Tagged Pregnancy and Childbirth

Is ‘Femtech’ the Next Big Thing in Health Care?

Start-ups and tech companies are creating products to address women’s health care needs. It’s still a small segment of the market, but growing.

This article is part of our new series on the Future of Health Care, which examines changes in the medical field.

Women represent half of the planet’s population. Yet tech companies catering to their specific health needs represent a minute share of the global technology market.

In 2019, the “femtech” industry — software and technology companies addressing women’s biological needs — generated $820.6 million in global revenue and received $592 million in venture capital investment, according to PitchBook, a financial data and research company. That same year, the ride-sharing app Uber alone raised $8.1 billion in an initial public offering. The difference in scale is staggering, especially when women spend an estimated $500 billion a year on medical expenses, according to PitchBook.

Tapping into that spending power, a multitude of apps and tech companies have sprung up in the last decade to address women’s needs, including tracking menstruation and fertility, and offering solutions for pregnancy, breastfeeding and menopause. Medical start-ups also have stepped in to prevent or manage serious conditions such as cancer.

“The market potential is huge,” said Michelle Tempest, a partner at the London-based health care consultancy Candesic and a psychiatrist by training. “There’s definitely an increasing appetite for anything in the world which is technology, and a realization that female consumer power has arrived — and that it’s arrived in health care.”

She said one reason women-related needs had not been focused on in the field of technology was that life sciences research was overwhelmingly “tailored to the male body.” In 1977, the U.S. Food and Drug Administration excluded women of childbearing age from taking part in drug trials. . Since then, women have been underrepresented in drug trials, Dr. Tempest said, because of a belief that fluctuations caused by menstrual cycles could affect trial results, and also because if a woman got pregnant after taking a trial drug, the drug could affect the fetus. As a result, she noted, “we do lag behind men.”

Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.
Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.via Clue

The term “femtech” was coined by Ida Tin, the Danish-born founder of Clue, a period and ovulation tracking app established in Germany in 2013. In an article on the company’s website, Ms. Tin recalled how she first had the idea for the app. In 2009, she found herself holding a cellphone in one hand and a small temperature-taking device in the other and wishing she could merge the two to track her fertility days, rather than manually having to note her temperature on a spreadsheet.

Clue allows women to do exactly that with a few taps on their smartphone. Today, the company has a lot of competition in the period- and fertility-tracking area. And plenty of other women-specific tools have come onto the market. Elvie, a London-based company, has marketed a wearable breast pump and a pelvic exercise trainer and app, both using smart technology. Another strand of femtech known as “menotech” aims to improve women’s lifestyles as they go through menopause, providing access to telemedicine, and information and data that women can tap into.

Clue’s period and ovulation app. Ms. Tin had the idea when she found herself holding a cellphone in one hand and a small temperature-taking device in the other.Clue

Finally, there are medical technology companies focused on cancer that affects women, such as cervical cancer and breast cancer.

According to the World Health Organization, cervical cancer is the fourth most common cause of cancer among women around the world. In 2018, about 570,000 women had it, and as many as 311,000 died. The W.H.O. in November announced a program to eradicate the disease completely by the year 2030.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. A smart colposcope — a portable imaging device that’s one and a half times the size of a smartphone — is used to take a photograph of a woman’s cervix from a distance of about a meter (3 feet). The image is then transmitted to the cloud via a smartphone, where artificial intelligence is used to identify normal or abnormal cervical findings.

A diagnosis is delivered in about 60 seconds — compared to the weeks it takes to receive the results of a standard smear test (which, in developing countries, extends to months.) In addition to this screening, doctors still use smear tests.

The technology was recently used to screen 9,000 women during a three-month period in the Dominican Republic as part of a government-led campaign, the company announced last month. Another 50,000 women are expected be screened in the next six months.

Leon Boston, the South African-born chief executive of MobileODT, said the privately owned company was selling into about 20 different countries including the United States, India, South Korea and Brazil, and is going into a fund-raising round to build on its initial seed money of $24 million.

But the leading cause of cancer among women all over the world is breast cancer. One French start-up is focused on dealing with its aftermath. Lattice Medical has developed a 3-D printed hollow breast implant that allows for the regeneration of tissue and is absorbed by the body over time.

How it works: Post-mastectomy, the surgeon harvests a small flap of fat from the area immediately around the woman’s breast and places it inside the 3-D-printed bioprosthesis. That piece of tissue grows inside the implant, and eventually fills it out. In the meantime, the 3-D-printed shell disappears completely 18 months later.

So far, tests on animals have been encouraging, said Julien Payen, the company’s co-founder and chief executive. Clinical trials on women are expected to start in 2022, with the aim of getting the product into the market in 2025, he added.

Asked why the global femtech market was so small for technology companies, Mr. Boston said it was partly because of the “high level of regulation” involved in medical technology.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. MobileODT

“If your technology is incorrect and comes up with the wrong result, a woman who thinks she’s not positive for cervical cancer is actually positive,” he said. As a result, “the world of medical technology is slow to move.”

Still, prospects are favorable, according to Mr. Boston. “It’s very rare to have a totally barren market open for full potential, as we have today in medical technology,” he said.

The data forecasts appear to back that up. According to a March 2020 report by Frost & Sullivan, a research and strategy consultancy, revenue from femtech is expected to reach $1.1 billion by 2024.

Mr. Payen explained that for the femtech market to expand and develop, there have to be many more tech companies offering genuine health benefits to women, not just well-being apps crowding the market and adding little in terms of health or medical value. He cited the example of Endodiag, a French medical technology company that allows early diagnosis of endometriosis and a better management of the condition.

Either way, said Mr. Payen, the industry showed promise.

“Over the last 10 years, thanks to #MeToo and other movements, women are being listened to and heard more than ever before,” Mr. Payen said. And “more and more women are running companies and investment funds,” he added.

“In 10 or 15 years from now, as a new generation takes over, things will have changed even more radically,” he said. “Femtech is clearly poised to grow.”

Why I Gave My Mosaic Embryo a Chance

‘It was like rolling the dice, except for someone you’ve never met.’

My husband and I were sitting in an Upper East Side office with deep-toned velvet couches and fluffy throw pillows, surrounded by photos of smiling babies, as the fertility doctor gave his spiel. He told us that after age 35, a woman’s chances of getting pregnant drop. Older women produce few normal embryos even with fertility treatment. But we’d have a healthy baby in our arms within a year — if we tested the embryos.

By testing the chromosomes in my embryos, he said, we could weed out the abnormal embryos that may lead to miscarriage or a child with disabilities and only use viable ones.

I’ve always been a late bloomer — I met my husband at 37 and married at 39. I was in good health but pushing 40, with diminishing egg count and quality. After six months of trying to conceive on our own, we wanted all the help we could get. My husband and I jumped at the embryo testing suggestion.

After two long rounds of in vitro fertilization, we had five embryos, but the genetic testing deemed four of them “abnormal,” meaning they contained extra or missing chromosomes. Our fifth embryo, a girl, was what our genetic counselor called “mosaic,” meaning it had both abnormal and normal cells.

Starting in the late 1990s, doctors testing fertilized eggs classified them as normal or abnormal, then added the classification “mosaic” in 2015. Mosaic embryos can be either low- or high-level, depending on the number of abnormal cells. Twenty percent of tested embryos are mosaic.

Ours was a low-level mosaic embryo, with a few cells having an extra 22nd chromosome. Scientists are still trying to understand mosaicism, but this meant our embryo could be normal and lead to a healthy baby; she could have genetic abnormalities that would lead to miscarriage; or she could be born with congenital heart defects, asymmetrical development (meaning one side of her body could look like it was melting while the opposite side looked normal) or other disabilities that would cause her to use a wheelchair for life. It was like rolling the dice, except for someone you’ve never met.

It turns out there are a lot of online communities for mosaic kids and their families, including one on Facebook dedicated specifically to mosaics with an extra 22nd chromosome. Some adults lived normal lives and only find they have mosaic +22 later in life. Some women who were pregnant with babies with mosaic +22 miscarried. Children — ranging from newborns to young adults — had varying developmental challenges.

What scared me most was that in girls, the extra 22nd chromosome could cause infertility. I felt selfish for wanting her so desperately that I would allow her into the world without this same opportunity.

We had to make a fast choice: do a third cycle of I.V.F., hoping to get a normal embryo, or risk transferring the mosaic. Should we first try the mosaic embryo or risk having more nonviable embryos to agonize over? Because of the risks to the fetus and the developmental challenges our baby might face, the genetic counselor advised us to not transfer.

I had always hoped my future children wouldn’t be short like me. My husband, who sprouts freckles in the sun, hoped they would inherit my darker skin. Otherwise, we had no lofty dreams of them going to Harvard or making any “world’s most beautiful baby” list. We picked a dog that was the runt of the litter, with a lopsided face, because we thought she was modern art. But that’s a lot different from bringing a child into the world knowing it had a risk of living a difficult life.

It was a lot to take in. I wasn’t scared that my life would be curtailed if I brought up a child with special needs — I was ready to dedicate myself to a child. But I worried that my wanting a child was blinding me to some of my potential shortcomings. Was I capable of giving up everything to concentrate on this person who would need me in ways I couldn’t even fathom yet? I was terrified that I couldn’t handle having a child with special needs and would take it out on her.

I was also a little embarrassed that I cared so much about having a “perfect” baby that fit the standard 46-chromosome human body. Who was I to make this life and death decision for another human?

But it turns out that I didn’t know as much as I thought I did. Because genetic tests of I.V.F. embryos are far from perfect.

“Labs only test five cells from around 150 that make up the fertilized egg,” said Dr. Hugh Taylor, chairman of the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine. “We’re fooling ourselves if we think we have full information on an embryo based on those few cells.”

A recently published study of 1,000 mosaic embryos found those that progressed into a late-term pregnancy and full term birth had similar odds of being born without any discernible genetic differences to a normal embryo. But there were no guarantees.

I didn’t want to try another I.V.F. cycle. In late February 2020, we decided to transfer the embryo into my uterus — just in time for New York City to shut down during the pandemic.

Five months later, I got a call from a physician who was filling in for my doctor; she canceled my appointment, claiming she was uncomfortable transferring a mosaic embryo. I was livid and overcome with grief.

“The larger question that emerges with embryo testing is who gets to take on the risk of possibly bringing a child with potential disabilities into the world,” Dr. Taylor said. “The decision should not be left to physicians. Patients should be given the freedom to decide, and properly counseled in cases where there are abnormalities that will inevitably lead to death.”

Parents I had met online described wheeling or driving their frozen abnormal and mosaic embryos in unwieldy metal tanks to other clinics when their physicians refused to transfer. Fortunately, my regular doctor came back and scheduled a new appointment for the following month.

My husband and I got lucky. Our beautiful, imperfect embryo attached to the uterine wall, mesmerizing us with her wild beating heart at biweekly ultrasounds. As each week brought on fresh worries — that I could miscarry, that the baby might have other abnormalities not caught at embryo testing — I found comfort in Dr. Taylor’s words: “Mosaicism is more common than we think. Many of us are mosaic without knowing it.”

At three months, my doctor recommended a blood test that checked the baby’s DNA fragments in my blood to see if she was at risk for genetic abnormalities. At this point, my husband and I had begun to notice families in the dog park whose children had genetic disabilities. We quietly found acceptance that we would add variety to the families in our community and decided that we wouldn’t terminate the baby — no matter the result.

They came back as normal. But like embryo testing, the blood test couldn’t diagnose a fetus’s genetic condition with certainty. Our doctor offered a more accurate amniocentesis test, but we had already made our decision. I decided to leave it there.

Now, during ultrasounds, our daughter hides her face behind her hands or presses hard against the placenta, as if asking us to let her grow in privacy. The last time I glimpsed her full profile, at five months gestation, her nose, long and sharp, was prominent and unmistakable. I wondered if it was one of the characteristics of the extra 22nd chromosome or if she’d simply inherited my husband’s nose. As my due date draws nearer, her genetic profile is less of a concern. I’m thrilled we’ve made it this far.

Jacquelynn Kerubo is a writer and public health communicator.

After Genetic Testing, I Took a Chance on an ‘Imperfect’ Pregnancy

‘It was like rolling the dice, except for someone you’ve never met.’

My husband and I were sitting in an Upper East Side office with deep-toned velvet couches and fluffy throw pillows, surrounded by photos of smiling babies, as the fertility doctor gave his spiel. He told us that after age 35, a woman’s chances of getting pregnant drop. Older women produce few normal embryos even with fertility treatment. But we’d have a healthy baby in our arms within a year — if we tested the embryos.

By testing the chromosomes in my embryos, he said, we could weed out the abnormal embryos that may lead to miscarriage or a child with disabilities and only use viable ones.

I’ve always been a late bloomer — I met my husband at 37 and married at 39. I was in good health but pushing 40, with diminishing egg count and quality. After six months of trying to conceive on our own, we wanted all the help we could get. My husband and I jumped at the embryo testing suggestion.

After two long rounds of in vitro fertilization, we had five embryos, but the genetic testing deemed four of them “abnormal,” meaning they contained extra or missing chromosomes. Our fifth embryo, a girl, was what our genetic counselor called “mosaic,” meaning it had both abnormal and normal cells.

Starting in the late 1990s, doctors testing fertilized eggs classified them as normal or abnormal, then added the classification “mosaic” in 2015. Mosaic embryos can be either low- or high-level, depending on the number of abnormal cells. Twenty percent of tested embryos are mosaic.

Ours was a low-level mosaic embryo, with a few cells having an extra 22nd chromosome. Scientists are still trying to understand mosaicism, but this meant our embryo could be normal and lead to a healthy baby; she could have genetic abnormalities that would lead to miscarriage; or she could be born with congenital heart defects, asymmetrical development (meaning one side of her body could look like it was melting while the opposite side looked normal) or other disabilities that would cause her to use a wheelchair for life. It was like rolling the dice, except for someone you’ve never met.

It turns out there are a lot of online communities for mosaic kids and their families, including one on Facebook dedicated specifically to mosaics with an extra 22nd chromosome. Some adults lived normal lives and only find they have mosaic +22 later in life. Some women who were pregnant with babies with mosaic +22 miscarried. Children — ranging from newborns to young adults — had varying developmental challenges.

What scared me most was that in girls, the extra 22nd chromosome could cause infertility. I felt selfish for wanting her so desperately that I would allow her into the world without this same opportunity.

We had to make a fast choice: do a third cycle of I.V.F., hoping to get a normal embryo, or risk transferring the mosaic. Should we first try the mosaic embryo or risk having more nonviable embryos to agonize over? Because of the risks to the fetus and the developmental challenges our baby might face, the genetic counselor advised us to not transfer.

I had always hoped my future children wouldn’t be short like me. My husband, who sprouts freckles in the sun, hoped they would inherit my darker skin. Otherwise, we had no lofty dreams of them going to Harvard or making any “world’s most beautiful baby” list. We picked a dog that was the runt of the litter, with a lopsided face, because we thought she was modern art. But that’s a lot different from bringing a child into the world knowing it had a risk of living a difficult life.

It was a lot to take in. I wasn’t scared that my life would be curtailed if I brought up a child with special needs — I was ready to dedicate myself to a child. But I worried that my wanting a child was blinding me to some of my potential shortcomings. Was I capable of giving up everything to concentrate on this person who would need me in ways I couldn’t even fathom yet? I was terrified that I couldn’t handle having a child with special needs and would take it out on her.

I was also a little embarrassed that I cared so much about having a “perfect” baby that fit the standard 46-chromosome human body. Who was I to make this life and death decision for another human?

But it turns out that I didn’t know as much as I thought I did. Because genetic tests of I.V.F. embryos are far from perfect.

“Labs only test five cells from around 150 that make up the fertilized egg,” said Dr. Hugh Taylor, chairman of the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine. “We’re fooling ourselves if we think we have full information on an embryo based on those few cells.”

A recently published study of 1,000 mosaic embryos found those that progressed into a late-term pregnancy and full term birth had similar odds of being born without any discernible genetic differences to a normal embryo. But there were no guarantees.

I didn’t want to try another I.V.F. cycle. In late February 2020, we decided to transfer the embryo into my uterus — just in time for New York City to shut down during the pandemic.

Five months later, I got a call from a physician who was filling in for my doctor; she canceled my appointment, claiming she was uncomfortable transferring a mosaic embryo. I was livid and overcome with grief.

“The larger question that emerges with embryo testing is who gets to take on the risk of possibly bringing a child with potential disabilities into the world,” Dr. Taylor said. “The decision should not be left to physicians. Patients should be given the freedom to decide, and properly counseled in cases where there are abnormalities that will inevitably lead to death.”

Parents I had met online described wheeling or driving their frozen abnormal and mosaic embryos in unwieldy metal tanks to other clinics when their physicians refused to transfer. Fortunately, my regular doctor came back and scheduled a new appointment for the following month.

My husband and I got lucky. Our beautiful, imperfect embryo attached to the uterine wall, mesmerizing us with her wild beating heart at biweekly ultrasounds. As each week brought on fresh worries — that I could miscarry, that the baby might have other abnormalities not caught at embryo testing — I found comfort in Dr. Taylor’s words: “Mosaicism is more common than we think. Many of us are mosaic without knowing it.”

At three months, my doctor recommended a blood test that checked the baby’s DNA fragments in my blood to see if she was at risk for genetic abnormalities. At this point, my husband and I had begun to notice families in the dog park whose children had genetic disabilities. We quietly found acceptance that we would add variety to the families in our community and decided that we wouldn’t terminate the baby — no matter the result.

They came back as normal. But like embryo testing, the blood test couldn’t diagnose a fetus’s genetic condition with certainty. Our doctor offered a more accurate amniocentesis test, but we had already made our decision. I decided to leave it there.

Now, during ultrasounds, our daughter hides her face behind her hands or presses hard against the placenta, as if asking us to let her grow in privacy. The last time I glimpsed her full profile, at five months gestation, her nose, long and sharp, was prominent and unmistakable. I wondered if it was one of the characteristics of the extra 22nd chromosome or if she’d simply inherited my husband’s nose. As my due date draws nearer, her genetic profile is less of a concern. I’m thrilled we’ve made it this far.

Jacquelynn Kerubo is a writer and public health communicator.

I Met My Husband on the Maternity Ward

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

Modern Love

I Met My Husband on the Maternity Ward

He needed someone to cuddle him.

Credit…Brian Rea

  • Feb. 26, 2021, 12:00 a.m. ET

My birth story, which is also my love story, began nearly 40 years ago in the mountain town of Spalding, Jamaica. It has been told to me time and again by the two women who were there that April day — my mother, Lorna, and a stranger, Lurline, who was giving birth in the same open ward.

My mother and Lurline lived in different towns far from each other and had traveled separately to the hospital in Spalding. At the time, men had no place in the maternity ward, so my father, Vivian, a farmworker, and Lurline’s husband, Jeral, a pastor, were not there for the deliveries. Lorna and Lurline were expected to handle labor alone, with the help of nurses and doctors, of course.

These young women were the first generation even to have the option of giving birth in a hospital; they both had been born at home in crude conditions. Percy Junor Hospital in Spalding boasted no modern amenities. There were no meals on sanitized trays. Patients had to bring their own food, or have it brought, preferably in thermoses if they wanted it to be hot. Expecting mothers also had to bring their own gowns, bedsheets, even cloth diapers for their newborns.

There were few if any locally trained doctors. Cuba had the nearest medical schools. These Cuban-trained doctors were assisted by Jamaican nurses who ruled the maternity ward, moving briskly between the sheer curtains that separated the beds. There was no privacy.

[Sign up for Love Letter, our weekly email about Modern Love, weddings and relationships.]

Lorna and Lurline lay nervously in their adjacent beds. While curtains separated them, they were connected by their fear of childbirth, and it was that fear that led them to start talking.

My mother was the first to go into labor, which began with a piercing pain that only intensified. As Lurline tells it, my mother began to moan and groan and quickly escalated to her mouthing unintelligible words in agony.

Lurline was overdue and believed that she should have been the one to be in labor. Shifting in her bed, she maneuvered her swollen and wobbly feet to the floor and, cradling her protruding abdomen, waddled to Lorna’s bedside. With her pastor husband, Lurline was a religious woman, a praying woman. She and Jeral led a small church in the Cascade Mountains, so she prayed for my mother at her bedside.

She later told me that witnessing my mother’s agony was akin to watching a body being split in two; my mother moaned and thrashed as if possessed. Lurline was seeing childbirth for the first time and it truly terrified her. She not only prayed for her new friend but also for herself, for what she would soon have to endure, as she held my mother’s hand through each contraction and breathed with her in unison.

These women had grown up in a time when subjects like sexuality and childbirth were not discussed, not even between mothers and daughters, so she found herself neither mentally nor emotionally prepared. The nurses did not take pity on first-time mothers and offered no comfort.

The nurses failed to realize, however, that my mother was in grave danger. She was hemorrhaging and growing lethargic, her legs shaking. Lurline told me that the brown of my mother’s irises even rolled over to reveal pure white, and her mind seemed to ebb and flow from awareness to oblivion.

When my mother’s body went still, the nurses, finally aware of the danger, busied themselves around her as night fell. It would be many hours before my mother would hear her baby’s cry — my cry — for the first time.

On Monday, April 13, 1981, my mother awoke to the sight of me being placed in her arms, but she was desperately weak, and the nurses decided she would need to remain in the hospital an extra four nights for observation. My mother’s happiness knew no bounds; my safe arrival was enough to calm the fear that had brought her to the brink.

Now it was Lurline’s turn, and the weight of her pregnancy was starting to drain her. She had thought she was emotionally prepared to deliver her baby, but seeing what my mother endured made her reel at the thought of pushing life from her own body.

Then the doctor came with bad news: Her baby was breech and would need to be surgically extracted. Lurline hadn’t anticipated this, but the doctor explained that her life and the baby’s life were in danger; she might even have to choose between them. The words “your life or your baby’s” terrorized her.

Lurline wrestled with this choice as the doctor’s warning rattled through her mind. She thought of the tumultuous yet tender days of her marriage, the life blossoming within her, and the moment she expected that she finally would hold the physical manifestation of her and Jeral’s love. Would that still happen now? As her mind veered between visions of life and death, she turned to her only source of solace — prayer — and in doing so, came to a decision: The baby’s life had to be saved.

Lurline suffered alone with the gravity of this decision. Despite her husband’s absence at the hospital, they managed life together and had started building a home for the family they were creating. They maintained a farm and a church. Jeral had made the long journey to the hospital when it was time for his wife to deliver their child, but he was not allowed to stay, so he had returned home.

As Lurline lay in bed, she worried about how Jeral would react if he were to come to take his family home and learn that only his child had survived. She pictured his face, perplexed by the doctor’s words. She saw his hands reaching for her in desperation and denial, only to confirm that his wife was, in fact, absent from her body.

Lurline inhaled the present: her church, her husband and the life inside her. Then she exhaled, as if letting go of all that might have been: a long marriage, parenthood, their rightful future. Placing her hand on her Bible, she glimpsed her wedding ring. She had not removed it since Jeral had slid it onto her finger years before, but she decided to remove it now, which took great effort, as her fingers had swollen.

Once it was off, she whimpered at the sight of her Bible and wedding ring. In life they were her identity, but in death they would be a memory.

If she were to die, Lurline needed Jeral to know what had happened during her last moments. As she approached my mother, holding her Bible and wedding ring, she felt guilty encroaching on such happiness, but she had no other choice. She didn’t want to cry, but upon seeing my mother holding me, Lurline’s eyes filled with tears. She put the ring and Bible in my mother’s hands with the request that Jeral receive them if she did not make it out of surgery alive.

These symbols of love and commitment felt like cement in my mother’s hands. She took a deep breath and nodded yes. Even if my mother didn’t quite realize the extent of Lurline’s trouble, she knew how deeply she had come to appreciate their newfound friendship.

Lurline had one more request for my mother, which was to have her read her favorite scripture, Psalm 35. As the anesthesia traveled through Lurline’s body, my mother’s words filtered through Lurline’s consciousness: “Plead my cause, Oh Lord — ”

On Wednesday, April 15, two days after my mother had given birth to me, a new life safely emerged by cesarean section, a boy named Ontonio.

At 13 pounds, Ontonio was the talk of the ward — no one had ever seen a baby of such great weight. Sewn up with stitches, aching from her surgery and unable to sit up or move about, Lurline rested beside her new friend, Lorna. Lurline’s delivery had been so traumatic and physically taxing that she would need time to heal.

And so it happened that the nurse took Ontonio from his mother and handed him to mine, who rocked, cuddled and sang to us both — me, Kadine, and Lurline’s baby boy, who in time, although we lived hours apart, would become my occasional childhood playmate, then teenage lover and now husband of 15 years.

Together, Ontonio and I entered this world, and together, four decades later, with three children of our own, we continue to revel in its mysteries and miracles.

Kadine Christie lives in Fairhope, Ala. She is the author of the memoir “I Am Home Within Myself.”

Modern Love can be reached at modernlove@nytimes.com.

To find previous Modern Love essays, Tiny Love Stories and podcast episodes, visit our archive.

Want more from Modern Love? Watch the TV series; sign up for the newsletter; or listen to the podcast on iTunes, Spotify or Google Play. We also have swag at the NYT Store and two books, “Modern Love: True Stories of Love, Loss, and Redemption” and “Tiny Love Stories: True Tales of Love in 100 Words or Less.”

When Vagisil Targeted Teens, the Backlash Was Swift

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

When Vagisil Targeted Teens, the Backlash Was Swift

Experts say the brand’s new intimate care line shames young people and might even pose potential health risks.

Credit…Getty Images
Dani Blum

  • Feb. 18, 2021, 11:46 a.m. ET

An oatmeal-infused anti-itch serum claims to soothe the “bikini and intimate” region. A scented body wash says that it is “gentle enough for your vaginal area.” A confetti-dotted package of cleansing feminine wipes is “small enough to fit in your locker or a backpack.”

These products make up a new line of vanilla- and clementine-scented intimate care items for teenagers called OMV! (a play on the expression “OMG!”). The sparkly new brand — which comes from the makers of Vagisil and includes personal wipes, a wash and a serum — has cutesy packaging and uses phrases on its website and social media that might sound familiar to younger generations. (Why not “level-up” your teen’s “self-care routine” and enhance their “glow-up”?)

But in recent weeks, OMV! has drawn the ire of gynecologists and other women’s health experts online, who have argued that the brand’s focus on “freshness” might be contributing to unhealthy body image issues for young people by promoting the idea that vulvas are “dirty” and that they should appear or smell a certain way.

“Hey @vagisil going to call you out here for this predatory line of products aimed at teen girls,” Dr. Jen Gunter, a gynecologist and contributor to The New York Times, wrote on Twitter.

“How many times have we talked about how this industry preys on the insecurities of women?” Dr. Staci Tanouye, a gynecologist in Florida, said about the product line in a TikTok video. “And now we are directly targeting teens to tell them that they’re dirty.”

As with other types of scented intimate care products that are marketed for use on or around the vulva, many experts also have concerns that these products might be harmful to vaginal health.

In a written statement to The New York Times, a representative from Vagisil said that their OMV! products are safe and were tested rigorously, “using board-certified gynecologists and dermatologists,” before the care line’s launch.

But Dr. Danielle Jones, a gynecologist in Texas, said that this phrasing could be misleading. “You’ll notice they’re very careful in their wording,” she said in an email. Saying that a product is “gynecologist-tested” isn’t the same as “gynecologist-approved,” she said, “and safe isn’t equivalent to necessary.”

For example, she said, if a company asks her to “test” their product and she says that it is “terribly irritating in some patients,” the company could still “claim ‘gynecologist tested’ in their marketing.”

In 2018, the global feminine intimate care market was valued at $1.1 billion, according to market research firm Grand View Research, with intimate washes accounting for nearly 40 percent of the share.

The OMV! brand, which launched last year, is just one of many personal care lines that advertise to young women by telling them they should feel “comfortable in your own body” by keeping it fresh and clean.

But that sends the wrong message, said Dr. Heather Irobunda, an ob-gyn at NYC Health + Hospitals, especially for teens who don’t have access to adequate sexual education.

“Not only does it teach girls at a young age that you should probably smell like a Creamsicle,” she said, “it also then has these young girls question what exactly is a normal smell down there.”

Dr. Gunter, who learned about the OMV! line after some of her Instagram followers sent her direct messages about it, said that after looking up the brand’s website, she was appalled by some of the language they used in their advertising. She was especially irked by the tagline on the landing page that implies that “period funk” is a nuisance to be eliminated, and that their “No-Sweat” vulva wipes are supposed to help teens “never worry about staying fresh again.”

“This is all purity culture,” Dr. Gunter said. “It’s infantilizing — you have to be pure, clean, fresh, natural. These products always make it sound like you’re supposed to be a contestant on a game show called ‘America’s Next Virgin Bride’ or something.”

At the same time, experts have said that for some, the damage from these and other types of scented intimate hygiene products can extend beyond the psychological.

Any product that is scented can potentially damage the skin, Dr. Tanouye said. And while not everyone may experience a reaction, or react immediately, experts said that certain health issues can emerge after prolonged use. “Fragrance is the No. 1 cause of allergic contact dermatitis,” Dr. Tanouye said, which is a condition in which the skin gets inflamed and becomes itchy, red and rashy after contact with an irritating substance.

Because these are some of the same symptoms that many of these products claim to soothe, health experts said they are concerned that, in an effort to get rid of symptoms like pain, itching or irritation — which could be signs of a larger problem, like a yeast or bacterial infection — women might keep using these products and potentially make their problems worse.

“If a person with a vagina has itching, the key isn’t to cover it up with an anti-itch cream,” said Dr. Jennifer Lincoln, an obstetrician in Portland, Ore. “We’re really concerned about people delaying care.”

Dr. Irobunda estimated that about 30 percent of the patients she sees in an average week come in with vaginal complaints like itching, pain and inflammation that they’ve tried to heal with over-the-counter products from brands like Vagisil or Summer’s Eve (which sells feminine hygiene items like douches, cleansing cloths and “freshening sprays”). She sees many patients who are underinsured or in low-income communities, and who opt to treat their symptoms with creams they can pick up at a pharmacy instead of seeking medical attention. “It doesn’t wash away the bacteria that causes an inflammation or smell,” she said. “If the area is already inflamed, using these products will irritate that area even more.”

Dr. Jones, who posted a YouTube video about the OMV! line under her channel “Mama Doctor Jones” (which currently has more than 320,000 views), said she is concerned that teens might develop a habit of using these products. “It catches them early where it becomes something they think they inherently need for the rest of their lives,” she said.

And when use of these kinds of intimate care products becomes more regular, said Dr. Monica Woll Rosen, an ob-gyn at the University of Michigan Medical School, that can potentially disrupt the healthy balance of bacteria in the vagina, which can increase the risk of bacterial infections, sexually transmitted infections and urinary tract infections in teens.

Using these types of products in the vagina can “damage lactobacilli and mucus,” Dr. Gunter wrote on Twitter, which could increase the risk of sexually transmitted infections if exposed.

The first thing Dr. Tanouye tells patients who complain about vaginal itching or irritation is to stop using any scented products.

If you have an odor that suddenly changes, or experience a change in the color of your vaginal discharge, it’s time to see a doctor, rather than reach for over-the-counter products, she said.

“The catastrophic consequences are probably uncommon but not impossible,” Dr. Gunter said. “But irritation from these products? Absolutely. I see that every day.”

Evidence Builds That Pregnant Women Pass Covid Antibodies to Newborns

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

Evidence Builds That Pregnant Women Pass Covid Antibodies to Newborns

A new study suggests that protective antibodies can be transferred through the placenta, and the baby may receive more of them if a mother is infected with Covid earlier in her pregnancy.

A woman in McAllen, Tex., who tested positive for Covid-19 while she was pregnant. Studies suggest that pregnant women infected with the coronavirus can pass antibodies to their babies. 
A woman in McAllen, Tex., who tested positive for Covid-19 while she was pregnant. Studies suggest that pregnant women infected with the coronavirus can pass antibodies to their babies. Credit…Carolyn Cole/Getty Images
Christina Caron

  • Jan. 29, 2021, 9:04 p.m. ET

One of the many big questions scientists are trying to untangle is whether people who get Covid-19 during pregnancy will pass on some natural immunity to their newborns.

Recent studies have hinted that they might. And new findings, published Friday in the journal JAMA Pediatrics, provide another piece of the puzzle, offering more evidence that Covid-19 antibodies can cross the placenta.

“What we have found is fairly consistent with what we have learned from studies of other viruses,” said Scott E. Hensley, an associate professor of microbiology at the Perelman School of Medicine at the University of Pennsylvania and one of the senior authors of the study.

Additionally, he added, the study suggests that women are not only transferring antibodies to their fetuses, but also transferring more antibodies to their babies if they are infected earlier in their pregnancies. This might have implications for when women should be vaccinated against Covid-19, Dr. Hensley said, adding that vaccinating women earlier in pregnancy might offer more protective benefits, “but studies actually analyzing vaccination among pregnant women need to be completed.”

In the study, researchers from Pennsylvania tested more than 1,500 women who gave birth at Pennsylvania Hospital in Philadelphia between April and August of last year. Of those, 83 women were found to have Covid-19 antibodies — and after they gave birth, 72 of those babies tested positive for Covid-19 antibodies via their cord blood, regardless of whether their mothers had symptoms.

According to Dr. Karen Puopolo, an associate professor of pediatrics at the University of Pennsylvania and one of the senior authors of the study, about half of those babies had antibody levels that were as high or higher than those found in their mother’s blood, and in about a quarter of the cases, the antibody levels in the cord blood was 1.5 to 2 times higher than the mother’s concentrations.

“That’s fairly efficient,” Dr. Puopolo said.

The researchers also observed that the longer the time period between the start of a pregnant woman’s Covid-19 infection and her delivery, the more antibodies were transferred, a finding that has been noted elsewhere.

The antibodies that crossed the placenta were immunoglobulin G, or IgG, antibodies, the type that are made days after getting infected and are thought to offer long-term protection against the coronavirus.

None of the babies in this study were found to have immunoglobulin M, or IgM, antibodies, which are typically only detected soon after an infection, suggesting that the babies hadn’t been infected with the coronavirus.

Experts don’t yet know if the amount of antibodies that passed on to the babies were enough to prevent newborns from getting Covid-19. And because only a few of the babies in the study were born prematurely, the researchers can’t say whether babies who are born early might miss out on those protective antibodies. The study authors also noted that because their results were from just one facility, the findings would need to be further replicated.

The placenta is a complex organ, and one that has been understudied, said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of the Covid expert group at the American College of Obstetricians and Gynecologists, who was not involved with the study.

And more research is needed to better understand whether vaccine-generated antibodies behave comparably to antibodies from Covid-19 infection, said Dr. Andrea G. Edlow, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.

In a study published in the journal Cell in December, for instance, Dr. Edlow and her colleagues found that Covid-19 antibodies from a natural infection might cross the placenta less efficiently than the antibodies produced after vaccination for flu and whooping cough (pertussis).

“What we really want to know is, do antibodies from the vaccine efficiently cross the placenta and protect the baby, the way we know happens in influenza and pertussis,” Dr. Jamieson said.

Experts do not know whether the Covid vaccine will work in this way, in part because pregnant women were excluded from the initial clinical trials.

“It’s plausible that the Covid vaccine will offer protection to both pregnant mothers and their infants,” said Dr. Mark Turrentine, a member of the Covid expert group at A.C.O.G. “To me,” he added, “this study highlights that inclusion of pregnant women in clinical trials such as the Covid-19 vaccine is essential, particularly when the benefit of vaccination is greater than the potential risk of a life-threatening disease.”

Pregnant Women Get Conflicting Advice on Covid-19 Vaccines

The W.H.O. and the C.D.C. provide differing views, and experts partly blame a lack of data because expectant mothers have been excluded from clinical trials.

A New Option for Morning-After Contraception?

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

A New Option for Morning-After Contraception?

An hormonal IUD may work as well as morning-after pills for preventing pregnancy, a new study suggests.

Nicholas Bakalar

  • Jan. 27, 2021, 5:04 p.m. ET

Only two forms of “morning-after” contraception are approved by the Food and Drug Administration, both hormonal drugs taken orally as pills: levonorgestrel (Plan B One-Step and other brands, available over the counter) and ulipristal acetate (Ella, available by prescription). Observational studies strongly suggest that a nonhormonal copper intrauterine device (ParaGard) may also be effective.

Now researchers have found that another type of IUD, one containing the hormone levonorgestrel (Liletta and other brands) works as well as the copper IUD, and perhaps even better than the F.D.A.-approved oral pills for preventing pregnancy.

The study, in the New England Journal of Medicine, tested the copper IUD against intrauterine levonorgestrel in a randomized trial. Researchers recruited 638 women seeking emergency contraception at three Utah family planning clinics, randomly assigning them to one device or the other.

After one month, there were no pregnancies among women who used the copper IUD, and one among those who used the hormonal IUD. The researchers calculate that the incidence of pregnancy with intrauterine levonorgestrel is 0.3 percent, compared with 1.4 to 2.6 percent with oral contraceptives.

Neither of the intrauterine devices is now approved for emergency contraception, but the lead author of the study, Dr. David K. Turok, an associate professor of obstetrics and gynecology at the University of Utah, expects professional guidelines to include them soon.

“The main thing is that this is another option that may be highly attractive,” he said. “Now we have a well-designed and executed study that shows it can be used.”

A ‘Baby’ Aspirin a Day May Help Prevent a Second Pregnancy Loss

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

A ‘Baby’ Aspirin a Day May Help Prevent a Second Pregnancy Loss

Women who have had a pregnancy loss and are trying to get pregnant again may benefit from a daily low-dose aspirin.

Nicholas Bakalar

  • Jan. 27, 2021, 12:07 p.m. ET

For women who have had a pregnancy loss and are trying to become pregnant again, a simple routine might increase their chances: taking one baby aspirin a day.

A previous randomized trial suggested that aspirin had no beneficial effect. But a re-analysis of the data, concentrating on women who were strictly adherent to the dosage, shows that a daily 81-milligram tablet taken while trying to become pregnant and throughout pregnancy is highly effective. The new report is in Annals of Internal Medicine.

The re-analysis included 1,227 women aged 18 to 40 who had one or two pregnancy losses and were trying to get pregnant again. The researchers found that compared with placebo, taking a baby aspirin five to seven days a week resulted in eight more pregnancies, 15 more live births, and six fewer pregnancy losses for every 100 women in the trial. The key was strict adherence to the aspirin regimen.

Women who were most adherent were more likely to be married, non-Hispanic white and of higher socioeconomic status, and less likely to be smokers. The association of daily aspirin use with successful pregnancy was apparent even after controlling for these factors.

The lead author, Ashley I. Naimi, an associate professor of epidemiology at Emory University, cautioned that the findings apply only to women who have lost one or two pregnancies, but those women, he said, “could consider low-dose aspirin provided there are no other contraindications for aspirin use.” Check with your doctor about taking a daily low-dose aspirin.

Celebrity Pregnancy Is Big Business

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

Celebrity Pregnancy Is Big Business

These days, content begins at conception.

Clockwise from top left, Instagram posts by Danielle Brooks, Nicole Polizzi, Iskra Lawrence (pictured with Philip Payne) and Audrina Patridge, all of whom teamed up with brands to produce pregnancy-related content.
Clockwise from top left, Instagram posts by Danielle Brooks, Nicole Polizzi, Iskra Lawrence (pictured with Philip Payne) and Audrina Patridge, all of whom teamed up with brands to produce pregnancy-related content.

  • Jan. 23, 2021, 5:00 a.m. ET

The year 1948 yielded one of history’s great non-announcements: an opaque statement from Buckingham Palace that Queen Elizabeth II would undertake “no public engagements after the end of June.” That she was pregnant with her first child, Prince Charles, went wholly unmentioned.

In the intervening decades, things have gotten a bit more explicit — and lucrative. The news that a public figure is pregnant often comes directly from the source, in a post that may also be an #ad.

The most obvious brand partners in this area are purveyors of pregnancy tests. Clearblue has worked with upward of 70 celebrities and influencers on endorsements of its products since 2013. First Response has sponsored pregnancy announcements, too, including ones by the singer Kelis and the ballroom dancer Karina Smirnoff.

Other companies, like Belly Bandit (which sells maternity wear), Enfamil (the formula maker) and CBR (a cord-blood banking company), also make deals with celebrities around pregnancy and other parenting milestones.

When Audrina Patridge of “The Hills” announced her pregnancy on Twitter in 2015, her words were accompanied by a photo reminiscent of a 1950s advertisement for laundry detergent: pleasant partial smile, product (a Clearblue pregnancy test) positioned on a diagonal with the model’s shiny eyes and, of course, some copy to hammer the point home (#babyontheway).

“It was a very clear, easy way to announce to the world and let everybody know at the same time that you’re pregnant, because it says ‘pregnant.’ You’re holding it,” Ms. Patridge said. (Still, it seemed to confuse her reality co-star Spencer Pratt, who was unsure whether the post was an ad or personal announcement. Today, we take for granted that celebrity baby posts can be both.)

Iskra Lawrence, a British model with four million Instagram followers, told her management team that she’d seen the paid announcement posts and was interested in doing one herself. She shared her news in late 2019 with First Response and donated $20,000 — most of the fee, she said — to two followers experiencing infertility; the post was, at once, a P.R. blast, an ad and an awareness campaign.

The amount of exposure a brand will get by sponsoring a pregnancy announcement is “exponential,” said Sarah Boyd, a vice president at Socialyte, which brokers marketing deals for influencers and celebrities. The fee depends on “their fame and their relevance at the time,” she said, and likely diminishes after their first child. Ms. Boyd estimated that someone like Kylie Jenner could ask for more than $1 million.

But for many stars, the decision to post at all is fraught with questions about control, influence, labor and privacy.

‘People Want More and More of You’

These brand partnerships reinforce the idea of motherhood as defined by consumption and spending, said Renée Cramer, a professor of law, politics and society at Drake University and the author of “Pregnant With the Stars: Watching and Wanting the Celebrity Baby Bump.”

In her book, she explains the way celebrity mothers become “branded exemplars of how ordinary people can and should live.” When we see a celebrity holding up a certain brand of pregnancy test or diapers, Dr. Cramer said in an interview, it reminds “average people that, well, this company belongs in your nursery, even if there’s no good reason for it.”

Ellis Cashmore, a visiting professor of sociology at Aston University in Birmingham, England, and the author of “Kardashian Kulture: How Celebrities Changed Life in the 21st Century,” noted that celebrities have already licensed their names to perfume lines, turned their lives into smartphone apps and sold their time on apps like Cameo. “It’s only logical to expect that they are monetizing a life before it becomes a life,” he said.

Nicole Polizzi, who came to fame as Snooki on the MTV show “Jersey Shore,” has watched the tide shift on celebrities navigating this part of their public lives. She announced her first pregnancy in 2012 on the cover of People magazine. “Back then it was such a big deal,” she said. “By the third, you’re just like, ‘Right, Instagram post. Here it is.’”

The public once wrestled with the notion of celebrity moms oversharing. Now, fans want to know the sex, the name, the due date. Paparazzi are stationed outside of maternity wards. In a world that is always on baby bump watch, the celebrity has two options, Dr. Cramer said: “I can try and control the image, or I can profit some way.”

Babies are expensive, said the actress Danielle Brooks (best known for her role on “Orange Is the New Black”), who ultimately felt joyful about teaming up with Clearblue to announce her pregnancy to the world in late 2019. “You have to do what is right for your family.”

There is also pressure as an online figure to “keep creating content” to build your following, said Ms. Lawrence, the model. After birth, she said she felt a “tug of war” between wanting to be present with her baby and wondering: “Is this something that I should capture just in case?”

“People want more and more of you,” said the author and actress Jenny Mollen, who is married to the actor Jason Biggs. She has talked about postpartum bladder leakage, Grave’s disease, Botox and her placenta; she announced her second pregnancy with a baby product company in a five-figure deal, she said.

Dr. Cramer said this continuing sharing is “double performative labor.” The celebrity not only carries out the reproductive and care-taking labor of motherhood, but also transmits a performance of that identity to followers.

Even celebrities who keep a lid on their pregnancies must strategize the eventual rollout of their child. On Aug. 26, UNICEF announced the birth of a baby to Katy Perry and Orlando Bloom on Instagram. (Ms. Perry had announced her pregnancy in a music video.) Ms. Perry then reposted the Unicef link; her post was liked by more than 5.5 million people.

The Private Becomes Public

Pregnant people famous and not grapple over the timing of these announcements. Conventional wisdom is to wait until at least 12 weeks before revealing a pregnancy, though second- or third-trimester pregnancy loss is still possible. When a publicly announced pregnancy is lost, it becomes a much bigger story, said Dr. Cashmore.

Takiema Bunche-Smith woke up in her Brooklyn home on Oct. 1 to direct messages from friends warning her that she may find social media triggering that day. Chrissy Teigen had just posted photos portraying the loss of her third child with John Legend, and social media was overflowing with both sympathy and criticism.

Ms. Bunche-Smith’s first child was stillborn at 37 weeks and two days in 2003; at the time, talking about such a loss felt taboo. She found Ms. Teigen’s post powerful. “The photos were so poignant and bittersweet and such a clear example of what every one of us experiences,” she said. (Ms. Teigen noted in a Medium essay that the responses she received from followers were overwhelmingly kind, and that they helped her through an impossible time.)

“You worry about upsetting other pregnant women, you worry about how your loss will affect them,” said Georgina Brackstone, a 40-year-old jewelry designer in London who lost her first daughter 33 weeks into pregnancy nine years ago. She said public figures like Ms. Teigen had “allowed people like me to talk about their experiences.”

Elizabeth Cordero, a Los Angeles hairdresser who has had multiple miscarriages and lost her baby seven days after birth, said there is no “safe” date after which to announce. She is halfway through a pregnancy and said that “this time around, we’ve decided that we’re just going to celebrate every damn day.”

In situations where there are birth complications, difficulties breastfeeding, perinatal mood and anxiety disorders, or bladder leakage, celebrities now seem more inclined to share this too, with the hope that their openness may help someone else.

“If they are doing a public service, or they believe that they are, in talking about a product, there are women who will benefit from that message, whether or not it’s paid,” Dr. Cramer said.

It is assumed that the sharing also benefits the author, something Ms. Mollen has begun to question. “The more of ourselves we give away, the more the more we’re sort of rewarded for it, and that’s a slippery slope,” she said. “It’s all performance, even the stuff that you’re saying: ‘This is real. This is my real life.’”

In April, Ms. Lawrence welcomed her baby with her partner, Philip Payne, who is a music executive. When her followers wanted to know about her at-home water birth, she shared a video of that. It seemed important, she said.

Now, she’s not as sure about putting it all on Instagram. “The aim is to be more in control of my life and future and career,” she said. “Having it so much reliant on social media feels unstable.”

The Eggs I Sold, the Baby I Gained

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

Ties

The Eggs I Sold, the Baby I Gained

Instead of lolling around in a lush pool of liquid, our baby was balled tight. Was there a connection to the eggs I had donated 10 years earlier?

Credit…Lucy Jones

  • Jan. 22, 2021, 5:00 a.m. ET

My son’s life began, as all babies’ lives do, with an egg.

Although, in my case, the egg that started it all — the egg that set off the Rube Goldberg machine leading to Finnegan’s life — was released not 10 months before his birth, but 10 years.

And released isn’t quite the right word. More like extracted. Because, those 10 years ago, I was an egg donor, and my eggs went to a wealthy Upper East Side couple. I, in return, got $8,000.

I used the money to pay rent on my East Village sublet. I used it to pay back taxes. And when my visa expired — I’m Canadian — and I needed to temporarily leave the United States, I used it to pay for a flight to Europe. It was there, in a 16-bunk room in a hostel in Prague, that I met my husband, Emmett. Still buoyed by my doctor’s comment, during a post-donation checkup, that she’d retrieved an “impressive” 29 eggs from me, I joked to Emmett, half-bragging and half-warning, that I was “aggressively fertile.” I was aware, even as the words left my mouth, of the dangerous karmic territory I was putting myself in.

A decade later, I was back on the Upper East Side, watching a sonographer slide a scanner across my slick stomach. On the screen overhead, our son surfaced, then slipped away, a grainy creature rising and receding from view.

At first, I thought the sonographer was just deep in concentration. A few minutes ago, she’d let us listen to our baby’s heartbeat, and having heard it, I’d relaxed. A heartbeat meant alive, after all. But I hadn’t considered another possibility — the space between “everything’s fine” and “we’re so sorry.” That in-between space was this silence, stretching from seconds into minutes as the sonographer arced and dipped, slid and burrowed, performing an artful slalom along the contours of my abdomen.

A lifetime of television and movie watching had taught me what to expect from an ultrasound image — bigheaded babies swimming in inky seas of amniotic fluid, extending their spindly limbs like in utero E.T.s. What we were looking at — it wasn’t that. Our baby didn’t float in space, because there was none. Instead of lolling around in a lush pool of liquid, he was balled tight, cloaked in something resembling Saran Wrap. Everything beyond that was static gray and solid. I stared hard, struggling to interpret what I was seeing. The technician left to get the doctor.

Amniotic fluid doesn’t seem like much. At that moment, the 16-week mark of my pregnancy, it was basically saline. But for unborn babies, that briny bath is everything — the air they breathe, the food they eat, the home they live in. And our baby was living with very little of it. The fact that he was living at all, the doctor explained to us, was a minor miracle.

“Your membranes have collapsed,” she said, the tip of her manicured nail indicating the thin layer that clung claustrophobically to our baby. “And we’re seeing very little amniotic fluid.”

“If your fluid levels fall any further,” she explained gently, “it’s likely the baby won’t be viable.”

The baby. Interesting that she didn’t say “your baby,” the way other doctors had before. It already felt as if he was slipping away from me.

Another thing that slipped away from me in that moment was certainty. Specifically, the certainty that having an abundance of something at 22 meant being able to count on it at 32. But bodies aren’t like that. And women’s bodies, understudied and misunderstood as they often are, frequently defy easy explanation.

Just as the American College of Obstetricians and Gynecologists reported that 50 to 75 percent of women who suffer from recurrent miscarriages will never know why, and the Obstetrical and Gynecological Survey found that as many as 30 percent of couples who struggle to conceive are diagnosed only with “unexplained infertility,” I couldn’t draw a definitive line between the eggs I traded so cavalierly and the baby barely surviving inside me.

But after my sonogram, as the cab carrying me and Emmett home came to rest, briefly, in front of the entrance to the egg donor clinic I had frequented so many years ago, I didn’t feel like being fair-minded. Instead, my eyes narrowed, as if looking askance at an enemy.

You did this, I thought. It was you who cranked up my hormones. You who sucked the stuff of life out of me. You who made me flippant about my fertility. I nearly hissed these accusations aloud.

But then I imagined the cool glass and chrome of the clinic’s revolving doors hissing back. Saying: Anything could have caused this. Saying: Without me you wouldn’t have met your husband. Saying: You should be thanking me that you’re pregnant at all. It was so vivid I could practically picture the revolving doors slinging words as they spun. And the doors would have been right.

I spent the next four months on bed rest — lying on my left side, drinking gallons of water a day. And though my fluid levels didn’t rise, they didn’t fall either. My son and I persisted in the liminal space between life and death, right on the razor-thin edge of viability, watching time tick away. I tracked the passage of that time not only by how far along I was, but also by how old my egg donor children might have been. They could have been in the fourth grade. They could have been old enough to ride the subway alone. They could have been clipping me with their bike wheels as they rounded a street corner near my home in Flatbush.

I made it to 33 weeks before Finnegan arrived. He was born folded and twisted like a street cart pretzel, with knee, hip and elbow dislocations. He was born with lungs so weak he needed the help of machines to breathe for nearly two months. But he was born. And as I stared down at him in the NICU, noting his similarities to me — the blue eyes, the brown hair, the upturned nose that got me called Miss Piggy as a kid — I wondered: If Finnegan and I were out together someday and we saw kids who shared our same constellation of features, would I notice? Or, having been mixed with some unknown Y-chromosome, would my egg donor children be unrecognizable even to me?

Recently, I listened to a podcast about the children of a serial sperm donor. Each of them innocently submitted swabs to 23andMe, expecting to find out what part of the world they were from and what diseases they were susceptible to. Instead, they discovered they had dozens of donor siblings (or “diblings,” as they called each other). This floored me. I’d never imagined there would be a line — traceable and discoverable for a mere $199 — from Finnegan to the children who might have been born from the eggs I sold. The cloak of anonymity under which I donated my eggs couldn’t have predicted the rapid rise of consumer DNA tests. Which meant I couldn’t predict how the decision I made 10 years before Finnegan’s birth might reverberate for the rest of his life.

As Finnegan, now 2, gets healthy at home — ditching his medications, outgrowing his casts and walking on his own — I’ve begun to consider how Emmett and I will talk to him about his possible part-siblings someday. It’s forced me to question, after all these years, how I see my egg donation.

Was it a means to an end, simply a way to supplement my meager intern’s salary?

Was it the ultimate gift, making the dreams of would-be parents possible?

Was it the thing I’ll always suspect damaged my womb and endangered Finnegan’s life?

Or was it, as I imagined those revolving doors saying, the necessary precursor to everything in my life that I love? Not so much a revolving door as, to borrow a Gwyneth Paltrow rom-com metaphor, a sliding one?

Yes. Yes. Yes. And, yes.

And so, when we eventually tell Finnegan his birth story, it will be a story of circumstances, close calls, a fateful meet cute, and so much love. A story with at least one happily ever after. Or maybe as many as 29.

Justine Feron is a writer and advertising executive who lives in Brooklyn with her husband and son.

Hypertension During Pregnancy Tied to Later Cognitive Decline

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

Hypertension During Pregnancy Tied to Later Cognitive Decline

Pregnant women with blood pressure readings above 140/90 had deficits on tests of mental agility 15 years later.

Nicholas Bakalar

  • Jan. 20, 2021, 2:46 p.m. ET

Women who develop gestational hypertension — high blood pressure during pregnancy — may have reduced cognitive abilities later in life, a recent report suggests.

The study, in Neurology, included 115 women with a history of gestational hypertension between 2002 and 2006. They measured their mental agility an average of 15 years later using well-validated tests of verbal fluency, processing speed, memory and visuospatial skills. Then they compared their results with those of 481 women whose blood pressure remained normal during their pregnancies.

After controlling for ethnicity, educational level, pre-pregnancy B.M.I. and other factors, they found that women who were hypertensive during pregnancy had significantly lower scores on tests of working memory and verbal learning than those whose blood pressure was normal.

The lead author, Dr. Maria C. Adank, a researcher at Erasmus University in Rotterdam, pointed out that the effect was driven mainly by the 70 percent of women in the study who had only mild hypertension — readings above 140/90 — and not by the 30 percent who had pre-eclampsia, the extremely high blood pressure that, untreated, can lead to organ damage and death in both mothers and babies.

“These are women with only mild hypertension. They’re healthy. But even at age 45 they have impaired cognition,” she said. “They and their clinicians should be aware of the risk, and they should be followed up. We think that hypertension is going to persist beyond pregnancy, and it should be treated.”

Weekly Health Quiz: Exercise, Body Temperature and a Covid Vaccine Mystery

1 of 7

An 11-minute program of calisthenics and rest, done three times a week for six weeeks, had this effect on out-of-shape young men and women:

It increased their fitness levels

It improved their endurance by 7 percent

It increased their leg power slightly

All of the above

2 of 7

Which statement about body temperatures is not true?

Worldwide, average body temperatures seem to be decreasing

Body temperatures tend to rise during and after exercise

Older people tend to have lower body temperatures than younger people

Body temperature tends to be higher in the morning than in the evening

3 of 7

Health authorities are investigating the death of a 56-year-old doctor in Florida who developed this blood clotting disorder days after receiving the Covid vaccine:

Hemophilia

Pernicious anemia

Acute immune thrombocytopenia

Myelodysplastic syndrome

4 of 7

Creutzfeldt-Jakob disease, sometimes called mad cow disease, is thought to be caused by this type of infectious organism:

Bacteria

Virus

Fungus

Prion

5 of 7

Which statement about throat cancers is not true?

Most throat cancers are caused by human papillomavirus, or HPV

Having oral sex at a young age increases the risk of developing throat cancer

HPV-associated throat cancers are more common in women than men

HPV-associated throat cancers are more common in whites than in African-Americans

6 of 7

Being overweight during pregnancy was tied to this fertility issue, Danish researchers report:

Mothers who are overweight during their first pregnancy are at increased risk of fertility problems during subsequent pregnancies

Daughters born to overweight mothers were at increased risk of having fertility problems

Sons born to overweight mothers were at increased risk of being infertile

All of the above

7 of 7

Diets rich in this vitamin were tied to a lower risk of developing Parkinson’s disease:

Vitamin A

B vitamins

Vitamins C and E

Vitamin D

Fathers Health Tied to Pregnancy Loss

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

‘Fertility Is a Team Sport’: Father’s Health Tied to Pregnancy Loss

Conditions like hypertension, high cholesterol, obesity and diabetes in a father may affect whether a pregnancy reaches full term.

Nicholas Bakalar

  • Dec. 23, 2020, 12:40 p.m. ET

A father’s poor health before conception may increase the risk for pregnancy loss, a new study suggests.

Researchers analyzed records from an employee insurance database that included data on 958,804 pregnancies between 2007 and 2016, along with information on the health of the parents for an average of about four years before conception. The study is in Human Reproduction.

They scored the fathers’ health based on elements of the metabolic syndrome: diagnoses of hypertension, high cholesterol, obesity or diabetes, plus the presence of other common chronic diseases. About one-fifth of the pregnancies ended in either ectopic pregnancy, spontaneous abortion or stillbirth.

Compared with men who had none of these five indications of ill health, those who had one had a 10 percent increased risk for siring a pregnancy that ended in loss. Having two increased the risk by 15 percent, and men who had three or more had a 19 percent increased risk. The age of the mother made little difference, and the study controlled for other maternal and paternal health and behavioral factors.

“We need to think about the father even pre-conception,” said the senior author, Michael L. Eisenberg, an associate professor of urology at Stanford. “We contribute half the DNA, so it makes sense that that would affect the trajectory of the pregnancy. I want to show that the father is important — fertility is a team sport.”

Covid Vaccine During Pregnancy? Even Doctors Struggle With This Question

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

Doctors

I’m a Pregnant Doctor. Should I Get the Covid Vaccine?

A doctor struggles with the lack of data surrounding the Covid-19 vaccine and pregnancy.

Credit…Nam Y. Huh/Associated Press

  • Dec. 22, 2020, 5:00 a.m. ET

The morning after the Food and Drug Administration approved the emergency use authorization of the first coronavirus vaccine, I awoke to a message from my hospital asking me to sign up for an appointment to get vaccinated.

It brought tears to my eyes. As a primary care doctor, I haven’t exactly been on the front lines of the Covid-19 fight, but it’s upended my life and the lives of my patients. With the vaccine’s approval — and now a second one — we finally have an end in sight. Within hours, my colleagues were all texting each other, abuzz with the excitement of scheduling their vaccine appointments.

But I quickly learned I have an impossible choice ahead of me.

I am pregnant, and all of the clinical trials on Covid-19 vaccines excluded pregnant people. This is no surprise: pregnant people are frequently left out of clinical research because of the complexity of pregnancy, including concerns about potential harm to the fetus. That leaves us with little data to help us make decisions about medications and vaccines.

Instead we’re on our own, winging it during an already vulnerable time. And as I care for a ballooning number of coronavirus-positive patients each day, my decision about the vaccine seems more urgent than ever.

The news of my pregnancy was a joyful moment for my family in a difficult year, but Covid-19 has been a terrifying backdrop. I practice in Camden, N.J., and our community has been hard-hit. Infections are soaring above the springtime peak. My inbox contains positive case after positive case.

My patients are the most essential of essential workers — home health aides, warehouse workers, janitors — still, even after all we’ve learned this year, with little job security, minimal paid sick leave and inadequate personal protective equipment. And as my patients get exposed to the virus, so do I.

The data on coronavirus infection during pregnancy are not reassuring. Pregnant people who get the virus seem to have a higher risk for severe symptoms and complications, and there also may be a small increased risk of preterm birth. Each day I walk into my clinic, I ask myself, “Will this be the day I get it?”

The early news about the efficacy of the vaccines was thrilling. But there has been little data on how the vaccine affects pregnant people. No pregnant patients were enrolled in the early trials, although some people got pregnant during the course of the study. Researchers are monitoring them to see how they do.

According to Ruth Faden, a Johns Hopkins bioethicist who studies vaccine policy, the reluctance to include pregnant research subjects in clinical trials has a long history.

“There’s an inertia that’s set in,” she told me. Studying pregnant people requires extra effort in safe study design and recruitment efforts, so rather than do the hard work, she says, pregnant women are often just excluded altogether.

“It’s an ethically complex situation,” she added. “Pregnancy is like nothing else. Anything you do to a pregnant woman also has a chance of affecting the developing offspring.”

Researchers estimate we have adequate data on the risk of birth defects in less than 10 percent of medications approved by the Food and Drug Administration since 1980. That means any time a pregnant person thinks about using a medication or vaccine, she might feel like she’s making a decision at random, without any rigorous information to guide her.

That’s certainly how I feel right now. My medical training taught me to respect my patients’ autonomy; I see my job as guiding them through confusing medical information and helping them make decisions, not making decisions for them. Patient autonomy is a primary value in medicine.

I was glad to see that the F.D.A. left the choice of whether or not to get the Covid-19 vaccine up to pregnant women, rather than excluding us from eligibility altogether. For a pregnant nursing home aide, or a pregnant intensive care unit nurse, the risk of getting Covid-19 might be greater than the risk of any potential vaccine side effects.

This isn’t a theoretical exercise for hundreds of thousands of health care workers. Women make up an estimated 76 percent of the health care work force, many of us of childbearing age. I have text message chains with several pregnant and breastfeeding physician friends, all of us trying to sort through the limited information we have.

But without any data to guide me, my autonomy to make the decision doesn’t feel as meaningful. The American College of Obstetricians and Gynecologists offered this wildly unsatisfying recommendation: “Covid-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination.” The Centers for Disease Control and Prevention issued similarly noncommittal guidance: “Health care personnel who are pregnant may choose to be vaccinated.” Both are a far cry from the two organizations’ enthusiastic support for the flu vaccine in pregnancy, for example.

So it’s up to me and my nurse midwife, both of us smart clinicians, but not vaccine experts. I asked her what she thought, and she told me, “Honestly, I have no idea.”

I try to weigh the costs and benefits: I care for positive patients, but it’s not as if I’m an I.C.U. doctor. Many vaccines are safe in pregnancy — I gladly got my flu shot early on — but other vaccines aren’t. How can I weigh the costs and benefits if I don’t know what the costs are?

The two vaccines that have now been approved use a novel messenger RNA technology that has not been studied in pregnancy. It’s possible the mRNA and the bubble it travels in, made of lipid nanoparticles, could cross the placenta, according to Dr. Michal Elovitz, a preterm labor researcher and obstetrician at the University of Pennsylvania. This might, in theory, cause inflammation in utero that could be harmful to the developing fetal brain.

Or, the lipid nanoparticles might not cross the placenta, Dr. Elovitz says. It’s also possible the new vaccines could be totally safe in pregnancy, like the flu shot. We just don’t have the data yet.

“To avoid having pregnant people guess, we should be advocating for more preclinical and clinical research focused on pregnant patients,” she told me.

My bottom line: If I have the chance, I’ll gladly enroll in a clinical trial of a Covid-19 vaccine for pregnant people. It’s a choice that feels much more grounded in science than trying to figure this out on my own, because I’d be making it alongside the expertise of the scientists designing the trial.

I’d feel reassured that experts in immunology and pregnancy physiology had determined the safest trimester to get the vaccine. I’d feel reassured that they had done that using evidence from animal studies, and I’d feel reassured by the ethics board that approved the trial. It wouldn’t be a risk-free decision, but it would make me feel like it wasn’t a totally reckless one.

Until then, I’ll take care of my patients with my mask, my face shield, and my gloves, hoping I don’t get infected, thinking every day about my health and the health of my baby.

Dr. Mara Gordon is a family physician in Camden, N.J.

In Mexico, Midwives Step in as Covid Overshadows Childbirth

Doctors released Alejandra Guevarra Villegas, 19, from the operating room after delivering her baby girl by emergency C-section in San Luis Acatlán, a small town in the Costa Chica zone in the Mexican state of Guerrero.
Doctors released Alejandra Guevarra Villegas, 19, from the operating room after delivering her baby girl by emergency C-section in San Luis Acatlán, a small town in the Costa Chica zone in the Mexican state of Guerrero.

In Mexico, Childbirth in Covid’s Shadow

Midwives and doctors struggle to help women give birth safely during the grim days of the pandemic.

Doctors released Alejandra Guevarra Villegas, 19, from the operating room after delivering her baby girl by emergency C-section in San Luis Acatlán, a small town in the Costa Chica zone in the Mexican state of Guerrero.Credit…

Supported by

Continue reading the main story

  • Dec. 22, 2020, 3:00 a.m. ET

Rafaela López Juárez was determined that if she ever had another child, she would try to give birth at home with a trusted midwife, surrounded by family. Her first birth at a hospital had been a traumatic ordeal, and her perspective changed drastically afterward, when she trained to become a professional midwife.

“What women want is a birth experience centered on respect and dignity,” she said. She believes that low-risk births should occur outside hospitals, in homes or in dedicated birth centers, where women can choose how they want to give birth.

In late February, Ms. López and her family were anticipating the arrival of her second child at their home in Xalapa, Mexico, while following the ominous news of the encroaching coronavirus pandemic. She gave birth to Joshua, a healthy baby boy, on Feb. 28, the same day that Mexico confirmed its first case of Covid-19. Ms. López wondered how the pandemic would affect her profession.

photophotophoto

Rafaela López and her partner, José Hernández, awaiting the birth of their baby, with Rafaela’s daughter, Johana, 11, nearby.

Accompanied by midwife Pilar Victoria Rosique, Rafaela López Juárez tried to manage intensifying contractions when her labor started inside her home. Her partner José recorded the timing of the contractions.

Rafaela López examined Jessica Garcia Pérez, 32, while Ms. Garcia’s son took a photo during a prenatal home visit in Xalapa, Veracruz.

About 96 percent of births in Mexico take place in hospitals that are often overcrowded and ill-equipped, where many women describe receiving poor or disrespectful treatment. The onset of the pandemic prompted concern that pregnant women might be exposed to the virus in hospitals, and women’s health advocates in Mexico and globally expressed hope that the crisis might become a catalyst for lasting changes to the system.

A national movement has made determined but uneven progress toward integrating midwifery into Mexico’s public health system. Some authorities argue that well-trained midwives would be of great value, especially in rural areas but also in small nonsurgical clinics throughout the country. But so far, there has been insufficient political will to provide the regulation, infrastructure and budgets needed to employ enough midwives to make a significant difference.

During the first few months of the pandemic, anecdotal evidence suggested that midwifery was gaining traction in the country. Midwives all over Mexico were inundated with requests for home births. The government encouraged state authorities to set up alternative health centers that could exclusively focus on births and be staffed by nurses and midwives.

As Covid outbreaks spread, health authorities around the country started to see sharp declines in prenatal consultations and births in hospitals. At the Acapulco General Hospital in Mexico’s Guerrero state, Dr. Juan Carlos Luna, the maternal health director, noted a 50 percent decline in births. With skeletal staffs at times working double shifts, doctors and nurses pushed through under dire conditions. “Nearly everyone on my team has tested positive for the virus at some point,” Dr. Luna said.

photophotophotophoto

Funeral workers remove the body of a patient who died from Covid-19 at the General Hospital in Acapulco, Guerrero, Mexico.

Employees of a German company, Sanieren, based in Mexico City, sanitized the Covid triage area of the Acapulco General Hospital.

Medical personnel assisted María de Jesús Maroquín Hernández, preparing her for discharge from the Covid-19 intensive care unit at the Acapulco General Hospital.

María de Jesús Maroquín Hernández contracted Covid when she was 36 weeks pregnant, and was hospitalized for five days at Acapulco General Hospital, four hours from her home near Ometepec, Guerrero, Mexico. Later, she gave birth to a baby girl, who she and her husband named Milagro, Spanish for miracle.

Inside the Covid-19 intensive care unit at Acapulco General, doctors treated María de Jesús Maroquín Hernández. She had developed breathing problems at 36 weeks pregnant, prompting her family to drive her four hours to the hospital. Doctors isolated Ms. Maroquín while her family waited outside, watching funeral workers carry away the dead Covid patients and worrying that she would be next. She was discharged after five days and soon gave birth, via emergency cesarean section, in a hospital near her home. She and her husband decided to name their baby girl Milagro — miracle.

photophotophoto

A central hub for dozens of mostly indigenous communities, San Luis Acatlán, a small town in the Costa Chica area of Mexico’s Guerrero state, became a “zone of high contagion” during the pandemic. Signs warned residents to wear masks.

Soldiers guard the Ometepec General Hospital in Mexico’s Guerrero state. As the Covid pandemic intensified, the public sometimes stormed hospitals and threatened doctors.

Ometepec General Hospital was nearly empty at times, as the public shunned hospitals in fear. State health authorities had ordered the reconfiguration of many public hospitals to create separate Covid and non-Covid sections.

In Mexico’s Indigenous communities, women have long relied on traditional midwives, who have become even more important today. In Guerrero, some women have given birth with midwives at dedicated Indigenous women’s centers called CAMIs (Casas de la Mujer Indígena o Afromexicana), where women can also seek help for domestic violence, which CAMI workers say has increased. But austerity measures related to the pandemic have deprived the centers of essential funding from the federal government.

Other women have chosen to quarantine in their communities, seeking help from midwives like Isabel Vicario Natividad, 57, who keeps working though her own health conditions make her vulnerable to the virus.

photophotophoto

Salustria Leonídez Constancia and her daughter in-law, Citlali Salvador de Jesús, examining Juliana Toribio Teodoro, 27, in Yoloxóchitl, a small Mixteco community located near San Luis Acatlán in Mexico’s Guerrero state.

Midwife Alma Delia Felipe Hidalgo attending a birth at Casa de la Mujer Indígena Nellys Palomo Sánchez, in San Luis Acatlán, a small town in the Costa Chica zone of Guerrero state.

In the remote community of Pueblo Hidalgo, in the Southern mountains of Guerrero state, Isabel Vicario Natividad, a midwife, approached the home of one of her clients, Guillermina Francisco Flores, 38, pregnant with her fifth child.

As Covid-19 cases surged in Guerrero, state health authorities reached out to women and midwives in remote areas with potentially high rates of maternal and infant mortality.

“If the women are too afraid to come to our hospitals, we should go find them where they are,” said Dr. Rodolfo Orozco, the director of reproductive health in Guerrero. With support from a handful of international organizations, his team recently began to visit traditional midwives for workshops and to distribute personal protective equipment.

photophotophotophoto

Ms. Vicario performing a prenatal check on Ms. Flores.

Melquiades Villegas Feliciano, 23, supporting his wife, Luisa Ortega Cantu, while Ms. Vicario helped the couple prepare for the birth of Ms. Ortega’s third child.

Luisa Ortega Cantu’s newborn was kept attached to the umbilical cord and placenta for several minutes after delivery, a practice of traditional midwives.

Isabel Vicario with Ms. Ortega’s baby.

In the capital city of Chilpancingo, many women discovered the Alameda Midwifery Center, which opened in December 2017. During the initial phase of the pandemic, the center’s birth numbers doubled. In October, Anayeli Rojas Esteban, 27, traveled two hours to the center after her local hospital could not accommodate her. She was pleasantly surprised to find a place with midwives who actually allowed her to give birth accompanied by her husband, José Luis Morales.

“We are especially grateful that they did not cut her, like they did during her first hospital birth,” Mr. Morales said, referring to an episiotomy, a surgical procedure that is routine in hospital settings but increasingly seen as unnecessary.

photophotophotophoto

Hoping to avoid the coronavirus, many women in Mexico sought maternity care at places like the Alameda Midwifery Center in Chilpancingo in Guerrero. During the initial months of the pandemic, the center’s birth numbers doubled.

Members of the Maternal Health Unit of the Guerrero health care sector teaching local midwives about Covid protection measures and breast cancer detection methods.

Midwives who took part in the course by the Maternal Health Unit received a set of P.P.E.

Anayeli Rojas Esteban, 27, tries giving birth in a standing position at the Alameda Midwifery Center.

While Mexico’s state health authorities struggled to contain the virus, the situation in the nation’s capital further illustrated the dangers and frustrations that women felt.

In the spring, health authorities in Iztapalapa, the most densely populated neighborhood of Mexico City, scrambled as the area became a center of the country’s coronavirus outbreak. The city government converted several large public hospitals in Iztapalapa into treatment facilities for Covid-19 patients, which left thousands of pregnant women desperate to find alternatives. Many sought refuge in maternity clinics such as Cimigen, where the number of births doubled and the number of prenatal visits quadrupled, according to the clinic’s executive director, Marisol del Campo Martínez.

Other expectant mothers joined the growing ranks of women seeking a home birth experience, for safety reasons and to avoid a potentially unnecessary cesarean section. In Mexico, roughly 50 percent of babies are delivered via C-section, and pregnant women face pressure from peers, family members and doctors to have the procedure.

In July, Nayeli Balderas, 30, who lived close to Iztapalapa, reached out to Guadalupe Hernández Ramírez, an experienced perinatal nurse and the president of the Association of Professional Midwives in Mexico. “When I started to research about humanized birth, breastfeeding, et cetera, a whole new world opened for me,” Ms. Balderas said. “But when we told our gynecologist about our plan, her whole face changed, and she tried to instill fear in us.” Undaunted, Ms. Balderas proceeded with her home birth plan.

Her labor, when it came, was long and increasingly difficult. After 12 hours, Ms. Balderas and her husband conferred with Ms. Hernández and decided to activate their Plan B. At 3 a.m., they rushed to the private clinic of Dr. Fernando Jiménez, an obstetrician-gynecologist and a colleague of Ms. Hernández, where it was decided that a C-section was needed.

photophotophotophotophotophoto

Janet Jarman

Juan Luis de la Torre Islas joined dozens of other parents waiting to receive vaccinations for their children at Cimigen, a small maternity hospital in Iztapalapa, Mexico City’s most populous and most densely populated delegation, that had become the epicenter of the virus.

Nayeli Balderas, 30, in labor, with her husband, Javier Basilio Lara, 31, in their Mexico City apartment, where they hoped she would give birth. Ms. Balderas had expected a hospital birth, but after the pandemic began, the couple decided to try for a home birth to avoid the coronavirus.

After hours of labor, Ms. Balderas’s baby still had not rotated into the right position for birth. The nurse midwives advised different birthing positions, but the infant still would not budge. Twelve hours later, the midwives took her to a small, private clinic for a cesarean birth.

Ms. Balderas with her son, born by cesarean section in a small private clinic at 4 a.m.

Maira Itzel Reyes Ferrer, 26 and her husband, Hugo Alberto Albarran Jarquin, 33, attended a class offered by an obstetric nurse and a 92-year-old traditional midwife who together blend traditional practices and modern medicine. Ms. Reyes had her first child a week later.

Elva Carolina Díaz Ruiz, the obstetric nurse, massaged Ms. Ferrer as her contractions begin to intensify. Pilar, her midwife, right, was in attendance.

In September, on the other side of Mexico City, Maira Itzel Reyes Ferrer, 26, had also been researching home births and found María Del Pilar Grajeda Mejía, a 92-year-old government-certified traditional midwife who works with her granddaughter, Elva Carolina Díaz Ruiz, 37, a licensed obstetric nurse. They guided Ms. Reyes through a successful home birth.

“My family admitted that they were sometimes worried during the birth,” Ms. Reyes said. “But in the end, they loved the experience — so much so that my sister is now taking a midwifery course. She already paid and started!”

As winter begins, Mexico is confronting a devastating second wave of the coronavirus. Hospitals in Mexico City are quickly running out of space. The much-discussed government midwifery birth centers have not yet come to fruition, and medical workers at prestigious hospitals like the National Institute of Perinatology, or INPer, are working around the clock.

Early on in the pandemic, INPer personnel discovered that roughly one-quarter of all women admitted to the hospital were testing positive for the coronavirus. Administrators set up a separate Covid-19 ward, and Dr. Isabel Villegas Mota, the hospital’s head of epidemiology and infectious disease, succeeded in securing adequate personal protective equipment for the staff. Not all frontline workers in Mexico have been this lucky; the Covid-19 fatality rate for medical personnel in Mexico is among the highest in the world.

photophotophoto

Grecia Denise Espinosa tested positive for the coronavirus at the National Institute for Perinatology in Mexico City, and was admitted to the Covid unit where she gave birth by cesarean.

Minutes after the births, Ms. Espinosa’s twins were examined and tested for the virus.

Because Ms. Espinosa and her babies were in good condition, doctors encouraged her to breastfeed, provided that she wore a mask and face shield. 

When Grecia Denise Espinosa learned she was pregnant with twins, she made plans to give birth at a well-known private clinic. But she was shocked by the high cost and decided to consult doctors at INPer instead. To her surprise, when she entered the hospital in November, she tested positive for the virus and was sent to the Covid-19 unit, where doctors performed a C-section.

Maternal health advocates have long said that Mexico’s obstetric model must change to center on women. If ever there were a moment for health authorities to fully embrace midwifery, now is the time, they say, arguing that the thousands of midwives throughout the country could help alleviate pressure on an overburdened and often distrusted health care system while providing quality care to women.

“The model that we have in Mexico is an obsolete model,” said Dr. David Meléndez, the technical director of Safe Motherhood Committee Mexico, a nonprofit organization. “It’s a model in which we all lose. The women lose, the country loses, and the health system and medical personnel lose. We are stuck with a bad model at the worst moment, in the middle of a global pandemic.”

Sunset over the Casas de la Mujer Indígena o Afromexicana in Guerrero.
Sunset over the Casas de la Mujer Indígena o Afromexicana in Guerrero.

Janet Jarman is a photojournalist and documentary filmmaker based in Mexico, and director of the feature documentary “Birth Wars.” She is represented by Redux Pictures.

How Midwives Have Stepped in in Mexico as Covid-19 Overshadows Childbirth

Doctors released Alejandra Guevarra Villegas, 19, from the operating room after delivering her baby girl by emergency C-section in San Luis Acatlán, a small town in the Costa Chica zone in the Mexican state of Guerrero.
Doctors released Alejandra Guevarra Villegas, 19, from the operating room after delivering her baby girl by emergency C-section in San Luis Acatlán, a small town in the Costa Chica zone in the Mexican state of Guerrero.

In Mexico, Childbirth in Covid’s Shadow

Midwives and doctors struggle to help women give birth safely during the grim days of the pandemic.

Doctors released Alejandra Guevarra Villegas, 19, from the operating room after delivering her baby girl by emergency C-section in San Luis Acatlán, a small town in the Costa Chica zone in the Mexican state of Guerrero.Credit…

Supported by

Continue reading the main story

  • Dec. 22, 2020, 3:00 a.m. ET

Rafaela López Juárez was determined that if she ever had another child, she would try to give birth at home with a trusted midwife, surrounded by family. Her first birth at a hospital had been a traumatic ordeal, and her perspective changed drastically afterward, when she trained to become a professional midwife.

“What women want is a birth experience centered on respect and dignity,” she said. She believes that low-risk births should occur outside hospitals, in homes or in dedicated birth centers, where women can choose how they want to give birth.

In late February, Ms. López and her family were anticipating the arrival of her second child at their home in Xalapa, Mexico, while following the ominous news of the encroaching coronavirus pandemic. She gave birth to Joshua, a healthy baby boy, on Feb. 28, the same day that Mexico confirmed its first case of Covid-19. Ms. López wondered how the pandemic would affect her profession.

photophotophoto

Rafaela López and her partner, José Hernández, awaiting the birth of their baby, with Rafaela’s daughter, Johana, 11, nearby.

Accompanied by midwife Pilar Victoria Rosique, Rafaela López Juárez tried to manage intensifying contractions when her labor started inside her home. Her partner José recorded the timing of the contractions.

Rafaela López examined Jessica Garcia Pérez, 32, while Ms. Garcia’s son took a photo during a prenatal home visit in Xalapa, Veracruz.

About 96 percent of births in Mexico take place in hospitals that are often overcrowded and ill-equipped, where many women describe receiving poor or disrespectful treatment. The onset of the pandemic prompted concern that pregnant women might be exposed to the virus in hospitals, and women’s health advocates in Mexico and globally expressed hope that the crisis might become a catalyst for lasting changes to the system.

A national movement has made determined but uneven progress toward integrating midwifery into Mexico’s public health system. Some authorities argue that well-trained midwives would be of great value, especially in rural areas but also in small nonsurgical clinics throughout the country. But so far, there has been insufficient political will to provide the regulation, infrastructure and budgets needed to employ enough midwives to make a significant difference.

During the first few months of the pandemic, anecdotal evidence suggested that midwifery was gaining traction in the country. Midwives all over Mexico were inundated with requests for home births. The government encouraged state authorities to set up alternative health centers that could exclusively focus on births and be staffed by nurses and midwives.

As Covid outbreaks spread, health authorities around the country started to see sharp declines in prenatal consultations and births in hospitals. At the Acapulco General Hospital in Mexico’s Guerrero state, Dr. Juan Carlos Luna, the maternal health director, noted a 50 percent decline in births. With skeletal staffs at times working double shifts, doctors and nurses pushed through under dire conditions. “Nearly everyone on my team has tested positive for the virus at some point,” Dr. Luna said.

photophotophotophoto

Funeral workers remove the body of a patient who died from Covid-19 at the General Hospital in Acapulco, Guerrero, Mexico.

Employees of a German company, Sanieren, based in Mexico City, sanitized the Covid triage area of the Acapulco General Hospital.

Medical personnel assisted María de Jesús Maroquín Hernández, preparing her for discharge from the Covid-19 intensive care unit at the Acapulco General Hospital.

María de Jesús Maroquín Hernández contracted Covid when she was 36 weeks pregnant, and was hospitalized for five days at Acapulco General Hospital, four hours from her home near Ometepec, Guerrero, Mexico. Later, she gave birth to a baby girl, who she and her husband named Milagro, Spanish for miracle.

Inside the Covid-19 intensive care unit at Acapulco General, doctors treated María de Jesús Maroquín Hernández. She had developed breathing problems at 36 weeks pregnant, prompting her family to drive her four hours to the hospital. Doctors isolated Ms. Maroquín while her family waited outside, watching funeral workers carry away the dead Covid patients and worrying that she would be next. She was discharged after five days and soon gave birth, via emergency cesarean section, in a hospital near her home. She and her husband decided to name their baby girl Milagro — miracle.

photophotophoto

A central hub for dozens of mostly indigenous communities, San Luis Acatlán, a small town in the Costa Chica area of Mexico’s Guerrero state, became a “zone of high contagion” during the pandemic. Signs warned residents to wear masks.

Soldiers guard the Ometepec General Hospital in Mexico’s Guerrero state. As the Covid pandemic intensified, the public sometimes stormed hospitals and threatened doctors.

Ometepec General Hospital was nearly empty at times, as the public shunned hospitals in fear. State health authorities had ordered the reconfiguration of many public hospitals to create separate Covid and non-Covid sections.

In Mexico’s Indigenous communities, women have long relied on traditional midwives, who have become even more important today. In Guerrero, some women have given birth with midwives at dedicated Indigenous women’s centers called CAMIs (Casas de la Mujer Indígena o Afromexicana), where women can also seek help for domestic violence, which CAMI workers say has increased. But austerity measures related to the pandemic have deprived the centers of essential funding from the federal government.

Other women have chosen to quarantine in their communities, seeking help from midwives like Isabel Vicario Natividad, 57, who keeps working though her own health conditions make her vulnerable to the virus.

photophotophoto

Salustria Leonídez Constancia and her daughter in-law, Citlali Salvador de Jesús, examining Juliana Toribio Teodoro, 27, in Yoloxóchitl, a small Mixteco community located near San Luis Acatlán in Mexico’s Guerrero state.

Midwife Alma Delia Felipe Hidalgo attending a birth at Casa de la Mujer Indígena Nellys Palomo Sánchez, in San Luis Acatlán, a small town in the Costa Chica zone of Guerrero state.

In the remote community of Pueblo Hidalgo, in the Southern mountains of Guerrero state, Isabel Vicario Natividad, a midwife, approached the home of one of her clients, Guillermina Francisco Flores, 38, pregnant with her fifth child.

As Covid-19 cases surged in Guerrero, state health authorities reached out to women and midwives in remote areas with potentially high rates of maternal and infant mortality.

“If the women are too afraid to come to our hospitals, we should go find them where they are,” said Dr. Rodolfo Orozco, the director of reproductive health in Guerrero. With support from a handful of international organizations, his team recently began to visit traditional midwives for workshops and to distribute personal protective equipment.

photophotophotophoto

Ms. Vicario performing a prenatal check on Ms. Flores.

Melquiades Villegas Feliciano, 23, supporting his wife, Luisa Ortega Cantu, while Ms. Vicario helped the couple prepare for the birth of Ms. Ortega’s third child.

Luisa Ortega Cantu’s newborn was kept attached to the umbilical cord and placenta for several minutes after delivery, a practice of traditional midwives.

Isabel Vicario with Ms. Ortega’s baby.

In the capital city of Chilpancingo, many women discovered the Alameda Midwifery Center, which opened in December 2017. During the initial phase of the pandemic, the center’s birth numbers doubled. In October, Anayeli Rojas Esteban, 27, traveled two hours to the center after her local hospital could not accommodate her. She was pleasantly surprised to find a place with midwives who actually allowed her to give birth accompanied by her husband, José Luis Morales.

“We are especially grateful that they did not cut her, like they did during her first hospital birth,” Mr. Morales said, referring to an episiotomy, a surgical procedure that is routine in hospital settings but increasingly seen as unnecessary.

photophotophotophoto

Hoping to avoid the coronavirus, many women in Mexico sought maternity care at places like the Alameda Midwifery Center in Chilpancingo in Guerrero. During the initial months of the pandemic, the center’s birth numbers doubled.

Members of the Maternal Health Unit of the Guerrero health care sector teaching local midwives about Covid protection measures and breast cancer detection methods.

Midwives who took part in the course by the Maternal Health Unit received a set of P.P.E.

Anayeli Rojas Esteban, 27, tries giving birth in a standing position at the Alameda Midwifery Center.

While Mexico’s state health authorities struggled to contain the virus, the situation in the nation’s capital further illustrated the dangers and frustrations that women felt.

In the spring, health authorities in Iztapalapa, the most densely populated neighborhood of Mexico City, scrambled as the area became a center of the country’s coronavirus outbreak. The city government converted several large public hospitals in Iztapalapa into treatment facilities for Covid-19 patients, which left thousands of pregnant women desperate to find alternatives. Many sought refuge in maternity clinics such as Cimigen, where the number of births doubled and the number of prenatal visits quadrupled, according to the clinic’s executive director, Marisol del Campo Martínez.

Other expectant mothers joined the growing ranks of women seeking a home birth experience, for safety reasons and to avoid a potentially unnecessary cesarean section. In Mexico, roughly 50 percent of babies are delivered via C-section, and pregnant women face pressure from peers, family members and doctors to have the procedure.

In July, Nayeli Balderas, 30, who lived close to Iztapalapa, reached out to Guadalupe Hernández Ramírez, an experienced perinatal nurse and the president of the Association of Professional Midwives in Mexico. “When I started to research about humanized birth, breastfeeding, et cetera, a whole new world opened for me,” Ms. Balderas said. “But when we told our gynecologist about our plan, her whole face changed, and she tried to instill fear in us.” Undaunted, Ms. Balderas proceeded with her home birth plan.

Her labor, when it came, was long and increasingly difficult. After 12 hours, Ms. Balderas and her husband conferred with Ms. Hernández and decided to activate their Plan B. At 3 a.m., they rushed to the private clinic of Dr. Fernando Jiménez, an obstetrician-gynecologist and a colleague of Ms. Hernández, where it was decided that a C-section was needed.

photophotophotophotophotophoto

Janet Jarman

Juan Luis de la Torre Islas joined dozens of other parents waiting to receive vaccinations for their children at Cimigen, a small maternity hospital in Iztapalapa, Mexico City’s most populous and most densely populated delegation, that had become the epicenter of the virus.

Nayeli Balderas, 30, in labor, with her husband, Javier Basilio Lara, 31, in their Mexico City apartment, where they hoped she would give birth. Ms. Balderas had expected a hospital birth, but after the pandemic began, the couple decided to try for a home birth to avoid the coronavirus.

After hours of labor, Ms. Balderas’s baby still had not rotated into the right position for birth. The nurse midwives advised different birthing positions, but the infant still would not budge. Twelve hours later, the midwives took her to a small, private clinic for a cesarean birth.

Ms. Balderas with her son, born by cesarean section in a small private clinic at 4 a.m.

Maira Itzel Reyes Ferrer, 26 and her husband, Hugo Alberto Albarran Jarquin, 33, attended a class offered by an obstetric nurse and a 92-year-old traditional midwife who together blend traditional practices and modern medicine. Ms. Reyes had her first child a week later.

Elva Carolina Díaz Ruiz, the obstetric nurse, massaged Ms. Ferrer as her contractions begin to intensify. Pilar, her midwife, right, was in attendance.

In September, on the other side of Mexico City, Maira Itzel Reyes Ferrer, 26, had also been researching home births and found María Del Pilar Grajeda Mejía, a 92-year-old government-certified traditional midwife who works with her granddaughter, Elva Carolina Díaz Ruiz, 37, a licensed obstetric nurse. They guided Ms. Reyes through a successful home birth.

“My family admitted that they were sometimes worried during the birth,” Ms. Reyes said. “But in the end, they loved the experience — so much so that my sister is now taking a midwifery course. She already paid and started!”

As winter begins, Mexico is confronting a devastating second wave of the coronavirus. Hospitals in Mexico City are quickly running out of space. The much-discussed government midwifery birth centers have not yet come to fruition, and medical workers at prestigious hospitals like the National Institute of Perinatology, or INPer, are working around the clock.

Early on in the pandemic, INPer personnel discovered that roughly one-quarter of all women admitted to the hospital were testing positive for the coronavirus. Administrators set up a separate Covid-19 ward, and Dr. Isabel Villegas Mota, the hospital’s head of epidemiology and infectious disease, succeeded in securing adequate personal protective equipment for the staff. Not all frontline workers in Mexico have been this lucky; the Covid-19 fatality rate for medical personnel in Mexico is among the highest in the world.

photophotophoto

Grecia Denise Espinosa tested positive for the coronavirus at the National Institute for Perinatology in Mexico City, and was admitted to the Covid unit where she gave birth by cesarean.

Minutes after the births, Ms. Espinosa’s twins were examined and tested for the virus.

Because Ms. Espinosa and her babies were in good condition, doctors encouraged her to breastfeed, provided that she wore a mask and face shield.

When Grecia Denise Espinosa learned she was pregnant with twins, she made plans to give birth at a well-known private clinic. But she was shocked by the high cost and decided to consult doctors at INPer instead. To her surprise, when she entered the hospital in November, she tested positive for the virus and was sent to the Covid-19 unit, where doctors performed a C-section.

Maternal health advocates have long said that Mexico’s obstetric model must change to center on women. If ever there were a moment for health authorities to fully embrace midwifery, now is the time, they say, arguing that the thousands of midwives throughout the country could help alleviate pressure on an overburdened and often distrusted health care system while providing quality care to women.

“The model that we have in Mexico is an obsolete model,” said Dr. David Meléndez, the technical director of Safe Motherhood Committee Mexico, a nonprofit organization. “It’s a model in which we all lose. The women lose, the country loses, and the health system and medical personnel lose. We are stuck with a bad model at the worst moment, in the middle of a global pandemic.”

Sunset over the Casa de la Mujer Indígena Nellys Palomo Sánchez  in San Luis Acatlán, Guerrero.
Sunset over the Casa de la Mujer Indígena Nellys Palomo Sánchez  in San Luis Acatlán, Guerrero.

Janet Jarman is a photojournalist and documentary filmmaker based in Mexico, and director of the feature documentary “Birth Wars.” She is represented by Redux Pictures.

Should You Bank Your Baby’s Cord Blood?

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

Should You Bank Your Baby’s Cord Blood?

The stem cells in this vital fluid could save someone’s life, but it probably won’t be your child’s.

Credit…Jun Cen

  • Dec. 18, 2020, 1:25 p.m. ET

To bank or not to bank — that is the question I found myself reckoning with around six months into my pregnancy, when advertisements for private cord blood banks seemed to be popping up everywhere. “Protect what matters most,” a poster in my obstetrician’s office said. “Build your family a healthy future,” an ad on my Instagram feed prompted.

At the time, I had no idea what cord blood was, or why I’d want to pay some company hundreds of dollars per year to hold onto it. But didn’t I want to protect my family? I was forced to pay attention.

Cord blood, I learned, is the stem-cell-rich blood that flows through the umbilical cord and the placenta when your baby is in the womb. When providers cut and clamp the umbilical cord after delivery, they can collect the remaining blood and send it to a bank where it’s plunged into a deep freeze. But while the Food and Drug Administration has approved cord blood from a donor to treat a variety of blood and immune system disorders like leukemia, lymphoma and sickle cell disease, some private cord blood companies are advertising this valuable fluid as a blanket biological insurance policy against a host of other conditions, including autism, cerebral palsy, Alzheimer’s and more.

The only problem: It’s not approved to treat any of these ailments.

“These are really cool cells and they have a lot of potential properties,” said Paul Knoepfler, a stem cell biologist at the University of California, Davis. But before positioning them as a treatment for anything beyond blood diseases, researchers need to prove that they are safe and effective. “And that hasn’t been done,” he said.

Why cord blood is so special

Swirling around cord blood are millions of special kinds of blood stem cells known as hematopoietic stem cells, which can develop into any type of blood cell in the human body. On a given day, the stem cells in your bone marrow make billions of new red and white blood cells to replenish old ones that have died. But if they make mistakes, the result can be serious, even fatal. Leukemia, for instance, results when the body produces too many abnormal white blood cells, which can crowd out healthy ones.

Before the 1980s, the only way to get a blood stem cell transplant for a disease like leukemia was to use bone marrow from a donor. But that can be a long and challenging process (bone marrow is not collected until you find a perfect match) and can come with serious risks for the recipient (and sometimes for the donor). Cord blood transplants, which come from your own cord blood or a donor’s and which are administered similar to a blood transfusion, proved to be faster (cord blood has already been collected and can be administered right away), less risky and in many cases, just as useful. They also became a boon for people of color, since bone marrow registries in the United States tend not to be racially and ethnically diverse, and cord blood doesn’t require as exact a match as bone marrow.

How banking works

After collection, your baby’s cord blood is shipped to either a public or a private blood bank, depending on which you choose.

Public cord blood donations cost the donor nothing and are made available to anyone (including scientists) through a national registry. With public banking, however, you can’t always ask for your own baby’s cord blood back if a family member needs it.

Private banking, on the other hand, costs money but is held for your baby or another family member (most likely a sibling) when or if they may need it. Banks typically charge an initial collection fee of $1,000 to $2,000 per birth, followed by about $150 to $200 per year (storage costs can vary from bank to bank). Insurance doesn’t cover private banking, but some cord blood banks offer financial help for families with immediate relatives who have a known blood disorder and would benefit from a stem cell transplant.

It’s important to know that if your baby has a genetic blood disorder, like sickle cell anemia, her own cord blood probably won’t be helpful in treating her condition because her blood will contain the same genetic defect that is making her sick (this is also true of bone marrow transplants). In such a case, she would likely need cord blood from another healthy donor, like a sibling.

In theory, your baby’s banked blood can be preserved indefinitely. But because public cord blood banks have only been around for about 30 years, it’s hard to know for certain how long frozen cord blood remains viable.

The controversy over private banking

Though public and private banks provide a similar service — the ability to store cord blood — their methods and standards can differ substantially.

The F.D.A. considers publicly banked cord blood a “drug” and a “biological product” that is subject to strict requirements and regulations. Public banks must meet high sterility standards, and the blood must be disease- and contamination-free and have a minimum number of cells before it is banked.

Private banks, on the other hand, don’t always meet the same quality or viability standards, and generally don’t impose a lower limit on the number of cells that must be collected. This means there is not always a guarantee that the banked blood will contain enough stem cells for a successful transplant. One limited study published in 2010 found that fewer than half of privately banked units in the United States met the F.D.A.’s criteria, with public banks faring better.

Private banks are also for-profit companies. In some cases, their marketing advertises cord blood as a therapy for conditions like autism or cerebral palsy, when in fact such treatments have not been proven to work, said Alan Leahigh, chief executive officer of the Cord Blood Association, a nonprofit that supports cord blood banking, research and awareness.

ViaCord, one of the nation’s largest private banks, states on its website that “special properties of cord blood stem cells” may help those with autism, in part by encouraging their brain cells to repair and by boosting their immune system. As evidence for that claim, they reference a 2017 clinical trial of 25 children with autism who were given cord blood transfusions.

The trial did suggest that the therapy might be safe. But it was not designed to determine whether it worked, said Dr. Joanne Kurtzberg, a pediatric hematologist-oncologist at Duke University Medical Center and president of the Cord Blood Association, who led the trial.

Dr. Kurtzberg has also led two subsequent Phase 2 clinical trials — one on the efficacy of cord blood transfusions as a treatment for autism, and another on cerebral palsy. In both cases, while the results have been encouraging, they are still preliminary; it would take larger, Phase 3 trials in more patients to prove that a treatment is truly safe and effective.

“I think that some of the companies you’re referring to leverage and take advantage of our studies in a way that is premature,” Dr. Kurtzberg said about private cord blood banks.

Some private cord blood banks are also floating vague possibilities of regenerative stem cell medicine as a cure for heart disease, Alzheimer’s, diabetes and other conditions. Not one of these therapies has made it past a Phase 2 trial, or is approved by the F.D.A.

Morey Kraus, chief scientific officer at ViaCord, said that he understands that more research on cord blood is needed for use in unapproved conditions, but that even if the research doesn’t pan out, parents will have been glad they had the option of banking and trying it as a therapy.

Not everyone agrees: “The data suggest there might be a little help there, but I find it not at all convincing,” said Dr. Steven Joffe, a pediatric oncologist and bioethicist at the University of Pennsylvania Perelman School of Medicine. The cost of private banking “would be hard to justify at this point,” he said, unless someone in the family has a known blood disorder that might require a stem cell transplant.

According to Dr. Knoepfler, cord blood stem cells should not be thought of as “some kind of panacea” for all diseases. “People are in desperate situations,” he said, “they’re looking for hope, and giving them false hope has definite downsides.”

A difficult choice

At the end of the day, is it worth it to bank your baby’s cord blood? As with many medical matters, the answer is complicated.

The American Academy of Pediatrics and The American College of Obstetricians and Gynecologists say that there’s not enough evidence to recommend routine private cord blood banking, except in unique circumstances: If a first- or second-degree relative is in need of a stem cell transplant (because of a blood disorder like leukemia) or if someone in your family has a known genetic disorder, like sickle cell disease.

But even in those instances, private banking is still a gamble: There’s not always a guarantee that your banked blood will contain enough stem cells to be usable. And if that same genetic condition happened to be passed on to your baby, the stem cells would be unusable, a fact which private banks do not always make clear.

If your family doesn’t have a genetic disease or blood disorder, the odds of using your baby’s own blood are vanishingly small — especially if you’re saving it just for your baby. According to data posted on the website of Cryo-Cell, one of the country’s oldest and largest private banks, most units they release go to clinical trials or family members of the newborn. They are almost never used to treat a blood disorder in the child itself.

The A.A.P. and ACOG, however, encourage families to consider public banking — not because it might benefit them specifically, but because it might be a lifesaver for someone else.

How to decide

Whether you ultimately choose to bank your baby’s cord blood, it’s best to start thinking about it during your second trimester, so that you have enough time to ask yourself the relevant questions and discuss them with your family and provider. Is there a good chance that someone in your immediate family will need a stem cell transplant? Is it important to you to donate cord blood? Is your hospital set up to accept donations? Are you willing to pay for a service your baby or family may never use?

If you decide to bank privately, notify your bank of choice so that they can mail you a kit. It usually takes a few days, but most private banks will also rush a collection kit or deliver it directly to the hospital if you make a last-minute decision.

If you decide to go public, donating cord blood costs nothing and requires minimal planning. You’ll still need to make sure that your hospital of choice is set up to accept public donations — there are currently 16 public cord blood banks in the United States, and about 147 hospitals that can accept public donations.

Either way, it’s a personal decision, and what works for someone else’s family may not be right for yours. “I do not think a family should ever feel like it’s imperative to bank their kid’s cord blood, like if they don’t, they’ve denied their child access to some lifesaving therapy,” said Dr. Kurtzberg.

If you have the financial means and understand the cells may never be useful for anything, she said, then go ahead. Or else, donate them to a public bank where they’re much more likely to save someone’s life.

Dana Najjar is a journalist and software developer living in Brooklyn.

Pregnant and Breastfeeding Women May Opt to Receive the Vaccine

Advertisement

Continue reading the main story

Supported by

Continue reading the main story

Pregnant and Breastfeeding Women May Opt to Receive the Vaccine

Although no coronavirus vaccine has been studied in these women, many scientists believe the benefits will outweigh any potential risks.

With vaccines in short supply, the F.D.A.’s decision most immediately affects the estimated 330,000 pregnant and breastfeeding health care workers in the United States.
With vaccines in short supply, the F.D.A.’s decision most immediately affects the estimated 330,000 pregnant and breastfeeding health care workers in the United States.Credit…Callaghan O’Hare/Reuters
Apoorva Mandavilli

  • Dec. 11, 2020, 11:14 p.m. ET

In its emergency authorization of the Pfizer-BioNTech vaccine on Friday night, the Food and Drug Administration took an unexpected step, leaving open the possibility that pregnant and breastfeeding women may opt for immunization against the coronavirus.

The agency authorized the vaccine for anyone 16 and older, and asked Pfizer to file regular reports on the safety of the vaccine, including its use in pregnant women.

There had been no guarantee that the agency would take this route. The vaccine was not tested in pregnant women or in those who were breastfeeding. Regulators in the United Kingdom recommended against these women receiving the shots even while acknowledging that the evidence so far “raises no concerns for safety in pregnancy.”

The Centers for Disease Control and Prevention has not yet endorsed the vaccine for pregnant women, but an advisory committee to the agency is expected to meet this weekend to make further recommendations.

Some experts said the virus itself poses greater risks to pregnant women than the new vaccine, and noted that vaccines have been given to pregnant women for decades and have been overwhelmingly safe.

“This is a really huge step forward in recognizing women’s autonomy to make decisions about their own health care,” said Dr. Emily Miller, an obstetrician at Northwestern University and a member of the Covid-19 task force of the Society for Maternal and Fetal Medicine.

With the first doses of the vaccine reserved for health care workers and residents of long-term care facilities, the F.D.A.’s authorization most immediately affects the estimated 330,000 pregnant and breastfeeding health care workers in the United States.

“I am incredibly supportive of the F.D.A.’s decision to leave the door open to Covid vaccination for pregnant and lactating workers,” said Ruth Faden, a bioethicist at Johns Hopkins University in Baltimore.

Some health care workers are at high risk of Covid-19, either because their jobs bring them into intense contact with the virus — for example, cleaning the rooms of sick patients — or because they live in low-income and multigenerational homes, Dr. Faden said.

“We have to be able to give women the opportunity to think through this for themselves with whoever it is providing obstetrical care to them,” she said.

Health care organizations should also help their employees weigh the risks, and accommodate women who do not feel comfortable working on the front lines, she added.

None of the vaccine clinical trials have so far included pregnant or lactating women, nor even women who are planning to get pregnant; some trials are expected to begin in January.

Still, the American College of Obstetrics and Gynecology, the S.M.F.M. and other organizations have been calling on the F.D.A. to allow pregnant and lactating people access to the vaccine.

At a meeting on Thursday to review Pfizer’s data for an emergency use authorization, Dr. Doran Fink, the F.D.A.’s deputy director for vaccine development, signaled that the agency was open to the idea.

“We really have no data to speak to risks specific to the pregnant women or the fetus, but also no data that would warrant a contraindication to use in pregnancy at this time,” Dr. Fink said. “Under the E.U.A., they would be then free to make their own decision in conjunction with their health care provider.”

The E.U.A. did not endorse the vaccine for pregnant or breastfeeding women, other than to note that Pfizer should collect long-term data on how the vaccine performs in pregnant women.

Since the 1960s, pregnant women have been urged to receive vaccines against influenza and other diseases. These women are generally cautioned against live vaccines, which contain weakened pathogens.

Even so, the benefits of live vaccines outweigh the risks in some situations, said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of A.C.O.G.’s committee on Covid vaccines.

“We have a long track record of giving pregnant women vaccinations, and nearly all vaccinations are very safe,” Dr. Jamieson said.

Dr. Jamieson said she was “disappointed that F.D.A. was not more explicit” but encouraged that “there is no explicit contraindication regarding pregnancy, which is good.”

Health care providers should be prepared to counsel pregnant patients on the decision to be immunized, based on the patients’ potential exposures and underlying conditions like diabetes and obesity, Dr. Jamieson added.

“A woman who can stay home, who doesn’t have any other children and no one in the household is working, is very different than an essential worker who needs to go out every day and be around other people,” she said.

Women who are contemplating pregnancy should get both vaccine doses before trying to get pregnant, she added.

In the initial rollout, it will be mostly pregnant health care workers who must weigh the benefits and possible risks. By the time the vaccine is available to pregnant essential workers or to women in the general population, there should be a lot more data available, the experts said.

“The big question we don’t know quite yet is if it actually crosses the placenta,” said Dr. Geeta Swamy, an obstetrician at Duke University in Durham, N.C., and a member of A.C.O.G.’s Covid vaccine group, referring to the vaccine. “To be honest, what would be the most reassuring would be to see some of the animal data.”

Got a confidential news tip?

The New York Times would like to hear from readers who want to share messages and materials with our journalists.

So-called D.A.R.T. — developmental and reproductive toxicity — studies are conducted in animals to assess a vaccine’s possible effects on a fetus. These data are typically required for licensing a vaccine, but not for an E.U.A.

Animal studies would ideally have been conducted as soon as safety data on the vaccines were available and before companies started large trials, Dr. Faden, the bioethicist, said. But at the F.D.A. meeting on Thursday, officials at Pfizer hinted that the animal data would be available by the end of the year.

(Moderna did not respond to queries about its timeline for animal studies, and it was unclear whether AstraZeneca and Johnson & Johnson had begun theirs.)

“The vaccines that are behind — if they haven’t started their D.A.R.T. studies, they should start them yesterday,” Dr. Faden said.

The experts were particularly enthusiastic about the prospect that breastfeeding women might get the vaccine. “The biologic plausibility to there being some risk of harm to an infant from breastfeeding is extremely, extremely low,” Dr. Swamy said.

In the time it would take an antigen — the essential ingredient in the new vaccine — injected into a woman’s arm to travel through her bloodstream and into breast milk, the antigen would disintegrate.

“There’s not a good reason even to think that vaccinating children is unsafe,” Dr. Swamy added. “To be honest, the reason we don’t have pediatric studies yet is because they’re trying to figure out the right dosage.”

Some women breastfeed for years and, particularly in low- and middle-income countries, not being able to do so may have devastating consequences for babies, experts said.

“I would applaud the fact that the F.D.A. has recognized that in the absence of data and meaning in either direction, decisions should be made between patients and their providers,” Dr. Swamy said. “We’re talking about women who are adult individuals, right?”

Cesarean Sections May Increase Infection Risk in Babies

Babies born by cesarean section may have an increased risk of being hospitalized with infections, a new study suggests.

The analysis, published in PLOS Medicine, used data on 7,174,787 singleton births in Denmark, Scotland, England and Australia from 1996 to 2015. Of these, 1,681,966 were by C-section, 43 percent of them elective. They followed the children through their 5th birthdays, tracking infection-related hospitalizations.

More than 1.5 million of the children were hospitalized with infections over the course of the study. Babies born by C-section had a 10 percent higher risk of infections that required hospitalization than those born vaginally. The risks persisted over five years, and the rates were highest for gastrointestinal and respiratory infections.

The study controlled for many factors that may increase the risk of infection, including the mother’s smoking, gestational diabetes and high blood pressure; the family’s socioeconomic status; and the baby’s gestational age and birth weight. But the researchers had no data on breastfeeding, vaccination or postnatal smoke exposure, which could also affect infection rates.

“This is not about telling women how to deliver, or making them feel guilty about how they deliver their babies,” said the senior author, Dr. David P. Burgner, a senior research fellow at the Murdoch Children’s Research Institute in Melbourne, Australia. “That decision is for the woman in consultation with her doctor. This is a large-scale observational study that shows a small but consistent risk.”

Crossing Paths: A Baby and His Grandfather

Josephine Sittenfeld and Thad Russell

In a photo essay, Thad Russell and Josephine Sittenfeld chronicle the end of life of a beloved father and the beginning of life of their new baby.

Nov. 20 – Thad

I’ve left my very pregnant wife, Jo, and our little daughter, Polly, to drive up to northern Vermont to retrieve my 86-year-old father and bring him back to Providence.

But when I get there, Dad is hunched over in his chair in the living room. He looks thin and tired, unshaven, confused, cold, short of breath.

In a weak voice he says that his lungs aren’t working and he can’t get enough air. With his arm hanging limply over my shoulder I move him toward his bedroom. I take off his shoes and glasses, turn off his light, and kiss him goodnight. I go to bed shaken to the core.

Dad grew up on a farm, played football in high school, went to M.I.T. to study engineering and architecture, and had a long career designing and building houses.

He became an expert skier back in the 1950s when downhill skiing was rebellious and dangerous.

And now, maybe for the first time ever, he doesn’t want to get out of bed.

I call my friend Bill, an emergency room doctor. He tells me quietly and firmly, “Call 911 and get him to a hospital ASAP. Don’t think about it. Just do it.”

This is the last time my father will ever see his land or be in his own house or sleep in his own bed. In fact, it is the last time he will sleep in any bed that isn’t in a hospital or nursing home. It’s the last time he will live without the assistance of a walker or a wheelchair, a professional caregiver or an adult diaper.

At the hospital, Dad’s cardiologist puts it bluntly. “Your father needs a new heart, and he’s not going to get one. I’ve used up my bag of tricks. Have you thought about hospice?”

Josephine Sittenfeld and Thad Russell

Jo

That tiny, rapidly fluttering shape amid the gray static — even though I’ve been through ultrasounds before with my first child, the evidence of the life inside me is still awe-inspiring. I feel excited and tearful.

Nov. 28 – Thad

Dad’s vital signs are bad. He has trouble breathing and now needs oxygen full-time. It’s Thanksgiving morning, and Dad is taken by ambulance from the nursing home to the Miriam Hospital. I meet him in the emergency room, abandoning Jo to cook her first turkey and prepare for a house full of in-laws. The emergency room staff does a battery of tests and confirms what we already know: Dad is suffering from late-stage heart failure.

But after a few hours, he’s released, and I bring him home for Thanksgiving dinner.

Dec. 25 – Thad

Amazingly, Dad is able to be at our house on Christmas Day. He doesn’t believe in Santa Claus, or even Jesus for that matter. But he does like a good turkey dinner.

Josephine Sittenfeld and Thad Russell

Jan. 9 – Jo

I wake up at exactly midnight with contractions. Around 6 a.m. the contractions get closer together. Polly wakes up and thinks it’s funny that I’m mooing like a cow. Thad and I take Polly to a neighbor’s house and head to the hospital.

I have another killer contraction in the lobby. I’m on all fours on the floor, moaning. People are staring.

Once we finally get to the room, I get into the tub. It feels good to be in the water, but the contractions are painful and intense — after the tub I’m on a ball, then on the bed, then standing, then on the toilet, then back on the bed.

Thad is on the phone in the next room trying to coordinate a urology appointment for his dad when all of a sudden things intensify. The baby’s head starts crowning, and it burns like hell. The nurse runs out to get Thad. And with a few more pushes our baby is out.

When they hand him to me, he’s big and grayish, but pretty quickly turns pink.

It’s intense and beautiful and crazy and amazing.

Baby Curtis lies on my chest, still connected through the umbilical cord, and Thad and I just take him in.

Josephine Sittenfeld and Thad Russell

Jan. 13 – Thad

Dad is excited to meet his first grandson  —  and a little confused. He keeps calling him Matt, and asks when we have to give him back.

Josephine Sittenfeld and Thad Russell

Jan. 24 – Thad

A nurse calls to tell me that Dad has fallen. I meet him in the E.R., again. He looks pretty beat up and has a big gash on the top of his head.

The test results worry the doctors.

And yet he survives  —  for days, then weeks, then months.

I visit Dad as often as I can and for as long as I can. I pick him up and we go on little field trips: to doctors’ appointments, to get new eyeglasses, to get his hearing aids cleaned, or to our house for dinner.

Josephine Sittenfeld and Thad Russell

Occasionally, I find Dad asleep in his room, his face lit by the light of CNN Headline News. Some nights I stay with him for quite a while, rubbing his feet, watching him breathe and wondering what he is dreaming about.

I feel conflicted  —  it’s not that I want Dad to die, but I sometimes wonder if this is the way he ever wanted to live.

Dad can’t walk, get dressed or complete most basic daily routines without assistance, but his spirits are good.

In July, Dad has a bad fall, spends another week in the hospital. I call my siblings and tell them it’s time. We’re going to start hospice.

Josephine Sittenfeld and Thad Russell

Aug. 8 – Jo and Thad

Dear Family & Friends –

We are sad to report that Sam died Friday evening. He was 87 years old.

For the past year, Dad continually impressed us with his dignity, toughness and overriding will to live. He  —  and we  —  were rewarded with some distinctly good days that we will never forget.

But last week, he and his heart decided it was time. He retired early one evening, declaring that his bed felt “wonderful,” and started his long sleep.

In the end, he passed quietly and gracefully, surrounded by his family (including his bouncy and bubbly baby grandson Curtis, who played happily at the foot of his bed), and a wonderfully compassionate team of rotating attendants and nurses.

Ever the solar animal, he waited until just after sunset to pass.

With love and thanks,

Thad & Jo

Josephine Sittenfeld and Thad Russell


Thad Russell and Josephine Sittenfeld are photographers who live in Providence, R.I., and teach at the Rhode Island School of Design. More of their work can be found at thadrussell.com and josittenfeld.com.

Flu Vaccine in Pregnancy Offers Brief Protection of Babies

Unborn babies are temporarily protected by their mother’s flu shot, but that immunity fades within weeks after birth, a new study found.

In a randomized, double-blind placebo-controlled study, researchers measured the efficacy of the flu vaccine on the unborn children of vaccinated pregnant women by comparing rates of disease and levels of antibodies in 1,026 infants born to vaccinated women and 1,023 controls born to unvaccinated mothers. The study, which was paid for by the Gates Foundation, is online in JAMA Pediatrics.

The vaccine was about 86 percent effective until the babies were 8 weeks old. But between 8 and 24 weeks, its power dropped rapidly, and the effect of the vaccine became statistically insignificant.

The lead author, Marta C. Nunes, a researcher at the University of Witwatersrand in Johannesburg, stressed that vaccination during pregnancy is nevertheless essential.

“It’s still important to vaccinate women during pregnancy,” she said. “Pregnant women are a high-risk group, and vaccinating them protects them as well as their babies.”

Finding a vaccine for pregnant women that confers long-lasting immunity on the baby is important because no flu vaccine is approved for babies under the age of 6 months.

“We have to work on creating vaccines that work in babies or that are more immunogenic in the mother so that her antibodies last longer,” she said.

A Call for Action on Toxic Chemicals

Cosmetic and lotion bottles contain phthalates, a chemical that allows the plastic to be flexible. Absorption of phthalates are also linked to preterm births and impaired neurodevelopment in girls.

Cosmetic and lotion bottles contain phthalates, a chemical that allows the plastic to be flexible. Absorption of phthalates are also linked to preterm births and impaired neurodevelopment in girls. Getty Images

Every day, children and adults are exposed to a variety of chemicals found in common household items. Now a growing body of research suggests that many of these chemicals — which are used to make plastic more flexible, fruits and vegetables more abundant and upholstery less flammable — may also pose a threat to the developing brain.

While the link between early chemical exposure and neurodevelopment disorders in children remains a matter of scientific debate, a unique coalition of top doctors, scientists and health advocates is calling for more aggressive regulation. The goal is to protect expectant mothers, infants and children from neurotoxic chemicals by stepping up efforts to curb air pollution, remediate old lead pipes, phase out certain pesticides, ban endocrine-disrupting chemicals used in food packaging and plastics and come up with a plan for getting rid of furniture laden with fire retardants.

The scientists note that neurodevelopmental disorders are complex and have multiple genetic, social and environmental causes. But most chemicals in use today were not adequately tested for safety before being allowed on the market, said Dr. Jeanne Conry, an obstetrician-gynecologist and a past president of the American College of Obstetricians and Gynecologists, which is part of the coalition.

“Before we can prescribe medicine, we have to prove it’s safe,” she said. “So how come with the chemical industry, we assume everything is safe and have to prove there’s harm?”

On Friday the coalition endorsed a first-of-its-kind consensus statement called Project Tendr, which stands for Targeting Environmental NeuroDevelopmental Risks. The statement was published in the scientific journal Environmental Health Perspectives, and related articles are being published over the next few months in endocrinology, nursing, pediatrics and epidemiology journals.

“We as a society should be able to take protective action when scientific evidence indicates a chemical is of concern, and not wait for unequivocal proof that a chemical is causing harm to our children,” the statement says.

This chart shows a list of common chemicals and their possible effects on the body. <a href="https://static01.nyt.com/images/2016/06/30/health/wellchart/wellchart-superJumbo.png">Click here to view the entire chart.</a>

This chart shows a list of common chemicals and their possible effects on the body. Click here to view the entire chart. Centers for Disease Control and Prevention and Project Tendr

The call to action comes just one week after President Obama signed into a law a much-debated overhaul of the nation’s 40-year-old toxic chemical rules. The update to the 1976 Toxic Substances Control Act subjects some 64,000 existing chemicals to eventual safety testing. But critics say the changes don’t go far enough, and the testing of chemicals is far too slow — just 20 chemicals at a time with a deadline of seven years per chemical. And the new law doesn’t cover pesticides used in food production – which critics say are one of the largest sources of childhood chemical exposures.

An official with the American Chemistry Council, which represents companies that make flame retardants, plastics and phthalates, said the new law already addresses the concerns raised by the Tendr coalition. The new rules give more authority to the Environmental Protection Agency and require the agency to take into account vulnerable populations like pregnant women, children and the elderly, she said.

“This new law will give Americans greater confidence that chemicals in commerce are being used safely,” the American Chemistry Council said in a statement.

The Tendr coalition includes pediatric neurologists, several minority physician associations, nurses, learning disability advocacy groups, environmental organizations, and the Endocrine Society, which has compiled several scientific statements documenting adverse health effects linked to endocrine-disrupting chemicals that mimic or disrupt the hormones in our own bodies. Dozens of scientists and health providers have signed the statement, as has Linda Birnbaum, director of the National Institute of Environmental Health Sciences and the National Toxicology Program.

The bottom line: The group wants the chemical industry to prove a chemical is safe, rather than waiting on the medical and scientific community to prove it is harmful. “We’re saying, shift the burden of proof,” Dr. Conry said.

Wading into a potentially contentious issue like regulation of chemicals is unusual for ACOG, a professional medical association for doctors who care for pregnant women. The group has been alarmed by rising rates of neurodevelopmental disorders and other health problems in children, which it linked to toxic exposures in a 2013 scientific paper.

National health surveys show that 15 percent of children had a developmental disability in 2008, up from 12.8 percent in 1996. Researchers say changes in diagnostic criteria and a greater awareness of developmental disorders including autism, attention deficit disorders, and other learning disabilities may explain some of the increase in rates, but not all of it.

The chemicals singled out by the coalition are widely used, and manufacturers and some experts say more research is needed to demonstrate they have harmful effects. They include:

  • Organophosphate Pesticides: Although health concerns led to a ban on residential use of some of these pesticides, they are still permitted on crops like fruit, vegetables, wheat, soy and corn. In one study, women who were pregnant when they lived near areas where these pesticides were in use were up to three times more likely to have a child who developed autism or other developmental disorders. Janet Collins, a senior vice president at CropLife America, which represents pesticide manufacturers, said the studies show only an association between pesticide levels and autism disorders, not a cause-and-effect relationship.
  • Flame Retardants: Recent studies have found that children exposed prenatally to higher levels of flame retardants had lower I.Q.s and higher hyperactivity scores. Similar effects have been found in animal studies. Flame retardants are used in fabric and upholstery padding, plastic casings for televisions and computers and baby products. A major source of exposure is household dust, which can accumulate with residue from treated products. American retailers and manufacturers have phased out one commonly used flame retardant, some of which still lurk in old sofas and other items; some scientists worry that they are being replaced with similar chemicals that may not be any safer.
  • Lead: The government has banned leaded gasoline and household paint, but old homes and pipes often still contain lead that gathers in dust and leaches into water. Lead is so toxic that no level of exposure is considered safe, and even low blood levels are associated with lower intelligence and attention deficits. In 2010, an estimated 535,000 children were identified with alarmingly high levels of lead.
  • Phthalates: These chemicals cross the placenta during pregnancy, and prenatal exposure has been linked in studies to problems with attention and intellectual deficits. The Consumer Product Safety Commission has banned the use of six phthalates in toys and child care products, but they are still widely used in all kinds of products, from food packaging to personal care products and building materials.
  • Combustion-Related Air Pollutants – These include nitrogen dioxide, particulate matter (a mix of small solid particles and liquid droplets) and other toxic chemicals including benzene and formaldehyde, as well as polycyclic aromatic hydrocarbons (or PAHs). Air pollutants can cross the placenta, and prenatal and early childhood exposure to some pollutants has been linked with preterm birth and low birth weight, as well as developmental delays, inattention and reduced I.Q.

Studies show almost all American women have these chemicals circulating in their bodies during pregnancy. A recent study of about 300 women found detectable levels of pesticides, flame retardants, phthalates, PCBs and other chemicals in 99 percent to 100 percent of the women tested.

Gestation is a particularly vulnerable time for the developing fetal brain, because it is growing so rapidly, said Irva Hertz-Picciotto, co-executive director of Project Tendr and director of the MIND Institute Program in Environmental Epidemiology of Autism and Neurodevelopment at the University of California, Davis.

Many chemicals of concern are endocrine disruptors, which can interfere with the activity of the body’s own hormones, like thyroid hormones, estrogen and androgens. These hormones play an important role in healthy brain development, said Heather B. Patisaul, professor at the Center for Human Health and the Environment at North Carolina State University at Raleigh.

“The goal is not to demonize every chemical on the market,” Dr. Patisaul said. “We need to find the group that are harmful, and figure out why, and develop new chemicals that are significantly less harmful.”

How to Limit Your Exposure to Toxic Chemicals

A coalition of doctors, scientists and health advocates says you may be able to reduce your overall exposure to toxic chemicals by taking the following steps:

  • Reduce pesticide exposure by choosing organic strawberries, apples, nectarines, green beans, celery and spinach.
  • Choose seafood low in mercury like salmon, sardines, trout.
  • Breast-feed your baby if you can; if you use formula, make sure the water is lead-free.
  • When buying furniture with padding like a high chair, sofa or mattress, ask for products that are labeled free of toxic flame retardants.
  • Avoid exposing the family to tobacco smoke, wood smoke from fireplaces and wood stoves, idling car exhaust, cooking fumes from stoves and grills.
  • If you’re putting in a new floor, choose either phthalate-free vinyl flooring or wood, bamboo or cork.
  • Avoid plastic toys, backpacks, lunch boxes and school supplies made of polyvinyl chloride (PVC) which can be a source of phthalates.
  • Choose fragrance-free personal care products to avoid phthalates in fragrances .
  • When using stool softeners, laxatives and other time-release capsules, look for phthalates on the list of inactive ingredients so you can avoid them.
  • Use nontoxic alternatives to pesticides in your yard and on your pets.
  • Screen your house for lead. If it was built before 1978, lead paint may place your family at risk. If paint is chipping or peeling, it can build up in house dust and stick to children’s hands.
  • Reduce household dust that may contain lead, flame retardants, phthalates and pesticides. Take shoes off before you come into the house and use a doormat to trap dirt outside and inside the doorway. Damp mop, use a HEPA-filtered vacuum cleaner and dust with a microfiber cloth.