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Month: August 2013

Home 2013 August

CWCC Response To Study Linking Labor Induction To Autism

August 13, 2013Obstetricsadmin

A recent study published in JAMA Pediatrics (August 12, 2013) received national attention in the media and has caused a number of our patients to have concerns. The study examined whether labor induction (using medication to start labor) or augmentation (using medication to enhance labor once it has already started) was associated with an increased risk of autism. Over 600,000 deliveries in North Carolina from 1990-1998 were examined and matched with school records.

The authors found that children who were born after a labor that was induced or augmented had a higher chance of having a diagnosis of autism than children who were born without labor induction/augmentation. Unfortunately some of the media took this information out of context and reported that labor induction causes autism, which would some lead patients to believe that induction of labor should be avoided for this reason.

This is certainly not the case and the authors are careful to note that there are also “significant maternal and fetal benefits of labor induction including reduced fetal/neonatal death and meconium aspiration syndrome; lower cesarean section delivery rates; lower risk for neonatal ventilation, sepsis and intensive care nursery admission and reduced maternal mortality”. They also state that “our results are not sufficient to suggest altering the standard of care regarding induction or augmentation; our results do suggest that additional research is warranted”.

While the study suggests that labor induction/augmentation may be linked to autism,  this study certainly does not prove that induction causes autism. It is important to understand that link between two things does not prove cause and effect, and the media is notoriously bad at pointing out this fact, as it reduces the “shock” effect of the news story. There are many factors which could account for a link between labor induction and autism. Many women being induced have underlying diseases which provide the reason for induction, and the medical problem may be the true association rather than the induction itself. For example, a link between obesity and autism, and between increased maternal age and autism, have been noted in various studies. These are both factors that increase the chance of labor induction/augmentation. It is also possible that women being induced are in environments with a higher level of medical care in general, and a higher likelihood of early diagnosis of autism. There are many factors other than the induction itself which could contribute to this association.

When evaluating TV or newspaper reporting of medical studies, it is always good to recognize that scientific studies are easy to take out of context if reduced to a one line headline or a short summary by a lay person whose job is to make a sensational sounding news article. There are many examples of news stories about medical “facts” that simply got it wrong by over-reacting to a single study, and later the information reported was found to be completely false. While we are not discounting that this study is of value and raises interesting questions about why labor induction and autism seem to be weakly linked, as always we recommend adhering to the standard of care until sufficient compelling data exists to change that standard.

All of us here at CWCC have our patients’ and their babies’ best interests at the forefront of our decision making, and we anxiously await additional research to emerge over the next few years which will hopefully shed more light on this interesting study.

Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to shs@cwcchouston.com.

I Love My Husband, But Am I The Only One With No Sex Drive?

August 1, 2013Gynecology, Menopauseadmin

One of the most common complaints that we here in our office from married women aged 30 to 50 with children is that their desire for sex has dwindled and they think there is something wrong. Sometimes patients even come in with their husbands who are certain that there must be a problem since they used to have sex all the time and something has changed.  Working with a group of almost 50 women and having seen thousands of women every year for 14 years in a very intimate setting, I can tell you with certainty that having low libido is the norm for American women in this age group. I am not saying that this is ideal, but simply that it is normal (if normal means common and average). Very rarely do I meet at patient in this age group who describes her libido as high.

The perception that we are given in the media is that everyone else is having sex all the time. Trust me, they’re not. This is just another one of the many unrealistic ideals that are imposed upon us by our culture. I think starting from a place of understanding that low libido is normal when we are married with young children and working from there is healthy. Certainly trying to improve our sex life is important for our marriages and is a goal that we should all work towards. But thinking that it should be easy and should come naturally can be lonely, disappointing and frustrating. This is an issue that we don’t talk about because of the perception that something is wrong with us, and we fear shame if we expose the truth that our sex lives are not as exciting as they used to be.

Speaking openly and honestly is the best way to disempower shame because we realize that many other people are experiencing the same thing. Most of my patients in this age group describe sex and enjoyable once they get started, but the desire to initiate in significantly reduced. In other words they would be fine to go without. They don’t miss it and don’t need it. Orgasm can usually still occur but it takes more effort so can become a bit of a “chore” when they would just as soon go to sleep. If you feel this way, you are in very large company.

So why does this happen and what can we do about it? Sex drive for women is mostly related to issues above the neck not below the waist. My theory is that evolutionary programming makes women desire sex when they are hunting for a mate or trying to get pregnant. Many of us experienced a fantastic sex drive when we were dating in our 20s. I often see a great sex drive return in women in their 40s and 50s who are starting a new relationship. So once we are married and settled, even if we are deeply in love, some of that pre-programmed desire can simply go away.

Once we are done having children and that biological need to procreate also leaves, our bodies may tell us that there is simply no need to have sex anymore. From an evolutionary point of view it makes sense to stop having sex when one doesn’t want or cannot support any more children, since women historically have been most likely to be the primary caretaker. Men don’t have this biological sex drive reduction, as they are fertile often up into their 80s and their bodies continue telling them to procreate.

In addition to the evolutionarily programmed reasons for libido reduction and there are also physical changes that happen in our bodies as we enter our 40s. Bloodflow is dramatically reduced in the genital area as we approach menopause, and reduction in estrogen changes our vaginal tissue making it drier and less elastic. These physical changes can make it uncomfortable to have intercourse and can reduce our ability to reach orgasm easily. I am not suggesting that we should just given to this natural decline in libido, anymore then I suggest giving into other age related changes without putting up a fight. But I do think it is important to understand what is normal and not to feel guilty or shameful about a natural and somewhat hardwired process.

The most important step to take is to talk about it. Share with your spouse that this is normal and that there is nothing wrong with you, or with him. Men take this stuff very personally and chances are your spouse thinks that your low libido means he is not good in bed. Men have fears and vulnerabilities too, and this is one of the biggest ones. Realize and accept that it is more work than it used to be, and make a little more time for it. Even if it is only once a week when it used to be 3 times, make sure that it happens.

I tell patients to think of it like going to the gym. Some people don’t have a natural desire to work out. But when they go, they enjoy it and realize that they feel better afterwards and they understand that it is healthy. They commit to going regularly and may keep it up for a while, but soon they are back in their old habits and are skipping classes that they committed to do. Those who feel that way have low gym-drive. On the other hand, some of us love the gym and will go to great lengths to get our workouts in and feel physically and emotionally unwell when we can’t go. For those with high gym-drive, going to the gym is easy, it happens naturally. Both types of people need to go to the gym, because it is undeniably healthy. But if both types occur in one marriage, and they need to attend the gym together, the number of gym visits a week will need to be a compromise between zero and every day.

Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to shs@cwcchouston.com.

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