TIME Reproductive Health

How a Baby Was Born Encased in an Amniotic Sac

Silas Johnson born still in the amniotic sac at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.
Cedars-Sinai Medical Center Silas Johnson born still in the amniotic sac at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.

The physician was so surprised that he snapped a photo on his phone

Correction appended

Silas Johnson is barely a day old and is already an internet sensation. The Los Angeles infant was born three months early, and was remarkably still completely encased in his amniotic sac, making it appear as if doctors delivered a large bubble with a tiny baby inside.

Johnson was born at Cedars-Sinai Medical Center via C-section, curled in the hallmark fetal position within, and his hands were visible pressing against the clear membrane of the sac. His physician was so surprised by the rare birth that he snapped a photo on his cell phone while his team rushed to ensure that the baby’s breathing and heart rate were normal.

The sac is the baby’s home during gestation, filling with fluid to cushion him during pregnancy. Just before birth, it normally ruptures — the so-called ‘water breaking’ that signals an expectant mom that labor is underway. (In cases where the water doesn’t break, doctors can puncture the sac to release the fluid.) In Cesarean sections like this one, doctors frequently pierce through the sac as they make their incision to remove the baby.

Silas Johnson born still in the amniotic sac with mother Chelsea Philips at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at  on Dec. 6th, 2014 in Los Angeles.
Cedars-Sinai Medical CenterSilas Johnson born still in the amniotic sac with mother Chelsea Philips at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children’s Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.

In vaginal births, the sac remains in the mother as part of the placenta, and isn’t released until the placenta is removed in the afterbirth. But in some births, parts of the sac follow the baby through the birth canal.

While seemingly unusual, births ‘en caul,’ in which the infant remains entirely inside the sac during the journey through the birth canal, can be intentional, particularly when the baby is premature. Dr. Amos Grunebaum, director of obstetrics at NewYork-Presbyterian Weill Cornell Medical Center, purposefully delivers some of his babies in the sac, as a way to protect them during the delivery process. “It protects the baby from being injured; it serves as a cushion around the baby.”

Amniotic sacs and its fluid are connected to the placenta, which provides oxygen to the baby. So as soon as the baby is born, the sac must be ruptured to help the baby breathe.

“There are a lot of myths surrounding en caul births,” says Grunebaum. “There are many, many difference sources in the literature where people think the person delivered that way has certain powers.”Johnson’s mother Chelsea isn’t worried about that, but told CNN after seeing her doctor’s picture that “Silas, you’re a little special baby.”

Correction: This article originally misstated the baby’s last name. It is Johnson.

Read next: How to Parent Like a German

Listen to the most important stories of the day.

TIME Reproductive Health

Beauty Products May Trigger Early Menopause

Pefume bottle
Bogdan Kosanovic—Getty Images

Biology determines when women hit menopause, but exposure to some common household products and pollutants may drive that timing even earlier

Menopause, like puberty, is a reproductive rite of passage, and marks for women the end of their fertility and child-bearing years. But studies show that it’s not just age that can determine when menopause starts — exposure to certain chemicals and pollutants can also play a role.

In one of the most comprehensive looks at possible menopause-disruptors to date, researchers led by Dr. Amber Cooper, from the department of obstetrics and gynecology at Washington University in St. Louis, report in the journal PLOS ONE that such exposure can push menopause up by as much as four years.

Cooper and her team studied 31,575 women enrolled in the National Health and Nutrition Examination Survey conducted by the government. Every two years, the women were surveyed about various health and nutrition issues, including whether they had begun menopause. At some point between 1999 and 2008, each of the participants also provided at least one blood and urine sample which the scientists analyzed for the presence of various chemicals, including dioxins contained in pesticides, phthalates found in fragrance, plastics, cosmetics and hair spray, plant-derived estrogens, and polychlorinated biphenyls, among others. The researchers found that women with the highest levels of 111 of these chemicals on average had menopause anywhere from 1.9 years to 3.8 years earlier than those with lower levels.

How could Cooper be so certain that the exposure was linked to the early menopause? She and her team conducted other analyses, including one of women closer to menopause, between the ages of 45 and 55 years, and found a similar association. They also found that it wasn’t just exposure, but increasing exposure over time that was also connected to problems with ovarian function, another potential consequence of the chemicals on reproductive health. And when they looked at all of the women in the survey from age 30 years on, those with the highest blood and urine measurements were six times more likely to be menopausal than women with lower readings.

“This is the tip of the iceberg,” says Cooper, who stresses that the results don’t prove that exposure to these chemicals causes early menopause, only that the two might be connected somehow. ”We need more longitudinal studies to better understand each of these chemicals.”

Previous studies have linked certain chemicals to disruptions in the reproductive hormones, including estrogen, which can then have unhealthy effects on the heart and bone.

What’s concerning is the fact that with the majority of the chemicals, there isn’t much women can do to reduce their exposure. That’s because each of the compounds have different half lives, or time in which they can linger before completely breaking down. While PCBs have been banned in the U.S. since the 1970s, for example, their long half lives mean people may still be exposed to them in the soil, air and water, and in through animals or other things that have contact with them. Women can try to reduce their exposure to some of these chemicals by using products that do not contain synthetic fragrance—which is listed as “fragrance” or “parfum” and which contains phthalates. Women can also opt for organic beauty products, which would not contain pesticide residues and a number of other chemicals.

Cooper advises her patients to be more aware of their potential sources of exposure, including plastics in food packaging, and perhaps try microwaving only in glass and paper containers. “My goal is not to scare women, but raise awareness and promote future research,” she says.

TIME Reproductive Health

Birth Control Pill Risks May Now Include Brain Cancer

128897700
Raymond Forbes—Getty Images/age fotostock RM

Certain forms of birth control may promote growth of a rare brain tumor

Taking any drug is a matter of weighing the benefits and risks, and when it comes to birth control, women may now have one more factor to consider.

Dr. David Gaist, a neurologist at Odense University Hospital and the University of Southern Denmark, and his colleagues found that women taking hormonal contraceptives — those containing estrogen, progestin or a combination of both — showed higher rates of a rare brain tumor known as glioma. Their results, published Thursday in the British Journal of Clinical Pharmacology, raise questions about the connection between oral contraceptives and brain cancer, but shouldn’t yet be interpreted as a reason to stop taking birth control, says Gaist.

MORE: This Contraceptive Is Linked to a Higher Risk of HIV

Using data from Denmark’s national registries of health records, cancer cases and prescriptions, Gaist zeroed in on the women aged 15 years to 49 years diagnosed with glioma, and then analyzed whether they were prescribed contraceptives and for how long. Overall, women who had used hormonal contraceptives at any point in their lives showed a 50% higher risk of developing the brain tumors compared to those who had not used them. And women who used the birth control for more than five years nearly doubled their risk of the cancer. Still, Gaist says, since gliomas are rare, even a doubling of a rare event is still a small risk.

MORE: Which Birth Control Works Best? (Hint: It’s Not the Pill)

“If you look at women in Denmark aged 15 to 49, about five in 100,000 experience that terrible diagnosis in a year, and that figure includes women on hormonal contraceptives, so it’s a very rare event.”

But he admits he was “a bit surprised” by the results, since previous studies suggested that the sex hormones estrogen and progestin might be protective against the gliomas. But those studies primarily included women past menopause, who self-reported their use of contraceptives. In his study, the women were at the age where they would be taking contraceptives, and the data came directly from medical records and registries and therefore more likely to be accurate.

MORE: Take a Look at History’s Worst Contraceptives for Women

Interestingly, Gaist found that women using progestin-only birth control showed slightly higher risk of developing gliomas. While it’s not clear why, he suspects that obesity may be playing a role. In Denmark, regulations require that doctors avoid prescribing estrogen-based contraceptives to obese women, since estrogen can increase risk of blood clots.

Dr. Santosh Kesari, director of neuro-oncology at University of California San Diego and a member of the American Academy of Neurology, notes that rates of gliomas have not spiked since the introduction of hormonal contraceptives, but agrees that the correlation deserves discussion and more study. “It’s something women should be aware about, but I don’t think there is enough evidence to say don’t use it. But the discussion about this potential risk needs to happen,” he says.

Until more research is done to tease apart how the hormones in contraceptives are influencing cells in the brain, Gaist agrees that there isn’t any reason for women to stop using such birth control methods. “With the present knowledge we have, I would still favor using contraception in eligible women,” he says. “But we need to do more research to get a better handle on the issues.”

TIME Reproductive Health

The Second Most Popular Form of Birth Control Will Surprise You

102758095
Getty Images

Looks like the pill has some competition

About 62% of U.S. women from ages 15 to 44 use some form of contraception, and predictably, the pill is still the most popular. About 16% of women used it in 2011-2013, finds the latest report from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics.

But the second most popular contraceptive may come as a surprise to many: 15.5% of women—just a hair behind the pill—choose female sterilization. The CDC report shows that nearly one in three women ages 35 to 44 opted for female sterilization. By contrast, fewer than 1% of women between ages 15 to 24 chose it.

The rates of women choosing to undergo the simple, yet irreversible, surgical procedure might seem high, “until you start to peel back the layers and intricacies around forming a family,” says Dr. Vanessa Cullins, vice president of external medical affairs at Planned Parenthood Federation of America, who was not involved with the research. “Consider the fact that the majority of women in this country have had the number of children they want to have by mid-twenties to thirty or so—and they still have the capacity to get pregnant until they are 50 years old.” For a lot of women, that can mean 20 fertile years during which a woman may not want to become pregnant.

Cullins says women who tend to ask about sterilization don’t want to be bothered by other methods, even those that only require intervention every few years. The overall rate is slightly less than previous years, the CDC says, and Cullins says she expects the rate to continue to decline as long-acting contraceptives, especially the intrauterine device (IUD), become more popular and more affordable in the U.S.

But for now, the pill, female sterilization and condoms are more popular than the IUD. Long-acting reversible contraceptives, like the IUD and implant, remained stable from prior years, at 7.2% of women. They were most popular among women aged 25 to 34 and less popular among younger, sexually active women between ages 15 to 24. Women between ages 35 and 44 were the least likely to use them.

Because the IUD is much more convenient than the pill, with a lower failure rate, it may prove to be a bigger birth control contender in the future, some health experts say. And there are signs that with increased affordability and access, young women will opt for it. One recent study showed that when teenage girls were counseled about birth control and given their pick for free, a full 72% of them chose the IUD.

TIME Sexual Health

How Investing in Women’s Sexual Health Helps the Economy

Birth control pills
Laura Johansen—Getty Images

A new report looks at the myriad benefits of increasing contraception access and prenatal care around the world.

For about the cost of ticket to the movies and small popcorn, says Babatunde Osotimehin, Executive Director of the United Nations Population Fund (UNFPA), millions of women across the globe could gain access to vital reproductive health services.

The benefit of doing so, he says, can have a lasting impact not just on women and families, but the global economy.

“When you do that, protect the health of the woman or the girl,” says Osotimehin,”she becomes more productive in her community and the world. She becomes an asset.”

According to a new report by the Guttmacher Institute, an estimated 225 million women in developing countries do not currently have access to contraceptives, despite wanting to delay or avoid pregnancy.

Once they become pregnant, millions do not receive the pre- and postnatal care that can help protect their and their babies’ lives. Fifty-four million women do not attend the minimum prenatal visits recommended by the World Health Organization. Forty-three million deliver babies outside of a health care facility, and some 33 million newborn babies don’t get the care they need for health complications after birth. There are many more staggering statistics about women who cannot and do not access sexual health services, which can exacerbate fixable problems like contracting a bacterial sexually transmitted infection causing infertility and newborn death.

Compare that to the developed world, where almost all American women have babies at a hospital.

“We’re similar in that the more disadvantaged you are in the U.S., you have less access to care, but over all we’re doing a lot better than the disadvantaged in developing countries,” says Jacqueline E. Darroch, a senior fellow at Guttmacher and one of the report’s authors.

And yet, that’s not to say there hasn’t been dramatic progress over the past two decades. There are over 140 million more women using modern contraceptives today than in previous years. Infant and maternal mortality rates have fallen and more women are gaining access to prenatal care now than were in 2004, when the first Adding it Up report was released. Yet, in many parts of the world disparities persist, particularly in areas where health systems are the weakest including sub-Saharan Africa, parts of Asia, Latin America and the Caribbean.

“The greatest unmet need is in the poorest countries and among the poorest people,” says Darroch.

And making additional progress will not be cheap: it would cost about $39.2 billion to provide the necessary services for women annually, which averages out to about $25 per woman between 15 and 49. Currently, funding levels are at about $18 billion annually. In some countries, where access to care is worse, the cost ticks up to between $31 and $76 per year. It will fall on current funding sources: women and families seeking care, governments, and private organizations to boost dollars.

But, the long-term impact, Osotimehin says, will be significant. As the former Minister of Health in Nigeria, he has seen first hand the benefits of investing in reproductive health to better the lives of women, girls, and families.

“When a woman’s health needs are met, and she is able to go to school, she has children who also do that,” Osotimehin says. “Then you can begin to have new generations of young people who are more viable, more empowered than older generations.”

 

 

 

TIME Sex/Relationships

How Previous Sexual Partners Affect Offspring

At least, if you’re a fly. But the research suggests that it may be time to take into account more than just DNA when it comes to our offspring

It’s a long-held belief among animal breeders that pure-bred progeny are best produced by females who have never mated before. Call it puritanical or ridiculous, but in breeding, it’s been a long-standing practice—even though there has never been much science to back it up. Now, however, researchers at University of New South Wales in Australia believe they may finally have some evidence to give that notion some scientific support.

Working with flies, Angela Crean, a research fellow at the evolution and ecology research center, picked up on her mentor’s work of looking at how male factors can influence offspring outside of the DNA in his semen.

“The genetic tests showed that even though the second male fertilized the eggs, the offsprings’ size was determine by the condition of the first male,” she says of her findings, published in the journal Ecology Letters. “The cool thing is that the non-genetic effects we are seeing are not necessarily tied to the fertilization itself.”

Cool, or really disturbing. The implications of the study are that any mates a female has had may leave some legacy—in the form of physical or other traits that are carried in the semen (but not the DNA-containing sperm)—that could show up in her future offspring with another mate.

While there’s a growing body of work showing that a mother’s diet, her smoking status, and other lifestyle habits can have an influence on her offspring, the data on similar factors on the father’s side is just emerging. With flies it’s known, for example, that males who eat a maggot-rich diet while they’re mere larvae, develop into larger than average adults, and on top of that, sire larger than average offspring as well. Males fed a meager maggot diet tend to be smaller have have smaller progeny.

Eager to learn how this was happening, Crean conducted a series of mating experiments with female flies when their eggs were immature. At that stage, the eggs are more receptive to absorbing factors in semen, but because they aren’t fully developed, they can’t be fertilized and won’t result in baby flies. When she and her colleagues “mated” these females with males who were larger, then allowed the females to actually mate with smaller males once they were mature, the offspring turned out to be large, just like the first males the females had sexual contact with. Genetically, they were the offspring of the second, smaller male, but physically, they resembled the larger males.

The same was true when they reversed the experiment and first exposed the females to smaller flies and then mated them with the larger ones.

To be sure that the was indeed due to something in the semen, Crean repeated the studies with an unfortunate group of male flies who had their genitalia glued down so they could not pass on any semen during their encounters. (“It’s horrifying but seemed nicer than cutting them off,” she says.) When these males, both large and small, were the first “mates” for females, their size did not have an effect on the offspring when the female mated with her second mate and had offspring. In other words, those offspring were large if the second male was large, and small if the second male was small.

Crean says the idea of a female’s previous mates having an effect on their offspring isn’t unheard of. In fact, this very idea, called telegony, was proposed by ancient scholars such as Aristotle but dismissed with the advent of genetics. But new findings about epigenetics — how our behaviors, such as diet, smoking and drinking — can affect our genes and how those changes can be passed on, make the idea of such non-genetic inheritance possible. “This could be seen as a maternal effect [such as diet or smoking] where the mother’s environment are her previous mating partners,” she says. “We have to realize that it’s not just DNA that gets passed on. It opens up the opportunity for all these other pathways that we had excluded.”

And while flies aren’t people, what are the chances that the same phenomenon is occurring in human reproduction? “It’s something we definitely don’t want to speculate about yet with humans,” she says. “There is no direct scientific evidence for that at all.” At least, for now.

TIME Reproductive Health

See the Bizarre History of Contraception in This Fascinating PSA

A new PSA shows the lengths that women have gone to in order to prevent unwanted pregnancy

Get ready to cringe.

A new PSA from EngenderHealth’s WTFP?! (Where’s The Family Planning) Campaign takes viewers on a tour through history and the myriad ways women have tried to prevent unwanted pregnancy.

Many of the methods, outlined in the video above, are unsavory at best and dangerous at worst. In ancient Egypt, women used “crocodile dung mixed with honey” for spermicide. In ancient Greece, women drank lead-riddled “blacksmith water,” which is toxic. And in the U.S. during the 1960s, women would put fizzing cola in their vagina after sex as a bizarre — and misguided — way to prevent pregnancy. (The birth control pill was introduced in the U.S. in 1960, but as TIME noted in its 50th anniversary story about the pill, “women usually had to be married to get it.”)

But the point of the video isn’t just to give us a look back on the weird ways women have tried to control their bodies. According to EngenderHealth, a New York City-based non-profit that focuses on women’s reproductive health, today more than 220 million women around the world want to use contraceptives, but can’t access them. Factors such as income, cultural and religious restrictions, lack of information and poor healthcare can all prevent women from safely and effectively preventing pregnancy.

Even in the U.S., access to birth control is not universal and measures to make it free have often been met with severe backlash. Remember Sandra Fluke?

This matters. A 2013 report by the Guttmacher Institute found that women who can control when they have children, not to mention how many they have, are more likely to fulfill their education and career goals, and earn higher wages. What’s more, access to contraception has also been linked to lower rates of maternal and infant deaths.

So if EngenderHealth’s unsettling video and campaign helps increase awareness and access to contraceptives, it’s worth cringing through.

TIME Reproductive Health

Morning-After Pill May Not Be Affected By Body Weight

Morning-after pill
Jacques LOIC—Getty Images/Photononstop RM

Recent studies raised questions about the effectiveness of the contraceptive method among heavier women.

But after an investigation, the European Medicines Agency (EMA) says that emergency contraceptives are effective for women of all weights.

Last year, the agency requested a warning on the label of Norlevo, the European equivalent of Plan B containing levonorgestrel, indicating that it might not be as effective in preventing pregnancy for women with a body mass index (BMI) greater than 25. This decision was based on a 2011 study that showed heavier women who took products containing levonorgestrel—which prevents pregnancy after intercourse—were four times as likely to become pregnant as those with lower BMIs.

After that recommendation, the regulatory agency conducted a review of other emergency contraceptives containing levonorgestrel or ulipristal acetate, and found that the data in the earlier studies was limited and not substantial enough to conclude that the contraceptives’ effect was decreased with increased body weight. That doesn’t mean that weight may not play a role in the drugs’ effectiveness, but for now, the EMA’s Committee for Medicinal Products for Human Use (CHMP) recommends that Norlevo remove the current warnings from its label. It also said emergency contraceptives should continue to include on their product inserts some study results showing potentially reduced effects in heavier women.

While the European health authorities took action on Norlevo last year, the U.S. Food and Drug Administration has not issued any similar warnings for Plan B. “I don’t necessarily think it’s inevitable that the FDA would act on this,” Dr. Carolyn Westhoff, professor of obstetrics and gynecology and public health at Columbia University and senior medical adviser at Planned Parenthood Federation of America, told TIME in November 2013 regarding the data at the time. “People in the field have been scratching their heads since [the 2011 study] was published, saying what sorts of studies could we do to get more data to help us understand this better. To my knowledge, nobody has done those additional studies.”

EMA also admits that such data isn’t available yet, but says that there isn’t enough data to support the previous warning to women about weight.

TIME Sex

Stress Degrades Sperm and Fertility, Study Finds

Men who feel stressed have fewer, slower sperm

Psychological stress may degrade sperm quality and sperm fertility, according to a study published today in the journal Fertility and Sterility.

“Men who feel stressed are more likely to have lower concentrations of sperm in their ejaculate, and the sperm they have are more likely to be misshapen or have impaired motility,” said researcher Pam Factor-Litvak, an epidemiologist at Columbia’s Mailman School of Public Health, in a statement. “These deficits could be associated with fertility problems.”

Researchers studied 193 men ages 38 to 49, who rated how stressed they felt and shared the life events that led to said stress. Life stress degraded the quality of semen even when the scientists accounted for other factors, such as health concerns or previous issues with fertility.

Even though life stress affected the caliber of the sperm, workplace stress did not. However, job strain did lower testosterone levels and therefore could still hurt reproductive health. Unemployed men also had lower sperm quality than employed men, regardless of other stressors.

Scientists don’t know how exactly emotional strain affects semen, but this adds to a body of research examining the many ways emotional stress can take a toll on the body.

TIME Reproductive Health

FDA Panel Recommends Test That Would Replace Pap Smears

An FDA advisory committee unanimously agreed that a DNA test developed by Roche should be approved by the FDA as a primary screening tool for HPV.

Currently, women are tested for human papillomavirus (HPV) during a Pap test or after a Pap smear shows abnormal changes on their cervix. But the new test from Roche identifies screening HPV DNA as a superior source for detecting abnormalities. HPV screening is important since it is the most common cause of cervical cancer. The committee–made up of experts in the field–green lighted it as an initial test for women starting at age 25.

According to the New York Times, it’s highly unlikely that the Roche test will replace the pap smear, especially since many physicians will take a long time to incorporate it into their practice. However, in Roche’s trials, it showed that the test was better than the Pap in areas like detecting cancerous lesions.

The primary concern for HPV testing is that it could lead to unnecessary invasive procedures. Most people get infected with HPV in their younger sexual years, and the majority will the clear the virus naturally. HPV testing could mean that young women may be sent in for biopsies and examinations that aren’t necessary, since their infection would have likely gone away on its own. Joint HPV testing and Pap testing is thus recommended for women between the ages of 30 and 65 every five years, while women between the ages of 21 through 30 are recommended to receive Pap testing every three years.

[The New York Times]

Your browser is out of date. Please update your browser at http://update.microsoft.com