Sunday, February 7, 2016

The CDC, Women, and the Advice Everyone is Talking About

As I wrote this post I realized that, sadly enough, it should probably begin with a disclaimer.  Part of this recent CDC campaign against women drinking any amount of alcohol, involves suggesting that alcohol is the (or a) cause for hyperactivity in children.  As I'm about to argue against the recent statement, which has been making waves, I should probably begin by saying that I don't drink when I'm pregnant.  Or when I might be pregnant.  And as I'll delve into later in this post, I tend to have a pretty good idea pretty early in the process.  

If you've been around this blog for a while you may know that I tend to fall into the super-careful end of the things-people-do-while-pregnant spectrum.  Unpasteurized cheese, raw seafood and unheated lunch meat aren't on the menu these days.  After I had my miscarriage in the second trimester following food poisoning, I became hyper-vigilant about any and all things that could go wrong.  

I thought I should start with that though, since I do have two kids who are hyperactive, and since that was one of the CDC's angles.  

I'm not writing this because I love my liquor and don't want to put down the wine glass while I'm growing this baby.  I'm not a big drinker.  I probably have around 12 glasses of wine a year when I'm not pregnant, spread out around the calendar.  It's not that big a change to not drink when I'm pregnant.  

Even so though, I was bothered by this weeks CDC headlines.  

A few days ago the internet erupted in a storm of criticism over a statement the CDC made  that women of child bearing age should either be on a form of birth control or avoid alcohol altogether (see the infographic here).

This can hardly be surprising in a culture that often seems to view the female reproductive cycle as a complete mystery.  Myths about the female body and how it works are far more common than knowledge of basic bodily functions, so I guess I can't be shocked that the CDC feels the need to make blanket statements that are more than a little overenthusiastic in their scope.

Over the years I've been met with various levels of shock that I can identify on the calendar when I ovulated and how far along I am in a pregnancy, even though that information has never matched up with where I should be based on my LMP date.

This was never more apparent than it was with this pregnancy (although my OB is great about listening and believing me when I say the dates are different).  I knew that I ovulated on the 52nd day of my last cycle.  That meant that at the first appointment, as I sat in the office, I was 5 weeks pregnant, not, as the chart insisted, 10 1/2 weeks pregnant.

That's quite a difference.  Two ultrasounds, one at five weeks and one a few weeks later, confirmed that my dates were accurate down to the day.

Still at every appointment the LMP date at the top of my chart throws everyone off.

This is where I think a little information could go a long way.  If we could strip away a little bit of the mystery of the female reproductive cycle, so that the vast majority of women understood that they can't get pregnant every. single. day. of the month, we'd be taking a step in the right direction.  Understanding our bodies can help women who might not otherwise have a clue about what's going on, decide that maybe over indulging tonight, isn't the right choice

 In this article the CDC tells us that most women do not realize that they are pregnant until somewhere between four and six weeks into the pregnancy.

Babies usually implant somewhere between days 9-11 (although it can happen as early as 7 days after conception or as late as 12 days).  That would mean that, using gestational age, babies usually implant around the fourth week of pregnancy, around when a woman might realize her period was supposed to start in a 28 day cycle if you were using old rhythm method.

So if you have a drink one day or even one week after conceiving, it's unlikely baby has even implanted and tapped into your nutrients.

And that got me thinking.  With my five previous pregnancies I began to suspect something was up days before implantation was supposed to occur.  Ten days before my period was expected could I really be experiencing the symptoms that I thought I was experiencing?  Why was nursing already excruciating, which is only the case when I'm pregnant?  And the nausea?  How can that happen before implantation?

How could I be fairly sure that I was pregnant, when supposedly from everything I'd been told, it was impossible to tell.  Some people said that it was just progesterone levels rising, as they do at the end of any cycle, but that didn't explain why pregnancy after pregnancy I could tell the difference between a non-pregnant cycle and a pregnant cycle.

A study from the NIH suggests that it is possible.  EPF (early pregnancy factor) is an immunosuppresive substance that the body releases 48 hours after fertilization.  I can't find any studies on the effect of EPF on the body (sadly the main purpose of identifying it at the moment seems to be to see how it could be used to identify pregnancies for early termination...), but it brings up the possibility that when a women thinks she might be having pregnancy symptoms before they should even be possible, she really might be experiencing something beyond PMS.

Which is a round about way of saying that, like our cycles, whether or not we're pregnant isn't always the mystery that it's made out to be.  I've spent too much time talking to women who are very aware of their cycles and the possibility that they could be pregnant, or are not pregnant, to buy into the idea that we can't have an idea of what's going on with our bodies at any given time.

For it to work, we need to pay attention.  Women need basic information about how their bodies function, which is sadly lacking for many.

I think that's what bothers me the most about the CDC announcement.  It underestimates women, and men, on so many levels.

It seems to imagine women across the country, of child bearing age, as binge drinkers, unable to decide for themselves if they might have done something that could result in the birth of a child in the not so far off future.

It also imagines that only women who aren't taking contraceptives can become pregnant, which as most adults know, simply isn't the case.  Contraception fails far more often than most people would like to admit.  But talking about the real world failure rates of contraceptives isn't as popular (even if they are rather dramatic).

I'm not going to delve into the choice of drinking an occasional alcoholic beverage while pregnant.  This article by Forbes has some interesting information against drinking even a drop.  I tend to think that an occasional drink during pregnancy isn't damaging, as it's portrayed in the US healthcare system, since drinking some alcohol during pregnancy was not uncommon during most of human history, and since it is still common in much of the world.

And with virtually no actual data on the effects of a single drink, I'l leave it to other women to decide on the level of risk that they feel exists.

Still, if the CDC is ready to tell women that we need to completely step away from having a single sip of alcohol, even if we aren't pregnant, than I think they might want to take a look at this study in the American Journal of Epidemiology.

In this study it was found that a woman's drinking may not be the only thing that affects a pregnancy.  The study showed that men and women who had ten or more drinks a week, while trying to conceive, were between two and five times more likely to have a pregnancy end in miscarriage.  This was the case in the study even when only the men were the ones drinking.

And since it's long seemed as though a single drink and twenty drinks were indistinguishable to many in the hallowed halls that issue decrees on what should and shouldn't be done, then perhaps men of childbearing age should abstain as well?  No?  Too ridiculous?

Or perhaps it shows us how ridiculous this entire thing is?

If the last few weeks of Zika and overbearing CDC statements have taught us anything, it's that women bear the brunt of instruction on what we should and shouldn't be allowed to do with our bodies, generally from groups who crow about bodily autonomy when it comes to matters of life and death.

I have a feeling that this has far more to do with the pushing of contraceptives on those few remaining who don't use them, amping up the pressure to do the "responsible thing" rather than on actual scientific data, which is rather lacking in this area.

On this one I think I'll have to trust individual women's judgement over the CDC's dire warnings.  Most women these days are on a form of birth control.  Most who aren't have an idea of what might happen if they have sex.  And women of all ages generally have an idea of what it means when their period is late if they aren't on some form of contraception.

 In fact, with the numbers of failures and women who don't have regular cycles on birth control, I'd be surprised if the numbers the CDC is throwing around doesn't have something to do with the fact that a woman on the pill (or some other form of birth control) might not realize she's pregnant and might keep drinking for far longer than a woman who isn't contracepting, and who is expecting a period sometime in the near future.  Just a thought.

Advertising the "perk" of not having a period is awfully fashionable these days.  And when contraception fails (as the above study I linked shows is very likely to happen over a ten year period with actual use), not everyone is willing to have an abortion (thank heavens).

With actual use failures being what they are, maybe the CDC's next step should be to look at how many babies whose moms were drinking heavily who thought that they couldn't conceive when they did, because they were taking a pill, or popped in a ring, or had an iud.

That would shine the light in a place they don't want us looking though.  It's easier to blame those who aren't marching in lock step to their tune, of being the problem, than it is to realize that the solutions they're proposing don't make all that much sense.

Throwing pills at people (or better yet!  An IUD that a woman can't discontinue using on her own!) is easier though, than finding actual solutions, whether those solutions include eliminating standing water or taking a closer look at the science behind how much alcohol actually causes disabilities like FAS in children.

Why would we need data though?  Over reaching government scare tactics are easier.  It only takes an afternoon to come up with an infographic.  Answers supported by research are obviously harder to come by.

Besides answers like that, the kind supported by data and statistics, are tricky things.  They might not support what the population control agenda of the moment wants us to hear.  And sometimes the message is more important to the people handing out decrees, than the truth.  


  1. You touch on so so so many important and TRUE issues with their announcement. It's so frustrating that the world discounts women's fertility and demonizes it.

  2. Amen! And it makes contraception that eliminates periods so much scarier - there's the illusion of safety when in fact the health risks are so much greater!


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