Which Birth Control Works Best? (Hint: It’s Not the Pill)

http://healthland.time.com/2012/05/24/iuds-and-implants-beat-the-pill-in-preventing-pregnancy/?iid=hl-article-mostpop1



REPRODUCTIVE HEALTH

By ALICE PARK

Long-acting contraceptives like IUDs and implants, which eliminate the potential for human error, are far more effective than more commonly used methods like the Pill, patch and vaginal ring.


 

Long-lasting contraceptives such as the intrauterine device (IUD) and implants are better at preventing pregnancy than more popular birth control methods, including the pill, patch and vaginal rings, a new study concludes.

The study involved 7,486 women participating in the Contraceptive Choice Project, run by researchers at Washington University School of Medicine in St. Louis. The women, aged 14 to 45, were given their choice of contraception for free and then tracked for up to three years for unintended pregnancy. The results, published in the New England Journal of Medicine, found that longer-lasting contraceptives were up to 20 times more effective — that is, women using IUDs, implants or hormone injections were up to 20 times less likely to get pregnant — after three years than the shorter-acting methods of birth control.

(MORE: Plan B: 1 in 5 Pharmacists May Deny Eligible Teens Access to Emergency Contraception)

Among the 1,500 women who chose to use birth control pills, patches or vaginal rings, 4.8% became pregnant after one year, compared with only 0.3% of the nearly 5,800 women who chose IUDs or implantable contraceptives. After three years, 9.4% of women using short-acting contraceptives got pregnant, compared with 0.9% of those using longer-acting methods.

Women using hormone injections (a minority at 176) had even better success, with 0.1% becoming pregnant after one year and 0.7% becoming pregnant after three years.

The results, while striking, aren’t all that surprising, considering that shorter term options depend on consistent compliance to work most effectively: pills must be take daily and patches and rings must be replaced within days or weeks.

In contrast, IUDs, which are fitted into the uterus, last five or 10 years, depending on the device. Hormonal implants, which are surgically placed under the skin of the upper arm, are effective for three years. And injections last three months.

(MORE: The Pill at 50: Sex, Freedom and Paradox)

How well a birth-control method worked depended also on the age of the user: younger women, under 21, using pills, patches or vaginal rings were nearly twice as likely to become pregnant as older women who used the same contraceptives. Why? Because they were more likely to forget to take their pills or to change their patch or ring. There were no age-related differences in pregnancy rates among women using IUDs, implants or injections.

Overall, poorer women with less education were also more likely to experience contraceptive failures.

The researchers hope their results will prompt more women to consider using long-acting contraceptives to prevent unwanted pregnancy. Each year in the U.S., there are an estimated 3 million unplanned pregnancies, about 1.2 million of which lead to abortion, according to the study. About half of unintended pregnancies occur because of because of incorrect or inconsistent use of contraception, including condoms and birth-control pills.

Still, the pill is the most commonly used contraceptive in the U.S. That may be because women don’t hear about long-acting methods as often as other contraceptives, or because women are more comfortable taking a pill or using a patch than having a device implanted in their body. Another factor: cost. IUDs and implants are expensive and aren’t typically covered by insurance.

(MORE: Teen Sex Ed: Instead of Promoting Promiscuity, It Delays First Sex)

“Nationally, only about 5 percent are using long-lasting methods like IUDs and implants. We know one of the barriers to why they’re not using them more frequently is up-front costs,” the study’s lead author, Dr. Brooke Winner of Washington University School of Medicine, told Reuters. “If [more] women were using these products nationally, there would be a very significant drop in unintended pregnancies, which would have far-reaching effects.”

While longer-lasting contraceptives can be more expensive up front, they may turn out to cost about the same as the pill when the expense is broken down by day, the researchers noted. IUDs and implants can be removed when women wish to become pregnant, and fertility typically returns immediately.

The researchers hope their study will also encourage doctors to consider IUDs and implants when discussing birth control with their patients. “If there were a drug for cancer, heart disease or diabetes that was 20 times more effective we would recommend it first,” another study author, Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University, told the Wall Street Journal.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

Read other related stories about this:

• Long-Term Contraception More Effective than Pills Reuters
• Long-Lasting Birth Control Cuts Pregnancy Rate The Wall Street Journal
• Long-Acting Contraceptives Are Best at Preventing Pregnancy The Los Angeles Times

Extended Breast-Feeding: Is It More Common than We Think?

http://healthland.time.com/2012/05/10/extended-breast-feeding-is-it-more-common-than-we-think/?iid=hl-article-editpicks



BREAST-FEEDING

By BONNIE ROCHMAN

It’s hard to ignore TIME’s May 21 cover. There’s Jamie Lynne Grumet, looking every bit the supermodel in superskinny jeans, ballet flats and a strappy tank top with the neckline tugged down to make way for … her nearly 4-year-old son. He’s breast-feeding.

Over the past few months, breast-feeding has grabbed headlines as moms have staged nationwide nurse-ins to draw attention to their right to breast-feed in public. Mothers with babes in arms have collectively bared their breasts in Target stores; they’ve had their infants latch on at Facebook’s headquarters and at the state capitol in Georgia.

But the campaign for greater acceptance of nursing in public — and all those detractors who recoil when they see a mother feeding a baby just as her body is programmed to do — pales next to the startling image of Grumet feeding a boy who clearly doesn’t need breast milk to thrive. Or does he?

(MORE: My Sister, My Surrogate: After Battling Cancer, One Woman Receives the Ultimate Mother’s Day Gift)

In a society that still gets squeamish when a baby is nursed in public, the idea of continuing to nurse that baby until he’s a toddler or even a preschooler is a real show stopper. But much of the world doesn’t share the U.S.’s uneasiness. The World Health Organization (WHO) recommends breast-feeding up to a child’s second birthday “or beyond.” Most U.S. mothers don’t even meet the recommendation made by the American Academy of Pediatrics and the U.S. Surgeon General that they skip infant formula and breast-feed exclusively for six months. According to the CDC’s 2011 Breastfeeding Report Card, 75% of U.S. mothers start out nursing their babies, but only 44% have stuck with it by the time their child is 6 months old — and just 15% are breast-feeding exclusively by that point. By baby’s first birthday, less than a quarter of mothers are breast-feeding at all.

From that small remainder emerges an even smaller group of extreme breast-feeders like Grumet. Which women are crazy enough to continue to nurse a child who can walk and talk?

Um, me.

(QUIZ: What’s Your Parenting Style?)

I spent more than six years total nursing my three kids. I have no idea how this happened. Unlike Grumet, I do not adhere to the philosophy of attachment parenting — the subject of this week’s cover story by Kate Pickert (available to subscribers here). The tenets espoused by its guru, Dr. Bill Sears, always felt too proscriptive: you must co-sleep and wear your baby in a sling from morn till night and breast-feed for years and never, ever let your baby cry. My kids slept in cribs, and easily transitioned to big-kid beds in their own rooms, although they still sometimes creep into my bed in the middle of the night. I enjoy cuddling them too much to move them back.

At one point, I owned half a dozen strollers (attachment parenting frowns upon these because they keep Mom from physically connecting with her baby), but I also strap my almost 5-year-old into an Ergo baby carrier — and love feeling her big-girl weight on my back. I “Ferberized” my oldest child, allowing him to cry for longer and longer blocks of time in a quest to sleep-train him before my maternity leave ended, and it worked. He still smiled at me when I plucked him from his crib the following morning, and nine years later, he’s a champion sleeper who doesn’t appear to have suffered any psychological ramifications, as far as I can tell. I wish I could say the same for myself; the experience of letting him “cry it out” was so traumatic that I let sleep-training slide with my younger kids. (The 5-year-old still wakes up at night.)

All this is to say that parenting is about embracing contradictions. So while I never could live up to many of attachment parenting’s pillars, extended breast-feeding appealed to me. That’s the term typically applied to nursing after a baby’s first birthday. I didn’t plan to do this. It just unfolded, with weeks slipping into months, and months melting into years. I loved nursing my children, the closeness that it engendered, the mandatory time out in a day filled with to-do lists. That said, nursing my children as they got older became largely a private affair — not because I was embarrassed but because they no longer needed to nurse at a restaurant or on a picnic bench. They preferred to eat food. So I rarely had to contend with strangers’ stares because the older my kids got, the less they nursed. That’s the normal progression of things — it’s how weaning is ideally supposed to work.

(MORE: Why Breast-Feeding Isn’t the Bugaboo)

So why the undeniable gawk factor when the occasional mother breast-feeds a preschooler at the park? Bettina Forbes, co-founder of breast-feeding advocacy group Best for Babes, thinks it’s because we’re so uneasy with the concept of breast-feeding in general. “You’re talking about a culture uncomfortable with breast-feeding a 6-week-old,” says Forbes. “We’ve sexualized the breast so much that people have forgotten breasts are for breast-feeding.”

In 2008 the American Academy of Family Physicians did its part to try to destigmatize nursing toddlers and older children, applauding the WHO guidelines even as it acknowledged that extended breast-feeding “is not the cultural norm in the United States and requires ongoing support and encouragement.” The group added:

It has been estimated that a natural weaning age for humans is between two and seven years. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment and having a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer. There is no evidence that extended breastfeeding is harmful to mother or child.

And it’s good for kids too, packed with nutrients and more fat and calories for older nursers. That’s the amazing thing about breast milk; it evolves to meet the needs of the child it’s nourishing. Still, my father, a physician, couldn’t figure out why I wouldn’t wean my children. “When are you going to stop breast-feeding already?” he’d ask each time he’d see me. “It’s not like I’m giving them soda,” I’d respond. “I’ll stop when I’m ready.”

(MORE: Confessions of an Accidental Attachment Parent)

In truth, I was never ready. I weaned my first two midway into subsequent pregnancies, bowing to pressure from my husband and doctors that it was probably a good idea to put my developing baby’s needs first. Plenty of women, of course, continue to safely nurse through pregnancy. But I wasn’t crazy about the thought of nursing two at a time. Several years later, I weaned my youngest because I had an unavoidable out-of-town trip. She was pushing 3 at the time, and I was able to have a conversation with her about what was about to happen. We had a kind of farewell party: she celebrated by munching on a cupcake made to resemble a breast with a gumdrop nipple, and that was it. We were done.

But the memories live on. When my daughter wants comfort, she asks if I can “hold her like a baby” — and she scoots into her old breast-feeding position to cuddle. Grumet’s mother breast-fed her until she was 6 (!), and in a Q&A posted on Healthland, she describes her memory of what suckling felt like:

It’s really warm. It’s like embracing your mother, like a hug. You feel comforted, nurtured and really, really loved. I had so much self-confidence as a child, and I know it’s from that. I never felt like she would ever leave me. I felt that security.

Years from now, I hope that’s what my kids remember too.

MORE: TIME’s Complete Coverage on Attachment Parenting

Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

The Upside of Peer Pressure: Social Networks Help Kids Exercise More

http://healthland.time.com/2012/05/28/the-upside-of-peer-pressure-social-networks-help-kids-exercise-more/#ixzz1wCcIPf2h


OBESITY



Peer pressure can be a powerful force, and sometimes a positive one. For example, hanging out with active peers may lead kids to exercise more, making a child’s social network a potential vehicle for promoting healthy habits and reducing obesity.

That’s what researchers led by Sabina Gesell, a research assistant professor in pediatrics at Vanderbilt School of Medicine, and her colleagues are reporting in the journal Pediatrics. The scientists studied networks of friends in an after-school program involving students aged 5 to 12. Using a pedometer-like device that recorded minute muscle movements, the researchers tracked kids’ physical activity levels over a period of 12 weeks.

At the start of the program, none of the children knew one another well, so the researchers were able to track how the youngsters’ made and dropped friends, and what effect these changing relationships had on their physical activity level.

(MORE: Why Active Video Games Don’t Make Kids Exercise More )

Turned out, it was a big one: during the time the children spent in the program, the strongest factor influencing how much time they spent engaged in moderate to vigorous physical activity was the activity level of their four to six closest friends. In fact, children changed their exercise level about 10% to better match those in their circle; children who hung out with more active students were more likely to increase their physical activity levels, while those who befriended more sedentary children became less active.

“We see evidence that the children are mirroring, emulating or adjusting to be similar to their friends,” says Gesell. “And that’s exciting because we saw meaningful changes in activity levels in 12 weeks.”

The results are encouraging also because they suggest a potentially inexpensive and effective way to change children’s behavior. Rather than relying only on organized exercise programs or drowning kids in messages to get moving, perhaps a subtler approach — introducing sedentary kids to more active ones — might help more kids get off the couch. From a public health perspective, that would mean seeding groups like after-school programs or community groups with children who like to exercise, so that by emulating them, others may become more active by association.

Even kids in day care can stand to benefit: a recent study found that children in day care are active only about 2% to 3% of the time they are there. Gesell says the results could help in providing a much-needed new tool for confronting the obesity epidemic.

(MORE: Back Off Mom. Parents Who Hover Impede Kids’ Activity)

Gesell is eager to conduct the next phase of studies, which would break down exactly how large an influence a single active child can have on the behavior of his more sedentary classmates. Hers is not the first study to analyze the “contagion” effect of social networks. Previous studies have documented how a person’s social network can influence everything from his likelihood of gaining weight or quitting smoking to levels of loneliness and happiness. However, Gesell is the first to study the phenomenon in children. “This is a novel approach to obesity prevention,” says Gesell. “None of the approaches to combating obesity are really working now, and we need a new approach. The social environment does carry more power than we have given it credit for, so we should leverage that intentionally.”

Given that children are increasingly connected to one another, whether through face-to-face interactions or virtual ones, their social networks can clearly have a profound effect on many aspects of their behavior and well-being. Using these childhood networks to encourage exercise — and perhaps other positive behaviors — could help kids in the long run, by turning them into healthier adults.

Venous cutdown

    

This procedure exposes the vein surgically and then a cannula is inserted into the vein under direct vision. If no cannulae are available the sterile end of the drip tubing may be used in adults after cutting off the Luer (cannula) connection. The procedure must be performed under sterile conditions to avoid sepsis developing which will not only shorten the life of the infusion but may have serious consequences for the patient.

During the procedure 2 ligatures (sutures) are placed around the vein. The distal ligature is used to tie off the vein distally and the proximal ligature holds the cannula in the vein While the vein is incised the ligatures help to hold it.

Equipment

1. Sterile gloves
2. Swabs and sterile drapes
3. Skin disinfectant
4. Local anaesthetic (5ml of 0.5% lignocaine is sufficient)
5. Scalpel
6. Two small curved artery forceps
7. Sharp pointed scissors (use scalpel if scissors blunt/unavailable)
8. Ligatures (2/0 catgut / vicryl are best, but silk is adequate)
9. Skin closing sutures
10. Cannula

Sites. In adults use the upper limb at the medial aspect of the antecubital fossa. Try to avoid the leg veins as they are thicker and more prone to thrombosis, phlebitis and infection. In children a cutdown may be performed using either the brachial or long saphenous veins.

Technique. Clean the skin and use the drapes to create a sterile area around the chosen vein.

(1) Infiltrate the skin with local anaesthetic.

(2) Make a 1.5 – 2cm transverse incision over the vein (a).

(3) Bluntly dissect out the vein by opening the forceps in the line of the vein (b).

(4) Make a small stab skin incision 1cm distal to the incision in the line of the vein. Pass two ligatures around the vein. Tie the distal one, but leave the ends uncut. Hold the ends of the ligatures with the artery forceps (c).

(5) Whilst holding the ligatures tight, make a “V” shaped incision in the anterior surface of the vein with the scissors or scalpel (d).

(6) Pass the cannula through the inferior stab incision and the through the “V” shaped incision into the vein. Tie the proximal ligature tightly over the cannulated vein and, if there is no bleeding, now cut the ends of the ligatures. If bleeding occurs place a further ligature around the vein. Connect the cannula to the giving set and commence the infusion.

(7) Close the skin with sutures (f).

After the infusion is finished the cannula can be removed by a firm steady pull followed by direct pressure over the site of the incision for 5 minutes.