« Lunchblock | Main | Quilt update »
02/21/2006
Cranky say relax
Via MotherTalkers comes this story from Forbes.com suggesting a link between stress and miscarriage:
Still more compelling evidence that all we need to do is relax.
In the wake of the study's findings, Dr. Mary Stephenson, the OB/GYN in charge of the University of Chicago's Recurrent Pregnancy Loss Program, has a helpful suggestion that will be of special interest to the infertiles and hab abs among us:
Hey, thanks for the help, Dr. Stephenson!
Comments (123)
Verify your Comment
Previewing your Comment
This is only a preview. Your comment has not yet been posted.
As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.
Having trouble reading this image? View an alternate.
Gee, why didn't I think of that?
God, my grandmother would love this. "I told you you were too worked up and that's why you miscarried."
My mom would love it as well..."See, once you relaxed, everything turned out fine" Ha ha ha ahem...
This was a pretty poor study...their sample size was only 61 women in Guatemala - not exactly a representative sample leading to generalizable study findings.
Oh good lord. I have been on a pregnancy after PIF bulletin board for two years. (During my pregnancy and since.) People who have been waiting for years to be pregnant. Broke, downtrodden, in despair beforehand; can hardly manage to be happy for themselves because they are so scared and superstitious. They are total stress cases...but somehow, thankfully, most of them make it through.
Just relax, my ass.
Is Dr. Mary Stephenson available to meet me at my home or place of employment and burn incense as she coaches me through some deep-breathing exercises no fewer than five dozen times a day? 'Cause without a solution, my failure to relax won't be abating anytime soon.
Obviously these researchers have never lost pregnancies?!
And I hate how eventual pregnancy that might be successful is regarded by family as a personal triumph over whatever 'stress' you were under.
I wanted to relax that one time but then I said "Nah, I'd rather be uptight...it's so much more satisfying."
*sound of my head exploding*
Oh, is THAT what we need to do? Gee, I wish someone had told me that years ago. 'Cause you know, if they did a study then it must be true.
I'm a "hab-ab"? Fab.
Ah, the old causality versus correlation bugaboo, wrapped up in small sample size and potential problems with sample selection (to wit: had any of these women ever aborted before? had trouble conceiving? demonstrated any prior known medical condition that might raise both their cortisol levels and their miscarriage risks?). Lovely.
I'm so glad there are actual smart people around to poke holes in the methodology when all I can do is to sputter inarticulately at the stupid of it.
Cortisol and stress is the latest fad in research. Badly designed studies get funded just because they include saliva swabs to be assayed for cortisol....guess what the topic of my dissertation is...
Gee, it's like it's designed to make women feel guilty. Really, I'm not infertile, but I have lost a baby in an early miscarriage, and I find this kind of information to be totally, utterly useless. It might be useful if there was a 'turn off stress here' switch in my body, but since there isn't, it seems like I'll just get more stressed by knowing it. And then when I can't control it, it's one more reason to feel guilty and therefore stressed...
Honestly, I have no idea how you women who are struggling to conceive stand this stuff. Like, how are you supposed to got through the 'treatments' and NOT get stressed. not to mention messing with hormones. I appreciate Jody's response explaining ways in which this research could be questioned.
argghh...
Maybe the women were stressed BECAUSE they had higher cortisol levels. Or all three things (stress, cortisol levels, and miscarriage rate) were due to a prior medical condition. This study doesn't rule out any of that. And sample size waaaay to small.
Scientists rock! There's no end to their search for knowledge - soon they'll be telling us that breathing is conducive to remaining conscious! Mark my words, it'll be any day now...
Gaaaaaah! Now my *hatred* hormone must have skyrocketed!
Julie, this is my first time commenting here (and already I yell...), though I've spent more time reading you than working in the last couple of days.
I had a miscarriage on December 29 at 9.2 weeks and I've been a total mess ever since. It's been a very lonely process and the only time I've found true comfort was while reading your posts. Thank you for sharing your stories and your incredible talent in such honest way.
the next person that tells me to relax will be strapped to a chair and go through an IUI...regardless of sex
so sick of hearing about that whole relax thing if that were the case, there would be no european births between 1936 and 1945 and no US births from 1929 and 1941
WTF.
You were in my dream last night. It was very bizzare, seeing as I do not know you/you do not know me.
It was a very sad dream at first... but them it kind of made me laugh.
You had Charlie, but he was adopted. Then, for some freak reason, Charlie got hurt and died.
That was the sad part.
The funny part is that in my dream you were played by Kelsey Grammar with a wig.
WTF.
the next person that tells me to relax will be strapped to a chair and go through an IUI...regardless of sex
so sick of hearing about that whole relax thing if that were the case, there would be no european births between 1936 and 1945 and no US births from 1929 and 1941
Ok, so I refuse to read the actual study, because seriously. BUT...
Speaking from the hab ab POV, if I become pregnant, I am going to stress and stress and stress some more. If I have an unfavorable outcome, I can't say that it's because of the stress. Rather, the stress is the result of previous bad outcomes. (And I can tell you there was never more stress than with my last pregnancy -- the only one that had a good outcome!)
Delurking: I remember that in the midst of my pregnancy (2004-05), a study came out linking stress during pregnancy to poor outcomes, low birth weights, blah blah blah. I had a very stressful pregnancy - due to Major Life Events (totally unconnected to the pregnancy) rising up and biting me on the ass. So I worried about my stress levels the whole way through until she was born. (Thanks a lot.) I definitely agree with ursula that stress is just the trendy topic to study right now.
what a load of crap. I bet the women who had m/c's and were stressed were probably stressed b/c they had had m/cs before or trouble conceiving before.
We tried for 2 and a half years to have a baby. Guess what, the cycle where I had the most stress, the one where I was trying to talk my way into my old college after a 14 year absence to finish up my last 8 credits, where I had to go talk to a scary chair of the department and a not very friendly young professor who was then stuck with being my advisor and made it clear that she would rather not be stuck with this 35 year-old returning student in the middle of the fall semester and at the same time I was running back and forth to my RE's having ultrasounds and bloodtests and IUIs and taking drugs that made me feel crappy AND having to fight with my boss about giving me work credit for finishing my degree which my job requires anyway-- that's the cycle I got pregnant in and so far so good, I am 18 weeks along and everything looks great--I know I have far to go, but let me tell you, returning to undergraduate college after more than a decade away to take a course where I will have to write a 50 page paper, having to pay 900 bucks per credit for 8 credits at my school, fighting with my boss, going through IUI stress and going for the first consultation at the IVF place the day I had my second IUI, dealing with all the money woes brought on by having to pay out of pocket for IF treatment --November was one of the most stress-filled months of my life and so far so good--all the numbers and ultrasounds and crown to rump measurements look great. Hopefully I will get a healthy baby at the end of this pregnancy, but my point is, stress did not seem to play a part in my pregnancy getting past the most miscarriage susceptible point, at least in my case.
What a crappy study. I guess I should read it beofre bashing it anymore, but I can tell you now, it's a load of crap. I had a good egg this time and so we got pregnant and the pregnancy has managed to make it to four and half months and counting. Cortisol my ass. I must have been swimming in cortisol the month I conceived.
This pisses me off on two levels. My head always explodes when anyone exhorts the infertile to relax. But for a split second I wondered if my blighted ovum wasn't somehow the result of my DBTs. It's been two years, but something like this can make the pain of it all come rushing back. Thanks a heap, Dr. Stephenson.
Sophia kicks ass. I can just see my husband's aunt being strapped down kicking and screaming. LOL.
I've been thinking about this all day and it's still bothering me.
I think I read something about cortisol being an inherited trait anyways. And that atheletes who do endurance training rely on cortisol to keep them going. (I am probably completely mistaken, forgive my sleep deprivation.)
It's as though cortisol is something we could completely control. And I dare anyone to find a Fab Hab-Ab who didn't worry *once* about the pregnancy. I doubt you could find any pregnant woman anywhere who hasn't been sick with worry over her baby at least once.
Gah. I guess scientists are now on my hit-list as well.
Like others have already said - correlation != causation. It's like the old progesterone supplements debate - is your low progesterone causing you to lose the baby or is the baby's incompatible-with-life problem causing the low progesterone? Who really knows?
And another anecdote (though I know the plural isn't data) to throw on the pile: when I got pregnant the first time, it was on my first IUI, I was working part-time, very low-stress environment, nothing exciting going on in my life, result, gruesome miscarriage. My second pregnancy (though there was a possible chemical in between the two) was confirmed three weeks before we made a cross-country move and four weeks before I was due to stand up in a wedding (also across country, but not in the same state we were moving to), EVERYTHING was a mess, we were busy 24/7, I was spotting, and I was a stressed-out disaster. Result, healthy baby boy. I'm guessing that the baby's health had just as much to do with my results as did my stress level; so often these researchers seem to forget that technically there is another chromosomally unique individual involved in this!
Oh, for fuck's sake.
I have severe dust mite allergies. They cause me to get sinus infections and headaches, which causes me to get stressed. Which, I'm sure, does my allergies no good.
Does anyone tell me to relax? No. They tell me how much allergies suck. They offer to do things for me. In the case of my allergists, they prescribe me lovely nasal sprays that help control the symptoms. I occasionally get some assvice (no, getting rid of the cats would NOT help, as I am NOT allergic to them, as TWO allergy tests have conclusively indicated) and occasionally get someone radiating waves of "oh, just stop whining already." But I never get told to relax, and I know of no one doing studies about whether relaxed allergy sufferers are more comfortable.
The conclusion?...not sure there is one. Just comparing/contrasting two rather widespread medical issues. (Sidenote: Apparently, years ago, conventional medical wisdom was that allergies were psychosomatic. I notice that that seems to have changed...for allergies, anyway.)
Accidentally hit "Post" too soon. Anyway, meant to say that I have always wanted to strangle people who told me to "relax" or "calm down." I get it from my mother's family, who does not understand this "relax" thing. I've never tried to conceive, so I have no idea of my fertility, but the rest of the women in my family are apparently as fertile as rabbits. It may be bad of me, but when I hear the "just relax and you'll get pregnant!" thing I think about my grandmother, who I loved dearly but was one of the most non-relaxed people I have ever known, and who got pregnant like THAT in her mid-to-late 30s, and I snicker. I feel murderous in solidarity, but in an amused way. Relax and get pregnant? Who ever thought of THAT connection?
It scares me that people actually believe this crap. Much to my dismay, I am often discribed as the most stressed person that my friends have ever met, but I never had a mc. Then again I hang-up on random pollers.
Kind of reminds me of my pre-school-aged-son, who argued with me that orange juice is a fruit, because his friend told him so.
I'd like to add an alternative viewpoint here.
Saying stress affects us negatively is smart, and it is true. Come on- we all know this.
The problem is telling someone to "calm down" does not manage stress whatsoever. It is not just in the mind. I think there might be some language issues here about what is meant by "stress", and how to manage it.
Despite all the freaking out in the comments, I think it is a good and useful thing to determine if stress influences the rate of miscarriages and health of pregnancies. Why? Because then it will become more standard, and insurance may start PAYING FOR, proven stress relief techniques- things like massage therapy, yoga, biofeedback, meditation, exercise, etc etc. Things that actually work. Stress might help people get pregnancy disability status. It might help caregivers realize if there is a particularly stressful situation in someone's life, that that is very important, and therefore would be encouraged to provide help.
I think there is a use to this train of thought. Please don't become all uber-defensive and think someone is telling you you had problems because you were too "stressed out". If they are doing that, then of course they are asswipe wackjobs. However, it's a valid topic to study and something to take seriously. Seeing how much additional stress is leveled on those that must deal with infertility HELL, one would think those people would be even more interested in getting support for reliable stress-reduction techniques. Something good may come out of this!
I was never so freakishly stressed in my life as when I was with my first two pregnancies. Only I was stressed the other way- I did not want to be pregnant! I wanted to miscarry-or die. I cried and panicked and stressed and fretted all the way to a nervous breakdown. The pregnancies did not go away- at least by themselves. Strange.
I have to say that I agree with jennyg. "Just relax" isn't helpful in the least, but there may be some utility to these types of findings.
On the advice of my gyn I stopped charting. She said she finds that it makes her patients worry too much and once you get to that point she will do the worrying for you and have you come in for tests, etc. to help you along. Frankly, it's a big relief and I didn't feel like she was saying "just relax."
Well, the problem with the point jennyg is making is this: study conclusions like the one referenced place the onus for miscarriage squarely on the miscarrying woman. That is what offends me. It doesn't actually matter what helpful attempts to mitigate that stress might come out of such a study (if it were indeed well conducted, which is, as other commenters have said, dubious), because, guess what? The minute such a belief becomes common or even more common there will be no end to the blame we place on ourselves when we miscarry anyway. "But I did three hours of meditation and positive visualization daily!" "Well, you must not have been visualizing hard enough."
Just to correct a slight misapprehension: Jessica says "maybe the women were stressed because they had high cortisol levels"...
Well, they would have no way of knowing they had high cortisol levels (it's not something you can find out any way other than doing a test!). Cortisol results from stress.
But although I can't find the article online yet, they have a previous study out that doesn't look terribly comprehensive - and I mean, 61 women??? Who were likely to be not very well nourished?
Having said that, it's not too surprising if stress does affect reproductive health negatively - but it is not something women either a) cause or b) can control. It's like saying "oh, you can't get pregnant because your tubes are blocked, if you just thought about them they'd unblock and you'd be magically pregnant!".
I guess and I know I just posted, but this gets me so steamed that the biggest problem I have with this is something katie touched on. Okay, so stress increases one's risk of miscarriage. So...what, then? What happens when you tell women, especially women who are already worried, "Reduce your stress level or you raise your risk of miscarriage"? You're asking us not to think of elephants, which is absurd.
Not only would I like to know more about the study's parameters, I'd like to be there in the lives of the subjects, to know which one was told by her partner that he doesn't want the baby and he wishes she'd get rid of it, which one had already miscarried twice before, which one had had bright red bleeding from implantation forward...and then, in the context of all those scenarios, determine what role stress plays.
katie ... that's exactly the problem. There really IS no way of determining whether the women were stressed first or had the high cortisol first, unless you did extensive prior screening in a large group of women likely to get pregnant, and have them fill out extensive questionaires. Add to that the fact that cortisol is notoriouly tricky and has a circardian rhythem - it may be one level at 7 am and a completely different one at 9 am. What were the cutoffs? Oh, and cortisol is an acute phase reactant that will respond to such things as infections. Did the women have a viral infection? Is that why they miscarried? I simply don't know enough about this study to draw ANY conclusion from it.
Is that why EVERYONE I've told that we just found out I'm not ovulating tells me to just relax?? Hmm... why didn't I think of that?? Oh yeah, because the two months that we took a "break" were two months in which I STILL didn't ovulate!!
Agree with Heather...stress can't be everything. I mean, I'm sure our great-great-great...great grandparents had a LOT of stress running from lions, bears, etc...and they still found time to have 15+ children...
Can I just say "Fuck the University of Chicago" !? I hate them SO much - and not the way others who read the post may hate them, but in a personal and more violent way.
My OB/GYN was at the University of Chicago (which supposedly worked well because I was / am a university employee). When I started bleeding with my first pregnancy I called and asked to see a doctor - the answer was no. "No" - I wasn't at 8 weeks yet and they wouldn't see me until I was. When I had increasing pain (the kind of pain that indicates a possible ectopic pregnancy) I called back. Still No - no visit, no talking to a doctor, not even a nurse. On my third call the receptionist got really rude and told me not to call again. Got sent to the ER. Waited there for several hours and finally left without being seen. The next day, got sent all over the hospital until finally someone took pity and saw me. Everything was fine, but I did have all the indicators, did need to be seen, and it was my first pregnancy - show a little compassion.
So I switched to Northwestern - but the change didn't take effect until after I was pregnant again. And after I started miscarrying again. And I got the same response - we don't give a damn and we won't see you. I got more response (even though they weren't supposed to see or talk to me until the insurance change) from the Northwestern nurses than anyone at Chicago.
I lived near that hospital for 8 years and knew a lot of women who had babies there (they had no choice as their husbands were students). Not one of them came out of there unscathed - horrible birth experiences, infections, damage to their babies.
Maybe there would be less stress on those at the University of Chicago's Recurrent Pregnancy Loss Program if they got away from the University of Chicago hospital as quickly as possible?
In conclusion - fuck the University of Chicago Hospitals.
Some people just DON'T GET IT...
I have damn all scientific knowledg eof this, and I'm sure that many of you out there are virtually experts by now, but are sex hormones and the endocrine system so tightly linked that any irregularity in one area likely to cause repercussions in any of the other areas? Therefore, raised cortisol might be caused by buggered up sex hormones or thyroid in the first place.
Ergo, "relaxing"=no fucking use whatsoever if the lack of relaxation is caused by a pre-existing disturbance in hormones and/or adrenals.
Recently I've read research suggesting that many drugs work differently in women in the first place, and are insufficiently tested on women, because they metabolise things differently according to the time in their cyle and a host of other factors.
I think that "the medical profession" generally has no real idea how women's bodies actually work, and how co-dependent every bit is.
I didn't look at the study, but I wonder if they controlled for repeat miscarriages or something. Becasue we know that once you miscarry once you are more likely to again AND likely to be just a bit scared and stressed about a new pregnancy, so that could skew their results rather spectacularly.
"Hab-Ab". Do we get to have a posse?
I'm at a loss of words... and they get GRANTS for this kind of crap?!?! You mean, my TAX DOLLARS paid for this?
I know what would reduce my stress level -- being able to shoot the next person who tells me that if I'd just relax I'd get pregnant.
Well, fuck a duck... why didn't 'I' think of that. I'll get on it immediately. Gobshite morons. Ugh.
I agree that stress is just a trendy topic these days. I won't be surprised to read that Hurricane Katrina was caused because there is too much stress in the world.
If stress caused m/c my son would not be here. I had high bp, layoff, joblessness, high-stress travel, money probs, 'you will be lucky to make 32 weeks' (heard this endlessly) all designed to rip my little man from his expensive hard-won perch in my body.
A pox on poorly-designed, badly-researched 'scientific' studies.
Oh, so all I needed to do was relax? Wish someone had told me that sooner.
Last time I checked IVF was 'a little' stressfull... hmm and some of us still get PG? Imagine that!!!!
DOH! I guess I should have relaxed, instead of having surgery to remove the uterine septum that was missed by about 5 doctors! I'm such a dummy! I could have avoided two hysteroscopies and a laparoscopy, and countless IVFs! Jeezus H.
I just wanted to comment again really quickly since Julie replied to me.
I re-iterate, again, since I think you missed my point a bit, that ANYONE who tells ANYONE to "just relax" or "be less stressed" is a Freaking Asswipe Moron. My entire point is that obviously that is no help at all.
The idea is that it's another facet of health that should be considered- whether you have a difficult pregancy, infertility, cancer, MS, whatever the problem. Stress is linked to our health in complex and very hard to determine ways- surely noone would argue with that? So the point is NOT for ANYONE to say to "relax". The point is for the doctor to say, "okay, we are taking care of this factor with heparin.. this factor with bp meds.. okay, so now what are we doing to try to reduce the stress BEING FOISTED UPON YOU? Let's sign you up for the free yoga class supported by this clinic. -or- Let's get you seeing a pg-certified massage therapist twice a week".
I can't imagine why anyone has a problem with *that* take on this type of thing. Stress is undertreated- I think that's a truthful, general, statement for just about everyone.
You say you don't like the statement because it puts the onus for miscarriages on the woman. Well, guess what? THE ONUS IS ALREADY THERE! Our bodies have already failed us in one way or another. That's very hard to deal wtih and come to terms with. I don't see how saying stress- that we can't control WITHOUT TREATMENT- is any different than saying having a motherfucker mutation is our own personal fault. I feel a lot like the comments on here reflect the idea that mental health is the *fault* of the individual- please don't fall into that trap. Of course it isn't. Perhaps think of it as healthy mental health instead of "stress". We take care of our bodies a lot, but then we tend to neglect our brains, and our brains need TLC too. I will guess that a lot of people out there, including me, have neither the time nor the money to do things like massage therapy. Well, if the doctor PRESCRIBED IT and made it a priority and god forbid if it were paid for.. a lot more of us would do it, and how could that be anything but helpful.
It's possible to have a healthy discussion about stress. There's so much in our lives we can't change, but sometimes we can improve little things to help us deal with the big monsters.