Tuesday, March 4, 2014

Disease Increases: Has the West's Health Really Improved?

CDC Wonder is an interesting tool to play with. It's an online US data base that collects data on the environment, population heath, births, and deaths. You can create tables or graphs, specifying by year, age, location etc. For instance, using this tool you can ascertain the mortality rate of certain diseases, and get an idea of how those diseases have risen or fallen over time. Which is exactly what I did. What I found was huge growth in particular of mortality for neurological or autoimmune diseases. These are usually chronic diseases, that progressively get worse over a period of years, as opposed to a sudden onset infection that can kill within days or weeks. The results were very startling, and my mind raced to think of all the different factors that have changed over time that could account for this huge rise in disease. My first thought was neurotoxic substances such as aluminium, mercury, fluoride. Make of it what you will.


Sunday, January 26, 2014

Straight From the Mama's Mouth: Advice on Fussy / Gassy Babies

Very often women bring up gassy / fussy baby issues on Beautiful Breastfeeding's Facebook page (Natural Mama NZ's sister site). Mothers pour in with helpful advice, sharing what has worked for them personally. For me this is the best advice and it's one of crowning achievements of motherhood support pages on Facebook. Because gassy / fussy baby  issues keep coming up on Beautiful Breastfeeding and other motherhood pages I thought I'd collate some of the great advice shared through various threads into a blog post. Enjoy...

Check the Latch
"Have you had your latch checked? It's more likely a latch issue than a milk issue; if your latch is slightly off he may be swallowing large amounts of air and he will get very uncomfortable from this."

Burp More Often
"Burp your baby mid-feed. Makes a world of difference with gassy barfy babies."
"Burp more throughout day not just around feedings. Also try burping before feeds. Check out Dunstan baby language."

Try Different Positions
"If you walk around with them tummy down on your forearm, head resting in the nook of your arm. I found this position helped them get through it. And sucking makes their guts move so nurse him. Even if he’s fighting it and cranky...it will help it move through."
"Holding upright after feeding helps, as does gas drops and gripe water. The best thing I've found are what I call “fartercise”. Bicycling wasn't enough I have to gently stretch his legs up until his feet touch his face. GENTLY I stress. And I start with knees bent and gentle pressure towards his tummy and work my way up. It was the only way I could get him some relief. Now he giggles the whole time I do it but as he's getting older he is able to take care of most of it himself."
"I had gassiness / fussiness problems with my daughter, what I did was to hold her up for an hour or more after each breast feed! Now she's two months and she is better, baby needs time to adjust with everything."

 Baby Massage
"Before cycling baby’s legs get some lotion and do the "I love you" massage (google it) and instead of doing JUST his legs lift his body up and slowly roll it back down, like you would do if you were stretching your back. Doing that gets so much more gas out."
"Along with bicycling baby's legs, I would do infant massage on tummy. Worked like a charm with mine."

"Carrying in a sling/wrap close to you is worth trying."
"My little guy had similar issues, so I would burp him after 10 min or so. I also wore him everywhere, and the movement helped him a lot. In the Moby wrap I would bounce-walk and it would calm him down when he was screaming in pain."
"I wear my baby in a Sleepywrap for most of the day and he is so comfortable, he just sleeps, and wakes when he's hungry."

"You can give your baby their own probiotics. It's the only thing that helped my daughter when she had gassiness / fussiness around the same age. We used BioGaia."
"Probiotics helped my son so much. We used Flora Baby."
"I give my baby probiotics! Works great! You can get it at any health food store!"
"You can buy Florajen probiotics for baby." 
"I highly recommend probiotics for your baby too! I started giving them to my baby girl when she was 8 weeks for gassiness / fussiness and they worked very fast. I've been giving them to her ever since and she's never had any GI problems. They're very good for immunity and overall health (I've been working on probiotic research in different diseases for the last 8 years). Hope he feels better soon!"

Change Your Diet
"Could be what you are eating... when I made some changes in my diet I saw a wonderful improvement in my baby."
"Write down what eat! I found out I can't have pepperoni at all my daughter gets gas and stomach ache so bad."
"I chose to cut out many things and it works for me. Some are ok with onions, garlic, soy, dairy, gassy veggies, corn and red meat, some are not. In order to know, you have to cut it out COMPLETELY for a couple of weeks."
"I had to cut all dairy and gluten and it made a HUGE difference."
"My youngest had an issue with me consuming any caffeine."
"Hot sauce hurt my little guy's tummy too."
"What about broccoli? Gave mine gas something fierce."
"I had to eliminate caffeine, peppers, and dairy from my diet."
"Cutting out dairy and other "gassy" foods completely was the only thing that helped us. My baby did grow out of it by about three months except for large amounts of dairy. Goodluck!"
"Try the elimination diet. It takes at least 3 weeks of total elimination from your diet for diary to get out of your system and see results that are consistent."
"If diary is the problem ALL dairy has to be avoided if it is supposed to work. Any dairy will elicit an adverse response in an infant that is allergic or sensitive to dairy (even hidden diary like casein). Same goes for soy and wheat. Please read this: http://kellymom.com/health/baby-health/food-sensitivity/ Also, if you consider cutting dairy altogether, this list may be helpful: http://www.godairyfree.org/dairy.../dairy-ingredient-list-2 See also here: http://kellymom.com/parenting/parenting-faq/gassybaby/ Take care x"
"Have you tried cutting all soy out of your diet? Could be egg allergy, too."
"Watch the onions, garlic, peppers, beans, broccoli and cabbage. I know it's tricky getting your feet on solid ground, but you will get there! And it's SO worth it!"
"Gluten could definitely be a culprit. Cut gluten containing foods front your diet (pay as much as you can attention to all products labels, it can hide anywhere) just for few days and see what' s new in his status. Take care!"
"Watch out for certain seasonings too. All I can eat is salt on my food. Only veggies are corn and squash too. It's worth it as no screaming baby! Oh and no soy either, even soy oil or lecithin... which is in chocolate!"
"My daughter was like this and it turns out she is cows milk protein intolerant. This meant I couldn't have any dairy or soya in my diet - none at all. It takes a month to get out of your system so you have to be patient, but it definitely worked for us. She's now 20 months and still has a dairy and soya free diet. Could be worth a try."

Foremilk / Hindmilk Imbalance
"What are his poops like? If green and lettuce like, you may have a foremilk/hind milk imbalance....baby may not be getting the full day milk that comes toward the end of a feeding session."
"It may be a foremilk and hindmilk imbalance, try to make sure he feeds at least 25 mins both sides. Lots of good energy, you can do it!"
"We had this issue ourselves! For us it had nothing to do with what we were eating, or when I breastfed. My baby was getting too much of the start of the breast milk that is like skim milk, and not enough of the cream at the end of the feeding. If this is your issue, feed on one side until that breast is completely empty. Even if the baby stops because it's full, start again on that same side the next time until it is empty. This way the baby gets all the digestive enzymes that are in the thicker milk to help them digest the skim. We fixed that problem in 24 hours doing that. We sure had a lot of crap advice to the contrary though. Hang in there!"
"How long is your baby nursing on one side?...If he is a quick nurser he could be getting too much foremilk. Foremilk has a lot of lactose in it when that lactose mixes with his little intestines it is painful. And creates a colicky acting baby. Try nursing on one side for a block if time. Each time in that block baby nurses go to the same side, don't switch. When the block is over do the same on the other side. Good luck!"
"Try feeding on one side only. My little guy was getting horrible gas from too much foremilk. Once I started nursing him on just one side it helped tremendously. I pumped out the other to keep my supply up. Around eight weeks it all changes a lot anyway. Stick it out mama! You're doing a great job!"

Forceful Letdown
"When my daughter had that problem our issue ended up being my letdown was too much for her to handle and caused her to take in air. We switched nursing positions to one where she sat upright while nursing and this worked out great for us."

"It may be reflux. My son has it. He just takes reflux medication and keeps on breastfeeding."
"You could ask your doctor to give you acid reflux meds and if the problem is reflux it will all go away within days. It worked for all 3 of my children. After weeks of crying with my first. Acid reflux is common in children whether breastfed or bottle fed. So if the problem is reflux, changing to formula will not fix this problem at all, the baby will still be fussy and upset."
"Might be acid reflux, try Ranitidine. Get it from your doc. That is what my baby had and it worked. He had the same symptoms."

It Gets Better With Time
"Time will solve it, some babies are gassy and colicky but this won't last forever!
Don’t give up because it is just a stage!"
"My pediatrician said baby’s guts "wake up" at around 4-6 weeks and they are just fussy and gassy for a little while."
"Some babies might just have a rougher time getting their digestion up and running smoothly. Baby will make it promise."
"Gas starts going away around 2 months old. My baby just smiles and farts now when it was so bad at first."
"We went through gassiness / fussiness with my daughter (now nearly 8mo). It was a rough 6 weeks but after that she was much better."
"ALL my babies (4) went and are going (3weeks old) through a period of gassiness / fussiness. I honestly think it is just their guts adjusting to life on the outside. I nursed them all until after 2 years old including my 21 month old I am still nursing along with the 3 week old."
"Both my babies always seemed in pain with gas, grunted, cried, and struggled...but breast feeding helped them push through it. It does and will pass as he grows, it may seem like it takes them forever to do so, but it will happen. Keep on breast feeding!"
"It will go away, mine went through a gassy phase at 6 weeks and it was gone around 8 weeks or so."
"My son had colic for the first three months of his life. He was our first baby and it broke our hearts to see him in such pain. He cried constantly and so did I. Everyone I knew (and didn't know) commented on his colic and many insisted I switch to formula. I refused and nursed him for the first three years of his life. I have absolutely no regrets about this decision. He was a very high needs baby who was and still is super sensitive but today he is an amazing 5 year old."
"I nursed, held and wore him constantly as a baby and I truly believe this attachment parenting created the foundation for a remarkable and confident young boy. Good luck to you, follow your heart and try to remain positive. His colic will decrease with age and you too can experience an incredible relationship together particularly with breast feeding."
"Both my babies were gassy in the beginning. What I can say is that by 12 weeks it disappeared completely, it's just that until then their tummies are incapable of digesting properly. Hang in there, I promise it passes."

"They say breastfed babies don't get colic but mine did, it was awful, but once we started colic drops it settled down."
"Baby Gerber Colic Drops. I didn’t believe in it til I tried the drops."
"Simethicone is good - it gathers all the air in the tummy just ingested with a feed, and it all gets burped up in one glorious burp! After a day of this, the colic settles down a lot as those tiny air bubbles never made it into the intestines. My son is 12 weeks and had a lot of colic. I started giving him simethicone a few weeks ago and it's made a difference."
"Mylicon works for my son."
"I had to give my baby Levsin (Hyoscyamine) and it worked wonders!"
"I used to use Infacol drops before each feed which helped."
"My baby was really gassy the first month or so too. I used the target brand gas drops. It worked better than the gripe water. And it tastes way better."
"Colief definitely."
"Try Little Remedies: Little Tummies. Both of my kids used it."
"My son is 7 weeks old and went through this the first 6 weeks. He has reflux and now is on a PPI medication and I give him gas drops Colic Calm he is a whole different baby! It’s truly trial and error! good luck momma!"
"I got stuff called Colic Calm at Walgreens and I'll tell you what IT WORKS! Invest in some!
"Try a product called Iberogast it's an amazing herbal product that is great for wind, colic and reflux."
"My son was very gassy and the only thing that worked was Ovol."
My daughter responded well to a little chamomile tea! I'd breastfeed then give her a couple tablespoons of tea...big burp, big fart and she was happy. Good luck mama" 
"Try cooled fennel tea or homeopathic chamomilla. My boy was the same and they really helped. Health food shops stock chamomilla granules especially for tiny ones."
"My baby had issues with gas and my pediatrician suggested an ounce of prune juice mixed with an ounce of water once a day. Helped my little guy out tons!"
"Buy some carroway seeds and make a tea out of it, you and the baby should drink some, it will help the gas get out!"

Check For Anatomical Problems
"Just make sure that your baby does not have lip or tongue tie that would cause the baby to have a poor latch and get more air when eating. Look at www.kiddsteeth.com to get information about how to check. If you think this is a problem, you can PM me. Good luck! This probably isn't the issue, but I just wanted you to rule it out because it does affect 3-5% of babies."

Chiropractic Care
"My son was diagnosed with GERD and given Zantac. It helped for a few months but he started presenting similar symptoms again. We took him to a chiropractor that diagnosed him with a hiatal hernia. He's been so much better ever since! I suggest looking into a reputable chiropractor that works on infants. And they don't adjust infants the same as adults. My son was on my lap the entire time. Good luck!"
"Chiropractor works miracles for babies! Highly recommend, we dealt with the same issue with my youngest and nothing else helped but the chiropractor. Good luck!"

Try to Avoid Formula
"Worst possible idea is to switch to formula - it will only make things worse as formula is a lot harder on an infant's gut than breast milk. Even just a bottle can cause severe damage to the natural Ph level of his gut. My son was the same, very colicky. I just persisted and he is now 5 months, still breastfeeding and very happy! Don't supplement his milk with anything, and just hang in there. http://www.health-e-learning.com/articles/JustOneBottle.pdf"
"Formula actually gave my daughter much worse gas."
"We tried formula and it made no difference with gas! Only made him constipated."

Helpful Books
"It may have nothing to do with his stomach or the milk. Colic is not always caused by stomach issues. My baby had colic for the first 4.5 months and it was so difficult but I was given a book called "Happiest Baby on the Block". Seriously this book is a must read for mothers of colicky or fussy babies, it saved our sanity. He will grow out of it and the book gives real solutions for calming him in the meantime that work. Good luck and don't give up yet."

Tuesday, January 7, 2014

The Implausibility of Vaccine-Based Herd Immunity

The phrase "herd immunity" is tossed a lot these days. I've often seen it used as ammunition against parents who choose not to vaccinate, with something along the lines of, "the only reason your unvaccinated child is so healthy is because those of us who vaccinate are keeping disease rates down". Is this really true? I decided to dig deeper to find out.

Herd immunity requires the assurance that a large percentage of the ‘herd’ (population) is immune and therefore unable to pass on disease. The theory is based on natural immunity, which provides lifelong or long term immunity. [1] Whether vaccination can be substituted for natural immunity when considering herd immunity, is an entirely different question.

Just how effective a vaccine is at providing immunity, is very difficult to gauge. Vaccination provides essentially a half-hearted immune response to infection. It may often provide a strong antibody reaction, but unfortunately provides a very poor innate immune response. [2] Nevertheless, traditionally vaccine effectiveness has primarily been based on antibody levels produced by the body in response to the injected pathogen, and the fact that vaccines illicit a poor innate immune response has largely been ignored.

However, recent research has thrown the traditional theory that antibodies are required for immunity into disarray. It is now known that antibody levels cannot accurately predict immunity. A person can have high levels of antibodies but still become infected, and conversely a person can have low levels of antibodies but not become infected. In fact, in 2012 Moseman et al revealed that antibodies were not even required to gain immunity and that antibodies elicited by vaccines could not by themselves provide adequate immunity. [3]

Pollard et al (2009) noted that children vaccinated with the Hib conjugate vaccine still suffered from Hib disease despite the presence of B-cell immunological memory:
"These children mount a memory immune response to infection but still suffer from Hib disease, which supports our view that the presence of immunological memory does not guarantee protection. These observations strongly suggest that B-cell memory (the kind of immune memory induced via vaccination) might not be as important as longlasting antibodies (T-cell memory cells induced via natural infection) for long-term protection against a rapidly invasive pathogen." [3a]

The immune system as a whole needs to work together, as it does in response to natural infection; something vaccines have to date been unable to achieve.

Despite this, vaccine manufacturers continue to use inadequate antibody testing to rate their products effectiveness. As inadequate and variable as antibody-based immunity conferred by vaccines is, it is further subject to rapid decline soon after vaccine administration, in some cases even after numerous boosters. In 2012 Klein et al studied the waning effect of the whooping cough (pertussis) vaccine and discovered: “The risk of pertussis increased by 42% each year after the fifth DTaP dose.” [4] In stark contrast, in 2009 Wearing et al determined that , on average, whooping cough immunity lasts at least 30 years and perhaps as long as 70 years after natural infection. [5]

It’s no surprise then that vaccines are often demonstrated to be ineffective in real world situations. For example numerous outbreaks of measles, mumps, whooping cough, chicken pox, influenza, and polio have been documented in highly vaccination populations. [6-23, 24-27, 28-35, 36-40, 41-62, 63-64]

In 2009 researchers Witt et al. examined whooping cough incidence in California, and concluded:
"Our data suggests that the current schedule of acellular pertussis vaccine doses is insufficient to prevent outbreaks of pertussis." [65a]

Likewise, in 2013 researchers Sala-Farré et al. studied whooping cough incidence in Vallès and concluded:
"Despite high levels of vaccination coverage, pertussis circulation cannot be controlled at all. The results question the efficacy of the present immunization programmes." [65b]

In addition, the Centers for Disease Control has admitted that unvaccinated people are NOT the cause of recent whooping cough incidence:
"Even though children who haven't received DTaP vaccines are at least 8 times more likely to get pertussis than children who received all 5 recommended doses of DTaP, they are not the driving force behind the large scale outbreaks or epidemics...We often see people blaming pertussis outbreaks on people coming to the US from other counties. This is not the case. Pertussis was never eliminated from the US like measles or polio, so there's always the chance for it to get into a community. Plus, every country vaccinates against pertussis." [65c]

Dr. Anne Schuchat, the director of the CDC’s National Center for Immunization and Respiratory Diseases further explains the recent increase in whooping cough incidence:
“Better diagnosis and reporting of whooping cough may be contributing to the increased numbers, along with the fact that the disease tends to peak and wane in cycles. It does not appear that anti-vaccination sentiment among parents has contributed…” [65d]

While lack of effectiveness constitutes one major problem with vaccination, an even worse complication actually implicates vaccination as a cause of disease epidemics. The current acellular whooping cough (pertussis) vaccine was shown by researchers Warfel et al. to create the illusion of immunity by exhibiting no symptoms in the vaccine recipient, when in fact the recipient was infected and spreading the infection to those around them. [65] Even though vaccine recipients had adequate levels of antibodies to be considered ‘immune’ by vaccine standards, it did not stop the infection persisting in the host or spreading it to others. [65] The researchers concluded:
"The observation that acellular pertussis, which induces an immune response mismatched to that induced by natural infection, fails to prevent colonization or transmission provides a plausible explanation for the resurgence of pertussis and suggests that optimal control of pertussis will require the development of improved vaccines." [65]

To make matters worse, the current acellular whooping cough vaccine is shown to lower the recipients ability to clear the infection, as well as lowering the body’s ability to clear other bacterial species that may invade the body in the future. This results in susceptibility to chronic bacterial infections that can lay undetected for an unspecified, possibly indefinite, period of time. [67]

The risks associated with the acellular whooping cough vaccine, which has been in use since 1991 [68], have been known as early as 2000. [69] Yet no recall of the vaccine was made, and the cause of reported whooping cough cases continued to be blamed on unvaccinated children. Why this problem wasn’t caught during preliminary testing before licensure of the vaccine is also cause for concern.

Other vaccines have also proven to be problematic. The chicken pox (varicella) and rotavirus vaccines have been documented numerous times causing infection in vaccine recipients and spreading the infection to others. The chicken pox vaccine has also been documented multiple times causing herpes zoster, a related virus with 3 times the morbidity and 5 times the mortality of varicella, in vaccine recipients. [69-93, 94-100]

The measles vaccine may also suffer from a similar problem to the chicken pox and rotavirus vaccines. Researchers Valsamakis et al (1999) studied how the vaccine-based measles virus changed over time when allowed to replicate for an extended period of time in human tissue. They discovered that it grew in strength, evolving back to a strength similar to that of the wild-type measles virus from which it was derived. The researchers warned that individuals with immune deficiency may suffer adverse outcomes if vaccinated, as they may be unable to clear the original, weakened, vaccine-based measles virus, allowing the virus to replicate for an extended period of time and grow to full strength. [101]

Rota et al (1995) found that the measles virus was shed in 14 of the 16 measles vaccine recipients tested:
"Measles virus RNA was detected in 10 of 12 children during the 2-week sampling period. In some cases, measles virus RNA was detected as early as 1 day or as late as 14 days after vaccination. Measles virus RNA was also detected in the urine samples from all four of the young adults between 1 and 13 days after vaccination." [103]

While viral shedding of the live measles vaccine is one concern, another is the risk of infection and subsequent shedding after a vaccinated person has been exposed to a wild measles virus (or a vaccine measles virus that has mutated back to full strength).

Damien et al (1998) found that people who are traditionally considered immune to measles (have produced sufficient amounts of antibodies) can still harbour the measles virus without showing outward symptoms and theoretically spread it to others. This phenomenon is known as an asymptomatic secondary immune response. It applies to both those who have acquired immunity through natural infection or through vaccination, however those who are vaccinated are 5-8 times more susceptible to this response. [102]

After an investigation of a measles outbreak in a highly vaccination school population, Matson et al (1993) found that even after revaccination of school children who did not develop antibodies to their initial measles vaccination, susceptibility to measles infection still remained high (albeit without the appearance of a rash):
"Revaccination appeared to reduce the portion of all students with neutralization titers predicting susceptibility to measles illness with rash from 7.9% to 3.0% and left the portion predicted to be susceptible to illness without rash unchanged (45%)." [104]

Helfand et al (1998) also examined the effects of a measles outbreak in a highly vaccinated school population and concluded:
"Mild or asymptomatic measles infections are probably very common among measles-immune persons exposed to measles cases and may be the most common manifestation of measles during outbreaks in highly immune populations." [105]

These results are not surprising given that vaccines that are injected, such as the MMR, do not stimulate mucosal immunity.[2] However the mucosa is precisely where the majority of infections reside.[106] So while vaccine recipients are usually protected from severe symptoms such as a rash or fever, many are still susceptible to infection, and theoretically will pass the infection on to those around them.[102]

This completely shatters any illusion that at least these particular vaccines can provide herd immunity. It implicates the current whooping cough, chicken pox, rotavirus, and possibly the mesasles vaccines as a cause of disease resurgence, and implicates the whooping cough vaccine as a cause of lowered immunity. The fact that antibodies alone have been shown unable to confer adequate immunity to pathogens calls into question the use of vaccination as a whole, as vaccine based immunity is primarily based on antibody production.

For these reasons, it is my opinion, that vaccination cannot in good conscience be used in the context of herd immunity. Until safer and more effective vaccines become available it seems a gamble to assume that vaccine recipients are truly immune.

1. Herd immunity and measles.
Fox JP. Rev Infect Dis. 1983 May-Jun;5(3):463-6.

2. Vaccine immunology
Claire-Anne Siegrist

3. B cell maintenance of subcapsular sinus macrophages protects against a fatal viral infection independent of adaptive immunity. Moseman EA et al. Immunity. 2012 Mar 23;36(3):415-26.

3a. Maintaining protection against invasive bacteria with protein–polysaccharide conjugate vaccines
Andrew J. Pollard et al. Nature Reviews, Immunology Volume 9, MARCH 2009, 213

4. Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children
Nicola P. Klein et al. N Engl J Med 2012; 367:1012-1019September 13

5. Estimating the Duration of Pertussis Immunity Using Epidemiological Signatures.
Wearing et al. PLoS Pathogens, 2009; 5 (10): e1000647

6. Velicko I, Vaccine. 2008 Dec 9;26(52):6980-5. Epub 2008 Sep 19.

7. Follin P, Effective control measures limited measles outbreak after extensive nosocomial exposures in January-February 2008 in Gothenburg, Sweden. Euro Surveill. 2008 Jul 24;13(30). pii: 18937.

8. Matson DO, et al, Pediatr Infect Dis J; 12(4): 292-9. -- 1993- 4- 1

9. Jahan S, Measles outbreak in Qassim, Saudi Arabia 2007: epidemiology and evaluation of outbreak response, J Public Health (Oxf); 2008 Dec;30(4):384-90

10. Yeung LF, Lurie P, A limited measles outbreak in a highly vaccinated US boarding school. Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. LYeung@cdc.gov, Pediatrics. 2005 Dec;116(6):1287-91

11.MMWR (Morbidity and Mortality Weekly Report), 38 (8-9), 12/29/89.

12. Pedersen IR, et al, Vaccine; 7(4):345-8. -- 1998- 8- 1

13. DCD; MMWR / 46(49); 1159-1163 -- 1997-12-12

14. Anders, Jennifer F. MD, Pediatric Infectious Disease Journal. 15(1):62-66 -- 1996- 1- 1

15. Hidaka Y, et al, Scand J Infect Dis; 26(6):725-30. -- 1994- 1- 1

16. G Ozanne et al, J Clin Microbiol; 30(7): 1778-1782 -- 1992- 7- 1

17. B S Hersh, et al, Am J Public Health; 81(3): 360–364 -- 1991- 3- 1

18. Chen ,R et al, American Journal of Epidemiology Vol. 129, No. 1: 173-182 1989 -- 1989- 1- 1

19. TL Gustafson, et al, New England Journal of Medicine Volume 316:771-774 Number 13 -- 1987- 3-26

20. Gustafson TL, NEJM, 316:771-774. -- 1987- 3- 1

21. Ronald M. Davis, et al, American Journal of Epidemiology Vol. 126, No. 3: 438-449 1987 -- 1987- 1- 1

22. Steven G. F. Wassilak, et al, American Journal of Epidemiology Vol. 122, No. 2: 208- 217 -- 1985- 1- 1

23. Cherry JD, et al, J Pediatr; 82(5):802-8. -- 1973- 5- 1

24. Anderson, LJ, Mumps epidemiology and immunity: the anatomy of a modern epidemic, Pediatr Infect Dis J; 2008 Oct;27 (10-suppl):S75-9

25. Boxall N, An increase in the number of mumps cases in Czech Republic, 2005-2006, Euro Surveill; 2008 Apr 17;13(16)

26. Hersh BS, et al, J Pediatr; 119(2):187-93. -- 1991- 8- 1

27. Salmón-Mulanovich G, Rapid response to a case of mumps: implications for preventing transmission at a medical research facility. Salud Publica Mex. 2009 Jan-Feb;51(1):34-8.C

29. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Jason M. Warfel, et al. 10.1073/pnas.1314688110

30. The 1993 epidemic of pertussis in Cincinnati. Resurgence of disease in a highly immunized population of children. Christie CD et al. N Engl J Med. 1994 Jul 7;331(1):16-21. PMID: 8202096. Study Type : Human Study

31. Outbreak of pertussis in a fully immunized adolescent and adult population.
Mink CA, et al. Arch Pediatr Adolesc Med. 1994 Feb;148(2):153-7. PMID: 8118532

32. Pertussis infection in fully vaccinated children in day-care centers, Israel.
Srugo I et al. Emerg Infect Dis. 2000 Sep-Oct;6(5):526-9. PMID: 10998384. Study Type : Human Study

33. Infant pertussis epidemiology and implications for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination: King County, Washington, 2002 through 2007. Hanson MP et al. Arch Pediatr Adolesc Med. 2011 Jul ;165(7):647-52. PMID: 21727277. Study Type : Human Study

34. A field survey carried out on the confirmation of a pertussis case in a village of Kirikkale Province, Turkey. Coplü N, et al. Mikrobiyol Bul. 2007 Apr;41(2):175-83. PMID: 17682703

35. Author Insights: Higher Pertussis Rates in Children Vaccinated With Newer Pertussis Vaccine
Bridget M Kuehn. JULY 31, 2012

36. Chickenpox outbreak in a highly vaccinated school population.
Tugwell BD, et al. Pediatrics. 2004 Mar;113(3 Pt 1):455-9.

37. Younger age at vaccination may increase risk of varicella vaccine failure.
Galil K, et al. J Infect Dis.2002;186 :102– 105

38. Outbreak of varicella at a day-care center despite vaccination.
Galil K, et al. N Engl J Med.2002;347 :1909– 1915

39. An elementary school outbreak of varicella attributed to vaccine failure: policy implications.
Lee BR, et al. J Infect Dis.2004;190 :477– 483

40. Vaccine Effectiveness During a Varicella Outbreak Among Schoolchildren: Utah, 2002–2003
Maryam B. Haddad et al. PEDIATRICS Vol. 115 No. 6 June 1, 2005. pp. 1488 -1493

41. Effectiveness of inactivated influenza vaccines varied substantially with antigenic match from the 2004-2005 season to the 2006-2007 season.
Belongia EA, et al. J Infect Dis. 2009 Jan 15;199(2):159-67.PMID: 19086915.

42. Effectiveness of the 2003-2004 influenza vaccine among children 6 months to 8 years of age, with 1 vs 2 doses.
Ritzwoller DP, et al. Pediatrics. 2005 Jul;116(1):153-9.

43. Effectiveness of influenza vaccine during pregnancy in preventing hospitalizations and outpatient visits for respiratory illness in pregnant women and their infants. Black SB, et al. Am J Perinatol. 2004 Aug;21(6):333-9. PMID: 15311370

44. Effectiveness of trivalent inactivated influenza vaccine in influenza-related hospitalization in children: A case-control study. Authors: Joshi, Avni Y et al, Allergy and Asthma Proceedings, Volume 33, Number 2, March/April 2012 , pp. e23-e27(5)

45. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis.
Osterholm MT et al. Lancet Infect Dis. 2012 Jan;12(1):36-44.PMID: 22032844. Study Type : Meta Analysis

46. Evidence of bias in estimates of influenza vaccine effectiveness in seniors
Lisa A Jackson et al. Int. J. Epidemiol. (April 2006) 35 (2): 337-344.

47. Further Evidence for Bias in Observational Studies of Influenza Vaccine Effectiveness: The 2009 Influenza A(H1N1) Pandemic
Michael L. Jackson et al. Am. J. Epidemiol. (2013)

48. Impact of influenza vaccination on seasonal mortality in the US elderly population.
Simonsen L et al. Arch Intern Med. 2005 Feb 14;165(3):265-72. PMID: 15710788. Study Type : Human Study

49. Impact of maternal influenza vaccination during pregnancy on the incidence of acute respiratory illness visits among infants.
France EK, et al. Arch Pediatr Adolesc Med. 2006 Dec;160(12):1277-83.

50. Influenza Vaccination During Pregnancy: A Critical Assessment of the Recommendations of the Advisory Committee on Immunization Practices (ACIP). David M. Ayoub, M.D., F. Edward Yazbak, M.D, Journal of American Physicians and Surgeons Volume 11 Number 2 Summer 2006

51. Influenza vaccination for healthcare workers who work with the elderly. Thomas RE et al. Cochrane Database Syst Rev. 2010(2):CD005187. PMID:20166073. Study Type : Meta Analysis

52. Influenza vaccination for healthcare workers who work with the elderly.
Thomas RE et al. Cochrane Database Syst Rev. 2006 ;3:CD005187. Epub 2006 Jul 19. PMID:16856082. Study Type : Meta Analysis

53. Influenza vaccine effectiveness among children 6 to 59 months of age during 2 influenza seasons: a case-cohort study. Szilagyi PG,et al. Arch Pediatr Adolesc Med. 2008 Oct;162(10):943-51. New Vaccine Surveillance Network. Strong Memorial Hospital, Rochester, NY 14642, USA.

54. Influenza Vaccine: Review of Effectiveness of the U.S. Immunization Program, and Policy Considerations
David A. Geier, B.A., et al. Journal of American Physicians and Surgeons Volume 11 Number 3 Fall 2006. Association of American Physicians and Surgeons, Inc.

55. Influenza-related mortality in the Italian elderly: no decline associated with increasing vaccination coverage. Rizzo C et al. Vaccine. 2006 Oct 30;24(42-43):6468-75. PMID: 16876293. Study Type : Human Study

56. Interim within-season estimate of the effectiveness of trivalent inactivated influenza vaccine--Marshfield, Wisconsin, 2007-08 influenza season.
CDC. MMWR Morb Mortal Wkly Rep. 2008 Apr 18;57(15):393-8. PMID: 18418344

57. No effect of 2008/09 seasonal influenza vaccination on the risk of pandemic H1N1 2009 influenza infection in England. Pebody R, et al. Vaccine. 2011 Jan 31. Epub 2011 Jan 31. PMID: 21292008.
Study Type : Meta Analysis

58. Vaccines for preventing influenza in healthy adults
Tom Jefferson et al, 2010, DOI: 10.1002/14651858.CD001269.pub4

59. Vaccines for preventing influenza in healthy children.
Jefferson T et al. Altern Ther Health Med. 2009 Sep-Oct;15(5):44-6. PMID: 18425905.
Study Type : Meta Analysis

60. Vaccines for preventing influenza in people with cystic fibrosis.
Dharmaraj P et al. http://www.greenmedinfo.com/article/there-currently-no-evidence-randomised-studies-influenza-vaccine-given-people-cf-benefitCochrane Database Syst Rev. 2009 Oct 7;(4):CD001753. PMID: 19821281
ArtiStudy Type : Meta Analysis

61. Vaccines for preventing influenza in the elderly.
Jefferson T et al. http://www.greenmedinfo.com/article/there-no-solid-evidence-available-supporting-belief-vaccines-are-effectiveCochrane Database Syst Rev. 2010(2):CD004876. Epub 2010 Feb 17. PMID:20166072. Study Type : Meta Analysis

62. What, in Fact, Is the Evidence That Vaccinating Healthcare Workers against Seasonal Influenza Protects Their Patients? A Critical Review.
Zvi Howard Abramson et al, Int J Family Med. 2012; 2012: 205464.

63. Lancet vol 338: Sept 21, 1991; 715-720.

64. Hawk, J, Science and Development Network -- 2006- 8-22

65. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Jason M. Warfel et al. doi: 10.1073/pnas.1314688110

65a. Unexpectedly limited durability of immunity following acellular pertussis vaccination in preadolescents in a North American outbreak.
Witt MA, et al. Clin Infect Dis. 2012 Jun;54(12):1730-5. PMID: 22423127

65b. Pertussis epidemic despite high levels of vaccination coverage with acellular pertussis vaccine.
Sala-Farré MR, et al. Enferm Infecc Microbiol Clin. 2013 Nov 8. pii: S0213-005X(13)00298-X.

65c. Whooping Cough

65c. CDC: Whooping Cough Heading to a 50-Year High

66. Cute as a Button, but tiny Isla was close to death
Mandy Squires. 14 march 2012. Herald Sun

67. Antibody Response Patterns to Bordetella pertussis Antigens in Vaccinated (Primed) and Unvaccinated (Unprimed) Young Children with Pertussis[down-pointing small open triangle]
James D. Cherry et al. CLINICAL AND VACCINE IMMUNOLOGY, May 2010, p. 741–747 Vol. 17, No. 5

68. Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices (ACIP)

69. Acyclovir-resistant chronic verrucous vaccine strain varicella in a patient with neuroblastoma.
Bryan CJ, rt al. Pediatr Infect Dis J. 2008 Oct;27(10):946-8. PMID: 18776818

70. Development of Resistance to Acyclovir during Chronic Infection with the Oka Vaccine Strain of Varicella-Zoster Virus, in an Immunosuppressed Child. Myron J. Levin et al. J Infect Dis. (2003) 188 (7): 954-959.

71. Chickenpox attributable to a vaccine virus contracted from a vaccinee with zoster.
Brunell PA et al. PEDIATRICS Vol. 106 No. 2 August 1, 2000 pp. e28

72. Disseminated varicella infection due to the vaccine strain of varicella-zoster virus, in a patient with a novel deficiency in natural killer T cells. Levy O, et al. J Infect Dis. 2003 Oct 1;188(7):948-53.

73. DNA sequence variability in isolates recovered from patients with postvaccination rash or herpes zoster caused by Oka varicella vaccine. Loparev VN, et al. J Infect Dis. 2007 Feb 15;195(4):502-10.

74. Herpes zoster after varicella-zoster vaccination
Fahlbusch M, et al. Hautarzt. 2013 Feb;64(2):107-9. PMID: 23358727

75. Genetic Profile of an Oka Varicella Vaccine Virus Variant Isolated from an Infant with Zoster
Andreas Sauerbrei et al. J. Clin. Microbiol. December 2004 vol. 42 no. 12 5604-5608

76. Herpes zoster and meningitis due to reactivation of varicella vaccine virus in an immunocompetent child.
Han JY, et al. Pediatr Infect Dis J. 2011 Mar;30(3):266-8. PMID: 20844461

77. Herpes zoster and meningitis resulting from reactivation of varicella vaccine virus in an immunocompetent child.
Iyer S, et al. Ann Emerg Med. 2009 Jun;53(6):792-5. PMID: 19028409

78. Herpes zoster by reactivated vaccine varicella zoster virus in a healthy child
Barbara Uebe, et al. European Journal of Pediatrics 2002, Vol 161, Issue 8, pp 442-444

79. Herpes zoster due to Oka vaccine strain of varicella zoster virus in an immunosuppressed child post cord blood transplant.
Chan Y, et al. J Paediatr Child Health. 2007 Oct;43(10):713-5.

80. Herpes zoster with skin lesions and meningitis caused by 2 different genotypes of the Oka varicella-zoster virus vaccine.
Levin MJ, et al. J Infect Dis. 2008 Nov 15;198(10):1444-7.

81. Live attenuated varicella vaccine use in immunocompromised children and adults.
Gershon AA, et al. Pediatrics. 1986 Oct;78(4 Pt 2):757-62.

82. Rashes occurring after immunization with a mixture of viruses in the Oka vaccine are derived from single clones of virus.
Quinlivan ML, et al. J Infect Dis. 2004 Aug 15;190(4):793-6. PMID: 15272408

83. Secondary transmission of varicella vaccine virus in a chronic care facility for children.
Grossberg R, et al. J Pediatr. 2006;148: 842– 844

84. Severe Varicella Caused by Varicella-Vaccine Strain in a Child With Significant T-Cell Dysfunction
Patrick Jean-Philippe et al. PEDIATRICS Volume 120, Number 5, November 2007

85. The incidence of zoster after immunization with live attenuated varicella vaccine. A study in children with leukemia. Varicella Vaccine Collaborative Study Group. Hardy I, et al. N Engl J Med. 1991 Nov 28;325(22):1545-50.

86. Transmission of vaccine strain varicella-zoster virus from a healthy adult with vaccine-associated rash to susceptible household contacts. LaRussa P, et al. J Infect Dis. (1997) 176 (4): 1072-1075.

87. Transmission of Varicella Vaccine Virus, Japan
Taketo Otsuka et al, Emerg Infect Dis. 2009 October; 15(10): 1702–1703. PMCID: PMC2866412

88. Transmission of varicella-vaccine virus from a healthy 12-month-old child to his pregnant mother.
Salzman MB et al. Homeopathy. 2009 Apr;98(2):77-82. PMID: 9255208. Study Type : Human Study

89. Transmission of varicella-zoster virus from a vaccinee with leukemia, demonstrated by polymerase chain reaction.
A Hughes P, et al. J Pediatr. 1994 Jun;124(6):932-5.

90. Vaccine Oka Variants and Sequence Variability in Vaccine-Related Skin Lesions
Judith Breuer et al. J Infect Dis. (2008) 197 (Supplement 2): S54-S57.

91. Vaccine Oka Varicella-Zoster Virus Genotypes Are Monomorphic in Single Vesicles and Polymorphic in Respiratory Tract Secretions. Mark A. Quinlivan et al. J Infect Dis. (2006) 193 (7): 927-930.

92. Vaccine-associated herpes zoster opthalmicus and encephalitis in an immunocompetent child. Chouliaras G et al. Pediatrics. 2010 Apr;125(4):e969-72. Epub 2010 Mar 1. PMID: 20194287. Study Type : Human Study

93. Virus Variant Isolated from an Infant with Zoster
Andreas Sauerbrei, et al. J. Clin. Microbiol. 2004, 42(12):5604.

94. Identification of strains of RotaTeq rotavirus vaccine in infants with gastroenteritis following routine vaccination. Donato CM, et al. J Infect Dis. 2012 Aug 1;206(3):377-83.

95. Sibling transmission of vaccine-derived rotavirus (RotaTeq) associated with rotavirus gastroenteritis. Payne DC, et al. Pediatrics. 2010 Feb;125(2):e438-41. PMID: 20100758

96. Symptomatic infection and detection of vaccine and vaccine-reassortant rotavirus strains in 5 children: a case series. Boom JA, et al. J Infect Dis. 2012 Oct;206(8):1275-9. PMID: 22872730

97. Vaccine-derived human-bovine double reassortant rotavirus in infants with acute gastroenteritis.
Hemming M, Vesikari T. Pediatr Infect Dis J. 2012 Sep;31(9):992-4. PMID: 22581224

98. Vaccine-derived NSP2 segment in rotaviruses from vaccinated children with gastroenteritis in Nicaragua. Bucardo F, et al. Infect Genet Evol. 2012 Aug;12(6):1282-94. PMID: 22487061

99. Rotavirus vaccines: viral shedding and risk of transmission.
Anderson EJ. Lancet Infect Dis. 2008 Oct;8(10):642-9. PMID: 18922486

100. The Case against Universal Varicella Vaccination
Gary S. Goldman. International Journal of Toxicology, 25:313–317, 2006

101. Altered Virulence of Vaccine Strains of Measles Virus after Prolonged Replication in Human Tissue
Alexandra Valsamakis et al. J Virol. 1999 October; 73(10): 8791–8797.

102. Estimated susceptibility to asymptomatic secondary immune response against measles in late convalescent and vaccinated persons.
Damien B, et al. J Med Virol. 1998 Sep;56(1):85-90. PMID: 9700638

103. Detection of Measles Virus RNA in Urine Specimens from Vaccine Recipients
PAUL A. ROTA, et al. J CLINICAL MICROBIOLOGY, Sept. 1995, p. 2485–2488 Vol. 33, No. 9

104. Investigation of a measles outbreak in a fully vaccinated school population including serum studies before and after revaccination.
Matson DO et al. Pediatr Infect Dis J. 1993 Apr;12(4):292-9. PMID: 8483623

105. Nonclassic measles infections in an immune population exposed to measles during a college bus trip. Helfand RF et al. J Med Virol. 1998 Dec;56(4):337-41. PMID: 9829639

106. Measles virus infection cycle. Immunopaedia

Thursday, November 28, 2013

Physical Preparation for Childbirth

I’ve often heard touted that nothing can prepare the body for childbirth or that nothing we do can possibly make the physical experience any different. It’s a common misconception. While it’s true that there’s few experiences that come near to the physical intensity of childbirth, there are indeed a range of techniques that can help prepare the body for the physical requirements of childbirth.

Muscles of the Pelvic Floor
The birthing process requires the coordinated effort of different muscles, in particular the pelvic floor muscles. The pelvic floor is made up of several muscles that support the pelvic organs like a hammock. These muscles are under voluntary control, meaning you decide when to contract or relax them. During labour the pelvic floor muscles are supposed to relax allowing the baby to descend as surges (contractions) nudge baby down further and further until born. While the pelvic floor muscles are relaxing, muscles of the abdomen also contract to help push the baby out during the decent stage. Women who are anxious during labour tend to contract instead of relax the pelvic floor muscles, meaning when baby nudges downward with the force of surges or voluntary abdominal muscle contraction, baby is effectively pushing against an unyielding muscular wall. When a labouring woman experiences pelvic pain, this may cause her to involuntarily tighten her pelvic floor muscles, creating a cycle of ongoing pelvic pain and increased pelvic floor muscle tension.

The major muscles of the pelvic floor are the levator ani, puborectalis, pubovaginalis, and spincter urethrae (pictured below).

Promoting Pelvic Floor Relaxation

Exercise 1: The Elevator
This exercise is done to gain full control of the pelvic floor muscles, increase flexibility, and develop awareness of tension/relaxation, which is important for labour.

  1. This exercise may be done in any position, although one that eliminates the forces of gravity, such as lying down, is easier.
  2. Imagine you are riding in an elevator. As you ascend to each floor, try to draw up the perineal muscles a little more until you reach complete tension. When you reach your limit, don't let go.
  3. Now descend, floor-by-floor, gradually relaxing the muscles. When you arrive at the ground floor (no tension), take the muscle group to the basement with a gentle blowing out breath through pursed lips. This should feel as if the perineum is bulging. This is very gentle bulging of the pelvic floor, bearing down too strongly can be counterproductive.
  4. Complete the exercise by lifting up the muscle back to the ground floor level.
  5. Repeat the entire exercise and remember to breathe normally as you tighten the pelvic floor muscles. To start with, do 5 in a series, holding each muscle contraction for 5 seconds, then releasing. Try to gradually build up to a series of 50.

Practice this exercise everywhere! This exercise can be done without anyone being aware of what you are doing. Some ideas: At red traffic lights, while cooking or brushing teeth, during commercials on TV, during sexual intercourse, anytime you are waiting, especially while standing, when coughing, sneezing, laughing, lifting, climbing stairs, straining, or squatting.

Exercise 2: Pelvic Floor Relaxation
This is a relaxation exercise which should not only help to relax your muscles but also relax your mind.

Source: http://www.michellealva.com
  1. Lie down on a comfortable surface on your back.
  2. Place the soles of your feet together and open up your hips.
  3. Extend your arms straight out form your sides.
  4. Take a deep breath in through the nose into the pit of your stomach focusing on relaxing your pelvic floor muscles. Breath into your diaphragm.
  5. Exhale slowly while maintaining focus on relaxing your muscles.
  6. Visualise your pelvic floor muscles relaxing and warmth pouring into the pelvic floor region.
  7. A warm pack placed over the pubic area or lower abdomen can assist pelvic floor relaxation if desired.
  8. Try to relax for about 20 minutes.

Exercise 3 : Easy Pelvic Floor Stretch
This stretch will give you a pleasant stretch to your pelvic muscles as well as giving your muscles a chance to relax.

Source: slism.com

  1. Warm up with some light stretches to get your blood moving.
  2. Lie Flat on your back in a comfortable spot or yoga/exercise mat.
  3. Place a folded over pillow (foam rollers, and other semi-firm shaped objects can be used) under your buttocks or upper thighs.
  4. Spread your arms directly out to your sides or stretching out above your head flat on the floor for a more intense stretch.
  5. Hold this position and breathe deeply focusing on relaxing your pelvic floor muscles.
  6. You should find as you take a deep breath into your diaphragm that you pelvic floor muscles will naturally relax, also relax your anus and surrounding muscles if you are prone to hold tension in these areas.
  7. Do this exercise for 10-15 minutes a day to help promote relaxation in your pelvic floor muscles.

Note: Always consult your physical therapist or doctor before performing any new exercises. This exercise can put a bit of strain on your lower back and abdominals so please take it easy and start with a smaller pillow and work your way up.

The KEY to this exercise is to have your pelvic bone as the highest point to not just relieve the pressure of the weight of your body bearing down on your pelvic muscles but to help produce an effective stretch.
The video below will also help you in loosening those tight hip rotators in order to perform the pelvic floor relaxation easier: http://www.youtube.com/watch?feature=player_embedded&v=BW1tskfu7cI

Exercise 4 : Pelvic Floor Massage - The Tennis Ball
Massage can be a very useful tool in fighting pelvic floor tightness. When used to loosen tight muscles before a stretching session you should experience better range of movement and a more intense stretch. The muscle we are primarily trying to target here is the perineum which for women between the vagina and anus. This is a common exercise used by dancers to push blood through the pelvic floor muscles and encourage the pelvic muscles to relax.

  1. Warm up before this exercise, either with a quick jog on the spot or heat pad on the perineum just to warm up the muscles before massage.
  2. Sitting on a chair or on the floor, place the tennis ball under your perineum and gently ease your body weight onto it.
  3. Breathe deeply and relax into the ball focusing on relaxing your perineum and surrounding muscles.
  4. You may feel involuntary contractions try to focus and prevent these from occurring.
  5. Stop after 3-5 minutes.

Vaginal Dilator Therapy
Vaginal dilators (shown below) are designed with progressively increasing length and/or diameter, and are used to help a woman become accustomed to vaginal penetration and to help train pelvic floor muscle relaxation. Vaginal dilators are usually used in the comfort and privacy of your own home.

The Epi-No vaginal dilator is designed to prepare the vagina and pelvic floor for childbirth and to restore after-birth muscle tone. It consists of a silicone balloon and a hand pump with an integrated Biofeedback pressure gauge to monitor muscle-tone improvement of the pelvic floor muscles.
The German Epi-No Trial (Schuchardt et al. 2000) measured Anxiety, Analgesic Use, Length of Second Stage Labour, Perineal Outcomes and Apgar Scores after 1 and 5 minutes. The Trial found that..." with daily EPI-NO training it is possible to reduce the anxiety of birth significantly. By reducing anxiety of birth it is also possible to shorten the second stage of labour as well as the analgesics requirements. By a slower, more gentle pre-expansion of vulva and vagina regulated by the woman herself, it has been possible to reduce injuries to the vulva as well as the vagina significantly." You can buy the Epi-No here: http://www.epino.de/en/epi-no.html

Pelvic floor relaxation can be practiced with specialized physical therapy known as biofeedback. Biofeedback helps to improve a woman’s pelvic floor muscle sensation and coordination. There are various effective techniques used in biofeedback. The most effective technique uses a small probe placed in the vagina (the Epi-No pictured above is one such device) or electrodes placed on the surface of the skin around the opening to the vagina and on the abdominal wall. These instruments detect when a muscle is contracting or relaxing and provide visual feedback of the muscle action. This visual feedback helps the individual understand muscle movement and aids in improving muscle coordination. Approximately 75% of individuals experience significant improvement with biofeedback. For more information on biofeedback for pelvic floor relaxation see the following links:
Pelvic floor biofeedback video: http://www.youtube.com/watch?v=731f9aDlG5Y
Study on pelvic floor biofeedback: http://www.ncbi.nlm.nih.gov/pubmed/19966605
Detailed instructions: http://my.clevelandclinic.org/Documents/Digestive_Disease/woc-spring-symposium-2013/biofeedback-for-pelvic-floor-muscle-reeducation.pdf

Other Manual Therapy for the Pelvic Floor Muscles
A trained pelvic floor physiotherapist may use specific methods to promote pelvic floor relaxation and to re-educate the correct activation of these muscles. Pelvic floor physiotherapists are highly trained and skilled in manual therapy techniques for the pelvic floor. These methods are usually progressed gradually over time and may involve:
  • Desensitising the pelvic area to touch (using physical touch or vaginal dilators)
  • Identifying specific areas of pelvic tension
  • Pelvic floor stretches
  • Massage techniques
  • Treating concurrent conditions which may present along with pelvic floor tightness such as problems with pelvic joints (SIJ joints), tailbone problems and low back problems.
  • Progressive strengthening of the pelvic floor muscles only when appropriate.

A Few Points to Remember About the Pelvic Floor
The article ‘How to Relax Your Pelvic Floor Muscles - Pelvic Floor Dysfunction’ offers some great points to remember:
  • Always be conscious of your pelvic floor muscles, if you find yourself contracting them. Relax and let them release their tension. Train your body and your mind to relax these muscles fully.
  • Pelvic floor relaxation is important but always remember whenever you are lifting anything heavy or performing vigorous exercises your pelvic floor muscles are required to contract strongly and tense in order to hold all your organs securely and support your body weight. Reteach your muscles to relax and contract when required.
  • During colder weather you may find your pelvic floor muscles are sometimes impossible to relax, use hot baths or steam rooms to help you fight the cold tight muscles.
  • Please be aware of your posture, don't lean on one leg or have your feet pointed outwards or two far in. All these types of things will put undue stress on pelvic floor muscles as they try to compensate for poor posture.

Strengthening the Abdominals
Why would you strengthen your abdominals during pregnancy you may ask? During the decent (or ‘pushing’) stage of labour strong abdominals play a major role in pushing baby out. Strong abdominals also support the exaggerated curve of the spine that occurs during pregnancy, and decreases the chances of the rectus abdominus (the 6 pack muscles) from separating (a condition called ‘diastasis’). Keep in mind that there is always a balance between strength and flexibility. Any muscle that is too toned, may lose its ability to stretch properly.

Is There a Right or Wrong Way to Push?

A common phrase in labour wards is to "hold your breath for 10 seconds, bear down, and push" (also called ‘purple pushing’, ‘closed glottis pushing’, or the ‘Valsalva Manuever ‘) . This puts a lot of pressure and strain on the pelvic floor muscles, possibly contributing to incontinence and hemorrhoid issues. Purple pushing can contribute to increased blood pressure, stress to the baby and popping blood vessels. As a reflex response the amount of blood pumped by the heart decreases. Death has been known to occur in cases where the blood pressure rises enough to cause the rupture of an aneurysm or to dislodge blood clots. In releasing the breath blood pressure falls; this, coupled with standing up quickly, commonly results in the incidence of blackouts. Women do not need to hold their breath. Breathing is much more effective and safe.

A More Effective Way to Use Your Muscles
Women who learn how to contract their abdominals and breathe out at the same time during labor, will get the most effective push possible. The pelvic floor muscles need to be relaxed during pushing in order to ‘let baby through’, which is easier to do if you are breathing out. Relaxed pelvic floor muscles also mean less stress will be put on those pelvic muscles, reducing the risk of incontinence and hemorrhoids.

Most Important Muscles
The deep transversus abdominis is the innermost abdominal muscle. It encircles your trunk like a corset and involuntarily contracts when you sneeze, exhale, or pull your belly in.

The action of this muscle compresses the abdominal cavity, and yes, it can also help you push during labor. During the decent stage of labor, you ideally draw in the deep transversus abdominis muscle and relax the pelvic floor to let the baby out. This mode of action will allow you to more effectively push your baby out rather than relying on pressure and tension from the rest of your body (eg. face, jaw, shoulders, arms, and legs).

Celeste from Mom Bod Fitness blog offers an interesting analogy (though she originally used a ketchup bottle for this analogy):

Picture a 1/2 full toothpaste tube. If you turned it upside down and wanted to get all of the toothpaste out, you wouldn't squeeze near the cap, you could barely get anything out. This is what happens when women try to push a baby out with their pelvic floor muscles. But if you squeeze the bottle up higher, from behind the bulk of the toothpaste, you will be more effective at getting it all out! When women use their transverse abs (up higher) they can do a much better job pushing the baby out. Just like the base at the bottom of the toothpaste tube should be open and relaxed, so should the pelvic floor muscles.

Toning the Abdominals
Transverse abdominus muscles can be toned using an exercise involving deep slow exhalations of the breath.

  1. Get into a position either lying flat on your back on the floor, on your hands and knees, or upright with your back against a wall. You might like to place a palm on your belly while you do this exercise.
  2. While trying to maintain a flat back, inhale deeply and release the muscle tone of the belly. Exhale deeply contracting the transverse. Imagine that with each exhalation you are tightening a corset around your middle and drawing their baby closer to your spine.
  3. You could also imagine that you have a 30cm ruler next to you. As you contract the abdominal wall, try to bring the belly into the 20cm mark on the ruler.
  4. Each time the belly is drawn in, count out loud. 1-2-and so forth. You can start by just counting up to 20 and throughout time maybe move up to 75 or 100.

Preventing Diastasis
Beyond understanding how to strengthen the abdominal region, it is important to understand how not to exasperate the diastasis. While it is normal to have some separation of the rectus abdominus muscles during pregnancy, more extreme diastasis can be prevented from just a few mindful movements.
Be mindful about movements like:

  • The way a woman gets in and out of bed or a chair, and how she lifts things can often increase separation.
  • “Kicking up” to seated from a reclined position or pushing up to standing when seated.
  • Moving from an upright position to a supine position without either using their arms to lower herself. Ideally they should be rolling to their side and then onto their back
  • Lifting heavy objects (or small children) incorrectly
  • Navasana which tends to “bulge the belly.”

All of these movements can be detrimental, as these actions usually cause a woman to push her belly out. That pushing out of the belly can in fact push the rectus abdominus apart can also cause extreme separation, as it can force the uterine wall to push between the rectus abdominus, increasing the separation between them.