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Tag: moms-to-be

  • The Missing Piece of the Foraging Renaissance

    The Missing Piece of the Foraging Renaissance

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    Harvesting wild local produce in Brooklyn’s Prospect Park may not seem like the best idea. And yet, on a foraging tour of the lively public park last month, a straw-hatted forager named “Wildman” Steve Brill and his teenage daughter, Violet, led roughly 40 of us amateurs into the grassy areas beyond the park’s paved footpaths for a four-hour tromp. Among plastic wrappers and bottle caps we found edible roots, fragrant herbs, and sturdy greens, all ripe for experimentation in the adventurous cook’s kitchen.

    At least in theory. There was food here, for sure, but hardly of the practical variety. We recovered fallen pods from the Kentucky coffeetree, whose seeds can be used to brew a caffeine-free alternative to a morning cup. That is, if one is willing to harvest enough of them, wash them of green toxic goo, and roast them for hours—though even then, it won’t really be coffee. I stuffed a few pods in a canvas bag alongside sassafras root, once used to make root beer the old-fashioned way, and a handful of lettuce-flavored violet leaves that could, in the right quantities, constitute a small salad. Two weeks later, I’m still wondering what, if anything, I’ll actually make with these odd new ingredients.

    What I didn’t anticipate were all the medicinal plants. Just a few minutes into the tour, we came across enough wild analgesics and anti-inflammatories to insure a casual hike. Here among the cigarette butts was broadleaf plantain, an easy-to-miss herb (unrelated to the bananalike fruit) known for calming mosquito bites. Over near the urinating puppy was jewelweed, which soothes poison-ivy and stinging-nettle rashes. Twigs snapped from a black birch tree exuded wintergreen oil, also known as methyl salicylate, a relative of aspirin that powers pain-killing ointments such as Bengay and Icy Hot.

    Interest in foraging for food has taken off in recent years, owing in part to the gourmet-ification of eating locally and in part to its popularity on social media, where influencers make chips out of stinging nettles and add fir needles to granitas. Foraged ramps and morel mushrooms have become so well known that they now appear on restaurant menus and in high-end grocery stores. But the foraging boom has largely left behind what has historically been a big draw of scrounging for plants—finding treatments for minor ailments. To be clear, medicinal plants aren’t likely to save the casual forager’s life, and they lack the robust clinical data that back up pharmaceuticals. But even some scientists believe they can be handy in a pinch. In a way, being able to find a jewelweed stem is more useful than identifying a handful of leaves that can substitute for lettuce.

    That has definitely been the case for Marla Emery, a scientific adviser to the Norwegian Institute for Natural Research and a former research geographer for the U.S. Forest Service who studies community foraging. Several years ago, when huge, oozing blisters formed on her legs after a run-in with poison ivy on a hunting trip, Emery visited an herbalist in Scotland who applied lobelia, an herb with pale-violet flowers, and slippery elm, a tree with mucilaginous properties, to her calf. Soon, she felt a tingling sensation—“as if someone had poured seltzer over the area”—and within an hour the blisters had healed, Emery told me.

    Both plants, traditionally used to treat skin conditions, “are supportive of health and have medicinal value,” she said, and they’re especially useful because “you’re highly unlikely to poison yourself” with them. Such anecdotes illustrating the profound utility of medicinal plants are common among botanist types. “If you get a cut and put [broadleaf] plantain on it, you can see it close up,” Alex McAlvay, an ethnobotanist at the New York Botanical Garden, told me. At least for some species, he said, “the proof is in the pudding.”

    Though foraging has long been a medicinal practice, and so many modern drugs are derived from plants, in the West, medicinal flora has largely been relegated to “traditional” or “folk remedy” status. Still, their use lives on in many communities, including immigrant groups that “come with medicinal-plant uses from their homelands and seek to continue them,” Emery said. People in Chinese, Russian, and certain Latin communities in the U.S. commonly forage dandelion, a weed with diuretic properties, to support kidney and urinary-tract health, she added.

    Along the concrete footpaths of Prospect Park, the Brills pointed out stands of burdock; its roots, in addition to being a tasty potato dupe, are used in some cultures to detoxify the body. Pineapple weed, found in baseball diamonds and sidewalk cracks, can calm an upset stomach, Steve told me later. Scientific data for such claims are scant, much like they are for other foraged plants, and using the plants for health inevitably raises questions about scientific credibility. Many medicinal plants that a casual forager will encounter in the wild will not have been studied through rigorous clinical trials in the same way that any prescription drug has been. Whether people ultimately embrace foraging for medicinal plants depends on how they believe “we make evidence and truth,” McAlvay said. “A lot of people are like, ‘If there’s no clinical research, it’s not legit.’ Other people are like, ‘My grandma did it; it’s legit.’” Nothing beats clinical research, though clearly some plants share valuable properties with certain drugs. Lamb’s quarters, a dupe for spinach, is so packed with vitamin C that it was traditionally used to prevent scurvy; stinging nettle, traditionally used for urination issues, may have similar effects as finasteride, a prostate medication.

    Naturally, the experts I spoke with unanimously recommended using foraged medicinal plants only for minor ailments. Just as foraging for food comes with some risks—what looks like a delicious mushroom can make you sick—the same is true of medicinal foraging. Take established, reputable classes and use books and apps to correctly identify plants, many of which have dangerous look-alikes; the edible angelica plant, for example, is easily confused with poisonous water hemlock, of Socrates-killing notoriety. Learning about dosage is important too. A benign plant can become poisonous if too large a dose is used, warned Emery. When working with medicinal plants, she said, “you’ve got to know what you’re doing, and that doesn’t lend itself to the casual TikTok post.” Beginner foragers should stick to “gentle but definitely powerful, easy-to-identify herbs,” such as dandelion and violet, said McAlvay.

    As the Brills instructed, when I got home I submerged a foraged jewelweed stem in witch hazel to make a soothing skin tincture. Days later, when I dabbed some onto a patch of sunburn on my arm, I felt, or maybe imagined, a wave of relief. Whatever the case, my delight was real. When I had asked both tour-goers and experts why foraged medical plants mattered in a world where drugs that accomplish the same things could be easily bought at a pharmacy, some said it was “empowering” or “satisfying,” but the description that resonated with me most came from McAlvay, who called it “magic”: the power to wield nature, in nature, in order to heal.

    When I got home from the tour and opened my bag of foraged goods, I found a black birch twig, still redolent of wintergreen. Coincidentally, that is the one smell I have craved throughout 38 weeks (and counting) of pregnancy, but moms-to-be are advised to avoid the medicinal ointments containing the oil. I sniffed the twig deeply, again and again, recalling that it might become useful in the months to come. When teething infants are given black birch twigs to chew, the gently analgesic qualities of the low-dose wintergreen oil helps soothe their pain, Brill had said. All of a sudden, their crying stops. What’s more magical than that?

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    Yasmin Tayag

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  • Please Don’t Call My Cervix Incompetent

    Please Don’t Call My Cervix Incompetent

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    If you haven’t been pregnant, you’d be forgiven for thinking the language of pregnancy is all baby bumps, bundles of joy, and comparisons to variously sized fruits. But in the doctor’s office, it’s a different story. The medical lexicon for moms-to-be can be downright harsh. Case in point: the phrase geriatric pregnancy, which, until recently, was used to refer to anyone pregnant after their 35th birthday.

    This unfortunate term is thought to stem from a concept that dates back to the 1970s, when amniocentesis, a procedure to screen for genetic abnormalities, was becoming routine. That year, the National Institutes of Health identified 35 as the age at which the risk that the test would harm the fetus was roughly equal to the chance of a fetus being born with Down’s syndrome. In the four-plus decades since, advancements in screening technology have made that calculation essentially obsolete—and the idea that your 35th birthday is some sort of cliff-of-no-return absurd. Moms, for their part, always hated the phrase: When Jamila Larson, a 49-year-old mother of two in Hyattsville, Maryland, was called “geriatric” by a midwife in 2011, “it felt like a gut punch,” she told me.

    Though you’ll still hear it occasionally, this term has (thankfully) been on its way out for a while. One reason is changing demographics. As more and more women give birth after turning 35—in 2020, about one in five babies in the United States was born to a mom who had passed that birthday—labeling them as particularly “old” no longer makes sense. Last August, the American College of Obstetricians and Gynecologists (ACOG) announced that its preferred terminology is now “pregnancy at age 35 years or older”—or, even better, that doctors and researchers should simply indicate patients’ age in five-year increments starting from the age of 35.

    This is how progress works: When a medical term outlasts its usefulness, we thank it for its service and move on. So it may surprise you to learn that a litany of dubiously appropriate and medically inaccurate words are still used to describe pregnancy and childbirth. Over the past decade, the field of medicine has acknowledged that language has the power to perpetuate bias among doctors, and worked to scrub its vocabulary of such terms, including schizophrenic (which reduces a person to a stigmatized disease), drug abuser (which reduces a person to their addiction), and sickler (a derogatory term for someone with sickle-cell disease). And yet, doctors continue to describe women’s bodies using charged terms such as hostile uterus, incompetent cervix, and habitual aborter—words that arguably sound worse than the now-shunned geriatric pregnancy. Why do some words evolve, while others insist on haunting moms’ medical charts like ghosts of medicine past?

    [Read: The culture war over ‘pregnant people’]

    Geriatric pregnancy got a spurt of publicity in 2021, when the makers of the fertility and motherhood app Peanut turned their attention to the minefield of pregnancy language. After a video of a distraught woman whose doctor told her she would be “geriatric” if she were to get pregnant garnered attention on the app, Peanut launched a campaign to come up with more neutral-sounding alternatives to existing medical language. That April, they released a glossary of proposed replacements. Still, more attention from the public doesn’t always translate into institutional action: Although 20,000 people have downloaded Peanut’s glossary, there hasn’t been any official movement within medicine to do away with the original terms.

    Across the U.S., doctors are still doling out diagnoses that sound not only archaic, but downright weird. Many of these terms are enshrined in the global catalog of diseases that doctors use to report procedures to insurance companies, known as the ICD-11. The latest version of that glossary, released in 2022, still includes the phrase elderly primigravida, which is basically a synonym for geriatric pregnancy. In 2016, during her second pregnancy, Larson’s notes read “elderly multigravida”—meaning she was both over 35 and had been pregnant before.

    Or consider incompetent cervix, a term that is in both the ACOG dictionary and the ICD-11. Really, it means a pregnant person’s cervix has dilated before the pregnancy is complete, which can lead to premature birth or miscarriage. Meena Khandelwal, an ob-gyn and the director of research for obstetrics and gynecology at Cooper University Health Care in Camden, New Jersey, told me she avoids using the phrase in front of patients (she sometimes uses weak cervix instead, though she isn’t sure that it’s much better). But because incompetent cervix is entrenched in insurance codes and her hospital’s record-keeping system, the phrase is likely to show up in patients’ notes anyway.

    [Read: She got pregnant. His body changed too.]

    To be sure, communicating that the cervix has opened early is crucial; it prompts doctors to monitor the situation using ultrasound, to temporarily sew the cervix closed, or to try another treatment. Providers need to be able to inform one another about patients quickly and clearly; one could argue that is a much more important function of medical jargon than protecting patients’ feelings. The point of language evolution is not to make words so gentle that they become meaningless.

    But in many cases, the existing language is less clear and precise than gentler alternatives. For example, failure to progress—a general term meaning that labor has lasted longer than expected—says nothing about the reason the labor is slow. And calling a patient “geriatric” offers less information than simply stating whether she is in her 30s, 40s, or 50s. The outdated words even have the potential to worsen patient outcomes: a 2018 study on physician bias found that when doctors read stigmatizing language in a patient’s charts, they tended to have more negative attitudes toward the patient and treat their pain less aggressively. Besides, “incompetent” is a strange way to describe whether a cervix is open or closed. It makes it sound like this organ should be worried about its next annual review.

    This odd quality unites many pregnancy-related terms: They make it sound as if the pregnant person, or their body part, could have chosen a different path. When you are told your uterus is being “hostile” or are accused of “failure to progress,” it’s hard not to feel like you’ve somehow failed the assignment. “It sends a message of ‘You could be normal, but you’re not. You’re not working with us here,’” says Kristen Syrett, an associate professor of linguistics at Rutgers University. Even geriatric pregnancy, which doesn’t explicitly apply blame, seems to suggest that a mom-to-be has knowingly brought more risk upon her unborn child by choosing pregnancy “later” in life.

    [Janice Wolly: My first pregnancy]

    Many moms told Peanut that the most devastating label they encountered was habitual aborter. That term usually refers to someone who experiences multiple miscarriages before 20 weeks of pregnancy, a condition that affects 1 to 2 percent of women. (Its cousin is spontaneous abortion, which means such a miscarriage has happened once). From a purely medical perspective, abortion refers to any procedure that terminates a pregnancy, and includes procedures to empty the womb after a miscarriage. But in layman’s terms, it has come to mean a chosen termination of a pregnancy. That, plus the implication that aborting is a bad habit you can’t seem to break, made the term feel particularly inappropriate. “It’s really horrific if you think about it,” says Somi Javaid, an ob-gyn and the founder of the health-care company HerMD, who consulted on the Peanut project.

    This sense of blame becomes more acute when you consider that for many people, reproductive organs are intimately tied to a sense of identity and self-worth—at least compared with, say, the kidneys. In the context of wanting a child, it’s difficult to hear that your uterus is “hostile” or your cervix is “incompetent” without thinking that those terms apply to your whole self. Even physicians can be taken aback: When Javaid was in her 20s, her own doctor deemed her “infertile” in her notes on account of her “old” uterus—meaning that its lining had thinned, a side effect from a fertility medication she was taking. “It felt like being slapped in the face,” she told me. “The impact of the word was not muted by my knowledge at all.”

    Medical terms can, and do, change. But usually the field is responding to larger shifts in the culture, rather than leading the charge. That’s what happened with the phrase pregnant women, which organizations including the ACLU and the CDC have been incrementally phasing out in favor of pregnant people, a term that has sparked vigorous debate about inclusive language and feminism. Last February, ACOG followed suit, announcing that it would “move beyond the exclusive use of gendered language” to better encompass the fact that people of all genders can become pregnant.

    [Helen Lewis: Why I’ll keep saying ‘pregnant women’]

    With geriatric pregnancy, the change was likely more bottom-up, starting with doctors themselves. After all, for many, it was personal: The length and intensity of medical training increases the odds that doctors will have children later than other women—that they will be, in their own language, geriatric moms, says Monica Lypson, a vice dean at Columbia University’s medical school who researches equity and inclusion. Lypson was deemed “geriatric” when she was pregnant at age 36—a choice of words she found “jarring” as a patient.

    Perhaps because incompetent cervix, habitual aborter, and the like refer to conditions that aren’t so common, many providers don’t realize just how hurtful they can be. Ariel Lefkowitz, an internal-medicine physician who cares for patients with pregnancy complications in Toronto, told me that he used to think of failure to progress the same way as he thought of kidney failure or heart failure. He didn’t notice the negative connotations until his wife, Sarah Friedlander, started training to be a birth educator and pointed them out. Now he sees that “it’s a lot more loaded, it’s a lot more personal,” he said.

    That realization pushed him to think harder about the bias embedded in medical language in other fields, such as failure to cope. “We’re so medicalized and supposedly neutral and in this clinical environment,” said Lefkowitz, who in 2021 co-wrote an editorial in the journal Obstetric Medicine on the importance of inclusive language in obstetrics. “It’s very easy to become numb to the ridiculous ways in which we speak.”

    The outdated terms that are currently stuck in the ICD-11, doctors’ offices, and the pages of medical journals may yet change. More doctors are recognizing that how patients perceive their words can have real impacts on health outcomes, says Julia Raney, a primary-care provider for adolescents who has created workshops on using mindful language in clinical settings. Accordingly, medicine is moving toward more person-centered care, including a focus on concrete risks rather than on blame and stereotypes. For instance, in her work with teens, Raney will note that they have a BMI in the 95th percentile rather than refer to them as simply “obese.” The goal is not to shield the patient from reality, but to better define their medical needs. Like ACOG’s move to designate moms as “35–39” or “40–44” rather than “of advanced maternal age,” this has the double benefit of being both less judgmental and more medically precise.

    [Anya E. R. Prince: I tried to keep my pregnancy secret]

    Doctors also have new reasons to be careful with their language. Since April 2021, an “open notes” law has given patients the right to freely and electronically access just about everything their doctors write about them. While the rule is still largely unknown to patients, open notes can make doctors more conscious (and, sometimes, anxious) about how what they write could affect their patients. “I think we’re all aware of that when we write anything,” Steve Lapinsky, an editor in chief of the journal Obstetric Medicine, told me. This increased transparency, he said, might just be the kick medicine needs to accelerate the pace of language change and do away with terms like incompetent cervix once and for all.

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    Rachel E. Gross

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