Belly Tales

This is a site I found through Women’s Health News, but I felt it really deserved a post all its own.  A midwifery student decided to take a picture of her cervix every day for one entire menstrual cycle, and the pictures are absolutely amazing.  I want to print them out and show them to all of my clients who are trying to conceive as a way of illustrating what fertile cervical mucus looks like, and when they should be having sex!  She has entitled the website My Beautiful Cervix, and I can’t think of a more appropriate name.  I really need to get a mirror in my exam room and start to show women their cervix during our exams.  Women really need to see their cervix to understand.  There’s something so powerful and so positive and affirming about seeing this amazing, hidden, little secret thing inside of you that you never get a chance to see, and yet is always humming along, doing her thing.  It’s truly eye-opening.  I will never, ever forget the very first time I saw my own cervix.  In fact, I am somewhat tempted to take pictures of my own cervix for a month, and join her project.  Anyway, massive kudos to her courage and ingenuity in getting these pictures online.  Hopefully she won’t be forced to move the website again, due to heavy traffic and complaints about “inappropriate images”.  It’s only a cervix, after all.  Just think of how much more peaceful our world would be if the defining symbol underlying our culture was a cervix instead of a phallus.

National Advocates for Pregnant Women just concluded its 4 day Summit To Ensure the Health and Humanity of Birthing Women in Atlanta, GA, this past weekend. This summit, one of the first of its kind, was organized by NAPW and NAPW’s director, Lynn Paltrow, to explore the grey area where pregnancy, birth and the law intersect. In our increasingly litigious society, the debate about reproductive choice and reproductive freedom is not limited only to the debate over abortion; women are constantly facing difficult decisions, constrictions and legal battles on a daily basis simply to be allowed to give birth where they want, how they want and when they want. It seems like one of the overt aims of this conference was to widen the terms of the discussion and to get the reproductive rights advocates talking with the pregnany and birth rights advocates, demonstrating how these two debates are really just different ends of the same spectrum, and how all womens’ rights are being constricted, whether they choose to have children or whether they choose to have an abortion.

The Summit program covered everything from the overbearing and disempowering birthing machine in this country to our culture’s rampant fear of birth, from the legal restrictions being placed on VBACs, contraception and abortions to the disturbing rise in fetal rights, where mothers with substance abuse problems are prosecuted for “child abuse” on behalf of their unborn fetus, instead of being offered the care and treatment they need….and so much more, more, more. I really wish I could have attended! NAPW even offered several bloggerships to a few of the lucky feminist, birth and reproductive rights bloggers who were able attend. Too bad we didn’t get a longer winter break; school started again on January 9th, alas.

It’s been absolutely fascinating reading the reports and thoughts of many of the bloggers who were able to attend. I’ve linked to a partial list of the blogs on the Summit, so that you can read for yourself. It’s almost as good as being there (although not quite).

Feministing: Semi-live blogging from NAPW Conference

Gymno: Sick Blogging

Gymno: Summit Day 1 (cont.)

Is there no sin in it: NAPW Conference is happening now!

bird in a bottle: More Lynn Paltrow love (and a prelude to Blog for Choice Day)

bird in a bottle: Language and Gender, Part Deux

bird in a bottle: Why I want to be Dorothy Roberts when I grow up

Angry Black Bitch: Thoughts inspired by sessions

Angry Black Bitch: Thoughts inspired by debates, particularly the VBAC v. cesarean delivery debate.

Pandagon: NAPW Summit kicks off

Pandagon: NAPW Summit: end of the 1st Day

Bitch PhD: Join this Organization

Women of Color: The first part of the conference

And even more from brownfemipower here and here and here, and finally: Midwives of Color.
Oh, and this is just too cute not to pass on.

And finally, a word or two from the demi-goddess herself: Lynn Paltrow’s article in the San Francisco Chronicle, On the Anniversary of Roe v. Wade

A friend of a friend recently asked me a question that I couldn’t answer. She is in her late 30s, has a two year old daughter, and has been breastfeeding on demand for the past two years. She and her husband have been trying to have another child, but she just recently learned that she miscarried after their first attempt. She has only recently started getting her period again, and was wondering if the breastfeeding could negatively impact her body’s ability to get pregnant again. I speculated that the high levels of prolactin which occur during breastfeeding might inhibit ovulation, just as high levels of estrogen inhibit breastmilk supply by competing with prolactin for binding sites in breast tissue, but I told her I wasn’t really sure and that I would investigate. I thought that somehow estrogen and prolactin were counter opposites: one could not exist in high levels while the other was around. Turns out I was waaaaay off base. Here’s what I found:

During pregnancy, the corpus luteum, acting on instructions from the placenta, secretes the estrogen and progesterone necessary to maintain the pregnancy. These high levels of steroid hormones simultaneously supress Follicle Stimulating Hormone (FSH) and Leutenizing Hormone (LH), the two hormones most responsible for ripening an egg and then triggering ovulation—after all, if you’re already pregnant, there’s no need to ovulate. After delivery, once the placenta is removed, the high levels of estrogen and progesterone no longer exist, and the levels of FSH and LH gradually begin to rise again, preparing the body for ovulation. Eventually, as the levels creep up, the pituitary takes notice again, and begins to release more FSH and LH through a negative feedback loop, which eventually will trigger ovulation.

“Most nonlactating women resume menses within 4 to 6 weeks of delivery, but about one-third of the first cycles are anovulatory, and a high proportion of first ovulatory cycles have a deficient corpus luteum that secretes sub-normal amounts of steroids. In the second and third menstural cycles, 15% are anovulatory and 25% of ovulatory cycles have luteal-phase defects…Lactation, or breastfeeding, further extends the period of infertility and despresses ovarian function. Plasma levels of FSH return to normal follicular phase values by 4 to 8 weeks postpartum in breastfeeding women. In contrast, pulsatile LH stimulation is depressed…in the majority of lactating women throughout most of the period of lactational amenorrhea.” [1]

In other words, after not menstruating for so many months, it takes the body a few tries to get the delicate hormone balance back up to speed again. The first few cycles either don’t release an egg, or if an egg is released, the corpus luteum, which is responsible for secreting enough progesterone to maintain the pregnancy until the placenta can take over, isn’t quite up to the task. This is called a luteal phase defect, and it’s a very common cause of early miscarriages. In women who are breastfeeding, the process of returning to normal ovarian cycles takes even longer.

In breastfeeding women, FSH, the hormone responsible for ripening an egg, returns to normal pre-pregnancy values fairly early, but LH, the hormone responsible for triggering egg release, continues to be surpressed due to the breastfeeding. (However, contrary to popular belief, prolactin is not at all responsible for this supression. It’s the constant suckling and stimulation of the nipple itself which actually suppresses ovarian function, which is why on demand breastfeeding is so essential to maintaining lactational amenorrhea.)

So, there you have it. To answer the question: it will probably just take a few more cycles for your body to get back into full swing in terms of ovulating, but continued breastfeeding did not contribute or cause the miscarriage in any way, and will not prevent conception. Most likely, the miscarriage was caused by a short luteal phase or corpus luteum that just wasn’t quite ready to maintain a pregnancy, and this will no longer be a problem once your body goes through a few more cycles and gets used to ovulating again.

[1] Hatcher, R.A. et. al. (2004) Contraceptive Technology, 18th Revised Edition. Ardent Media, Inc.: New York.

The curse, the red tide, my period, my monthly, my friend, on the rag, on the spurt, and on and on. All the jokes, all the whining, all the bitching, all the unfair media portrayal, the cultural stigma, the fear, the shame…menstruation gets such a bad rep that, at the very least, I felt it deserved to be paired with a word like “magical” for a refreshing change of pace, if for no other reason than its very complexity. Do you have any idea how many hormones are involved in your monthly menstrual cycle? Take a guess: 2 hormones? 3? 4? I can’t even tell you. Our lecture today covered the ups and downs of the 5 major hormones that are involved, but the lecturer kept slipping in little comments like: “and of course, prostaglandins, and inhibin, and [insert other hormone names that I wasn't even able to catch] also play a part, but I’m not going to get into that today.” Damn straight it’s magical. It’s absolutely amazing! If we ever tried to reproduce the entire cycle in a laboratory setting, there’s no way in hell we’d ever be able to get it right. Do you have any idea how many things are all happening at once? It’s a bit mind boggling.

Mind-boggled. Yup, that’s pretty much how I feel right now. This semester is going to be a TON of work. I have so much on my plate already that I don’t even know where to start (hence, this delightful post: why start in on your homework when you can procrastinate and post to your blog instead?). And as for the menstrual cycle…this is something we studied in nursing school, and I had a hard time grasping it then. This is something I’m going to have to go over again and again and again until I know it forward and backwards, because it’s so damn important (and so damn complex). This is the reason and the beginning, the why and the how, of pregnancy. The hypothalamic-pituitary-ovarian axis, the follicular phase, the proliferative phase, the secretory phase, the luteal phase…all these names for something that your body does automatically, naturally, without fuss and often with very few mistakes, every single month for most of your adult life.

Lecture today was great. The guest lecturer was smart and sassy and a lot of fun—material that could have been really boring was actually made fascinating, which says a lot. And lots of little fun facts tossed in for good measure. For example, did you know that bleeding is not actually necessary at all during the cycle if you’re on birth control? Because of the presence of progesterone from the very beginning of the cycle, the lining of the endometrium doesn’t ever proliferate very much at all, but just stays steady at about 2 mm of development, and can stay that way for quite some time, if you ever want to just go through a few pill packs back to back and skip the week of placebos that allow for bleeding. In fact, apparently the only reason the placebo week was structured into the pill cycle was because of a decision made by a very Catholic man in the 1950s, who felt that monthly bleeding was necessary in order to help remind women of Eve, and the fact that they’re women, I guess. There’s a new pill out now that will charge you an arm and a leg for the privilege of only bleeding four times a year (Seasonale), but you might as well save some money and just take your regular pills back to back (although talk to your midwife/health care provider about it first, of course).

Another interesting fun fact: the Morning After Pill (aka EC or Emergency Contraception) really truly IS birth control, and not an abortifacient, and yes, I already knew this, but now I understand why. EC is basically just pure progesterone, and it works best during the follicular phase of the cycle, where the sudden burst of incoming progesterone is enough to prevent the release of leutenizing hormone that triggers ovulation. In other words, EC works best if it’s taken before ovulation occurs, in order to prevent ovulation. However, if ovulation has already occurred, the surge in progesterone may slow down fallopian tube motility and therefore possibly prevent implantation (in which case, I guess I could see how conservatives could potentially argue that this prevention of implantation is in fact the killing of a baby, but I do think it’s a rather thin argument). However, the little fun fact I didn’t realize is this: as soon as you’re pregnant (i.e., as soon as the trophoblast has implanted), the corpus luteum begins to make progesterone in vast quantities, and if you happen to take EC at this point in the cycle, it won’t disturb or prevent the pregnancy in any way whatsoever. In other words, if you’re already pregnant (i.e., the trophoblast has already implanted), EC does not end or harm your pregnancy in any way. In other words, it’s NOT an abortifacient. As soon as that trophoblast implants, the corpus luteum is working its ass off to produce massive amounts of progesterone anyway just to keep the pregnancy afloat until the placenta can take over hormone duty; a little extra squirt of EC progesterone at this time does NOTHING to disrupt this. FYI. (Why do I feel that if more people actually understood how EC worked, so many of the objections to it would just disappear, and the FDA might finally get around to approving it for over-the-counter use? Righto. Get the word out, ladies.)

Yesterday, I thought we were living in a terrible nightmare where The Handmaid’s Tale was on the verge of becoming reality. To quote extensively from Brendan Coyne’s article in The New Standard:

Oct. 5 - A legislative commission in Indiana may recommend the state adopt strict new rules governing medically-assisted reproduction. The proposed legislation would bar unmarried people from having babies except through sexual intercourse and makes doing so – or even attempting to do so – a misdemeanor.

Same-sex and unmarried couples, as well as singles, would be legally prevented from using methods other than sexual intercourse to have a family under the legislation. In most cases, Indiana adoption law already prevents singles and homosexuals from adopting children, the Journal Gazette noted.

In addition to preventing people not in “traditional families” from using medical means to become parents, the bill would set a series of difficult, intrusive and potentially arbitrary standards that would-be parents must pass prior to approval of any artificial insemination procedures.

(The Fort Wayne Journal Gazette also picked up the story).

I mean, what the hell…unauthorized reproduction?? Refusing to let single woman and gay couples have access to IVF, simply on account of them being single or gay? Arbitrary tests that would-be parents must meet before they’re allowed to have IVF? Because we’re trying to breed a super-race of conservatives, and only those who are heterosexually joined in holy matrimony are allowed to have babies??

Right.

So, as of today, I was incredibly happy to see that they came to their senses rather quickly. “State Sen. Patricia Miller, R-Indianapolis, issued a one-sentence statement Wednesday saying: ‘The issue has become more complex than anticipated and will be withdrawn from consideration by the Health Finance Commission.’ ”

Well, duh. But I suppose that in a climate where the FDA refuses to approve Plan B on completely spurious grounds, and Roe v. Wade is becoming more and more endangered on a daily basis…deciding who can and cannot have IVF is the logical next step, right? Except for this one little caveat in our Constitution which talks about life, liberty and the pursuit of happiness for all, not just for straight, married couples.