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Bars in Alaska have installed free pregnancy tests in their women's bathrooms in an effort to curb drinking among pregnant women. The tests are subsidized by the state of Alaska as part of a campaign to reduce fetal alcohol syndrome, which is more prevalent in Alaska than in any other state.
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Three things to know about postpartum depression as you read about Miriam Carey and the Capitol car chase
Yesterday, Miriam Carey died after being shot by police following a car chase between the White House and the US Capitol building. Carey is reported to have tried to ram through barricades at the White House, hitting at least one officer as well as a squad car. She then drove her vehicle into barriers in front of the Hart Senate Building before being fatally shot by law enforcement officers. She was unarmed. A child identified as her daughter — a little more than one year old — was in the car the whole time.
Today, news outlets are reporting that Carey had a history of traumatic brain injury and postpartum depression, the latter of which may have been severe enough to send her to the hospital at some point in the past year. Nobody knows what, if any, effect this may have had on what happened yesterday. But it's led to plenty of speculation, and the spread of bad information that stigmatizes women suffering from an incredibly common mental illness.
For instance, on NBC's Today Show this morning, psychologist Jennifer Hartstein declared that "postpartum depression has led mothers to kill their children" — a statement that conflates PPD with a different disorder AND overstates the risk that other disorder poses to kids.
Over the next few days, we're all likely to hear a lot of discussion about postpartum depression. As you absorb that news, keep the following facts in mind:
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I'm 38 weeks pregnant now. Two weeks ago, my husband and I both got Tdap vaccines — tetanus, diphtheria, and pertussis. This despite the fact that we've both gotten Tdaps relatively recently, within the last six years, thanks to a home renovation lifestyle that involves regular exposure to rusty nails.
So why re-up on the Tdap before the birth of our baby? It's all about the pertussis. Also called whooping cough, pertussis is particularly hard on infants. Pre-vaccine, it killed 4000 Americans every year, and most of them were new babies — and infections are on the rise in this country, so there's actually a reasonable risk of a newborn coming into contact with the bacteria that causes pertussis. But the larger problem is with the pertussis vaccine, itself. It doesn't have the staying power it once did. A little over 20 years ago, we switched the formulation for pertussis vaccines. There were good reasons for doing that — the "new" formula has fewer side effects. But it also doesn't seem to protect people as well for as long. In fact, the protection starts to wear off within a year of vaccination.
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As a woman, you do become less fertile as you get older, eventually culminating in menopause and the end of your potential babymaking years. But what does "less fertile" mean, and at what age, and how quickly does the drop-off in fertility happen?
According to this really fascinating piece by Jean Twenge at The Atlantic, some of the commonly cited scare stats — that one in three women ages 35 to 39 will not be pregnant after a year of trying, say — are based on extremely old data collected from historical birth records that don't necessarily reflect what's happening with real women who are alive right now. That statistic mentioned above, for instance, comes from French records (likely those collected by local church baptismal registries) for the years 1670 to 1830.
That matters because fertility is affected by things like quality of nutrition, infection rates, and even childhood illnesses — all of which have changed drastically for the average Western woman since the 19th century.
Look at more modern records, and the outlook for post-30 babymaking is completely different.
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Hillary Rosner is a fantastic environmental reporter — the sort that digs facts and stories more than outrage-bait and blind activism. She's currently pregnant and, like all pregnant ladies, is finding herself subject to a deluge of warnings and "helpful" advice. When you're pregnant, there is always somebody who wants to let you know what you're doing wrong, why you're being irresponsible, and how you've totally ruined your kid's life already.
But in the midst of this, Rosner noticed something really fascinating: When it feels like the world is conspiring to make you terrified and guilty, it's sometimes easier to just tune out the world rather than investigate which claims are true and which aren't.
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Kate Clancy is one of my favorite bloggers. An anthropology professor at the University of Illinois, she studies the evolution of female reproductive anatomy. Her blog covers science I don't see anywhere else—the human evolution, cultural anthropology, and behavioral science behind ladybusiness.
So Clancy's blog was one of the first places I looked yesterday after reading about Missouri Rep. Todd Akin thoughtful commentary on female biology. In a long, well-written, and (fair warning) rather graphic post, Clancy talks about what we know about rape—think of it this way, you know way more people who have been raped than who have a gluten intolerance—and the way that emotional trauma affects conception and pregnancy.
First off, there is absolutely no difference in the rate of conception between women who have been raped and those who had consensual sex. Clancy breaks this down nicely in her blog post, and even offers a surprising tidbit from the research literature that all people should consider—at any given day in a woman's cycle (even days when she is supposedly "infertile") there's about a 3% chance of unprotected sex leading to a pregnancy.
The impact of stress on miscarriage is a lot messier. I've mentioned here before that we know very, very little about miscarriage, relative to a lot of other medical issues. To paraphrase my family practice doc, when you start talking about conception and miscarriage you very quickly wander past the small amount of hard evidence and straight into voodoo. And also into the counter-intuitive nature of reality. For instance, from reading Jon Cohen's excellent book on miscarriage science, Coming to Term, I know that one of the very few miscarriage interventions that's ever performed better than placebo in multiple trials is something called "Tender Loving Care". The idea: For whatever reason, women who have had recurrent miscarriages have a greater chance of carrying the next pregnancy to term if they have regular access to mental health services, stress-relieving practices like meditation, and doctors who listen and respond to their fears. But that's not the same thing as saying that stress, or a scare, or a severe mental trauma will, inevitably, cause a miscarriage. Here's Kate Clancy:
Yes, psychosocial stress is associated with fetal loss in some samples. That is not the same thing as saying that stress causes fetal loss. Some women are more reactive to stress than others, and this seems to be based on genes and early childhood experiences. As I pointed out in my post, it certainly isn’t something women have conscious control over. And so it is irrational to link the stress of rape, while awful and severe, to fetal loss, when we understand the mechanism of the stress response and its relationship to pregnancy so poorly, and when we know next to nothing regarding how variation in stress reactivity is produced.
Basically, while stress (and the associated hormones) are correlated with a higher risk of miscarriage in some (but not all) studies, that seems to have more to do with an individual's biological makeup than it does with the source of the stress. And, frankly, we barely know enough to even say that.
• Read Jon Cohen's book, Coming to Term. (I keep recommending this, but, seriously, it's wonderful. And a hugely sane-making force in my life.)