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	ask the experts michel odent

Michel Odent, MD
Labor and Birth, Waterbirth

• Type I diabetic - high risk?
• Naturally inducing labor at home
Risks with induction
• Early vs. late umbilical cord clamping
• Genital herpes
• 4th degree tear
• Rhogam - possible adverse affects
• Stillbirth fears
• How can I get my baby to turn head down?
• Vaginal birth after cesarean
• A second waterbirth
• Herbs that initiate/prepare for labor
• Fistula injury
• Group B Strep
• Avoiding an episiotomy
• Excess amniotic fluid
• The accordian method
• Haemoglobin levels

This is an archived list of previous questions. View the complete list of Michel Odent's Expert questions here.

I have been a type I diabetic since early childhood. I have no complications, and have consistently had an A1c (measure of diabetic control) close to that of a non-diabetic. I am on the heavy side, but otherwise in very good health. I currently work with type I diabetics, and they often report a snowball of interventions when they have their babies at the hospital due to being categorized as "high risk" (whether or not they have good control). I am planning to get pregnant soon and very fearful of how my birth experience will be affected by being treated as "high risk." The OBs I have talked to are very eager to intervene in the natural course of my pregnancy. I have not, however, found a midwife who is willing to "risk" working with a type I (even CNMs doing hospital birth and working collaboratively with OBs). What can I do at this point?

If you have been diagnosed as diabetic in early childhood, you are probably the best person in the world to control your own metabolisms. As soon as you are pregnant try to evaluate as accurately as possible the day of conception (if your cycle is not always perfectly regular), taking into account details of your private life that will be easily forgotten later on in pregnancy. Apart from diabetic control (and detecting a gross abnormality if you are ready for an abortion), always wonder what the medical institution can offer to you. If you are offered a test, always ask questions about its immediate practical implications. For example: 'Why an ultra-sound scan at 32 weeks? What can you do now if the baby is too big or too small? 'nothing'. At the end of pregnancy, avoid the usual misinterpretations of hemoglobin concentration that lead to give pregnant women iron supplements. Iron inhibits the absorption of zinc. When you are diabetic, you must not play with the absorption of zinc.

It is probable that after 37 weeks the doctors will start talking about the size of the baby. Whatever the method, it is always difficult to evaluate the weight of a fetus. If they say that the baby is too big and if you don't feel comfortable with a scheduled c-section, try to obtain the principle of a trial of labor. It is a guarantee that your baby will have given the right signal, and that you and your baby will have released hormones that give a last touch to the maturation of the lungs. If you give birth in a hospital where CNMs work with doctors, if you don't go to the hospital before being in really hard labor, and if you belong to a family where women give birth easily, why not a quasi-normal pregnancy and a birth by the vaginal route?

I am 35 weeks,one centimeter dialated and very uncomfortable. When is it safe to start naturally inducing labor at home and what are the dangers in using castor oil?

At 35 weeks, the point is to hope that labor will NOT start prematurely. It is not usual to ask questions about induction at that phase of the pregnancy. Labor induction cannot be 'natural'. It is always a way to precede the signals given by the baby and by your own body. Castor oil is unpleasant (diarrhoea) and potentially dangerous.

What are some of the possible health risk associated with induction?

An induced labour is more difficult than a labour that started spontaneously. The needs for drugs and intervention are increased.

Labor induction probably has life long consequences for the child. I suggest that you visit the 'Primal Health Research Data Bank' (www.birthworks.org/primalhealth) via the key word 'labor induction'. It will lead to several studies suggesting that labor induction might be a risk factor for autism.

My interest in autism started in 1982, when I met NikoTinbergen, one of the founders of ethology, who shared the Nobel prize withKonrad Lorenz and Karl Von Frisch in 1973. As an ethologist familiar with the observation of animal behavior, he studied in particular the non-verbal behaviour of autistic children. As a 'field ethologist' he studied the children in their home environment. Not only could he offer detailed descriptions of his observations, but at the same time he listed factors which predispose to autism or which can exaggerate the symptoms(1). He found such factors evident in the period surrounding birth: induction of labour, difficult forceps delivery, birth under anaesthesia, and resuscitation at birth. When I met him he was exploring possible links between difficulty in establishing eye-to-eye contact among autistic children and the absence o feye-to-eye contact between mother and baby at birth.

It is probably because I met Niko Tinbergen that I read with special attention, in June 1991, a report by Ryoko Hattori, a psychiatrist from Kumamoto, Japan.(2) She evaluated the risks of becoming autistic according to the place of birth.She found that children born in a certain hospital were significantly more at risk of becoming autistic. In that particular hospital the routine was to induce labour a week before the expected date of birth (and to use a complex mixture of drugs during labour).

There are many reasons why further studies about labor induction as a possible risk factor for autism (and other abnormal behavior) are urgently needed. The first one is that the authors of the oldest studies included in our database came across risks associated with induction, whereas the most recent studies did not take into account this variable. 'Labor induction' should be explicitly taken into consideration, because it can be associated either with birth by the vaginal route (with or without intervention such as forceps), or with caesarean birth. Another reason is that the epidemic of autism and the epidemic of induction seem to have developed side by side. Most importantly, a third reason is that the results of recent studies suggest that children with autistic disorder show alterations in their oxytocin system.(3)

Such findings are of paramount importance at a time when an accumulation of data from animal studies confirm the potent effects of oxytocin on social behavior, communication and rituals. Artificial induction of labour in general, particularly the use of drips of synthetic oxytocin, create situations that undoubtedly interfere with the development and the reorganization of the oxytocin system in such a critical period. This only fact is a reason for further epidemiological studies focusing on labor induction as a possible risk factor for a great variety of abnormal or subnormal behavior.

1 - Tinbergen N, Tinbergen A. Autistic children. Allen andUnwin. London 1983.
2 - Hattori R, et al. Autistic and developmental disorders after general anaesthetic delivery. Lancet 1991; 337: 1357-8.
3 - Green L, Fein D, et al. Oxytocin and autistic disorder: alterations in peptides forms. Biol Psychiatry 2001; 50 (8):609-13..

I am researching early vs. late umbilical cord clamping. What is your opinion on the issue? Any suggestions on more resources?

Clamping the cord before the delivery of the placenta is to interfere with the physiological processes.

Having been in charge of more than 10,000 'non-managed third stages' of labour in the French state hospital of Pithiviers. I cannot see any reason to interfere with the exchanges of blood between the newborn baby and the placenta. We must keep in mind that it is between the birth of the baby and the delivery of the placenta that a woman has the capacity to release the highest possible peak of the hormone oxytocin. The release of oxytocin is always highly dependent on environmental factors. The main condition, in the particular case of the third stage of labour, is that the mother has nothing else to do than to look at the baby's eyes and to feel the contact with the baby's skin...in complete privacy, without any distraction. Clamping the cord or trying to detect the time when the cord stops pulsating are powerful distractions that 'brings back to our planet' a woman who had 'forgotten the rest of the world'.

Needless to recall that this peak of oxytocin is necessary for a safe delivery of the placenta and that this hormone has well-documented behavioural effects (it is the main 'hormone of love').

I have genital herpes and am pregnant. I want a natural childbirth, but have been told that a c-section may be necessary. I thought that I would pass antibodies onto my baby? If I have a lesion at the time of birth can I still deliver vaginally? What are my options?

I understand that you have a recurrent herpes and that the first invasion preceded the current pregnancy. In this case you have probably developed low-weight antibodies (IgG) that cross the placenta, so that your baby is immunized: it is not unwise to give birth by the vaginal route. It would be different if the first invasion had occurred recently, while you are pregnant. In this case you would have developed only high-weight antibodies (IgM) that do not cross the placenta and that do not protect the baby in the womb.

I recently suffered a 4th degree tear, 1 centimeter into the rectum, it was repaired by a surgeon. This began as a wonderful homebirth labor, the delivery was tough though, nuchal arm, shoulder dystocia, 10.6 baby. The doctor realized that it was out of his scope and I was transported to the hospital for repair. What are my chances of another natural birth?

Most obstetricians will advise you to have a c-section for the birth of the next baby. However the vaginal route might be possible if you are given the opportunity to give birth in complete privacy, for example with nobody else around than one experienced, motherly, low-profile and silent midwife. In such a context, if you don't feel guided, it is highly probable that you'll have a powerful 'fetus ejection reflex' and that you'll find spontaneously a position that is not dangerous for the perineum (usually an asymmetrical kneeling posture).

was interested in finding out more about the antibody called Rhogam and possible adverse affects before agreeing to take it for my RH sensitivity. With the birth of my other child I did not take it and everything was fine, is it really as important as they make it sound?

RhoGAM is the name of a trademark of anti-D immunoglobulins. It is injected (during pregnancy or just after the birth) to mothers who belong to the blood group Rh negative. An Rh negative woman may conceive an Rh positive child if the father is Rh positive.

The objective of this injection is to prevent the formation by the mother of 'anti D' (= anti RH) antibodies that might be detrimental for the babies in future pregnancies only. In other words it is a way to reduce the risks of accidents caused by a conflict between mother and babies. The most typical accident caused by this sort of blood incompatibility is a severe jaundice related to the destruction of fetal red blood cells. Today these accidents are exceptionally rare in developed countries, first because women don't have many babies (only children who have older siblings are at risk), and also because the prevention is routinely recommended.

Such explanations are necessary, so that informed women can decide if the injection is really useful in their particular case. For example if a pregnant woman knows that the baby's father is also Rh negative, she does not need the injection. Another woman might also decide not to have the injection because she knows that she will never be pregnant again (e.g. a 'miraculous' unexpected conception in her late forties).

Let us mention that today most anti-D products do not contain any mercury derivative, and that their viral safety is well accepted.

My sister delivered her third daughter on 11.25.03. The baby was 11 days post-mature. After two previous inductions on an unripe cervix, she made the informed decision to allow labor to begin naturally. On the Saturday before delivery, my sister felt an almost unbearable contraction while grocery shopping. Within hours she reported to me that the baby was not moving, and although we have not yet discussed it, I think she knew her baby was gone. We managed an almost completely natural hospital birth, the only intervention being use of the external monitor. Needless to say, the nurses were unable to find a fetal heartbeat. After 6 hours of un-medicated labor, her child delivered stillborn. Her death was blamed on the heavy presence of meconium. Her birth weight was 7lbs. 2oz. Can you offer me any information that I could pass on to my sister that would help her stop blaming herself for being stubborn and repeatedly not showing up for her scheduled inductions? This experience is shaking my belief in the natural approach to pregnancy and childbirth.

This 'unbearable' pain, followed by the death of the baby and the presence of heavy meconium, is highly suggestive of a 'partial placenta abruption'. This means that the placenta stopped working properly because it was suddenly more or less separated from the uterus. This rare accident is unpredictable. It can occur at any time during the last months of any pregnancy. More often than not there is no obvious cause. It is more common among women who already had babies. It can follow an abdominal trauma. A previous intra-uterine intervention (e.g. a c-section) is a risk factor. The chances that this accident occurs again when your sister is expecting another baby are very small.

How can I get my baby to turn head down? I am 36 weeks pregnant and desperately want to birth this child at home. Methods we are currently trying are: manual version by the midwives, breech tilt (behind in the air on all fours and also on a tilt on my back), moxabustion, pulsatilla 200 in two doses, two days apart, headphones taped to my lower belly with lullabies softly playing, meditation, pleading! I have an appointment scheduled with my naturopath to try other options: osteopathic adjustments and/or acupuncture and later a higher dose of pulsatilla 1M after risk of preterm labor has passed. This is my second birth (9 years apart). My son was born without any complications in 6 hours.Is there anything else we can try?

Many babies turn by themselves after 36 weeks. This is probably why all the methods you mention have a high rate of immediate successes. As a last resource, why not trying the medical way, that is to say an experienced obstetrician doing a manual version under ultrasound scan control, while the uterine muscle is in a state of relaxation thank to the use of 'tocolytic' drugs? By the way, I would not be scared by a vaginal breech birth in your case, since your first baby was born in six hours.

I had planned on a homebirth with my son (now 6 months old). When I was in the pushing stage, the Midwife discovered that he was in a frank breech position. I was uncomfortable with the idea of delivering at home in this case, so I elected to go to the hospital and got a cesarean. I have been told I will never be able to have a baby vaginally again. Is this true?

I have often been surprised by how easy a delivery can be after a previous caesarean in late labor. One of the plausible interpretations of such easy births is that when a woman is trying to give birth vaginally after a previous in-labor caesarean, this implies that she has already had an opportunity to develop her uterine receptors to the hormone oxytocin. In other words, the second time her uterus is more sensitive to the effects of the hormone that makes contractions effective.

According to the most authoritative studies, a trial of labour is successful among approximately 70 to 80 per 100 women. Several studies have established predictive scores for the success of such trials, so that women may be given an individualised answer. I don't know everything about your story, but I assume that your chances are high. Of course, for obvious reasons, the published studies could not take into account the degree of privacy, which might be the most important factor for success. Electronic fetal monitoring probably has a strong negative effect that has not been evaluated in the particular case of a vaginal birth after cesarean.

I have met several women who were in a panic after telling their doctor that they would prefer to try a vaginal delivery in spite of a previous caesarean. The reaction of the doctor was to focus on the risk of uterine rupture. After this some of these women could not get rid of vague and terrifying bloody mental pictures. Today clinicians are in a position to provide a reassuring and individualised risk assessment. Thanks to a series of recent authoritative studies, it is easy to explain that the risk of uterine rupture during a vaginal birth after cesarean is in the region of 1 for 200 trials, if the labour has not been induced. The main risk factor for uterine rupture is induction. You also need to know that a rupture can be suspected if there is a failure to progress or if the baby's heart rate is not reassuring. During the intervention a dehiscence (a 'window') may be found, more often than a complete rupture.

I delivered my first born in the water and had a wonderful loving experience. My plans were to deliver my second also using hydrotheraphy. However, the hospital I where I planned to deliver has suspended all waterbirths/labors due to rising cost of insurance. With only 10 weeks remaining in my pregnancy I am faced with finding another hospital, mid-wife or alternative birth plan. I know this is a personal decision, but I am confused about potentially having the birth I desire and leaving the midwife I trust. Any words of wisdom that might help me feel comfortable with my choice?

How lucky you are! You had a wonderful experience when your first baby was born and now, while expecting your second baby, you can still rely on a midwife you trust! When we introduced the concept of birthing pool in a French hospital in the 1970s our objective was to replace drugs in the case of a difficult and long labor. It was what you rightly call a sort of 'hydro-therapy'. A 'therapy' is to treat what is abnormal. It is very probable that for the birth of your second baby you will not need any 'therapy', if you are in a situation of real privacy with a silent, low profile and experienced midwife. What is more important for you: a midwife you trust or a birthing pool available? I can guess your answer if the question is asked that way.

My sister and I were discussing childbirth. She is very influenced by her friend, a nurse, to have an intrusive, medicalized birth. What kind of resources can I share with her to show her that a natural childbirth is a wonderful and safe birth choice?

You might first explain to your sister and her friend that a natural childbirth is not a choice. This term can only be used in retrospect, when a woman has given birth without any drug and without any intervention. The environment where you give birth is the real choice. You must explain that your main objective is safety and that according to common sense an easy birth is safer than a difficult birth. So your priority is to make the birth as easy as possible thanks to an environment that can satisfy your basic needs when you are in labor.

Your basic needs are easy to explain in the current scientific context. Physiologists, scientists who study the body functions, tell us that adrenaline (the emergency hormone we release in particular when we are scared or when we are cold) makes difficult the release of oxytocin, the hormone necessary for effective uterine contractions. You can explain that you release a lot of adrenaline when you are in an unfamiliar and clinical environment. You can add that, in contrast, you can imagine yourself giving birth in a familiar environment, with - for example - nobody else around than an experienced, motherly, low profile and silent midwife knitting in a corner. It is probable that in such an environment your body will work well.

The second aspect of the safety preoccupation is: what to do if there is something wrong? In the age of the safe c-section and widespread cell-phones, there is usually an easy answer to this question, which should always be the second one.

Many health professionals need to learn to think in terms of 'ratio of benefits to risks'. Where out of hospital births are concerned, they immediately ask: 'what will you do if…' instead of asking first: 'how to make the birth as easy as possible'.

You are asking what kind of resources you can share. You might share data about the Dutch birth statistics. In Holland, where 82% of the midwives are independent primary care givers, about 31% of the births occur at home, and an autonomous midwife attends many of the hospital births. The rates of c-sections are around 10% for the whole country and more than 90% of the laboring women do not need an epidural anesthesia. The birth outcomes are much better than in the USA (number of babies alive and healthy at birth).

Do not recommend books about 'natural childbirth' because they are usually written for the converted. Instead you might suggest updated books focusing on one of the main aspects of industrialized childbirth, such as 'The Caesarean. Free Association Books 2004'. In order to help your sister and friend to learn to think long term, you might indicate the 'Primal Health Research Data Base' that is specialized in studies exploring the long term consequences of what happened at the beginning of our life. It appears that the way we are born has life long consequences and that, today, in spite of the safe caesarean, we have good reasons to try to rediscover the basic needs of women in labor and of newborn babies.

Can you tell me your opinion on herbs that initiate/prepare for labor, specifically blue and black cohosh?

Because they are obsessed by the date they were given for induction, if their labor has not started spontaneously, some women are tempted to use non-medical methods. These women don't always realize that any effective method (from acupuncture to herbs, nipple stimulation and sexual intercourse) implies that labor may start before the baby has signaled its maturity. There is no natural way of inducing labor. The risks associated with the use of some methods are well documented.(1-5) This is the case of blue and black cohosh. Blue Cohosh (caulophyllum thalictroides) contains vasoactive glycosides and an alkaloid known to produce toxic effects.
Michel Odent

1 - Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med 2004; 351(3): 302-303.
2 - Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh.
Med J Aust. 2003 Oct 6;179(7):390-1
3 - Rao RB, Hoffman RS. Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient.
Vet Hum Toxicol. 2002 Aug;44(4):221-2.
4 - Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis.
Med J Aust. 2003 Apr 21;178(8):411-2
5 - Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication.
J Pediatr. 1998 Mar;132(3 Pt 1):550-2.

Do you have any information about natural vaginal birth after a previous birth fistula injury? I'm being advised to plan a cesarean but I really want a natural birth. My fistula was vaginal/rectal and healed without surgery, but I would hate to have another, possibly worse one, with this birth.

If your absolute priority is to eliminate the risk of a recurrent vaginal/rectal fistula, everybody will advise you to plan an elective cesarean.

If your priority is to give birth vaginally, your particular case must be looked at in detail. It is noticeable that the opening between vagina and rectum healed without surgery. We might claim that it was not a real fistula, because the usual definition of the term vaginal/rectal fistula implies that the opening is lined with epithelial cells: this makes spontaneous healing almost impossible. If the healing was spontaneous, it is probable that there is now a high quality scar that cannot open again. All surgeons know this general rule.

I assume that this opening between vagina and rectum occurred after a long and difficult second stage of labor on your back, with a lack of privacy (several people around and somebody guiding you). Next time you might try to give birth in a different environment, ideally with nobody else around than an experienced, motherly, silent and low profile midwife. In such a context, you'll reach more easily an ideal hormonal balance and your body will find the best possible postures to avoid a prolonged compression of the posterior wall of the vagina (for example complex asymmetrical postures on hands and knees).

Finally nobody can give you a precise advice. You must decide what your priorities are. You must take into account your intuition.

My wife and I are expecting our first child and would like a homebirth (preferably a water birth). My wife has tested positive for Group B Strep and she plans to avoid taking antibiotics in labor. Would labor/delivery in the water carry any increased risk?

Let us first recall that Group B Streptococci very rarely infect an average birth weight baby born at term. The risks are higher in the case of a premature or low weight newborn baby. Let us recall also that B Strep comes and goes, and that the test must be repeated as close to the due date as possible. It has been claimed that inserting in the vagina a crushed or cut clove of garlic during three to five nights usually makes a second test negative.

I share the point of view of your wife and I am not comfortable with the fact that a great part of the population is now exposed to antibiotics just before being born. There are already studies suggesting that early exposure to antibiotics might be a risk factor for allergic diseases later on in life. Furthermore such a widespread practice might explain the increased incidence, in some medical centers, of neonatal infections by antibiotic-resistant strains of e-colis.

There are therefore serious reasons to give a great importance to a series of studies suggesting that the efficacy of a local vaginal treatment with the antiseptic chlorhexidine is comparable to the efficacy of antibiotics in the prevention of such neonatal infections. You cannot discuss this issue with health professionals without providing the relevant references. For mysterious reasons these studies are not well known, although published in authoritative medical journals.

If the first stage of labor is long and difficult in spite of complete privacy, there is no reason why your wife would not try to reduce her level of adrenaline through immersion in water at the temperature of the body (I originally introduced the concept of birthing pool in a French hospital in order to avoid drugs when the labor is difficult). If your wife suddenly has a series of irresistible contractions and does not want (or has not the time) to get out of the pool, the baby may be born under water.

References:

1. The Swedish Chlorhexidine Study Group. Burman LG, Christensen P, Christensen K, Fryklund B, Helgesson AM, Svenningsen NW, Tullus K. Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. Lancet. 1992 Sep 26;340(8822):791; discussion 791-2.
2. Facchinetti F, Piccinini F, Mordini B, Volpe A. Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term. J Matern Fetal Med 2002 Feb;11(2):84-8
3. Taha TE, et al. Effect of cleansing the birth canal with antiseptic solution. BMJ 1997; 315: 216-20.
4. Stray-Pedersen B, Bergan T, Hafstad A, Normann E, Grogaard J, Vangdal M. Vaginal disinfection with chlorhexidine during childbirth. Int J Antimicrob Agents 1999 Aug;12(3):245-51
5. Christensen KK, Christensen P, Dykes AK, Kahlmeter G. Chlorhexidine for prevention of neonatal colonization with group B streptococci. Effect of vaginal washing with chlorhexidine before rupture of the membranes. Eur J Obstet Gynecol Reprod Biol 1985 Apr;19(4):231-6
6. Kollee LA, Speyer I, van Kuijck MA, Koopman R, Dony JM, Bakker JH, Wintermans RG. Prevention of group B streptococci transmission during delivery by vaginal application of chlorhexidine gel. Eur J Obstet Gynecol Reprod Biol 1989 Apr;31(1):47-51

How can I avoid an episiotomy? I had one with my first child (hospital birth, no anesthesia) and the memory of the pain while being stiched up and for months afterwards is terrible ! My first arrived quite fast, after about 4 pushes and he weighed only 2.5kg. Looking back, I think my episiotomy wasn't necessary. What can be done before and during labor to avoid this procedure ? Should I have pushed 'less'?

The best way to avoid an episiotomy or a dangerous tear is to give birth with nobody else around than an experienced, motherly, silent, and low profile midwife who does not guide you. If you don't feel observed and guided, you can more easily ago to another planet, stop being rational, and just listen to your body. In such a context there is a high probability that you'll find yourself in the best possible posture, for example on hands and knees. If the need for privacy was understood, 'episiotomy' would become a topic for historians.

I am 7 weeks pregnant with my second child and would like a natural birth. My first birth was long and my cervix did not open for several days. Realizing that I was depleted of food and energy, we opted for interventions to help the labor progress. Is it possible that the abnormally large amount of amniotic fluid I had over-stretched my uterus, causing the contractions to be ineffective? Is there a way to encourage my body to have less amniotic fluid this time around? Any input you have would be most appreciated!

The first important point is to avoid calling a midwife (or going to a birthing place) before the time when you are absolutely sure that it is really hard labor. During the night don't switch on the light if you can stay in bed in the dark. Don't walk if your body asks you to lie down. Eat and drink if your body asks you to eat and drink, but don't eat and drink if you don't feel hungry and thirsty.

When you are in hard labor, remember that the length of labor is usually proportional to the number of people around. Avoid the presence of anybody who might release adrenaline. The best situation I know for an easy birth is when there is nobody else around than an experienced, motherly and silent midwife who does not behave like a guide or an observer. The most common cause for a long and difficult labor is the presence of the baby's father. I know that what I say is not politically correct. However, at a time when there is an epidemic of 'failures to progress', it is becoming acceptable to smash the limits of political correctness.

Meanwhile watch the moon, listen to the music you love, and avoid reading books about childbirth, particularly chapters about amniotic fluid.

Can you explain in detail "the accordian method", or refer me to a book or other resourse that does?

It would be premature to explain in detail what the accordion method is, because our research center is still in the process of evaluating its efficacy. The objective is to reduce the maternal body burden in man-made fat-soluble chemicals before the conception of a baby. We all have in our bodies hundreds of chemicals that would not have been there sixty years ago because they did not exist at that time. They belong to families such as PCBs, dioxins, etc. They accumulate over the years in our adipose tissues. Since the late 1990s we have gathered a sufficient amount of data to realize that one of the main threats for the health of the unborn generations is intrauterine (pre-birth) pollution by such molecules.

The basis of our program is to repeat short fasting sessions in order to mobilize the stored lipids. During such sessions there are more free fatty acids (and therefore pollutants) in the blood. This is the right time to combine all the possible routes to try to eliminate some of them. We rely mostly on sweat, bile and the intestinal route. Because women recover quickly their weight soon after each session our program is called 'accordion method'.

My haemoglobin is now 11.4 in week of gestation 19. A friend of mine has 7.8. Do I have to take ferrum? Is there a haemoglobin-limit?