Wednesday, December 15, 2010

Pregnancy Calls for Common Sense

Last weekend, I drank about two ounces of red wine. Yes, I'm five months pregnant and I drank the dreaded A word. This topic, whether or not a glass of wine every now and then during pregnancy is okay, came up on a bulletin board I'm on for pregnant women. I've seen a little bit of backlash but I'm expecting more as time goes on.

Frankly, I think that there are a lot of old, tired arguments against alcohol consumption during pregnancy. I figured I'd like to address a few of them.

Studies show that there is no safe level of alcohol consumption during pregnancy.

How exciting! Has anyone actually looked at these studies? I did, when I was pregnant with my daughter. I'll start with one of the more specious ones. In this particular study, they asked mothers who were no longer pregnant (some had finished childbearing several years before) to comment on their alcohol consumption during pregnancy. Then they were grouped by the amount of alcohol they drank, and the resulting effects on their children were analyzed. Problem: in this particular study, there were only two groups: women who drank during pregnancy and women who didn't. So besides the fact that they were asking women to comment on their habits from years before, the woman who drinks one glass of wine during pregnancy and the woman who drinks three or more alcohol drinks per day during pregnancy were put into the same category. I'm sorry, but as someone who has at least taken introductory statistics and has a reasonable head on my shoulders, I don't consider this a viable study. I certainly don't consider it conclusive proof that there is "no safe level of alcohol during pregnancy."

I read another study performed by the CDC in 2002 that had similar grouping flaws.  There were three classifications for women who had drank during pregnancy: five or more drinks on one occasion; seven or more drinks per week; and everyone else. In my opinion, there's a HUGE difference between a woman who had one drink during the whole of her pregnancy and a woman who had six drinks a week during pregnancy.

Here was a claim from an article on iVillage about this very subject: "One study reported that 30 percent of offspring exposed to 14 ounces of absolute alcohol or greater around the time of conception or 3.5 ounces or greater during pregnancy had impaired neurological functions."

Remember, that's not 14 ounces of wine, that 14 ounces of absolute alcohol, all in one or two days since you don't spend five weeks conceiving. That would be about 35 ounces of rum or 98 ounces of wine. 3.5 ounces of absolute alcohol, one quarter of this damaging estimate, would be about 24 ounces of wine, which is hardly a half-glass once during pregnancy. Do you consider someone who downs 98 ounces of wine in one day to be a moderate drinker? I certainly don't.

Experts agree that there's no safe level of consumption, which means that you shouldn't consume any alcohol during pregnancy if you want to guarantee your baby's safety.

When I was researching this stuff while I was pregnant with E, one thing kept coming up: doctors were worried that women couldn't differentiate between one glass of wine occasionally and hardcore alcoholism, so it was better to just tell them they can't drink alcohol at all. That is so paternalistic. I even found a site that said that women of childbearing age (12-50) shouldn't drink alcohol on the off-chance that they might become pregnant, even if they are on birth control.

Apparently, Naomi Wolf felt the same way. In her book "Misconceptions," she says the following about the rigid diets women are expected to adhere to during pregnancy: "This was my gut feeling: because we are too dumb, with only the facts presented to us, to moderate our intake like sensible bovines. I felt manipulated by the authors as I gazed, dumb-founded, at the sheer mountains of roughage prescribed day by day. I tried to imagine eating five servings of bran or other unmodified grain product before nightfall, servings of leafy green vegetables with every meal, and for between-meal snacks, a mound of citrus fruit. If you eat a muffin, you have 'cheated.' You cannot have even a half a glass of wine 'except for a celebratory half glass of wine on a birthday or anniversary, with a meal,' because, though the studies on moderate alcohol intake show statistical insignificance, studies also show that pregnant hard-core alcoholics deliver compromised children. We can't be trusted with moderation. So drop that glass of white wine. Now."

To adopt a zero-tolerance attitude about alcohol consumption during pregnancy where it is not shown to be necessary is simply bad logic, if you consider how poorly-run many of these "conclusive" studies were. Frankly, it would be like saying that we know that women who eat five pounds of chocolate per day while pregnant are at risk for excessive weight gain and all the risks that poses to the pregnancy, so to be safe we'll say that women should not eat chocolate at all.

This absurd logic has so many applications, some of which probably deserve more consideration than the fearmongering over alcohol consumption. I wouldn't say we need to examine the risks presented by carrots, but what about morphine?

Let's look at the medications you might consider taking during pregnancy for whatever reason. The FDA classifies all medicines into five categories for pregnancy: A, B, C, D, and X. Since it is illegal to test drugs on pregnant women, there has been a degree of guesswork in deciding what drugs belong in which categories. The categories show the following: A means that it's safe for pregnancy, but few drugs are in this category. B means that there have been no significant risks of teratogenic effects on the growing fetus, and the benefits provided by taking the drugs outweigh the risks presented. C is a bit of a gray area. It means that the risks may outweigh the benefits, or the benefits may outweigh the risks. The C category usually indicates you should talk to your doctor about it, and decide if it's worth it to take the medicine or to consider a safer alternative. Since this is the "on-the-fence" category, almost all new medicines start in this category and then move either up or down. D means that the risks to the fetus will very likely outweigh the benefits to the mother, and so they should only be used during pregnancy with extreme care. The last category, X, is contraindicated, meaning the drug is so risky that it should not be used during pregnancy under any circumstances. The categories, as well as sometimes being somewhat vague (in the case of C), can also be fluid. Certain drugs that might be a Category B for infrequent use become a C if you use them all the time.

This is a complicated issue that deserves concern, at least the same level of concern as is shown for alcohol consumption. But in the halls of yellow journalism, where women who dare to take a sip of champagne on New Year's are likened to terrorists, the safety of the drugs women take during pregnancy gets much less attention. Why is that? Does it make it easier for us to ingest drugs instead of alcohol? It certainly doesn't make it safer. The fact that these categories (and the drugs that belong in each one) are widely available online indicates that women can be and are expected to do their own research and think about these things before they consume them. I can do that for my cyclobenzaprine (muscle relaxant, Category B) but apparently I'm too stupid to do that for alcohol, so every drop of alcohol is Category X.

If you can't go without it for nine months, you must have a problem.

This one is my favorite. The red herring. It's so effective because it reduces the poor woman to an alcoholic for having one or two drinks during pregnancy. The fact of the matter is that this argument can also be applied to an unlimited amount of consumables. After all, the only thing we must consume is water. After that, everything is optional. So if you can't give up apples for nine months, you must have a problem. If you like to eat cheese and you selfishly refuse to give that up too, you're an addict and you need help. Actually, cheese is yet another great example of the distinct lack of common sense women are expected to show during pregnancy.

Women are terrified of eating soft cheeses or raw milk cheeses out of fear that their fetus may develop listeria. No doubt, listeria in a pregnant woman is a serious condition. But most people fail to understand where the true risk is. Instead, they read an article in a newspaper (something that was intended to be controversial and draw attention) and draw conclusions from that, instead of doing the research for themselves. They don't understand the vast array of professional opinions on this subject (the same as there are for alcohol). The fact of the matter is that, in this country, all cheeses must be aged at least sixty days. That kills the listeria risk. Where you typically see problems with listeria outbreaks happens when someone has made locally or smuggled in cheese that has not been aged for sixty days. I remember this used to be a problem from time to time when I lived in San Diego. You'd read in the newspaper about a bunch of people getting food poisoning because they ate queso fresco that was made in somebody's bathtub. I don't eat cheese that isn't packaged and sold in the store. I especially like to know where raw milk cheeses have come from, so I do my research. But instead of doing that research while I was pregnant with E, I just quit eating that kind of cheese. When I went back to my favorite cheese shop after nine or ten months away, I got the education I sorely needed.

Be careful during pregnancy, but be careful overall. And be sensible overall, in all the activities you do and the food and drinks you consume. Avoiding alcohol doesn't give you a free ticket to be irresponsible otherwise. You're not doing your fetus an ounce of good if you forswear alcohol for nine months but load up on double cheeseburgers every day of your pregnancy, as someone I once knew was wont to do. Sure, drinking a regular amount of alcohol during pregnancy can cause harm to your fetus. But you are taking the same risk when you take Category C drugs, consistently fail to drink enough water, maintain a poor diet, or pursue a great deal of interventions during labor and delivery. I fully believe that severe dehydration has caused more tragedies on delivery day than alcohol ever will.

So the next time you see a pregnant woman with a glass of wine in her hands, don't be too quick to jump to conclusions. She's probably not an alcohol any more than you are. And frankly, the likelihood that you engage in similarly risky behaviors is so high that you don't want her to start loudly pointing out all the things you do that pose risks to you and your children.

Wednesday, December 1, 2010

I think we are all going to hell, at some point...

I want to start this blog with a story from 1998. At the time, I was working as a delivery driver for a company that did home delivery from various restaurants in the area. One of the places was a little burrito place that had some pretty good burritos. As our story goes, I was sent to the hotel room of a customer who had received his order incorrectly. I hated doing this because someone else had done the work and collected the tip, but it was my job to fix it on my somewhat-less-than-minimum wage hourly pay. When I arrived, he explained that his vegetarian burrito had been smothered in a sauce that had a meat broth base. No problem, the restaurant is close by, I'll fix it. I got to the restaurant, got the fixed burrito, and brought it back to the customer. The customer said he could not take it because it had been topped with cheese. I said this fit the criteria of a vegetarian burrito, and I did not see "no cheese" on the order. He explained he was not vegetarian, but vegan. I was a heathen college student at the time so of course I knew what he meant. When I asked him if he'd said he was vegan to the order-taker (people who routinely handle food requests are remarkably sharp about differing diets), he said he hadn't. He told me that he had said vegetarian because he assumed no one would understand what vegan meant. Sigh. So his failure to correctly describe his dietary needs meant that I had to go back to the restaurant a second time to get a burrito topped with broccoli, not cheese. While I was fulfilling his order, I missed the opportunity to deliver at least two, if not three orders. This guy's inability to say specifically what he wanted cost me at least $20 that night, which was a lot of money to me at the time. And now when I think about it, I wonder if the tortillas for the burrito were cooked in butter or lard. They probably were.

The point of this story is that I think we are all going to hell, at some point. Last week, I read an interesting blog post from a woman who used to be a vegan but isn't anymore. She was saying that she realized she wasn't really making sustainability on the planet much easier as a vegan: "Presenting veganism as a panacea that will stop global warming, save all the animals, and feed the starving masses is nearsighted and unfounded." It's an interesting blog post.

I don't think you can uniformly take the moral high ground in this world. For example, if you boycott Walmart for its terribly history of worker subjugation, will you boycott every small business that does the same? How do you find out these things? It's certainly not easy. I've been looking at preschools for Elizabeth, and of course I considered the preschool I went to that I loved and is only a couple miles from my house. But during the recent election, I learned that the founder and president of this preschool (which is now several K-8 schools in more than just Utah) funded some very disturbing political ads not endorsed by the candidates or parties she was endorsing. I'd rather that my money not go to that, so I don't think I'll be sending my daughter there.

Tasha (the former vegan) is right. I do not think that there is any one path that is perfect in its treatment of humankind or our poor earth. But also like she has said, I believe we still have the responsibility to do the best we can. For me, this means recycling everything I can and working to limit my garbage (and also recyclable) waste. I pledge to learn how to use the compost bin that is in my backyard and have a bigger home garden next year than I did this year. It means breastfeeding and cloth-diapering my infants and toddlers. It means feeding my family food that is as natural as possible as well as local, where available. And I have the responsibility to teach my children how to do this and why I think it is important.

Will I slip up, from time to time? Of course. I put E in disposables for six months, and I felt terrible about it. I feel better now that I'm making one or two fewer garbage bags each week, just by washing diapers and scrubbing a few of the dirty ones. It's been hard to recycle here since the city assumes you have recycling pickup, but they won't come to my mobile home complex. The dump, ironically, is the only place in the county that recycles everything. But it is my job to continue to try, and never to give up. Above all, that is a trait I would like to impart to my children.