9 Things No One Tells You About C-Section Recovery


Even if yours is planned and you think you’ve done your homework, these may surprise you.
c-section-recovery_feat

You know that C-sections are major surgery and you may have heard vague complaints from a friend that recovery was tough, possibly even tougher than she anticipated. But until you’ve had one yourself, you can’t know the entire list of weird and surprising challenges. Here, ob/gyns share all the down and dirty details about recovery.

1. Getting out of bed for the first time may hurt more than any labor pains you experienced.

Of course as a new mom you want to hop out of bed the instant you hear your tiny, brand-new bundle of love cry. But immediately after a C-section, and even up to two weeks after, it can be pretty darn painful to sit up and put your feet on the floor. While you’re in the hospital, you can avail yourself of the magic of the hospital bed, which can prop you up with the push of a button and has rails that you can use for support, not to mention around-the-clock medical care. But sadly, you can’t stay and enjoy the amenities indefinitely.

“Your doctor will prescribe you pain meds, which you should take,” Alyssa Quimby, M.D., assistant professor of obstetrics and gynecology at the University of Southern California, tells SELF. “That’s what they’re there for.” Once you’re home, experiment with rolling onto one side, using pillows (that Snoogle comes in handy) or asking your partner to lend a hand when you want to get out of bed.

2. Nursing after a C-section can get pretty uncomfortable.

“It can be difficult to situate your newborn in a position that you can maintain for upwards of 20 minutes comfortably when you have an incision on your lower abdomen,” Quimby says. “I encourage my patients to play around with different positions.” Many find the football hold, where you literally tuck your baby in along your forearm up to your breast like, yup, a football, to be the most comfortable post C-section, she says. (Confused? Ask your hospital’s lactation consultant for help.) You could also try a breastfeeding pillow or stack of soft throw pillows of different sizes and shapes to help get baby in a good position.

3. Going #1 and #2 may be uncomfortable. Very uncomfortable.

There are two different situations going on here. Peeing can burn or sting, or you may not feel that you fully emptied your bladder, because you more than likely will have had a catheter as part of standard hospital protocol prior to your epidural. (Women who get epidurals and have vaginal births may experience the same sensation.) “It’s totally normal to be irritated and should clear up in a few days,” says Quimby.

As for pooping—or rather, not pooping—there are a few possible culprits. “Pregnancy hormonestend to slow everything down digestive-wise and things don’t just miraculously return to normal immediately after delivery,” explains Angela Jones, M.D., founder of AskDrAngela.com. “So if you were having issues with constipation during pregnancy, they are not likely to resolve spontaneously once your baby is delivered.” Complicating the problem? Those pain meds. Many have a side effect of constipation. Though it’s undeniably difficult to get up and move around, even a short walk around the hospital floor can help get things moving again (ask for help if you’re feeling woozy). You can also try a stool softener, like Colace.

4. Those cute pre-pregnancy shoes you were fantasizing about wearing will have to stay in the back of your closet a little longer.

It’s very normal for your feet and legs and even hands and face to swell after any type of delivery and particularly after a C-section. During pregnancy, blood volume increases, on average, by almost 50 percent, to support your pregnancy. “Between that, and all the IV fluids you received during labor and/or at the time of your C-section, that fluid has to go somewhere,” Jones says. She recommends getting up and walking as soon as you can after surgery and drinking water with lemon to help flush it all out.

5. Forget about a good night’s sleep, starting tonight!

You just had a baby and major surgery, possibly after hours of labor, so of course you’ll be left alone to get a good night’s sleep, right? Not so, in a majority of hospitals. You’ll need to have your vitals checked (blood pressure and temperature) every three to four hours, likely for the duration of your stay. Not to mention that you now have a newborn, who won’t know the difference between day and night for weeks to come.

6. You may be left with a C-section “shelf” above the incision that is more puffy on one side…for years.

During the actual C-section procedure your obstetrician will cut horizontally through skin, your subcutaneous fatty layer, and the fascia, the tough, web-like connective tissue that surrounds all your body’s organs, explains Quimby. After delivery, your doctor stitches back your top layers, but your fascia closes on its own, which can create scar tissue. Sometimes the scar tissue develops unevenly, hence why the puffiness and tenderness can be more pronounced on one side. The scar tissue will soften over time and be less noticeable on the outside, but it may never disappear completely.

7. Itching and numbness along the scar are par for the course.

This goes back to the actual surgery itself, as well. “When your obstetrician cuts through those layers, she may cut some nerves, which can result in the loss of feeling,” says Quimby. It’s not unusual for the numbness to last for several years.

8. You’ll be sidelined for up to eight weeks.

“That means no lifting anything heavier than your baby, no pushing and pulling motions, and no deep bending until your incision heals,” explains Jones. In the real world, that translates into no carrying the laundry basket, no vacuuming or walking your dog, and no emptying the dishwasher for at least the first two weeks. Besides, you’ll have a new baby to tend to, so let your family and friends help with cooking and household chores. “You’ll also have to get used to sitting in the passenger seat for up to the first two weeks as driving is often a no-no, at least until you are comfortable looking over both shoulders without any pain and hitting the break without wincing,” Jones says.

As for exercise, walking and climbing stairs are great right off the bat. But wait a full eight weeks to make sure you’re entirely healed before you do any type of ab work, including Pilates, yoga, and even swimming. “We need to let that incision heal,” says Jones.

9. Planning another baby? A vaginal birth may still be in the cards.

Depending on the reason for your C-section, you may potentially be a good candidate for a vaginal birth after Cesarean section (VBAC). Women who had C-sections because of a non-recurring reason (i.e. breech birth, twins, fetal distress) are the best candidates, says Quimby. But even then, that doesn’t mean your doctor or your hospital will allow it. The biggest concern with VBAC is uterine rupture, which means the uterus tears open where the C-section scar is. It’s rare, but a real risk because it requires an emergency C-section and in some cases, a hysterectomy. Some hospitals simply aren’t staffed to handle VBACs and the potential complications. If that’s the case and experiencing a vaginal birth the next time around is important to you, seek out a second opinion.

Source:www.self.com

Frozen Condoms for Post-Childbirth Pains Are a Thing


One dad recently shared his advice—and doctors say it’s legit.
Zika-Condoms_Feat

It’s pretty much a given that you’re not going to feel amazing below the belt after you give birth to a baby vaginally. Many women bleed for weeks afterward, and the entire vaginal area is pretty swollen and sore for days after the birth. Now, one dad in Australia is opening up about a method he discovered for combatting postpartum vaginal soreness: ice packs made with…condoms.

Australian dad and blogger Martin Wanless wrote a post about his discovery on the parenting website DAD. In it, Wanless details surprising things he was sent out to buy after his wife gave birth—including condoms. “This isn’t male bravado, delusion, or wishful thinking,” he writes. “Make sure you’re stocked up on condoms. Filled with water and frozen, they’re the perfect shape to rest in between new mum’s legs and ease a bit of pain and swelling.”

Wanless insists that this is “actually a thing” and says that soon after his wife gave birth, she had a freezer full of condoms. He’s right about not being the only person to do this: Mom blogs and discussion forums are filled with women discussing the “frozen condom trick” and “condom popsicles for new moms.”

Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF that she and her colleagues used to make these for new moms in the hospital when she was in her residency. “We had a whole freezer full of them at the hospital,” she says, noting they were for external use.

After a woman has a vaginal delivery, her vulva and vaginal tissues are swollen, Streicher explains. Doctors typically recommend putting ice on the area to ease swelling, but most ice packs are bulky, uncomfortable, and don’t conform to the area well.

Amelia Henning, a certified nurse midwife at Massachusetts General Hospital, tells SELF that the frozen condom idea is “creative” but it should not be placed inside a woman’s vagina. “The risk for infection in the postpartum period is much higher than usual, and for this reason, nothing should be placed inside the vagina until the bleeding has completely stopped and healing has taken place, which is usually around six weeks after birth,” she says.

Melissa Goist, M.D., an ob/gyn from the Ohio State University Wexner Medical Center, agrees. “We don’t typically recommend anything in the vagina for a few weeks after delivery unless it is sterile,” she tells SELF. “Condoms are not sterile, which typically is not a problem but in the immediate postpartum period, when the cervix is more dilated, it could pose an increased risk of infection.” However, she says, using a condom ice pop in the perineal area (the area between the anus and vulva), which is where women are typically sore, is fine. (Keep in mind as well that if you have a latex allergy, you’ll still need to avoid using latex condoms for this.)

The idea is a “brilliant” use of resources, Jessica Shepherd, M.D., an assistant professor of clinical obstetrics and gynecology and director of minimally invasive gynecology at the University of Illinois College of Medicine at Chicago, tells SELF. “It’s definitely an innovative way for a dad to be involved with his wife’s recovery,” she says.

Women run the risk of getting a freezer burn down there if they apply a condomsicle directly to their vagina, so Streicher recommends putting a washcloth between the frozen condom and vagina for protection. Then, you can switch it out every 20 minutes or so, as needed.

While they didn’t exist when Streicher was a resident, disposable perineal ice packs—which essentially look like puffy menstrual pads—are now offered at many hospitals to women after they give birth. A new mom can simply stick it to her underwear, get relief, and throw it away afterward. But perineal ice packs aren’t cheap if you have to buy them yourself—Amazon offers some for $35 for a 24-pack. Henning says that women can also slightly dampen a regular menstrual pad and freeze it to get the same effect for less.

New moms are generally advised to use an ice pack for the first 24 to 48 hours after giving birth to help reduce swelling, but if you don’t have easy access to perineal ice packs, it doesn’t hurt to go the frozen condom route (but not actually inserting it in your vagina). “It’s a great idea,” says Shepherd.

Source:www.self.com

Doctors need to actually listen to the women they treat 


Ignoring mothers’ concerns about their unborn babies’ movement is just the tip of the iceberg. We need to stop relying on machines and focus on people.

A line of three pregnant women holding their stomachs

UK maternity care is steeped in patriarchy. Statements like this can sometimes cause outrage or ridicule, but I’m not sure why. We live in a world where most of our organisations and systems are built and run by men with men in mind, so it shouldn’t be much of a surprise that the labour ward is no different. The problem here, though, is that childbirth is a uniquely female experience, and the man-made structure that dominates and controls it is failing women on every front.

Women in the maternity care system often do not feel they are listened to or heard. This can have devastating consequences: a new University of Leicester MBRRACE report into cases of stillbirth found that over half of women had reported to concerns to their care providers such as reduced foetal movement, and that in half of these cases, there were missed opportunities to save a babies life.

Unfortunately some of the response to this terrible situation is often in itself patriarchal. Jeremy Hunt has pledged to halve stillbirth rates by investing in high tech monitoring equipment, ignoring the evidence which shows that plugging women into machines during labour is going to be far less effective than investing in human beings to be with women before, during and after the birth. The Cochrane review, for example, has shown that if women and their midwives build up a relationship, there would be a reduction in both premature birth and stillbirth, whereas other studies have also shown continuous electronic monitoring to be not only ineffective, but detrimental to women as it keeps them on the bed.

Childbirth: a risky time

Technological birth in a hospital is not automatically safest  

But just as individual women are not being heard, neither, it seems, is the evidence, and the determination to invest confidence – and money – in machines and technology and give this priority over human connection and relationships continues. Calls for less medicalisation in birth and more kindness, compassion and personalised care so often seems to fall on deaf ears, even when very clear and robust research shows that technological birth is not automatically safest.

Clear evidence now tells us, for example, that for many low-risk women, hospital is the least safe place for them to have their baby. The two major studies on which the latest NICE guidelines were based showed that, for first time mothers, the chance of episiotomy is nearly doubled if they choose an obstetric unit over a home birth. According to the NICE analysis, women having their second or subsequent baby are also five times more likely to have a caesarean in hospital versus home; over four times more likely to have an instrumental delivery and twice as likely to have a blood transfusion.

We do seem to be almost culturally deaf to statistics like these, and the notion that hospital birth is often the least safe choice is one that the majority of people are yet to be able to hear. In the meantime, women who voice their desires for a more holistic experience, perhaps at home or in a midwife-led unit, are often accused of being selfish and of putting their own experience over the safety of their baby. Indeed, the phrase, “birth experience” can even be used in a slightly mocking tone, in spite of the evidence that shows that everything that makes birth more enjoyable for women – a homely, dimly lit environment, carers they know and trust – also makes it safer.

Bev Turner homebirth

Beverley Turner gave birth at home, but women advocating for home birth are often mocked  

In pregnancy women who try to advocate for their wishes or challenge the status quo are often reminded, “A healthy baby is all that matters”. Women know this, of course, and it is their top priority. But should it be the pinnacle of their expectations, or the baseline? Surely, above and beyond a healthy baby, women matter too? This phrase, whilst it may be well meant, suggests quite implicitly that women don’t matter, that they are a mere vessel. It’s used after the birth too, and women who want to raise concerns about traumatic experiences or even downright disrespectful care often feel completely silenced by it.

As women we have been raised to be polite to the point of submission: being “good girls” earns us praise as children, and often as adults too. In maternity care – indeed across all areas of life – this can mean we are easily silenced: not only are we raising concerns in a system that is not listening very well, but we are probably raising them in rather apologetic ways, with language such as, “Do you mind if I just ask?” when we should be saying, “I demand answers.” Submissive language also pervades women’s birth stories, which so often contain the phrases, “I was not allowed”, or “They let me” – unthinkable levels of compliance which you would struggle to find in any other areas of 21st century women’s lives.

“Levels of fear are at an all time high: women feel childbirth is dangerous and terrifying and midwives feels disempowered to reassure them otherwise.”

Women who are not being listened to when they report concerns about their baby’s movements are just the tip of the iceberg in a system that is often more reassured by the beep of a machine than the touch of a hand. True improvements to could be made if the patriarchal grip was loosened – but can we trust women enough to put them back in charge of childbirth?

Device Mimicking Female Reproductive Cycle Could Aid Research


EVATAR is a book-size lab system that can replicate a woman’s reproductive cycle. Each compartment contains living tissue from a different part of the reproductive tract. The blue fluid pumps through each compartment, chemically connecting the various tissues.

Courtesy of Northwestern University

Scientists say they’ve made a device in the lab that can mimic the human female reproductive cycle.

The researchers hope the device, assembled from living tissue, will lead to new treatments for many medical problems that plague some women, ranging from fibroids and endometriosis to infertility, miscarriages and gynecologic cancers.

The researchers described the device Tuesday in the journal Nature Communications and dubbed it the EVATAR. The name, they say, is a play on the word “avatar.”

“An avatar is kind of a digital representation of an individual in a virtual environment,” says Teresa Woodruff, a biomedical engineer in the department of obstetrics and gynecology at Northwestern University who helped create the system. “So when we thought about this synthetic version of the female reproductive tract we thought of the word EVATAR.”

To create the EVATAR, the researchers used tissues from human fallopian tubes, a uterus and cervix donated by women who had undergone surgery.

The researchers placed each tissue type in separate plastic chambers that were connected through passageways that allow fluid to circulate among them.

One chamber contained ovarian tissue from mice because human ovarian tissue is difficult to obtain.

The device is about the size of a paperback book. It also includes human liver tissue to filter toxins from the system.

The researchers were able to trigger the system to produce the cascade of hormones that usually occur during a woman’s 28-day reproductive cycle. The cycle culminated in the ovarian tissue releasing an egg.

“We were able to recapitulate the full menstrual cycle — a complete menstrual cycle,” Woodruff says.

The scientists hope to use the system to learn more about the basic biology of how the female reproductive tract functions.

“EVATAR allows us to think about all the organs kind of connected in a way that eventually we hope will be the future of personalized medicine,” Woodruff says.

Lansing Taylor, director of the University of Pittsburgh’s Drug Discovery Institute, who was not involved in developing the system, says it could be especially useful in research because of the complexity of the female reproductive system.

“It’s a very important paper,” Taylor says. “Human reproductive tissues and organs have been particularly difficult to investigate.”

The scientists stress that they only want to use the EVATAR to study anatomy and try to develop new treatments.

But at least one bioethicist wonders if others may someday try to combine this kind of technology in worrisome ways with other advances in reproductive medicine.

“Certainly the technologies are rapidly moving forward where one could imagine these technologies being used to create a baby outside the womb in the laboratory,” says Insoo Hyun, a bioethicist at Case Western Reserve University.

That would raise many ethical issues.

“If, hypothetically, you can fertilize an egg outside a body and carry it all the way to term outside the body, then who’s responsible for this baby now?” Hyun says. He also stresses that scientists are nowhere near being able to do that yet.

In the meantime, the Northwestern researchers have already started to work on a male equivalent of the EVATAR.

They’ve created a system involving male testes and prostate tissue they call the “Dude Cube.” They are working on a more complex system that would connect the Dude Tube to other parts of the anatomy — a system they dub the “ADATAR.”

Source:http://www.npr.org/

Side effects of birth control pill.


The birth control pill was introduced in the 1960’s, and it quickly became one of the most popular birth control methods in the world. However, this new pill contained really high levels of estrogen and progestin which had many dangerous side effects.

The amount of hormones in the pill was 10 times than needed for contraception. The consequences were horrible: thousands died or became disabled by blood clots. 40 years later the pill might have a different formula, but the possible dangerous side effects remain.

10 things that every woman should know about the pill:

-The pill is a carcinogen

According to the World Health Organization, birth control pills are in the  same class of toxins as tobacco and asbestos. Moreover, studies suggest that these pills increase the risk of breast cancer for up to 30%.

-The pill leads to plaque buildup in arteries.

Synthetic estrogen’s cardiovascular risks have been known since 1940 including its ability to cause blood clots, varicose veins, miscarriage, and PMS. According to research done at the University of Ghent, Belgium, every 10 years of oral contraceptive use was correlated with a 20 to 30 percent increase in plaque buildup. Studies show that newer birth control pills contain drospirenone, a synthetic version of the female hormone, progesterone, which leads to a higher risk of blood clots than previous forms.

Studies show that newer birth control pills contain drospirenone, a synthetic version of the female hormone, progesterone, which leads to a higher risk of blood clots than previous forms.

-The pill lowers your libido.

The pill inhibits the production of certain hormones called androgens, such as testosterone, which directly interfere with sex drive and pleasure.

-Clitoral shrinkage

According to doctors, synthetic hormones in birth control pills can shrink the clitoris by 20% causing her to refer to the pill as “genital mutilation”.

 -The pill and weight gain

The estrogen dominance leads to insulin resistance, weight gain, depression, and psychosis.

-The pill is linked to weaker bones (osteoporosis)

According to Canadian researchers, women who are taking birth control pills have a lower bone mineral density than women who have never used oral contraceptives.

-The pill and diabetes

According to a new study, women who used the pill before getting pregnant are 40% more likely to suffer from gestational diabetes than women who do not use any method of birth control.

-The pill damages our gut flora

Birth control pills destroy the good bacteria in your digestive system which opens up a pathway to yeast infections and other illness. Usually, when women decide to get off the pill and have babies, they develop a severe microbial imbalance in the intestines.

It can cause arthritis, autoimmune illness, vitamin B deficiency, chronic fatigue syndrome, cystic acne, eczema, food allergies and food sensitivities, inflammatory bowel disease, irritable bowel syndrome, psoriasis and more. Besides, when you give birth naturally, your baby inherits your gut flora. If your gut flora is imbalanced, your baby consequently inherits it.

-The pill and nutritional depletion

Oral contraceptives can result in the following nutritional deficiencies: zinc, magnesium, selenium, vitamin C, vitamins B2, B3, B6, and B12, along with folate. These deficiencies can occur because the liver uses more of these nutrients to metabolize estrogen and detoxify it out of the body.

-Other risks

Other risks include migraines, gallbladder disease, high blood pressure, mood changes, depression, nausea, irregular bleeding or spotting, benign liver tumors, breast tenderness, and more.

Think twice before taking the pill. You need to take into account future long-term health implications that can ruin your health and potentially the health of your baby.

Source:http://www.medicalonline1.com

Polycystic Ovary Syndrome Might Start in the Brain, Not the Ovaries


Finally, some answers.

A new study has found evidence that the common and debilitating reproductive condition, polycystic ovary syndrome, could start in the brain, not the ovaries, as researchers have long assumed.

If verified, the research could change the way we think about the painful and severely misunderstood condition, which affects at least one in 10 women worldwide.

Anyone who has polycystic ovary syndrome (PCOS) – or knows someone with the condition – will be aware of how incredibly frustrating it can be.

Thanks to the variety of symptoms it can cause – from weight gain, large ovarian cysts, difficulty ovulating, acne, facial hair, depression, and agonising and heavy periods – it can take women years to get diagnosed.

Even then, there’s very little in the way of treatment options. Most women are simply told to go on the pill or take other hormonal medications to manage their individual symptoms, but not the underlying cause.

In the long-term, PCOS can lead to metabolic disorders, such as type 2 diabetes, cardiovascular disease, and hormonal dysfunction, including infertility. In fact, PCOS is the cause of more than 75 percent of anovulatory infertility, which is infertility caused by a woman not ovulating.

And yet, despite the severity of the condition, researchers still don’t understand how PCOS arises and how we can treat it.

Now, researchers led by the University of New South Wales in Australia have shown that mice without receptors for androgens – a group of steroid hormones commonly associated with males, such as testosterone – in their brains can’t develop PCOS. But if the androgen receptors in the ovaries are removed, the condition can still arise

 Seeing as mouse and human reproductive systems share many similarities, it’s compelling early evidence that doctors and scientists might have been focussing on the wrong piece of the puzzle all along.

“For the first time we have a new direction of where we should be looking to try and develop treatments that will treat the cause of PCOS, the androgen excess in the ovary but also in the brain,” said lead researcher Kirsty Walters in an emailed press release.

Before this, researchers knew that an increase in androgens, known as hyperandrogenism, was linked to the onset of PCOS. But exactly how and where these androgens act in the body was poorly understood.

“Hyperandrogenism is the most consistent PCOS characteristic; however, it is unclear whether androgen excess, which is treatable, is a cause or a consequence of PCOS,” the researchers write in their paper.

To get a better idea, the researchers took four groups of mice:

  • a control group of normal mice
  • a group of mice genetically engineered to have no androgen receptors (ARs) anywhere in their bodies
  • a group that had been engineered to have no ARs in just their brains
  • a final group that only had ARs missing from their ovaries.

The team then used a high dose of androgen to attempt to trigger PCOS in all four groups of mice.

While the control group developed PCOS as they expected, the mice missing ARs entirely, or just missing them from their brains, didn’t get the condition.

Interestingly, the mice that were only missing ARs from their ovaries still went on to develop PCOS, although at a lower rate than the control group. That means androgens acting on the ovaries can’t be the sole cause of PCOS.

The result suggests two important things: researchers were right about an excess of androgens triggering the condition; and the action of androgens on the brain is important to the development of PCOS.

That means if we can find a way to stop those excess androgens in the brain, it could signal a new way to treat PCOS.

“These data highlight the previously overlooked importance of extraovarian [outside the ovary] neuroendocrine androgen action in the origins of PCOS,” the researchers explain.

To be clear, this study has only looked at mice so far, and the results need to be replicated in humans before we can get an idea of whether the same thing is happening in our own reproductive systems.

But this is a big deal because, until now, the focus when looking for effective treatments and preventions has been on the ovaries – and we haven’t had much luck.

The new study, though it’s still early days, gives researchers a new target to look into, and it could hopefully lead to new, more effective treatments for people with the condition.

Source:http://www.sciencealert.com

Why Young Women All Over the World Are Still Dying in Childbirth


Why Young Women All Over the World Are Still Dying in Childbirth

Almost 800 women die every day while giving birth, and the curse of maternal mortality stretches from Sierra Leone to Myanmar.

By the time the pregnant 17 year old arrives at a hospital in Sierra Leone, it is already too late. Her baby has died—maybe the day before, maybe even longer. She has been left in labor for far too long—approximately 36 hours—waiting for a caesarean section that has been delayed due to an electricity cut. When power resumes, there is no doctor to help her. Now the race is on to save this teenage mother from death as well. Her womb is infected; the tissue falling apart. The doctors try their best to repair it, but her severe infection worsens overnight. The next morning is her last.

“Too much, too late,” writes a Médecins Sans Frontières obstetrics/gynecology registrar, Benjamin Black, on his MSF blog. This girl’s tragedy is shared by thousands more. In 2013, an estimated 289,000 women died during pregnancy or while giving birth. That’s almost 800 women every day. 99 percent of these deaths occur in the developing world.

Nearly all of these deaths and serious injuries are preventable and needless. Very few of them would happen in the west. Reading the statistics, we don’t need the World Health Organization (WHO) to tell us that maternal mortality is “unacceptably high” and that these deaths are a tragedy. The numbers speak for themselves: 800 maternal deaths every day are 800 too many. And yet, despite a 45 percent drop in maternal mortality since 1990, family planning organization Marie Stopes International still reports that the lifetime risk of dying from such complications is one in 22 in sub-Saharan Africa. In some African countries, the rate is as high as one in eight.

The United Nations Population Fund (UNFPA), whose work involves improving reproductive health, states on its website that the world has made “significant strides, but not enough.” While some developing countries have seen maternal deaths fall significantly in recent years, sub-Saharan Africa and southern Asia are still struggling.

A doctor with a baby Maasai patient in Kenya.

In Europe and North America, it is too easy to assume that death during childbirth is a thing of the past. A sensational plot development on an Edwardian costume drama—Downton Abbey, perhaps—or a Victorian tragedy in a Charles Dickens novel. You may be surprised to find that the five main causes of maternal death are, according to Marie Stopes: Hemorrhage, infection, unsafe abortion, eclampsia (a condition where convulsions occur in a pregnant woman with high blood pressure) and obstructed labor. Surprised—and horrified. Preventable, treatable, and avoidable; yet happening here and now in 2015.

 It’s worth underlining that there has been a significant and steady drop in numbers over the last 25 years. In addition, during the 2010 Millennium Development Goals Summit at the UN, secretary-general Ban Ki-moon unveiled a ‘global strategy for women’s and children’s health’ that aimed to save 16 million women and children over a four-year period. I asked Luc de Bernis, the UNFPA’s senior maternal health advisor in Geneva, if we are doing enough.

“Certainly not, but this is encouraging,” he said. “The challenge now is to maintain this gain in lives saved, and to accelerate the progress towards the goal and targets for 2030. Women’s health, maternal and adolescent health are not receiving enough attention, even if it has been demonstrated that the major part of the maternal and newborn mortality is preventable, even in poor settings.”

A woman had turned up to a hospital clearly needing a caesarean section. But there was no people to work the generator, no electricity, and no light.

“Unfortunately the answer isn’t simple and it’s not a purely medical answer,” said Black, the oby-gyn whose work with Médecins Sans Frontières has taken him to the Central African Republic and Sierra Leone. When it comes to maternal health, there is no “silver bullet,” as he puts it, to remedy this complex issue. “You’ve got to look at the social, political, economic dimensions to the problem,” he explained.

Benjamin talked about “the three delays”: A trio of barriers that too often prevent women from receiving the timely and effective medical attention they need. Delay one: The delay in recognising that something isn’t right. “If you’re a woman in sub-Saharan Africa who is in labor in your local village with your local birth attendant, they may not realize at first signs that there’s a problem. It may take more than a day,” he explained.

The second delay lies in actually getting to a place where you can even receive care. Benjamin recalled working in Sierra Leone, where it can take patients more than a day to reach a hospital because of poor roads, or because patients have no access to transport nor the money to pay for a taxi. Then there’s the third delay: The delay in receiving care once you’re there. Benjamin recalls the time “a woman had turned up to a hospital clearly needing a caesarean section. But there was no people to work the generator, no electricity, and no light.”

I was ‘a child giving birth to a child’ because I was only 14.

There’s another twist in this narrative: Teenagers are most at risk. Marie Stopes International, which provides sexual and reproductive healthcare to women around the world, reported on the case of 16-year-old Mi Aye, who lives in Myanmar. Married at 13 and pregnant at 14, Mi Aye told the organization: “Nobody told me about how you have children or how I could avoid getting pregnant, so of course, I got pregnant. I was ‘a child giving birth to a child’ because I was only 14. And afterwards I was really frightened about getting pregnant again but I didn’t know what to do to stop it.”

 Women aged between 15 and 19 are twice as likely to die during pregnancy or childbirth as women over 20; girls under the age of 15 are five times more likely to perish. Bethan Cobley, senior manager of policy and partnerships at Marie Stopes International explained why teens are most at risk. “Sometimes their bodies are not mature enough for pregnancy and childbirth, but more often it’s because young people are less likely to have access to quality health services, particularly in the developing world.”

Benjamin Black referred to this as an issue of ‘vulnerability.’ “Your vulnerability increases according to the wider socio-economic situation that you’re in,” he said. “For example, if you’re a 15-year-old girl from a poor [and] rural family, your vulnerability to each of those delays is much higher than, for example, a professional woman who’s working in a capital city, even in the same country.”

According to the UNFPA, access to trained midwives could help avert two-thirds of maternal and newborn deaths. According to de Bernis, “midwives can implement more than 85 percent of the recommended essential evidence-based RMNH (Reproductive, Maternal and Newborn Health) interventions”—yet there is so much more than mere medical intervention to tackling these horrifying mortality numbers.

Dr Azhar Abid Raza, a health and immunization specialist with UNICEF in New York, agreed that a holistic approach is “essential” and “is working.” Antenatal care and maternal vaccinations have improved. UNICEF also has programmes targeting child marriage. “In addition, UNICEF, WHO and UNFPA are collaborating to improve the nutritional status of mothers, and in promoting the concept of early initiation and exclusive breastfeeding,” he said.

Access to family planning is equally vital—as is ensuring abortions are a safe option for all women. As it stands, there are 222 million women in the world who would like to use contraception but aren’t able to access it. “An estimated 22 million unsafe abortions are performed each year, resulting in 47,000 deaths and leaving 8 million women with medical complications,” Bethan Cobley of Marie Stopes International told me. “It may sound obvious, but when women have access to contraception, the number of unplanned pregnancies falls dramatically.”

 It’s about the choices girls should be able to make—freely and safely—about their own bodies, without feeling stigmatized or judged.

Family planning and termination of pregnancy is still taboo in many developing countries. As a result, abortion becomes a secret and often deadly operation that can involve ingesting poisonous herbs or using sharp instruments. Perhaps unsurprisingly, these methods often lead to medical complications, infertility, and in the worst cases, death.

So what’s the bottom line? It’s about the choices girls should be able to make—freely and safely—about their own bodies, without feeling stigmatized or judged. When the political will, support and funding is there, women’s lives are saved.

“Where governments have made the decision to fund family planning services and remove policy restrictions, we have seen maternal mortality dramatically fall in a relatively short period of time,” Cobley said. “For example, the Ethiopian government has invested in family planning and as a result maternal mortality in the country has more than halved, falling from 990 deaths in 100,000 live births in 2000 to 440 in 2013.”

Pregnancy shouldn’t be an imposed death sentence for any woman, wherever she lives or whatever her financial circumstance. In 2015, it doesn’t have to be.

Over-the-Counter Birth Control Safe for Teens, Research Finds.


Days could be coming when birth control is harder to get, with no-copay contraception potentially dropping off the map. Even though costs could increase, researchers say there’s no reason oral contraception should remain restricted by prescriptions. While some have been recommending over-the-counter birth control pills for years, some have worried about safety. But new research shows birth control pills are very safe and effective — especially for teens.

NPR reports that a review of birth control pill research published in the Journal of Adolescent Health makes the most comprehensive case yet for allowing over-the-counter birth control for teens. In fact, the research found birth control pills might be safer for young people, because your risk for negative side effects such as blood clots is greater if you’re older.

“There is a growing body of evidence that the safety risks are low and benefits are large,” Krishna Upadhya, an assistant professor of pediatrics at the Johns Hopkins University School of Medicine and the lead author of the review, told NPR.

And when you’re young, Upadhya added, research shows you are less likely to experience some of the negative side effects of the Pill. While pills containing estrogen and progestin increase risk of a certain type of blood clot, Krishna said teens are less likely to develop that side effect and others, meaning the pill is “potentially safer the younger you are.”

 Research shows that good things happen when we reduce barriers to birth control. According to a 2016 research report from Urban Institute, about 63 percent of women reported that birth control reduces stress in their lives, about 54 percent said it had provided them health benefits, about 49 percent said it had helped them get their education, and about 49 percent reported more stable romantic relationships. On top of that, The American College of Obstetricians and Gynecologists backs access to over-the-counter birth control, as do many doctors.

With this new research, Upadhya told NPR, everyone, regardless of age, should be able to get the Pill from her local pharmacy, no prescription needed.

“These pills are safe and effective and we should reduce barriers to using them,” she said. “And teens should benefit just as adult women do.”

Source:http://www.teenvogue.com

10 Worst Toys Your Kids Should Stay Away From


Worst Toys for Kids

Story at-a-glance

  • Many top toy are hazardous and present strangulation, choking, and other risks to children
  • Toys often contain toxic chemicals that have been linked to cancer, reproductive problems, thyroid disruption, brain damage, and more
  • Many leading toys stores and top toy brands are among those offering dangerous products to kids

The US toy industry generates $22 billion in sales a year, with 65 percent of those sales taking place during the holiday season.1, 2 Unfortunately, many toys meant to bring children joy can end up injuring them instead, sometimes seriously.

According to Consumer Product Safety Commission (CPSC) data, there were 265,000 toy-related injuries and 11 deaths in 2012 alone.3 Many parents assume the toys they purchase from well-known retailers and toy brands, or which feature characters from popular movies and television shows, are heavily regulated and safe.

A new report from the World Against Toys Causing Harm, or W.A.T.C.H., reveals significant hazards abound. According to W.A.T.C.H.:

“Some toys that are in compliance with current industry or regulatory standards have proven to be hazardous, proving the inadequacy of existing standards.”

W.A.T.C.H., which recently revealed this season’s 10 worst toys, has been compiling hazardous toy lists for more than three decades, notes that many of the same hazards continue to appear year after year, showing manufacturers’ reluctance to make toys safer. Some of the top hazards could be easily changed, while others have no business being “toys” at all:

  • Dangerous projectiles
  • Strings that can cause strangulation
  • Small detachable parts that present choking hazards
  • Misleading or confusing warning labels, packaging, or instructions
  • Toy “weapons” designed to look real

The Top 10 Worst Toys List

While holiday shopping this year, be on the lookout for potentially hazardous toys such as the 10 that follow. These toys are meant to be examples of the types of hazards that exist widely in the toy industry, and are certainly not the only dangerous toys on the market.

Some of these are common sense… if you give a child a slingshot or bow-and-arrow to play with, there are obvious risks involved. Still, the way these toys are marketed draws in children and parents alike, often giving an illusion of safety when none actually exists.

What the list did not cover, unfortunately, are the dangerous chemicals lurking in many toys (see below for more information). Still, the list is an important reference for anyone who is planning to shop for toys this season or any time of year. W.A.T.C.H. stated:

“We are warning parents not to assume the toys they buy are safe. Many consumers are under the impression that heightened public attention to toy safety, increased government regulations and screening by big name manufacturers and retailers have eliminated hazards from toy store shelves—but this is not the case.

The key message today is to let caregivers know that while there are dangerous toys being sold in retail stores, awareness this holiday season and year-round truly can save lives.”

1. Air Storm Firetek Bow

This light-up bow-and-arrow set designed for kids 8 and up poses a potential for eye injuries. The arrows fly up to 145 feet and the toy (which is designed with illuminated arrows for “night or day” use) warns children not to pull back the arrows “more than half strength” or play with the toy “in complete darkness.”

 2. Radio Flyer Ziggle

This tricycle-like toy encourages children to “swerve & spin” and “race around the block,” but its low profile makes it a hazard for cars. It also poses a risk of forehead and other impact injuries. And while the warning states to “always wear” a helmet and other safety gear, the packaging shows riders using the device without protective gear.

3. Cat-a-Pencil

This toy is part pencil, part slingshot, which poses a risk of eye injuries. There are no warnings or age recommendations on the packaging, which encourages using the toy for “target practice from your desktop.”

4. Alphabet Zoo Rock & Stack Pull Toy

This pull toy has a pull cord measuring about 20 inches long, which poses a strangulation hazard and could cause entanglement injuries. Strangulation warnings are printed on the toy’s packaging but not on the toy itself. While strings on playpen and crib toys must be less than 12 inches long, pull toys have no such restrictions.

5. Swat Electric Machine Gun

This toy gun boasts “lights and realistic combat sound” and a warning that this “toy is a replica of a real weapon” that “may be mistaken for an actual firearm by law enforcement officers and others.” According to W.A.T.C.H.:4

In today’s world, there is no excuse for outfitting children with realistic toy weapons designed to produce potentially dangerous and unnecessary thrills.

Existing regulations addressing the hazards associated with such ‘toys’ are inadequate. Detailed replicas have resulted in a number of deaths through the years and should never be sold as toys.”

6. Wooden Instruments

One brand of wooden instruments distributed at Walmart stores is sold for babies as young as 12 months old, yet contains a slender, rigid 4.5-inch long drumstick, which could be ingested and cause choking. The toy contains no warnings.

7. Bottle Rocket Party

This bottle rocket kit, intended for children aged 8 and over, contains projectiles that could cause eye, face, or other impact injuries. It does include warnings that “this kit must only be used under strict supervision of adults,” but it makes shooting off bottle rockets sound like a party event. Also, though they advise safety goggles be used, they are not supplied.

8. Lil Cutesies Best Friends Doll

These dolls are marketed to children as young as 2, yet contain a decorative bow that could be detached and pose a risk of choking if ingested.

9. True Legends Orcs Battle Hammer

This hard plastic “battle hammer” is almost two feet long and poses the potential for blunt impact injuries. There are no warnings or cautions included.

10. Colored Hedgehog

This stuffed hedgehog, distributed by Toys R Us, is marketed to infants (ages 0+), but it has long, fiber-like hair that is “not adequately rooted and is easily removable.” It poses a potential for ingestion and aspiration injuries, a risk that is not referenced anywhere on the product or tag.

Chemicals: The Even More Insidious Toy Hazard

Just like many household products, toys are commonly made from materials that contain endocrine-disrupting chemicals (like bisphenol-A or BPA), carcinogens, and even toxic metals like lead. These chemicals are found in many toys at leading toy retailers, like Toys R Us. You might be familiar with some of the recommendations to avoid such toxins, such as choosing toys made from natural materials like fabric and wood, instead of plastic, but in some cases you may need to avoid a type of toy entirely.

One such example is make-up designed to be kid-friendly and “safe” for kids. One Toys R Us private label brand, TM! products, was recently outed by Andrea Donsky, the founder and editor-in-chief of NaturallySavvy.com.5 Some of the chemicals found in these children’s cosmetics (nail polish, hair and body gel, blushes, eye shadows, and lip glosses) include:

Propylene glycol, a solvent that produces a carcinogenic byproduct called 1,4 Dioxane Imidazolidinyl urea, a formaldehyde-releasing preservative that is carcinogenic and may cause allergic skin reactions
Fragrance, which may contain hundreds of synthetic toxic chemicals that are undisclosed on the label Parabens, which are carcinogens and endocrine disrupters that are used as preservatives
Synthetic dyes, which are often derived from coal tar and may be carcinogenic BHT, a preservative linked to tumor development in animals as well as developmental effects and thyroid changes, which suggests it may be an endocrine disrupter

Other brands, such as Disney and Barbie, didn’t fare any better. According to Donsky, of the children’s cosmetics sold at Toys R Us that she reviewed: They all contain parabens, phthalates and/or synthetic dyes. One of them even contains an artificial sweetener!”

Aside from children’s makeup, other top offenders included temporary tattoos, face painting sticks, glitter nail art, and body art. All contained chemicals on par with the toxins commonly found in adult cosmetics, and in some cases even worse. The Toy Industry Association (TIA) and the American Chemistry Council have successfully defeated numerous bills and policies that would have helped to keep hazardous chemicals like bisphenol-A (BPA), phthalates, formaldehyde, and others out of children’s toys.6

Last year, for instance, both groups opposed a now-defeated bill that would have required toy manufacturers to disclose the presence of 19 “high priority chemicals of concern for children’s health” – and remove the chemicals within five years.7 Many of these chemicals have been linked to cancer, fertility issues, thyroid disruption, and developmental problems, including brain damage and lower IQ, in children.

Steer Clear of Food-Based Toys…

The Easy Bake Oven is one of the most nostalgic family toys, but according to Donsky, the baking kits included with this brand are filled with toxic ingredients you and your children shouldn’t be eating. The same goes for the other food-based toys that Donsky encountered at her local Toys R Us – items like Cake Pops, a Blizzard Maker, and Slurpee Kits. Hydrogenated oils, artificial flavors and colors, genetically modified soybean oil, high fructose corn syrup, and preservatives are par for the course. If it makes you upset that kids are quite literally being deceived into destroying their health potential by junk food companies seeking revenue, then you will be equally dismayed to know that these junk foods are allowed to blatantly masquerade as children’s toys.

As you exit most Toys R Us stores, you’ll also pass by row upon row of candy, sodas and other snacks that represent the epitome of junk food, and which have been overwhelmingly implicated in rising obesity and chronic disease rates—especially among kids. Junk-food marketers know kids love toys, and what better place to capture their attention than in a toy store? Toys R Us, however, has the power to force its suppliers to at least remove the chemicals that we know are harmful, especially since their target market is children. If you’d like to get involved, please sign the petition below asking Toys R Us to stop selling products with toxic chemicals.Donate Today!

How to Choose Safe Toys: What to Look For

As W.A.T.C.H. stated, toys are designed and marketed for sales over safety. It’s very much a “buyer-beware” market when it comes to children’s toys, not only in regard to safety features but also in regard to the quality of materials and toxic compounds therein. So in addition to regularly monitoring toys in your home for broken parts, sharp surfaces, or dangerous wear-and-tear, you’ll want to pay attention to the quality of the materials from which your children’s toys are made.

There are many “green” and organic toy manufacturers that produce truly toxin-free toys for kids. If in doubt, contact the manufacturer directly and ask them what materials are used, and which are excluded, directly. Read toy labels and ask questions about where and how the toy is made. Additional tips to finding safe, pure toys include:

  • Purchase natural fabric or wooden toys instead of plastic ones, and if you’re going to purchase teethers and pacifiers, looks for those that are BPA- and phthalate-free (a frozen washcloth makes a great “natural” teether)
  • Avoid toys made from PVC plastic (soft vinyl plastic), which often contains lead and phthalates
  • Avoid children’s “play” jewelry and cosmetics, as well as food-based toys
  • Repurpose items around your home as toys (stainless steel bowls, measuring cups, cardboard boxes… get creative using items around your home as toys for kids)
  • Purchase simple high-quality toys that encourage imaginative play (wooden blocks, materials for building forts, construction paper, books, etc.)

Low levels of ‘anti-anxiety’ hormone linked to postpartum depression: Effect measured in women already diagnosed with mood disorders.


Effect measured in women already diagnosed with mood disorders

Summary:
In a small-scale study of women with previously diagnosed mood disorders, researchers report that lower levels of the hormone allopregnanolone in the second trimester of pregnancy were associated with an increased chance of developing postpartum depression in women already known to be at risk for the disorder.

In a small-scale study of women with previously diagnosed mood disorders, Johns Hopkins researchers report that lower levels of the hormone allopregnanolone in the second trimester of pregnancy were associated with an increased chance of developing postpartum depression in women already known to be at risk for the disorder.

In a report on the study, published online on March 7 in Psychoneuroendocrinology, the researchers say the findings could lead to diagnostic markers and preventive strategies for the condition, which strikes an estimated 15 to 20 percent of American women who give birth.

The researchers caution that theirs was an observational study in women already diagnosed with a mood disorder and/or taking antidepressants or mood stabilizers, and does not establish cause and effect between the progesterone metabolite and postpartum depression. But it does, they say, add to evidence that hormonal disruptions during pregnancy point to opportunities for intervention.

Postpartum depression affects early bonding between the mother and child. Untreated, it has potentially devastating and even lethal consequences for both. Infants of women with the disorder may be neglected and have trouble eating, sleeping and developing normally, and an estimated 20 percent of postpartum maternal deaths are thought to be due to suicide, according to the National Institute of Mental Health.

“Many earlier studies haven’t shown postpartum depression to be tied to actual levels of pregnancy hormones, but rather to an individual’s vulnerability to fluctuations in these hormones, and they didn’t identify any concrete way to tell whether a woman would develop postpartum depression,” says Lauren M. Osborne, M.D., assistant director of the Johns Hopkins Women’s Mood Disorders Center and assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “For our study, we looked at a high-risk population of women already diagnosed with mood disorders and asked what might be making them more susceptible.”

For the study, 60 pregnant women between the ages of 18 and 45 were recruited by investigators at study sites at The Johns Hopkins University and the University of North Carolina at Chapel Hill. About 70 percent were white and 21.5 percent were African-American. All women had been previously diagnosed with a mood disorder, such as major depression or bipolar disorder. Almost a third had been previously hospitalized due to complications from their mood disorder, and 73 percent had more than one mental illness.

During the study, 76 percent of the participants used psychiatric medications, including antidepressants or mood stabilizers, and about 75 percent of the participants were depressed at some point during the investigation, either during the pregnancy or shortly thereafter.

During the second trimester (about 20 weeks pregnant) and the third trimester (about 34 weeks pregnant), each participant took a mood test and gave 40 milliliters of blood. Forty participants participated in the second-trimester data collection, and 19 of these women, or 47.5 percent, developed postpartum depression at one or three months postpartum. The participants were assessed and diagnosed by a clinician using criteria from the Diagnostic and Statistical Manual of Mental Disorders, version IV for a major depressive episode.

Of the 58 women who participated in the third-trimester data collection, 25 of those women, or 43.1 percent, developed postpartum depression. Thirty-eight women participated in both trimester data collections.

Using the blood samples, the researchers measured the blood levels of progesterone and allopregnanolone, a byproduct made from the breakdown of progesterone and known for its calming, anti-anxiety effects.

The researchers found no relationship between progesterone levels in the second or third trimesters and the likelihood of developing postpartum depression. They also found no link between the third-trimester levels of allopregnanolone and postpartum depression. However, they did notice a link between postpartum depression and diminished levels of allopregnanolone levels in the second trimester.

For example, according to the study data, a woman with an allopregnanolone level of 7.5 nanograms per milliliter had a 1.5 percent chance of developing postpartum depression. At half that level of hormone (about 3.75 nanograms per milliliter), a mother had a 33 percent likelihood of developing the disorder. For every additional nanogram per milliliter increase in allopregnanolone, the risk of developing postpartum depression dropped by 63 percent.

“Every woman has high levels of certain hormones, including allopregnanolone, at the end of pregnancy, so we decided to look earlier in the pregnancy to see if we could tease apart small differences in hormone levels that might more accurately predict postpartum depression later,” says Osborne. She says that many earlier studies on postpartum depression focused on a less ill population, often excluding women whose symptoms were serious enough to warrant psychiatric medication — making it difficult to detect trends in those women most at risk.

Because the study data suggest that higher levels of allopregnanolone in the second trimester seem to protect against postpartum depression, Osborne says in the future, her group hopes to study whether allopregnanolone can be used in women at risk to prevent postpartum depression. She says Johns Hopkins is one of several institutions currently participating in a clinical trial led by Sage Therapeutics that is looking at allopregnanolone as a treatment for postpartum depression.

She also cautions that additional and larger studies are needed to determine whether women without mood disorders show the same patterns of allopregnanolone levels linked to postpartum depression risk.

If those future studies confirm a similar impact, Osborne says, then tests for low levels of allopregnanolone in the second trimester could be used as a biomarker to predict those mothers who are at risk of developing postpartum depression.

Osborne and her colleagues previously showed and replicated in Neuropsychopharmacology in 2016 that epigenetic modifications to two genes could be used as biomarkers to predict postpartum depression; these modifications target genes that work with estrogen receptors and are sensitive to hormones. These biomarkers were already about 80 percent effective at predicting postpartum depression, and Osborne hopes to examine whether combining allopregnanolone levels with the epigenetic biomarkers may improve the effectiveness of the tests to predict postpartum depression.

Of note and seemingly contradictory, she says, many of the participants in the study developed postpartum depression while on antidepressants or mood stabilizers. The researchers say that the medication dosages weren’t prescribed by the study group and were monitored by the participant’s primary care physician, psychiatrist or obstetrician instead. “We believe that many, if not most, women who become pregnant are undertreated for their depression because many physicians believe that smaller doses of antidepressants are safer for the baby, but we don’t have any evidence that this is true,” says Osborne. “If the medication dose is too low and the mother relapses into depression during pregnancy or the postpartum period, then the baby will be exposed to both the drugs and the mother’s illness.”

Osborne and her team are currently analyzing the medication doses used by women in this study to determine whether those given adequate doses of antidepressants were less likely to develop symptoms in pregnancy or in postpartum.

Only 15 percent of women with postpartum depression are estimated to ever receive professional treatment, according to the U.S. Centers for Disease Control and Prevention. Many physicians don’t screen for it, and there is a stigma for mothers. A mother who asks for help may be seen as incapable of handling her situation as a mother, or may be criticized by friends or family for taking a medication during or shortly after pregnancy.

Journal Reference:

  1. Lauren M. Osborne, Fiona Gispen, Abanti Sanyal, Gayane Yenokyan, Samantha Meilman, Jennifer L. Payne. Lower allopregnanolone during pregnancy predicts postpartum depression: An exploratory study. Psychoneuroendocrinology, 2017; 79: 116 DOI: 10.1016/j.psyneuen.2017.02.012

Source: Sciencedaily.com

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