Models stratified by area income, education, and percent Chinese or percent South Asian were explored to further examine potential spatial and residual confounding (see Supplemental Material, Table S4). Associations were slightly stronger in the highest income quintile, especially for term birth weight where a 0.1 increase in NDVI was associated with a 32.4-g (95% CI: 20.3, 44.5) higher average birth weight. However, with stratificaiton by area-level education and visible minority status, no clear gradients for any birth outcome were observed.
My hospital waited until the delivery room to start hashing out for the first time discrepancies between marketing promises and policies. Women were left to “negotiate” their birth plans while in active labor. At best, a woman would experience unnecessary anxiety – at worst, she would be forced physically to comply. It seems my hospital is blaming the unpredictability of their services on the unpredictability of birth.
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This all came at a time when more of my friends around the country were beginning to have babies, and I was beginning to realize just how differently birth was handled elsewhere. Before then, I didn’t know there were options. I was hearing of friends being allowed to move around during labor, use the restroom, drink water, avoid stirrups, and birth in different positions. I always had been confined to the bed with a bedpan or catheter, only allowed to eat ice chips, and on my back in stirrups for delivery. I always was prepped from the waist down with surgical cloths and washed with antiseptic prior to delivery. I just figured that’s how childbirth was done everywhere. Lots of these friends had natural births, and talked about them positively. They didn’t have routine interventions and their recoveries seemed faster.
where UEkit represents the creatinine-adjusted urinary concentration (micrograms per gram creatinine) of metabolite k in child i at time t, MWk is the molecular mass of metabolite k (micrograms per micromole), MWp is the molecular mass of diester p (micrograms per micromole), and CEsmoothed is the estimated average 24-hr urinary creatinine excretion (grams per day) based on a study of newborns at 28–42 weeks of gestation (). FUEp is the estimated fraction of diester p excreted in urine, and BWit is the body weight (kilograms) of child i at time t. We assumed the following values of FUE p based on studies of adults after oral intake of deuterium labeled phthalate diesters: 84% of DnBP excreted as MnBP, 70.3% of DiBP as MiBP, 70% of BBzP as MBzP, 45.3% of DEHP as DEHP metabolites (MEHP, MEHHP, MEOHP, and MECPP), and 30% of DiNP as DiNP metabolites (MiNP, MHiNP, MOiNP, and MCiOP) (, ; ). For DEP we assumed an FUE of 69% (excreted as MEP) based on previous estimate for DnBP excretion. This estimate has often been used, because a human kinetic study on DEP is missing (). To obtain a single median and selected percentile estimates for each phthalate at each sampling time (D7 through M14) according to PT or FT birth, estimates of DI for each child at time t were calculated as centiles. DI was not estimated for infants at time point D1–3, because creatinine is known to be elevated due to maternal contamination ().
I interviewed an OB/GYN at Brookwood during my first trimester. He told me the interventions I received during my first three births were unnecessary and risky. He criticized routine use of the drug pitocin (medication to speed up labor and control hemorrhage). He said there was no need to be confined to the bed, not even during monitoring. He explained how laboring in upright positions alleviates pain, increases blood flow, helps position the baby properly, and opens up the pelvis. He told me research showed no benefit in continuous monitoring for low risk women like me; in fact, intermittent monitoring was recommended. He told me that letting the normal physiological process play out would be safest for my baby and me—which aligned with all of the research I’d been doing. Finally, after much thought and prayer, I switched hospitals during my 20th week of pregnancy. I hired a doula, read a big stack of birth books, exercised, and ate a healthy diet. I carefully made a birth plan based on best medical research, approved by my doctor. I was ready!
What?! The contradiction between the marketing and the reality was so shocking that for a second I thought to myself, have I walked into the wrong hospital? I knew there was no medical evidence for what she was asking me to do. I asked her where the birth tub was because my birth plan included water birth, and she informed me my room didn’t accommodate a tub. I told her over and over that my doctor promised me I could walk around during monitoring, but she continued demanding I get in the bed on my back so she could hook me up to the wired monitor instead of the wireless one I was promised.
Description of cohort. Linked administrative data were used to establish a birth cohort that comprised all births from the period 1999–2002 in the metropolitan area of Vancouver (). Medical services and hospitalization data were provided by the BC (British Columbia) Ministry of Health (, ); vital statistics data by ; and perinatal data by . A total of 82,347 births were identified over the 4 years (1999–2002), and 73,387 had mothers with verified complete residential history information within the study area during the 9 months of pregnancy. We excluded 988 multiple births, 7 children without recorded birth weight or parity status, 2,014 births to women with missing maternal age, 1,593 children with missing First Nations status (ethnicity), and 1,197 who were missing specific census covariates. The cohort was therefore reduced to 68,249 births that had complete covariate information; of these we were able to assign measures of greenness, air pollution, noise pollution, and neighborhood walkability for 64,705 births. The study protocol was approved by the Institutional Review Board (Behavioural Research Ethics Board) of the University of British Columbia (#H04-80161). The British Columbia Ministry of Health, Vital Statistics, and Perinatal Services BC approved access to and use of the data facilitated by Population Data BC for this study.