Tagged Pregnancy and Childbirth

The Eggs I Sold, the Baby I Gained

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

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

‘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

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…

  • 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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…

  • 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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?

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

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.”

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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

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Credit 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?”

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Credit 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.

Photo

Credit 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.

Photo

Credit 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.

Photo

Credit 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.

Photo

Credit 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.

Photo

Credit 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

Photo

Credit 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

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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

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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.Credit 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.

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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.Credit 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.

Could Environmental Chemicals Shape Our Exercise Habits?

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Credit Getty Images

A disquieting new study finds that mice exposed prenatally to a common chemical found in many cosmetics and personal care products are less likely than other mice to exercise as adults, adding a new wrinkle to the mystery of exercise motivation. Although mice obviously are not people, the findings at least raise the possibility that exposure to environmental toxins before birth might change babies’ physiology in ways that affect their interest in exercise throughout their lives.

By now, we all know that we should work out to improve health and well-being. But a hefty majority of us never manage to exercise and many who do visit the gym do so reluctantly and sporadically.

The question of why some people are so loath to exercise is of pressing interest to exercise scientists. Work and family obligations of course play an outsize role, as do genes. Studies of the genetics of exercise suggest in fact that the will to exercise — or not — is mostly inherited.

But scientists also have begun to wonder about early physical development and whether differences in the environment within a mother’s womb might lead to changes in her baby that affect how much that infant moves around later in life.

A mouse study I wrote about recently suggested, encouragingly, that if a mother exercises during pregnancy, she might increase her offspring’s subsequent interest in working out.

But whether the environment within the womb might reduce a baby’s later desire to exercise has not been much studied.

So for the new study, which will appear next month in Medicine & Science in Sports & Exercise, scientists at Texas A&M University in College Station, Tex., decided to look at pregnancy, exercise behavior and phthalates.

Phthalates (THAL-ates) are a class of chemicals used as solvents and fixatives and to make plastic pliable. Found today in a boggling array of everyday products, from food containers to shampoos and perfume, they are virtually ubiquitous in the environment and in our bloodstreams.

They easily cross into a pregnant woman’s womb and accumulate in her offspring. Rather ominously, phthalates are known as endocrine disrupters, meaning that they can change the body’s production of the sex hormones testosterone and estrogen and, in animal studies, alter the onset of puberty in mouse pups exposed to high levels of the chemicals in utero.

The Texas scientists wondered whether phthalates might also influence how much exposed babies exercised, since varying levels of sex hormones, especially testosterone, are known to change how readily young animals move around.

To find out, they gathered healthy female mice, mated them with healthy males, and then fed half of the pregnant females benzyl butyl phthalate (B.B.P.), a common phthalate. The mice received the B.B.P. at the point in their pregnancies when their babies were rapidly developing organs and sex characteristics, which in human terms, would be near the end of the second trimester.

According to the scientists’ calculations, the exposure for each pup would be slightly higher than the amount that the E.P.A. has determined to be safe for humans.

The rest of the pregnant animals were fed a harmless oil to serve as a control group.

After birth, all of the pups were provided with running wheels and allowed to exercise as much or little as they chose.

The scientists checked the animals’ sex hormone levels at several points during the animals’ lives.

What the researchers found was that by young adulthood and continuing on into the mouse version of late middle age, the exposed animals were not moving much.

In fact, the male mice that had been exposed to B.B.P. in utero ran about 20 percent less during adulthood than the other animals, while the exposed females exercised about 15 percent less.

Interestingly, the exposed animals did not differ much from the other rodents in terms of body composition. They were not significantly fatter. Obesity and any accompanying disability had not discouraged them from exercising, the scientists concluded. They had been sedentary by choice, not necessity.

That choice, however, seems to have been influenced by disruptions in their sex hormones. Checking their data, the researchers found that the male mice exposed to B.B.P. in utero had notably lower levels of testosterone than the other animals in young adulthood, which is also when their running mileage cratered. Those differences lingered into middle age. The exposed females similarly developed during young adulthood low estrogen levels and other reproductive system abnormalities that then produced a profound desire, it seems, to sit for most of the day.

The implication of these findings is that, in mice, “exposure to the endocrine disrupter B.B.P. might affect lifelong physical activity,” said Emily Schmitt, a postdoctoral researcher at Texas A&M who led the new study.

It’s impossible at this point to say whether human babies would be similarly affected, Dr. Schmitt said.

Likewise scientists don’t know whether a father’s exposure to phthalates can affect his unborn offspring or if eating and dousing oneself in phthalates long after birth, including when you are fully grown, might dampen your subsequent enthusiasm for working out, although Dr. Schmitt and her colleagues hope to investigate some of those issues in future studies.

But even with many questions remaining unanswered, “it certainly seems like a good idea to try to avoid endocrine disruptors as much as possible, especially if you are pregnant,” Dr. Schmitt said.

You can find tips for reducing exposure to the chemicals at saferchemicals.org/.

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Folic Acid During Pregnancy May Lower Risk of Childhood Obesity

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Pregnant women should take folic acid, a B vitamin, during pregnancy to prevent neural tube defects in their babies. Now a new study, in JAMA Pediatrics, has found that sufficient folic acid during pregnancy may reduce the risk for obesity in children.

Researchers studied 1,517 mother-child pairs, measuring the mothers’ folic acid blood levels at delivery and following the children through average age 6. After controlling for other variables in both mother and child, they found that compared with those mothers who had folic acid levels in the highest three-quarters, those with levels in the lowest one-quarter had a 45 percent higher risk for obesity in their children.

Folic acid may be especially beneficial for obese mothers. Among obese mothers with the lowest folic acid levels, the risk of obesity in their children more than tripled. But in children of obese mothers, the risk for obesity was 43 percent lower if their mothers were in the top three-quarters for folic acid levels than if they were in the bottom one-quarter.

Experts advise that all pregnant women take a 400-microgram supplement of folic acid daily. But the senior author, Dr. Xiaobin Wang, a pediatrician at Johns Hopkins, said that there is no perfect correlation between the supplement dose taken and blood levels. So “for an overweight mother, it’s probably worth the trouble to do a blood test,” she said. “It’s not an expensive test, and it’s important information. We try to make an individualized decision, and this is a more precise way to do it.”

Diet Soda in Pregnancy Is Linked to Overweight Babies

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Drinking diet soda and other artificially sweetened beverages during pregnancy is associated with having overweight 1-year-olds, according to a new report.

Canadian researchers studied 3,003 mothers who delivered healthy singletons between 2009 and 2012 and had completed diet questionnaires during their pregnancies. They then examined the babies when they were a year old. Almost 30 percent of the women drank artificially sweetened beverages during pregnancy.

After controlling for maternal body mass index, age, breastfeeding duration, maternal smoking, maternal diabetes, timing of the introduction of solid foods and other factors, they found that compared with women who drank no diet beverages, those who drank, on average, one can of diet soda a day doubled the risk of having an overweight 1-year-old.

The study, in JAMA Pediatrics, found no association with infant birth weight, suggesting that the effect is on postnatal, not fetal, growth. The mother’s consumption of sugar-sweetened drinks was not associated with increased risk for overweight babies.

“This is an association, and not a causal link,” said the lead author, Meghan B. Azad, an assistant professor at the University of Manitoba. “But it certainly raises the question of whether artificial sweeteners are harmless. It’s not time to ban them or tell everyone not to consume them, but there’s no great benefit to consuming these drinks, so there’s no harm in avoiding them.”

Flu Shots Protect Babies, Too

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Here’s one more reason pregnant women should get a flu shot: It not only protects mothers, but a large study suggests it prevents flu in the infant, too.

Giving babies under 6 months old a flu vaccination does not work. Their immune systems are too immature to mount an effective response. But infants can get the flu, and it can have serious, even deadly, consequences.

Researchers used data on live births among women in a large health maintenance organization, including 23,847 babies born to mothers who had been vaccinated against the flu and 225,540 born to mothers who were not vaccinated. The study, published in Pediatrics, was carried out during the H1N1 flu pandemic of 2009-10.

Babies of unvaccinated women were 70 percent more likely to have a laboratory-confirmed case of flu, and 81 percent more likely to be hospitalized for flu before they were 6 months old.

The lead author of the study, Dr. Julie H. Shakib, an assistant professor of pediatrics at the University of Utah, said that after the 2009-10 pandemic, rates of vaccination of pregnant women went up sharply. In the 2013-14 season, more than 50 percent of pregnant women were vaccinated.

“We were encouraged to see the increase after the pandemic,” she said. “That’s when the public became aware of how much of a risk there was, and when obstetrics practices started delivering the vaccine as a routine part of care.”

For a New Mom, Relentless Fatigue Could Signal a Thyroid Problem

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Credit Stuart Bradford

For six weeks after delivering my son, I had postpartum thyroiditis. Every afternoon around the same time, I would shake uncontrollably. Anxiety about night feedings and colic (which my son didn’t have) plagued my thoughts all evening. One night while my husband put our son, Jackson, to sleep, my sister put me to sleep. We watched “Romancing the Stone” and she rubbed my back until I drifted off — as if I were the baby.

Moreover, I lost all the baby weight within weeks. At my two-week checkup with my obstetrician, I had lost over 25 pounds. I left that appointment proud, feeling like I could be on the cover of Us Weekly. It must be the breast-feeding, pumping and healthy eating. But I was kidding myself. I breast-fed for all of three days. Sure, I pumped a few bottles, but Jackson got mostly formula. And I wasn’t eating healthfully. I was eating takeout.

About two months after Jackson’s birth, my thyroid burnt out. I didn’t know it at the time, but I later learned that mild hyperthyroidism had given way to Hashimoto’s disease, a potentially more serious, and chronic, thyroid condition in which the thyroid becomes underactive. Over the next few months, I gained about 30 pounds and became extremely lethargic. When I woke each morning, my first thought was: When can I take a nap today?

My body was just transitioning, I thought. And I had a baby now. Most new moms were tired, right? Still I sensed that something intense was happening: I was a different person.

My husband and I had some traumatic fights during those months. I feared that our marriage, the very foundation for loving this new child, was falling apart. He said things like “you’ve changed and “I can’t live like this anymore.” And the truth was that we really couldn’t live like this anymore.

To make matters worse, I felt that my internist largely dismissed my concerns. He ran my blood work for virtually everything except my thyroid hormone level. We spent the follow-up appointment discussing my elevated cholesterol (also a symptom of hypothyroidism). He offered me Xanax and suggested I talk to a therapist about postpartum depression. Even most friends and family members chalked up these physical changes to the stresses of being a new mom.

Finally, when Jackson was 6 months old, I saw my O.B. again. She, too, bet on postpartum depression but ran thyroid tests to rule it out. I vividly remember when the doctor called with the results, “I’m surprised you can get out of bed in the morning, much less work full-time and take care of a baby.” When I hung up, I wept. I wasn’t losing my mind. I wasn’t just having a hard time adjusting. My thyroid, this little butterfly-shaped gland in my throat that I last worried about in high school biology, was having a hard time keeping my body up and running.

The synthetic thyroid hormone Synthroid helped with losing weight and energy levels. And ever since, I’ve had routine blood work and sonograms to monitor my hormone levels and the small lumps on my thyroid. During my second pregnancy, I saw an endocrinologist and had blood taken every month. My endocrinologist told me that it was important that I have my medication adjusted every month during the pregnancy since the thyroid helps the body stay pregnant.

I was surprised to find that several of my women friends also turned out to have thyroid problems. They tell the same story about discovering their condition either later in life or surrounding a pregnancy. Toni had three miscarriages in one year because of a mismanaged thyroid. Lisa was diagnosed accidentally at 41 when she saw a doctor for a double ear infection and bronchitis. “He felt my neck and noticed that my thyroid was quite enlarged,” she writes.

All the women had weight troubles. Eat less carbs. Exercise more. Take the baby out for walks. You’re getting older so it’s harder. That was the advice I got, along with speeches about the American diet of processed foods and sedentary lifestyle. But I’ve never been sedentary, and becoming a mother certainly didn’t have me sitting on the couch eating potato chips. My friend Jen remembers being patronized at her doctor’s office. “I was literally patted on the leg and told it’s just going to be hard for you to lose weight, dear,” she said. Her endocrinologist prescribed her a medication for diabetes and told her to eat 1,100 calories a day.

My takeaway from those six months is this: Even amid the huge life change that is motherhood, I knew something was really wrong with my body. And if I had put my health first, I would’ve figured it out much faster and with much less heartache. But prioritizing yourself isn’t something many new moms do very well.

Of course the early weeks with a newborn are exhausting for all parents, but if you don’t start to feel normal once the baby’s sleep schedule stabilizes, it’s worth getting your thyroid checked. A simple blood test can make all the difference.

Kristin Sample is a writer, teacher and dancer. Her novel “North Shore South Shore” is available on Kindle. Follow her on Twitter and Instagram @kristinsample or check out her blog, kristinsample.com.

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Treating Pregnant Women for Depression May Benefit Baby, Too

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Treating pregnant women for depression may benefit not just themselves but their babies as well.

A study, in the May issue of Obstetrics & Gynecology, included 7,267 pregnant women, of whom 831 had symptoms of depression. After controlling for maternal age, race, income, body mass index and other health and behavioral characteristics, the researchers found that depressive symptoms were associated with a 27 percent increased relative risk of preterm birth (less than 37 weeks of gestation), an 82 percent increased risk of very preterm birth (less than 32 weeks of gestation), and a 28 percent increased risk of having a baby small for gestational age.

They also found that among those who were treated with antidepressants for depression — about a fifth of those with the diagnosis — there was no association with increased risk for any of these problems. But they acknowledge that this group was quite small, which limits the power to draw conclusions.

Still, the lead author, Dr. Kartik K. Venkatesh, a clinical fellow in obstetrics and gynecology at Harvard, said that it was important to screen mothers for depression, not only for their health but for that of their babies.

“By screening early in pregnancy, you could identify those at higher risk and counsel them about the importance of treatment,” he said. “Treating these women for depression may have real benefits.”

Flu Shot During Pregnancy May Reduce Risk of Stillbirths

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Flu vaccination during pregnancy may reduce the risk of stillbirth, a new study reports.

Researchers studied birth and maternal vaccination records for 58,008 pregnancies in Western Australia during the 2012 and 2013 flu seasons. There were 5,076 births to women who had had the flu vaccine at some point during pregnancy, and 52,932 births to unvaccinated mothers.

After adjusting for maternal age, socioeconomic status, diabetes, hypertension and other health and behavioral characteristics, they found that the risk of stillbirth was 51 percent lower in vaccinated women than in unvaccinated ones.

The researchers acknowledge that the study, in Clinical Infectious Diseases, is observational and does not prove cause and effect, and that the results may not be generalizable to other populations or other flu seasons.

The Centers for Disease Control and Prevention recommends the flu vaccine during pregnancy, but more than half of all pregnant women in the United States are unvaccinated.

The lead author, Annette K. Regan of the Western Australia health department, said that pregnant women go unvaccinated for two main reasons: they are unaware of its importance and their doctor does not recommend it, or they fear it will harm the baby.

“We hope,” she continued, “that these results show not only pregnant women but also their providers that flu vaccination is safe during pregnancy and has major benefits for both mother and infant.”

Does Exercise During Pregnancy Lead to Exercise-Loving Offspring?

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Mice born to mothers that run during their pregnancies grow up to be rodents that love to run as adults, according to a thought-provoking new animal experiment, while pups with sedentary moms had a less-enthusiastic attitude toward exercise. Though it’s a long way from mice to people, the study’s findings hint at the possibility that to some extent our will to work out may be influenced by a mother’s exercise habits during pregnancy, and begin as early as in the womb.

Most of us have probably observed that activity patterns tend to run in families, a situation that has been confirmed in studies involving both people and animals. Children whose parents are sedentary often tend to be inactive themselves, whereas parents who are physically active typically have children who move around and exercise often.

Logically, home environment and nurture influence familial activity levels; children learn from and mimic their parents.

Recent science, however, suggests that there are other, deeper biological influences at work as well, including genetics. A number of studies have identified various snippets of DNA that, if someone carries them, predispose that person to be quite active, while other gene variations may nudge someone toward being a couch potato.

But scientists also have begun to wonder about the role of a process known as developmental programming. According to this theory, a growing baby’s body and its very DNA can be changed by the environment it experiences in the womb and immediately after birth. These changes may, in turn, affect lifelong health and disease risk. Mouse pups born to mothers that become overweight and metabolically unhealthy during pregnancy, for instance, are more likely to be overweight and diabetic as adults than genetically identical mice born to mothers that maintain a normal weight during pregnancy.

To what extent developmental programming might affect someone’s willingness to work out, though, had rarely been explored.

So for the new study, which was published this month in the FASEB Journal, researchers from Baylor University and Rice University in Houston gathered genetically identical female mice and put them in cages with running wheels. Mice like running, and most of these animals jogged about six miles a day. After a week with wheels, the females were matched with male mice from the same genetic line. Pregnancies ensued.

At that point, half of the pregnant mice had their running wheels locked so that they could not run freely during pregnancy.

The other mice were allowed to continue running at will throughout their pregnancies, and they did keep running, although their distance and speed declined as they grew heavy with young.

After the babies were born and weaned, the pups were removed to their own cages, without wheels. Their cages were separated from those of the adult mice, so the young mice would not have watched their mothers working out and tried to emulate them.

But at multiple points throughout their lives, this second generation of mice was moved for several days to special cages equipped with unlocked running wheels and monitors that tracked how much they moved when not on the wheels.

During the pups’ childhoods, the scientists noted few differences in exercise behavior between the young mice. But as the animals entered adolescence, those born to running moms started to become enthusiastic runners themselves, putting in more miles on the wheels than the other mice and moving around more frequently in their cages when they were not running.

These differences accelerated as the animals aged, so that during the rodent equivalent of middle age, the animals born to runners were running and moving around significantly more throughout the day than the other mice, even though all of them were genetically the same and had had identical upbringings.

The clear implication of these results is that “a mother’s physical activity during pregnancy likely affects the physical activity of her offspring,” said Robert Waterland, a professor of pediatrics and genetics at Baylor who led with study with his colleagues Jesse Eclarinal and Shaoyu Zhu.

In essence, baby mice with active moms had literally been born to run.

Of course, mice are not people, and this study can’t tell us whether similar programming occurs in our babies if we are active during pregnancy.

The study also can’t explain how exercise during pregnancy affects a developing infant’s later urge to work out. It may be, Dr. Waterman said, that the mother’s physical movements jiggle the womb slightly in ways that alter fetal brain development in parts of the brain devoted to motor control and behavior; or that certain biochemicals produced by the mom during exercise pass through the placenta, affecting the baby’s physiology and gene activity lifelong.

He and his colleagues hope to study those issues in future experiments.

But for now, he said, it’s important that no mother interpret these results as a criticism if she didn’t exercise much during pregnancy. Those of us who have borne children know how exhausting the experience can be. But, he said, if a pregnant woman — with her doctor’s blessings — can walk, jog, swim or otherwise be physically active, she may improve her own health and also, just possibly, instill an incipient love of exercise in the child growing within her.

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Six Months Pregnant and Asking, ‘Am I Depressed?’

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Credit Stuart Bradford

On a walk with my husband through Joshua Tree National Park in late January, I felt sad for no reason in particular. Or maybe for lots of really good reasons. I wasn’t sure which it was.

At the time, I was six months pregnant. My husband, Raj, asked me what was wrong. “Nothing,” I said, and kept walking, kept stewing, kept wiping away a few tears from under my sunglasses when he wasn’t looking.

“Are you depressed?”

The Times had recently published a story about updated guidelines calling for pregnant women to be screened for depression – both during the pregnancy and after giving birth. Raj must have read the article, too.

During my first pregnancy, when I was quite happy, Raj read all about postpartum depression. Soon after our baby arrived, the questioning began. Raj would get all serious, look me straight in the eye and say: “Do you have postpartum depression?”

Umm. No, hon, I am feeling pretty good.

But this time around, this pregnancy, things have felt different.

Did I have “pregnancy depression?” Would I pass the screening? What’s the difference between being pregnant – with a crazy amount of hormones flowing through your body – and being pregnant and depressed?

It can be so hard to tell. Like when there is a blizzard back home but you escaped just in time, and you are sitting by the pool at a beautiful hotel in Palm Springs, and the air feels just right, and your toddler has finally gone down for a nap, and yet, you are crying.

Or when you wanted to go pumpkin picking so your husband tried to cheer you up by returning from Home Depot with a large pumpkin and orange mums. You know he was just trying to help, but pumpkin picking at Home Depot? Pregnancy depression might be when you can’t see the pumpkin and mums on the front steps without bursting into tears.

Is that pregnancy depression, or just pregnancy?

Pregnancy depression could be when your toddler is playing on the balcony outside your hotel room and for a split second you think: If he falls, he falls; it would be an accident. And it doesn’t immediately occur to you just how disturbing that thought is.

That’s shocking, but is it depression?

I see doctors and nurses every four weeks for my pregnancy. But they haven’t once asked me how I’m doing emotionally. One time I arrived for an appointment visibly distraught. I hoped someone would ask, but nothing.

I don’t know why I haven’t raised the issue myself. Maybe it feels like they aren’t the right people to discuss this with. The nurses take my blood pressure. I trust my doctor to perform a C-section, if need be. What do they know about moodiness?

On the other hand, in recent years there has been a real increase in awareness about mood disorders during pregnancy. If the medical professionals seeing pregnant women and new mothers aren’t looking for these things, asking the right questions and identifying patients who need help, then who is?

When we returned from Palm Springs, I looked deeper into pregnancy depression and what it means. The episode with our toddler on the hotel balcony had scared me. My thought was fleeting, but I was horrified that I could even think such a thing.

The more I read about pregnancy depression, also called perinatal mood and anxiety disorder, the more I realized it might not just go away. I began to worry that I would struggle even more once I gave birth and was home with our baby – sleepless and overwhelmed with a newborn and toddler, especially when my husband was out of town on business.

I also wondered if our toddler could sense my mood. And what if when the baby came, my sadness affected my ability to bond with him?

Moodiness on its own I can manage. But depression that could affect my children and my relationship with them? That was something I wasn’t willing to tolerate.

It was time, I decided, to talk to my husband.

When I called Raj, who was traveling, he could hear something off in my voice. This time he asked, “Are you sad?”

Yes, I was sad.

I told him I was concerned that my sadness over the past few months was a real problem. That it wasn’t going away. That it might get worse.

It helped being so honest with him, and with myself. He didn’t judge me, which now I realize was my fear. He told me it wasn’t my fault. He said he’d watch our son, and I could see a therapist or support group available on the weekends. He said he was glad I had told him – and I was, too.

The next day I contacted Postpartum Support International, an organization that supports women facing mental health issues related to childbearing, and talked to a coordinator in New York City. She gave me a handful of therapists to call.

Something changed after I acknowledged that I was struggling, that I needed help: I started to feel better.

I found a therapist who was warm and understanding and let me go on and on about my concerns about taking care of two children while my husband was away, and my fears that I wouldn’t be able to manage.

The therapist didn’t have specific answers. (And unfortunately she didn’t offer to lend a hand with late-night feedings.) If anything, she told me what I already knew – that it can be really hard to tell the difference between a wave of pregnancy hormones and clinical depression. She said it seemed that I was suffering from the former.

But we also agreed that what I was experiencing was real. That hormone fluctuations can manifest in many different ways, and that it’s often not enough to just ignore them. In fact, sometimes, it’s the very act of addressing them head-on that makes all the difference.

Hanna Ingber is an assistant editor on the International desk at The New York Times.

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