To snip, or not to snip

In 2012, the American Academy of Pediatrics published a statement regarding newborn male circumcision. The statement made more than a few waves - both in the medical community and beyond. The statement has been published, re-published, agonized over and interpreted down to the letter.

The statement is more or less summarized by the following sentence, taken directly from the AAP website:

Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. 

Since then, researchers have been cranking out piles of literature. A very large cohort of European scientists were quick to publish this review after the statement had been published, calling attention to some of the weaker statistics and pointing out what they identified as cultural bias. The debate rages on two years later, with the New York Times publishing this blog post recently, in response to a recent paper in the Mayo Clinic Proceedings.

And so the question remains; to snip, or not to snip?

When I first came across the AAP Statement, my interpretation was (I believe) similar to that of the masses; that this was the AAP's way of subtly recommending newborn male circumcision. But the more I thought about it, I realized that this was not necessarily the case.

The AAP had been decidedly neutral on newborn male circumcision prior to 2012, and America saw a steady decline in newborn circumcision rates. Health insurance companies took note of this. As important as health insurance is, companies will not waste a second to cease coverage if a procedure is not deemed to be medically necessary.

The above statement may or may not provide sufficient evidence in favor of newborn male circumcision. But it undoubtedly provides evidence for the continuation of health insurance coverage of the procedure. In publishing their statement, the AAP is not so much saying that individuals should circumcise their children as they are protecting the individual's ability to do so without breaking the bank.

What do I think? Well, I've done quite a bit of research, and have given it a lot of thought. I haven't been practicing long, and as a Pediatric Nurse Practitioner I don't know much about the long-term sexual effects of the procedure. But in terms of medical complications, I have seen far more in individuals with in-tact foreskins than I have in individuals without foreskins. I have not noticed any significant difference in breastfeeding or maternal bonding, and the literature seems to agree with me. So as for now, my vote is for the snip.

Ovia Pregnancy: App Review.

Two posts, one day, ftw.

After scheduling my first appointment with my OB, I decided to download some pregnancy-related apps. I was looking for an app that would let me keep track of symptoms, check in on Babykirk's progress, and allow me to look up foods/medicines that might be unsafe.

I started out with "The Bump," because I had used its sister site "The Knot" for wedding-planning and really liked it. The best thing about The Bump - something that I was not initially looking for - is it gives you access to something called a Birth Club - a forum with all the other Moms-to-be who are due in the same month as you. Since I'm still in the "don't tell anyone!" stage of pregnancy, I've found it to be surprisingly comforting. Also, the "Your baby is the size of a..." section is pretty cute.

That being said, the app is otherwise pretty useless. Even their checklists are kind of stupid. Some are useful, like "Schedule your first ultrasound," but "Give yourself some 'Me' time?" Gross.

I tried a couple other "Can I eat this?" apps, but I didn't find anything worth keeping.

But today, a fellow Bump member recommended the Ovia Pregnancy App. If you find yourself looking for a pregnancy app that is comprehensive, cleanly designed, and easy-to-use, then look no further.

The front page presents a quick overview of your pregnancy to-date; complete with trimester, week counter, illustration of size of baby, and illustration of size of baby's handprint (awww).

Below that, it gives you a live feed of your "data." By clicking the "Add Data" button you can include updates on your weight, exercise, sleep, nutrition, symptoms, medications, and even blood pressure. Further along, you can also utilize a kick counter and a contraction timer (so cool). It allows you to set goals in all of these categories and gives you little updates (and recognition!) as you accomplish them

Also included in your feed are relevant articles and information about pregnancy and parenting. And...drumroll please...

Ya. It's basically like the holy grail of pregnancy info. The Food Safety Lookup has just about every food you can image, and allows you to search, rather than browse (good for very hungry pregnant women rummaging through the fridge at midnight). Pregnancy week-by-week provides enough information without being "too much." And Symptoms Lookup explains what the symptom is, whether or not it's expected, why it occurs, and what you can do about it.

Overall, I give the App 5 stars...or thumbs up...I don't know, I don't exactly have a functional rating system. I like it. You should use it.

** I also looked into "I'm Expecting," by Medline, "What to Expect," and "Sprout," by American Baby. They were pretty good, but not as comprehensive as Ovia.

The Drink

I'm a coffee person. I have often said that my blood type is Venti Bold. If you want a break down on why coffee is the greatest thing in the world, check out ilovecoffee or talk to my husband for more than five minutes.

Now that BabyKirk™ has come along, I've been doing some research into the effects of coffee on fetal development. Coffee is one of the few million things that you are not allowed to consume during pregnancy, because of course you and the baby will spontaneously combust and THE ENTIRE WORLD WILL END.

Coffee is an especially tough one for me because it has become so much more than a drink. It's actually a pretty significant part of my life. My morning routine legit doesn't exist unless I get a cup of coffee. At work, I perk up at just the though of my mid-morning joe. If I work nights, a quick stop at Starbucks is what gets me through the second half of my shift. So if this was something that had to go, I wanted to be sure that it really had to go.

I started out by browsing UpToDate. If you're not familiar with it, it's basically like medical Wikipedia. Really awesome, well-written, and well-researched medical Wikipedia. Subscribers only (sorry guys), it presents the lastest data on a variety of medical conditions, diagnostics, and treatments.

I expected to troll around for a while and maybe come across a link or two to some interesting studies on the topic, but to my surprise and delight, I stumbled upon a very comprehensive literature review titled "The Effects of Caffeine on Reproductive Outcomes in Women." Jackpot.

Turns off that coffee turns so many heads in the scientific world because of how accessible it is to the developing fetus:

Maternal caffeine metabolism declines significantly during pregnancy; the half life increases three-fold in the third trimester, reaching a t_1/2 of 11.5 to 18 hours. The fetus metabolizes caffeine very slowly, mainly due to immaturity of caffeine-metabolizing hepatic microsome enzymes and lack of CYP 1A2 activity in the placenta. Therefore, even low maternal caffeine consumption can be expected to lead to prolonged fetal caffeine exposure, particularly when the mother is a genetically slow caffeine metabolizer.  (Nisenblat, V, Norman, R, 2013).

This sounds exceptionally terrifying at first read, but the review goes on to explain that, despite the ready absorption, the effect of caffeine on the developing fetus is largely unknown. There is precious little literature on the effects of caffeine on human subjects, and the literature that does exist is of poor quality. Furthermore, there are a large amount of cofounders that have made studying the effects of caffeine difficult, most notably that the only women who consume large amounts of caffeine during pregnancy nowadays are typically doing other not-so-great things - like smoking, drinking, not accessing prenatal care - at the same time.

Poor evidence aside, the review did examine the effects of caffeine on a variety of reproductive outcomes. Here's the rundown:

1. Probability of conception (fecundability): Inconclusive, caution advised
2. Spontaneous abortion: More likely with >300 mg per day
3. Congenital anomalies: More likely with >300mg per day
4. Fetal Growth Restriction: Some good evidence that caffeine intake is associated with fetal growth restriction, but the range of concern varies between 200mg and 600mg
5. Preterm delivery: No significant association
6. Gestational Diabetes: Unclear (actually some studies showed that it was beneficial!)
7. Gestational Hypertension: Slightly increased risk, but no increased risk of preeclampsia
8. Post-partum depression and long-term effects on infant psychology: No significant association

Upon review, I feel that there is good reason to be cautious with caffeine intake during pregnancy. Given the outcomes, the most sensitive period (like everything in pregnancy) appears to be in the first trimester. After some consideration, my plan is to avoid caffeine entirely for the first twelve weeks. And then after, limit myself to <300mg daily. Although given the amount of caffeine typically found at your average Starbucks, that might be pretty difficult.

source: Huffington Post

Who knows? Maybe I'll start to like this whole decaffeinated tea thing.

Probably not.

**

Nisenblat, V., Norman, R. "The Effects of Caffeine on Reproductive Outcomes in Women." UpToDate. September 11, 2013. Published by UpToDate Inc. [0503-50.169.70.108-4E541A501A-6.14-178603391]

The test

The thing about knowing stuff is that occasionally, it takes the romance out of things. The surprise. The spontaneity.

For some time, I've dreamed about the moment in which I would discover my first pregnancy: the pregnancy test illuminating a brilliant blue, the Hallmark embrace with my loving husband, the single tear I would shed in the most elegant possible way.

I did not picture myself at 5 AM, bathrobe and slippers, shoving a stick (upon which I had just urinated) into my husband's face shouting "look, you can almost see it if you hold it up to the light." And him smiling through bleary eyes, saying "that's great, sweetie," and promptly falling back asleep.

I certainly did not picture myself buying an economy-pack of pregnancy tests so that I could start testing myself at nine days post ovulation and then daily until I achieved a shade of blue with which I was satisfied.

The other thing about knowing stuff is that occasionally, it makes you an absolute stud.

Basal body temperatures charted. Ovulation predictor kits utilized. Ovum fertilized. We knew we wanted a baby and we were not. joking. around.

The other thing about knowing stuff is that occasionally, you're wrong.

And this is where where we wait patiently to see if the other shoe drops...

My name is Erica and I'm a Pediatric Nurse Practitioner. Children are my business. I listen to heart beats, clean runny noses, pat babies on the head and hold mommys' hands. I debate feeding schedules, wax eloquent about limit-setting, and check upwards of forty ears a day. I can coax an 18-year-old to tell me about her drug use, and I can examine an 18-month-old without a single teardrop.

And - holy crap - I just found out that I'm pregnant.