoms, with mesh exposure mostly likely to respond to treatment. Of those who presented with pain, 51% reported persistent pain after excision.

Fischer concludes: “…of the many symptoms that are treated with mesh excision, persistent pain may be the most difficult. Patients with a history of chronic pain may not be ideal candidates for the use of synthetic mesh.”

Dr. Peter Rosenblatt, Director of Urogynecology at Mount Auburn Hospital in Cambridge, Mass., says that use of the mesh implants has, indeed, gone down. In an email, he writes:

There has certainly been a decline in the use of transvaginal mesh to treat prolapse, although many pelvic reconstructive surgeons still offer this treatment to patients who are at high risk of failure from traditional surgical repair of pelvic organ prolapse. The FDA safety update in 2011 raised concerns that some of the complications that are unique to these procedures, especially erosion (or more accurately “exposure”) of the mesh through the vaginal wall, are “not rare” and that physicians needed to counsel their patients about the potential risks of using mesh. Surgeons and their patients should weigh these risks versus the potential benefits of transvaginal mesh, which includes improved anatomic success rates. There is also no question that the ubiquitous and never-ending television ads by law firms have instilled a real sense of fear and apprehension among women who are suffering with these problems.

Meanwhile, myriad lawsuits brought by women who say they were harmed by the mesh implants, made by a Ethicon, a subsidiary of the drug giant Johnson & Johnson, continue.

Earlier this month, a California jury returned a $5.7 million verdict in favor of the plaintiff in a vaginal mesh case, according to a local TV news report.

And a West Virginia jury last year awarded $3.27 million to a woman who underwent surgery to remove a vaginal mesh device, reports the National Law Journal. Continue reading

New Spending Bill Adds Abortion Coverage For Peace Corps Rape Victims

File this under: “About #$@%&*! Time.

Tucked away in the recently passed $1.1 trillion federal spending bill is a provision that, according to women’s health and abortion rights advocates, is long overdue, ending a 35-year-old ban. The new measure offers abortion coverage to Peace Corps volunteers victimized by rape, incest or facing a life-threatening pregnancy; similar coverage is already provided to federal employees.

Bryan Dwyer, director of Peace Corps and Training in Kigali, Rwanda, and a Peace Corps volunteer in El Salvador from 2000-2002, expressed his strong approval for the new measure:

As both an RPCV [Returned Peace Corps Volunteer] and staff member, I am very pleased that PC [Peace Corps] Volunteers will now be afforded this protection, even as I earnestly hope that no one ever needs to avail herself of it.

Another former Peace Corps employee I talked to was a bit more blunt:

In a long overdue concession to reality, conservative members of Congress no longer forced their abusive “no choice no matter what” policy on women in the Peace Corps. For far too many years, they had prevailed in insisting that women who choose to serve our country who had been raped and impregnated should be repaid with no health care coverage to end those pregnancies. I am glad this truly appalling policy is finally at an end.

Edson Chilundo/flickr

Edson Chilundo/flickr

Here are more details and background in a Glamour magazine report:

Over the weekend, the Senate passed a $1.1 trillion spending bill that includes a provision to provide abortion coverage for Peace Corps volunteers in cases of rape, incest, or life endangerment.

It’s an important win for reproductive rights advocates in a year plagued by restrictions on abortion and other women’s health measures. President Obama is expected to sign the bill into law, granting Peace Corps volunteers and trainees the same type of abortion coverage offered to federal employees….

Currently, just over 60 percent of Peace Corps volunteers are female, and many of them work in areas with little to no access to safe, reliable health care. Continue reading

Why To Exercise (Outdoors) Today: Tranquility For Aging Ladies

(frodrig/Flickr)

(frodrig/Flickr)

It’s cold, it’s dark, it’s uninviting out there. So, all the more reason to drag yourself outside and do something.

In yet another study on how exercise can combat the bad physical and mental effects of aging, new research suggests that women who can get out the door, fight the elements and exercise might find some nifty benefits. Those benefits include alleviating depression and increasing adherence to an exercise program.

The small study, published in the journal Menopause, asserts it’s the outside air that really helps (as opposed to the stuffy gym or the treadmill in your basement, though I’ve found that when you’re desperate, those work too):

“Between baseline and week 12, depression symptoms decreased and physical activity level increased only for the outdoor group…” write the authors, led by Isabelle Dionne of the University Institute of Geriatrics of Sherbrooke in Quebec.

From the Reuters report:

Outdoor workouts left women in a better mood and kept them exercising longer than counterparts who exercised indoors, according to a small study from Canada.

Results of the three-month trial involving women in their 50s and 60s suggest that outdoor exercise programs should be promoted to help older women keep active, the researchers conclude…Only about 13 percent of Canadian women older than 59 years and less than 9 percent of older American adults get at least 150 minutes of physical activity each week… Continue reading

Culture Clash: U.K. Embraces Homebirth As Best For Some Women

Sarah Parente shortly after the homebirth of her daughter Fiona (Courtesy of Leilani Rogers)

Sarah Parente shortly after the homebirth of her daughter Fiona (Courtesy of Leilani Rogers)

By Jessica Alpert

Sarah Parente, an Austin, Texas-based doula and mother of four, gave birth to her first child in the hospital with no complications. But then she decided to make a shift: Parente delivered her next three babies at home. “For women with low-risk pregnancies, home birth can be a great choice,” she says. “You have less stress because you are in your own home surrounded by a birth team of your choosing.”

Though home birth has recently gained cache in the U.S. — with some celebrities trumpeting the benefits of having their babies at home  — the practice remains uncommon and the majority of pregnant women give birth in a hospital setting. Still, Parente may be getting a little more company, albeit slowly. Data released by the Centers for Disease Control (CDC) earlier this year shows the rate of homebirths in the U.S. has increased to 0.92 percent in 2013 and the rate of out-of-hospital births (including home) has increased 55 percent since 2004.

Experts in the United Kingdom are saying that’s a good thing.

The London-based National Institute for Health and Care Excellence (Nice) recently released recommendations that homebirths and midwife-led centers are better for mothers and often just as safe for babies as hospital settings, the BBC reports. Of the 700,000 babies born in England and Wales each year, nine out of 10 are born in obstetric-led units in hospitals. Continue reading

Brain Science, Dangerous? Not So Fast, Says Poverty Expert

Back in June, we wrote about a novel program in Boston that seeks to lift women and their families from poverty, in part by using the latest research in neuroscience. Specifically, the program (developed by the nonprofit Crittenton Women’s Union) takes into account recent studies that reveal how trauma, and poverty, can rewire the brain and potentially undermine executive function.

In an Op-Talk piece in this week’s New York Times headlined “Can Brain Science Be Dangerous?” writer Anna North cites our story, and then goes on to question whether this type of approach might be problematic. In the article, North refers to sociologist Susan Sered:

Dr. Sered…says that applying neuroscience to problems like poverty can sometimes lead to trouble: “Studies showing that trauma and poverty change people’s brains can too easily be read as scientific proof that poor people (albeit through no fault of their own) have inferior brains or that women who have been raped are now brain-damaged.”

She worries that neuroscience could be used to discount people’s experiences: “In settings where medical experts have a monopoly on determining and corroborating claims of abuse, what would happen when a brain scan doesn’t show the expected markers of trauma? Does that make the sufferer into a liar?”

We asked Elisabeth Babock, president and chief executive officer of Crittenten Women’s Union, to respond to the Times piece. Here, lightly edited, is what she wrote:

Moving out of poverty in the U.S. today is an extremely complicated and challenging process. It involves trying to maintain a roof over your head when the minimum wage doesn’t cover the minimum rent; and trying to get a better paying job when almost all those jobs require education beyond high-school and the costs of that education, in both money and time, are well beyond the means of most low-wage workers. It involves trying to care for a family while filling in the gaps in what the minimum wage will buy with increasingly-frayed public supports. It involves a lot of juggling.

We at Crittenton Women’s Union (CWU) understand this process all too well because we work with hundreds of people trying to navigate their way out of poverty every day: homeless families living in our transitional housing and domestic violence shelters, and people who are living on the edge of homelessness, struggling to make ends meet. What we at CWU see is that the stress of this everyday struggle creates an additional set of monumental challenges for those we serve.

Our families often describe themselves as feeling “swamped” by their problems to the point that they can only think about how to deal with the crisis of the moment. And in those moments, they may not have the mental bandwidth to strategize about how to change their current circumstances or help them get ahead.

One of the most valuable things brain science research does for this struggle is that it validates what our families share about the way being in poverty affects them. Instead of saying that stress leaves people “irrevocably debilitated”, or worse still, that people should somehow rise above this crippling stress to “just move on” the science actually suggests something much more important. It calls upon all of us to understand that poverty, trauma, and discrimination are experiences whose cumulative effects impact our health, decision-making, and well-being in tangible and predictable ways, and because of this, we as a society can and must do our best to remediate it. Continue reading

Til Stress Do Us Part: Marriage Angst Can Be Hard On Your Heart

(Neil Moralee/Flickr)

(Neil Moralee/Flickr)

By Alvin Tran
Guest Contributor

Marriage is hard even in the best of circumstances. But new research suggests that if things are particularly hard, the stress can take a toll on your heart — especially if you’re older and female.

In a study published this week in the Journal of Health and Social Behavior, researchers found that older couples in bad marriages have a higher risk for heart disease compared to those in good marriages. This link between the quality of a marriage and the risk of heart-related problems, such as high blood pressure, is even more pronounced among female spouses.

“The strain and stress from the marital relationship has a strong negative effect on people’s heart,” said Hui Liu, an associate professor of sociology at Michigan State University and the study’s lead author. “If the marriage is very stressful, it’s really hard on your heart.”

Liu, along with co-author Linda Waite of the University of Chicago, analyzed data from an ongoing nationally representative project that followed nearly 1,200 older men and women, ages 57 to 85, for a period of five years.

After comparing participants at the beginning of the study to the end of the five-year follow-up period, they found a significant link between an increase in negative marital quality with higher risk of hypertension among women. Not-so-hot marriages were marked by less spousal support and with husbands and wives spending less time with each other.

“The effect of marriage quality on cardiovascular risk is stronger for women than for men. It also becomes stronger as people get older,” Liu said during an interview. “We think marriage is one of the social factors that may affect the risk of cardiovascular disease.” Continue reading

Caution: ‘Acceptable’ Black Women’s Hairstyles May Harm Health

(U.S. Army)

(U.S. Army)

This spring, the Pentagon issued Army Regulation 670-1, which included bans on several hairstyles worn mainly by black women, including twists and multiple braids. After a major backlash that included accusations of racial bias, that grooming policy is now under review. Here, researchers at the Connors Center for Women’s Health at Brigham and Women’s Hospital argue that this is more than an issue of racial fairness; it could also cause harm to women’s health — and disproportionately impact black women, whose life expectancy is already five years less than white women’s.

By Tamarra James-Todd and Therese Fitzgerald
Guest contributors

We are encouraged by the news that the Pentagon is reviewing the Army’s grooming policy, Army Regulation 670-1, which many deemed to be racially biased because it banned hairstyles worn primarily by black women.

Such policies set unreasonable standards for what is appropriate or acceptable in our society, and promote the idea that natural “black” hair is somehow inappropriate and unacceptable.

But perhaps most disturbing is the growing evidence that the process involved in straightening curly hair and maintaining acceptable hairstyles is harmful to women’s health, disproportionately affecting black women and making the pervasive practice of banning “black” hair styles a major health equity issue.

Nearly half of black women and girls use hair products that contain endocrine-disrupting chemicals compared to just 8 percent of whites.

The military’s previous position on this reflects a precedent that unfortunately continues to exist in corporate and private sector settings throughout the country. Labeled as “grooming” issues, companies have fired employees for wearing dreadlocks and a private school in Orlando, Florida, threatened to expel a young girl if she refused to straighten or cut her natural black hair.

The public discourse around these biased policies should not only focus on the racism they perpetuate but also on the potential harmful health outcomes and health disparities they may leave in their wake now and for future generations.

In order to conform to the standards of appearance that these policies demand, black women and girls are often encouraged to straighten or otherwise change the texture of their natural “black” hair. Unfortunately, many of the hair relaxers, oils, creams and other products used to straighten or alter curly hair contain synthetic chemicals that disrupt the normal functioning of the human body’s endocrine system, which regulates and secretes hormones.

Based on hair product labels, nearly half (49 percent) of black women and girls use hair products that contain endocrine-disrupting chemicals compared to just 8 percent of whites, which could leave blacks with higher levels of these chemicals in their bodies compared to whites.

For example, phthalates, a class of endocrine-disrupting chemicals used in hair products, are known to be found at higher levels in blacks than whites. Research led by Dr. Tamarra James-Todd at the Connors Center for Women’s Health at Brigham and Women’s Hospital has revealed that higher phthalate levels are associated with a variety of poor health outcomes that disproportionately impact black women and girls including:

Type 2 diabetes, a condition twice as common among black women compared to white women, as well as insulin resistance and other associated conditions. Continue reading

AP: Supreme Court Strikes Down Buffer Zone For Abortion Clinics

(Update from the AP: “Attorney General Martha Coakley, whose office argued before the justices to keep the 35-foot zone, did not immediately say whether officials would seek to create a different buffer zone or take some other steps. But she said the ruling appeared to leave open other alternatives and called on lawmakers to act quickly.

“Every day that we don’t change the rules and make it safer for people to get access, people are put at risk,” said Coakley, a Democratic candidate for governor.

Senate President Therese Murray, D-Plymouth, said she expected lawmakers to act before the July 31 end of the legislative session, but would not speculate on what changes might be sought.”)

The AP reports that the U.S. Supreme Court today struck down a 35-foot protest-free zone outside abortion clinics in Massachusetts (read the court’s “slip opinion” here). We’ll update the news and add reactions as they come in, but for now, here’s the Associated Press, with reactions below:

The justices were unanimous in ruling that extending a buffer zone 35 feet from clinic entrances violates the First Amendment rights of protesters.

Chief Justice John Roberts said authorities have less intrusive ways to deal with problems outside the clinics.

While the court was unanimous in the outcome, Roberts joined with the four liberal justices to strike down the buffer zone on narrow grounds. In a separate opinion, Justice Antonin Scalia criticized Roberts’ opinion for carrying forward “this court’s practice of giving abortion-rights advocates a pass when it comes to suppressing the free-speech rights of their opponents.”

The case began when Boston-area grandmother Eleanor McCullen and other abortion opponents sued over the limits on their activities at Planned Parenthood health centers in Boston, Springfield and Worcester. At the latter two sites, the protesters say they have little chance of reaching patients arriving by car because they must stay 35 feet from the entrance to those buildings’ parking lots.

Planned Parenthood provides health exams for women, cancer screenings, tests for sexually transmitted diseases, birth control and abortions at its clinics.

The organization said that the buffer zone has significantly reduced the harassment of patients and clinic employees. Before the 35-foot zone went into effect in 2007, protesters could stand next to the entrances and force patients to squeeze by, Planned Parenthood said. Continue reading