women’s health

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The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

Women’s Anal Sex More Common And Still Taboo, Says Researcher

Sexual health researcher Debby Herbenick often says what the rest of us are merely just silently, sheepishly thinking.

A few years back, Herbenick, a researcher at Indiana University, co-director of the Center for Sexual Health Promotion, and a sexual health educator at the Kinsey Institute, raised the issue of pain during sex based on her landmark study of sex in the U.S. And here she is again, discussing the pros, cons and surprising new data on women and anal sex in America.

It’s worth reading her full report at Salon, titled Anal Sex: Science’s Last Taboo, but here’s a snippet:

That anal sex remains taboo may explain why a study about anodyspareunia – that is, pain during anal penetration – received little attention when it was published in the Journal of Sex & Marital Therapy. The study should have turned heads: It was the first research on anodyspareunia among women; it was conducted by a well-respected scientist (Dr. Aleksander Stulhofer from the University of Zagreb); and it was centered on young women and sex. That’s often the kind of research that attracts media attention (Young women sext! They get pregnant! They give oral sex! You get the picture …). However, anal sex remains such a strong taboo that this otherwise important study barely turned a head.

younglove

Except it did turn mine. Here’s why. In an incredibly short period of time, anal sex has become a common part of Americans’ sex lives. As of the 1990s, only about one-quarter to one-third of young women and men in the U.S. had tried anal sex at least once. Less than 20 years later, my research team’s 2009 National Survey of Sexual Health and Behavior found that as many as 40-45 percent of women and men in some age groups had tried anal sex. With its rising prevalence, I felt it was important to devote a chapter of my first book, “Because It Feels Good,” to anal health and pleasure — only to find that a magazine editor wouldn’t review it because the topic of anal sex was “not in the best interest of our readership.” Even though nearly half of American women in some age groups have done it! She added, “In the correct circles, I personally will be suggesting the book to those with whom I can share such a resource.”

Hmm. The correct circles. Which ones would those be? The ones where scores and scores of women openly sit around talking about anal sex between glasses of wine? Continue reading

Why To Exercise Today, Moms: For The Kids, Of Course

mikebaird/flickr

mikebaird/flickr

My 11-year-old daughter recently asked if she could take a hot yoga class with me. My first reaction was negative: it’s too hot, it’s not “fun” and it’s one of the few things I do that’s truly mine — 90 minutes in which I don’t have to worry about anyone else’s needs.

Of course, I said yes. And I’m glad I did. She made it through class, and was totally into it (though she wished there’d been more “tricks” and less pose-holding).

“That was great, Mom,” she said afterwards. “When’s the next class?” And whether she becomes a yoga fan or not, I consider those 90 minutes to be a small gift: another way for me to show her how strong and able a body can be, and how good it feels. It doesn’t much matter if it’s yoga or running or swimming or playing ultimate frisbee — our kids are clearly taking their physical activity cues from us.

A new study out of the U.K. confirms this: researchers report that physical activity levels in mothers and their pre-school kids are directly associated. The study, published in the journal Pediatrics, suggests that interventions to promote more physical activity among mothers (who, understandably, are often exhausted, harried and not great at fitting exercise into busy, kid-filled days) might also benefit their young children.

Here’s some of NPR’s report on the study of 554 mothers and their kids:

Mothers’ increased physical activity boosted children’s moderate and vigorous activity overall…

It’s not entirely clear whether it’s the mother’s activity that influences her child’s, or if mothers are more active because they’re busy keeping up with a playful child, says Esther van Sluijs, a behavioral epidemiologist at the University of Cambridge and the study’s lead author.

But busy mothers don’t have to drop all other priorities to play with their children all day. Van Sluijs says just small changes – walking to the park instead of driving or playing a good game of tag instead of a board game – can make a difference. Continue reading

Water Babies: Docs Challenge Growing Trend — Childbirth In A Tub

Lumina Gershfield-Cordova, after giving birth to her daughter in the water. (Photo: Erica Kershner)

Lumina Gershfield-Cordova, after giving birth to her daughter in the water. (Photo: Erica Kershner)

Earlier this month, Lumina Gershfield-Cordova gave birth to her healthy 8-pound daughter in a large tub of warm water.

And from that portable tub — set up in the bedroom of her Somerville, Mass., condo — came an atypical American birth story: Gershfield-Cordova describes the buoyancy of the water offering her delicious freedom to move, stretch, turn and, sometimes, relax in ways that are generally unavailable to a woman delivering a baby flat on her back in a hospital bed.

“It’s so wonderful the way the water supports your whole body,” she said. “You can assume positions you can’t get into when gravity is pulling down on you — it’s such a relief. You feel like a ballerina, or an athlete…I was able to work with my baby and together we found the right way for her to come out — there were actual moments of pleasure during her descent. It was amazing.”

Gershfield-Cordova, 35, is one data point in a growing trend. Actress Ricki Lake famously gave birth in a bathtub as part of her pro-natural childbirth documentary, “The Business of Being Born;” the movie created a kind of “Lake Effect” with more buzz around home birth in general, and water birth as well. One report recently quoted supermodel Gisele Bundchen saying her own child’s birth in the water was inspired by Lake’s film.

“It’s so wonderful the way the water supports your whole body…You can assume positions you can’t get into when gravity is pulling down on you — it’s such a relief.”

But it’s one thing to labor in the water, and quite another to actually give birth underwater, according to two prominent physician groups.

In a just-released joint opinion, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have come out squarely against childbirth in the water.

Their conclusion: laboring in water could be helpful for women as a way to reduce pain (and pain medication) and spend less time in labor, but giving birth underwater is too risky, with no peer-reviewed, randomized controlled trials showing benefits.

Despite such caveats from medical authorities, both water labor and water birth are becoming more popular around the world.

Consider: One percent of all births in the United Kingdom include some kind of immersion in water (one expert put the number closer to 5 percent); and in the U.S., according to a leading water birth advocate, most birthing centers and nearly 10 percent of the nation’s approximately 3,100 hospitals are now offering birthing tubs that allow women to either labor or deliver their babies in water.

Last year, in one private midwifery practice affiliated with a major medical center in Morristown, N.J., 50 percent of the 170 births were in water, says Lisa Lederer, president of the practice, Midwives of New Jersey. “The benefit is the ability to give birth naturally, without medication… it’s true pain relief without the side effects of epidurals or narcotics,” said Lederer, whose practice has been involved in about 1,000 water births since 2000. “Women will labor in the tub, and I ask them to get out to move around, to pee, or just for a change and they’ll beg to get back in and practically dive head first back in the water. This is not just nice or pretty — it actually helps them.”

Noting that water birth, along with home birth, is a growing trend in the U.S., Dr. George Macones, an obstetrician-gynecologist at Washington University in St. Louis, and chair of the committee that prepared the latest ACOG/AAP opinion, said: “I think there’s an important distinction between laboring in a tub and delivering in a tub. Most of us feel that laboring in a tub is fine, as long as the baby is doing well and mom is doing well. Delivering underwater is where there’s a bit more of a struggle — there isn’t a lot of data on this but there are a number of case reports of really bad things happening.” Mostly, he said, there are “concerns about the baby aspirating water.” Others cite infection as a potential problem.

Still, Macones said, at his hospital, where planning has begun for a new labor and delivery ward, “one of the hot topics is how many rooms will have tubs.”

The new ACOG/AAP opinion (which follows a 2005 AAP commentary on the risks of underwater delivery and 2012 ACOG guidelines on perinatal care) concludes that water birth should be considered an “experimental procedure ” and only performed as part of a clinical trial with informed consent — something that’s unlikely to happen in the U.S., according to Macones.

For comparison, here’s what the U.K. Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives stated back in 2006: “All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish.” The groups also also urged hospitals to support women in this pursuit: “…to achieve best practice with water birth it is necessary for organisations to provide systems and structures to support this service.”

Here’s more of the joint ACOG/AAP opinion, published online in the journal Pediatrics, and summarized in a news release:

Undergoing the early stages of labor in a birthing pool may offer some advantages to pregnant women. However, underwater delivery has no proven benefit to women or babies and may even pose a risk of serious health problems for the newborn…

“Many labor and delivery units are equipped with tubs to be used by laboring women, and immersion in water for relaxation and pain relief is appealing to some,” said Jeffrey L. Ecker, MD, chair of the College’s Committee on Obstetric Practice that developed the Committee Opinion. “But it is important to recognize that laboring in water is not the same as delivering underwater. Laboring in water may offer some potential benefits, but delivering underwater does not seem to have clear advantages, and the risk of rare, but serious, consequences to a delivering baby’s health is something women and providers should all be aware of.”

“The members of the committees conducted a thorough review of the literature, and came to the conclusion that there is no evidence to support delivering babies in water has benefits to the baby,” says Tonse Raju, MD, chief, Pregnancy and Perinatology Branch, the National Institute of Child Health and Human Development (NICHD), who served as the NICHD liaison to the AAP Committee on Fetus and Newborn.

The new recommendation acknowledges that there may be some positive effects of water immersion to pregnant women during the early stages of labor, such as decreased pain or use of anesthesia and shorter labors. However, there is no evidence that giving birth underwater improves newborn outcomes…

Potential risks of underwater delivery include a higher risk of maternal and neonatal infections; difficulty in the regulation of the baby’s body temperature; increased chance of umbilical cord damage; respiratory distress resulting from the baby inhaling tub water; and potential for seizures or asphyxiation of baby following birth.

The College and AAP say that underwater delivery should only be performed within the context of an appropriately designed clinical trial with informed consent.

Barbara Harper, an RN who founded the company Waterbirth International in the late 1980s after her two sons were born in water, has been called “the Billy Graham of water birth.” She says she’s personally attended around 600 water births and trained more than 7,000 physicians, nurses, medical students and others around the world — in Mexico, India, Israel, Malaysia, all over Europe, the U.K and U.S — on how to safely and effectively manage childbirth in the water. Based in Fort Lauderdale, Fla., Harper is currently in China conducting water birth training in medical schools and hospitals.

Harper refutes the ACOG assertion that water births are more risky than land births and cites a number of published studies and analyses that support her position, among them a 1999 British report that concluded: “perinatal mortality is not substantially higher among babies delivered in water than among those born to low risk women who delivered conventionally.”

Among water birth’s benefits, Harper says, are that it can speed up labor, give the mother more of a feeling of control, provide pain relief and reduce the need for drugs and inteventions such as epidurals, episiotomies and even cesarean sections. However, Harper says she has very strict criteria regarding who is eligible to give birth in a tub: “Anyone can labor in the water,” she says. “But if your labor goes into the pathology area and wanders out of normal physiology,” water birth should not be an option. She says, for instance, that women with preeclampsia, high blood pressure, abnormal bleeding or untreated infection or fever should not deliver babies in the water. Continue reading

New Home Birth Data: Numbers Rise A Bit, Controversy Remains Unchanged

A new CDC analysis of trends in out-of-hospital births from 1990-2012 found that home births are on the rise — but only a tiny bit.

The federal agency reports that 1.36 percent of U.S. births occurred outside a hospital in 2012, up
from 1.26 percent in 2011. Those new numbers mark the highest level of non-hospital births since 1975, according to the CDC.

In terms of actual births, that means 53,635 births in the U.S. took place out of a hospital in 2012, including 35,184 home births and 15,577 birthing center births, the CDC says.

(Source: CDC)

(Source: CDC)

Here are some more findings from the CDC news release:

• In 2012, 1 in 49 births to non-Hispanic white women were out-of-hospital births;

•The percentage of out-of-hospital births was generally higher in the northwestern United States and lower in the southeastern United States;

•Out-of-hospital births generally had a lower risk profile than hospital births.

Continue reading

Campaign To Reduce Early Births Pays Off — Mass. Now Leads Nation

Most obstetricians agree that babies should not be delivered early, before 39 weeks, unless the health of the mother or her child is at risk. Research shows important brain, lung and vital organ development occurs late in pregnancy. So hospitals across Massachusetts have been working to reduce so-called “early elective deliveries.”

(popularpatty/flickr)

(popularpatty/flickr)

Over the last three years, most hospitals have either stopped scheduling early deliveries, or set a goal of less than 5 percent. Last year, the state’s rate dropped, on average, to 1 percent, the lowest in the country. There is still variation from one hospital to the next. But the numbers, compiled by Leapfrog, a business group that advocates for improved hospital quality and safety, show the significant progress hospitals made in just one year.

The state’s low rate “should decrease some of the complications that newborns may experience from being born electively,” including, “admissions to the intensive care unit and long-term complications,” said Dr. Glenn Markenson, an obstetrician at Bay State Medical Center. Continue reading

Study Finds ‘Gender Gap’ In Medical Research

Dr. Paula Johnson (courtesy)

Dr. Paula Johnson (courtesy)

A new study finds a “gender gap” in medical research. And the Boston researchers say that leads to an incomplete understanding of how health problems should be specifically treated in women.

The report from Boston’s Brigham and Women’s Hospital finds fewer women than men are involved in clinical trials on new drugs and medical devices.

Dr. Paula Johnson, a study co-author, says one problem is the research into heart disease, which is the biggest killer of women. She says doctors have not closely examined how the disease manifests itself differently in women rather than men.

“Today we don’t really understand why that happens,” Johnson told WBUR’s Deborah Becker in a Morning Edition interview. “And, in fact, even that knowledge isn’t being addressed in testing in women today in the clinics the way it should be.”

Johnson says government health agencies should warn women that some treatments have not been tested specifically on and for women.

“These are all important funding agencies that need to pay attention to including adequate numbers of women and also reporting the data by sex,” she said.

The study also calls on medical journals to address gender when their publish studies.

You can listen to Johnson’s interview on WBUR here:

Why To Exercise Today: For Women, Svelte Aging Without Disability — And It’s Not Sitting

DSCN7346

This winter is a struggle. We’re awash in excuses not to get outside and move freely, and exercise seems secondary to just getting through the day. Yesterday, when it started raining ice, for instance, didn’t you just want to wrap up in layers with a hot cup of sweet tea? But, of course, that’s precisely what you shouldn’t do.

Two recent reports re-emphasize everything you already know, but with added detail: fitness (and that involves weight, nutrition, exercise and overcoming a sedentary lifestyle) matters.

Why? Well, here are some of the specifics (that are not actually about exercise per se, but related to it): for women, staying at a healthy weight and avoiding obesity can truly allow you to age (past 85, even) without disability.

Here’s Paula Span in The New York Times on “Weight Gain and Older Women“:

When the researchers looked at the impact that obesity or being overweight — calculated by body mass index — took on the women’s health, “we found that women with a healthy body weight had a greater chance of living to 85 without developing a chronic disease or a mobility disability,” Dr. Rillamas-Sun said. “The heavier you are, the worse your chances of healthy survival.”

And in another blow to the reclining life, researchers at Northwestern report that “every additional hour a day you spend sitting is linked to doubling the risk of being disabled.”

This is less a “why to exercise” finding than a “why not to sit” finding. Still, my point is that the more you’re jogging (or doing water aerobics, or yoga, or shoveling when necessary) the less you’re sitting.

Here’s how the Northwestern news release sums things up: “If there are two 65-year-old women, one sedentary for 12 hours a day and another sedentary for 13 hours a day, the second one is 50 percent more likely to be disabled.” Continue reading

Ban On Handcuffing Pregnant Inmates In Labor Clears Hurdle In Mass. Legislature

A proposal to prohibit the scary practice of handcuffing pregnant inmates during labor has cleared its first hurdle through the Massachusetts Legislature. If passed, the so-called “anti-shackling bill” would “create uniform laws in county jails and the state prison system banning the shackling of pregnant women during childbirth and post-delivery recuperation — unless they present a specific safety or flight risk,” according to an earlier WBUR report.

(MOZ278/flickr)

(MOZ278/flickr)

“This bill has been on file for over a decade — the language has changed a bit — but it’s never seen the light of day,” says Megan Amundson, executive director of NARAL Pro-Choice Massachusetts. The bill was reported out of committee on Friday, and now it will be given a new number and then most likely go to the House Ways and Means Committee, Amundson says.

Here’s more from the NARAL Pro-Choice Massachusetts news release:

In a step toward joining the 18 states that have passed legislation banning the shackling of pregnant incarcerated women, the Massachusetts Joint Committee on Public Safety has released the Anti-Shackling Bill, a bill the prohibits the practice of shackling pregnant women in our jails and prisons, sponsored by Senator Karen Spilka. The bill has now passed the first hurdle to passage.

“As hard as this is to believe, it is not unusual for pregnant women in Massachusetts jails to be handcuffed to the hospital bed even while in labor,” said Megan Amundson, Continue reading

Thyroid Doc: Kale Risks ‘Theoretical’ But In Reality, Very Low To Minuscule

bittermelon/flickr

bittermelon/flickr

This post — “The Dark Side of Kale (And How To Eat Around It)” — went wildly viral this week, generating huge traffic and high passions over this once minor but now hotter-than-hot vegetable. Among the accusations from readers were charges that the post was “dubious and dangerous” and that I was, in effect “discouraging Americans from eating vegetables” (my children would disagree).

Still, for a medical reality check, I turned to a doctor who specializes in treating the thyroid.

(Before we get to him, for background, my post was inspired by an earlier piece in The New York Times on potential thyroid problems linked to kale and other cruciferous vegetables, called “Kale? Juicing. Trouble Ahead.” This article was troubling to me since I, too, am a devoted kale fan.)

OK, back to the thyroid expert, who points out that this debate is particularly timely since January is Thyroid Awareness Month.

Dr. Jeffrey Garber is chief of endocrinology at Harvard Vanguard Medical Associates, and lead author of the latest clinical practice guideline on hypothyroidism in adults. He agreed to answer a few more questions on the kale-thyroid connection.

I’d sum up Dr. Garber’s take on the whole kale issue pretty simply: It’s probably unwise to embrace a long-term, pound-a-day raw kale habit, but even if you do, you will, in all likelihood, be fine. (Especially if you live in the U.S., where iodine deficiency isn’t a huge problem, and if you don’t have a family history or predisposition to thyroid disorders.)

“If one isn’t a food faddist or predisposed to a thyroid problem (family history, prior diagnosis) the risks are very low,” Garber said. And, he adds, if you have any concerns at all, check in with your doctor for a simple thyroid test.

Here, lightly edited, is our Q&A:

RZ: In plain terms, what’s the connection between kale, a cruciferous vegetable, and thyroid function?

JG: There are many substances that can interfere with the way the thyroid functions. Goitrogens, as in those that promote goiter, make up one of these categories.
(There’s an enormous amount of interest in environmental goitrogens, like BPA and other substances, but that’s another story: We’re talking about dietary goitrogens here.)

When you get into the way goitrogens can affect the thyroid directly there are three general ways (and all relate to iodine, which is what thyroid hormone is made from):

1. the way the thyroid picks up the iodine;

2. the way the thyroid produces the hormone once the iodine is in the thyroid;

3. the way thyroid hormone is secreted into the bloodstream.

When you look at dietary goitrogens, they interfere with one or more of these three steps.

OK, so kale is one of these so-called “goitrogenic” foods, right?

Yes. Continue reading