Sandra Steingraber on Having Faith: An Ecologist's Journey to Motherhood

Hi, It's a real honor to be here tonight. II know that whenever a speaker is on a book tour and um... crowds like this are assembled a lot of work goes on behind the scenes to make that happen, So thanks very much to Powell's Book Store, a book store I've heard about since least until 1988 when I began to work, at um... I had a very an un-illustrious career as a book buyer, actually, um, at Shaman Drum Book Shop, another um semi famous, ah, an independent bookshop in Ann Arbor, Michigan and Powell's is always this this mystical place. So now here I am. And um, thanks to to um to to Rachel's friends. Um, some of you know I was here in June, invited out by Rachel's friends. I talked to them out of my previous book Living Downstream, which investigates the link between cancer and the environment. And that book, um, for those of you not familiar with it, is subtitled A Scientist's Personal Investigation Into Cancer and the Environment, um precisely because, um not only does the book represent my best attempt as a biologist to um

understand and analyze and summarize the various links between carcinogenic exposure and cancer, but, it-- the book, it also took me back to my own hometown of Pekin, Illinois where I became a kind of environmental detective there and um re-learned this landscape of my hometown in a new way, um by, by filing Freedom of Information act requests and using Toxic Release Inventory data to uncover for example, a toxic waste site right near the high school where I grew up at the landfill near my father's home imported hazardous waste from all around the United States and the county made considerable money doing that. The dry cleaning fluids in the drinking water wells there etc. That was the tale I told in Living Downstream. In my new book, "Having Faith", which is named for my now-three year old daughter, Faith, it's an even more intimate investigation.

I became pregnant at the age of thirty-eight and I was a cancer patient by the age of twenty and I realize this is not the order in which most people live their lives but that's how mine kind of worked out and after almost twenty years of having been professionally an ecologist by the time I became a mother, I realized with some amazement that I myself was now a habitat and I began to imagine my the inside of my uterus as a kind of environment; in fact it is the first environment for all of us, so I challenged myself to write a book in which I would describe and narrate the events of pregnancy using the language of natural history writing, as though the body were a landscape and, and using that metaphorical structure I was able to discuss the ways in which toxic chemicals flow into this environment just as they do into other kinds of external environments. So "Having Faith" begins

with my finding out that I'm pregnant which I did in the bathroom stall in a university where I was guest teaching; I'm not sure why I did it that way [laughter] but I was peeing on a stick you know to find out if I was pregnant five minutes before I had to go teach a class and then when I found out I was pregnant I taught the worst class I'd ever taught. Then, the end of the ninth chapter then is the story of the birth of Faith and then there are three chapters devoted to breastfeeding, which is the reestablishment of symbiosis between mother and child after birth, so it takes you up until Faith is two years old. She's now three, I should say and the baby you're seeing being walked around here by my dear friend Maryanne, is my newborn son Elijah, who's ten weeks old and who's my audiovisual aid on this trip. I talk a lot about breastfeeding in the book, you'll probably see me breastfeeding

while I'm signing at the signing table. What I want to do now, I'm going to read three selections from "Having Faith" and I want to talk a little bit about the sciencey part of the book before I work my way into the reading. Essentially the science of this new book is the science of fetal toxicology and let me first go through with you some of the key events of embryonic and fetal life and then we'll go back and take a look at how toxic chemicals can impinge on those. So, if you can kind of turn your mind to what you know about the birds and the bees we'll have this famous talk together. You know the story all starts in the upper reaches of the fallopian tube when a sperm and egg get together and unite and once that happens it takes about four to five days for that little gondola boat to float down the canal, the fallopian tube. It opens out into the wetland of the

uterus and then the egg implants itself into the lining of the uterus and actually just sinks and buries itself right into the lining of the uterus. And at about week four or five; hang on-- Don't worry about your child making noise, it's really fine and I've spent so many times in the seminar bouncing my own kids outside the door and missing the whole thing. I think we should all learn how to focus when children are making noise, so please, if you're going to leave don't make it for my sake. OK. And after the ball of cells sinks in, just about the time a woman realizes she's missing her, her period, this remarkable event happens called organogenesis and this takes place between about weeks five and ten of pregnancy and essentially, during that window of time all the body parts of the embryo are formed and it starts out with three tissue layers, three flat-- flat letters it's like a process of Japanese origami where these three layers are folded and the flat structures form three dimensional structures.

After-- at week ten, you have a human being about the size of a paper clip with all of its parts there, present. It has a pancreas, it has a brain, it has fingers, it has legs, it has eyelids, everything you need, and the rest of pregnancy which is forty weeks long, s0 the remaining thirty weeks after week ten is really devoted to the growth and development of those parts that have all been formed. An amazing event happens in the fifth and sixth months of a pregnancy, so now we're into the second trimester here, when all of the parts of the brain which have all formed in the first trimester all have to get wired up, so those neurons, they're all there but they have to migrate and travel and they spin silken threads as they go just like spiders do and those threads have to get all wired up together and that happens throughout pregnancy but the big burst of brain growth and development is in months five and six and remember that, 'cause I'm going to come back to it in a second. Birth happens at the end of the ninth month, and essentially

at that point, all that blood flow which has gone down to the uterus has to be redirected up to the breast; that takes between two and five days for all that demolition and reconstruction to happen the blood vessels all have to be broken down and rebuilt and that step takes between two and five days for a mother's milk to come in after a pregnancy is over and thus, the symbiotic relationship is finally reestablished. Now let's go back and take a look at how certain kinds of toxic chemicals can affect that. We'll go back all the way to the eggs and the sperm, so kinda rewind the tape here. Air pollution can kill human eggs. We learned this first by studying women who smoke and for a long time there's this mysterious fact that nobody could explain which is this: women who smoke go into menopause a lot earlier than women who don't smoke, two to three years earlier and it turns out that there are substances in tobacco smoke, polycyclic aromatic hydrocarbons, that actually travel in the mother's bloodstream and get into the

ovary and turn on and turn off certain genes that cause eggs to die and so a smoking woman's fertile lifespan is shorter than a non-smoking woman. And it turns out that air pollution, which also contains polycyclic aromatic hydrocarbons, also can have the same effect on eggs, and we know for example that animals in laboratory exposed to ambient air pollution similar to that found in urban air we see evidence of the death of eggs in the female ovary. We know that sperm can also be damaged by exposure to toxic chemicals; this can create infertility but new research also shows that DNA damaged sperm are linked to childhood cancer in the offspring, so for example occupational exposures of fathers well before conception happens to substances such as solvents, diesel fuel, and turpentine raises the risk of one particular

childhood cancer called neuroblastoma, which is a cancer of the nervous tissue in a child and it's one of the more common childhood cancers. You can raise the risk by tenfold actually, by occupational exposure of the father before birth. So although my starting point in this book is that mothers' bodies are the first environment, fathers also have a role to play here, I think actually a neglected role in that requires more attention. Now if toxic chemicals are introduced during the period of implantation, you can get early miscarriages and a woman can misinterpret this as the fact that she's infertile if that miscarriage happens before before she thinks her period was late she may not know that she's had a pregnancy. Miscarriages can also happen by introducing toxic chemicals, particulary solvents, during that window of time called organogenesis between weeks five and ten. If the embryo isn't miscarried, physical malformations

can occur and again that's because that's when all those body parts are being formed from those three flat layers of tissue and of course we call these birth defects. Now I spend a considerable amount of time in "Having Faith" taking a look at the birth defect registry data, and I had thought my task was going to be very similar to my work in the cancer registry data which I spent a so much time on in my earlier book "Living Downstream" it actually was much much harder than "Having Faith" because we keep such poor records of birth defects in this country The Cancer Registry data, which has problems of its own, actually looks terrific, like the gold standard, compared to birth defect registry data. California and Texas have the best registries. There are only about ten states that have registries good enough to analyze the data. About thirty states have no registries at all, so if you wanted to let's say take a look at the time trends for certain kinds of birth defects or map them out to see what they look like you know, what the national pattern of let's say cleft palate or clubbed foot or Down's syndrome or anencephaly, which is

absence of a brain, you can't really do that very well with our data, so I had to use European data. Europeans do a much better job of keeping track of these things than we do so you can take a look, for example, in chapters four and five to see how residents near certain toxic waste sites in countries like Norway or Finland are related to risk of birth defects and how certain kinds of exposures to pesticides raise risks for other kinds of birth defects. We do have some evidence from California and Minnesota on pesticides and birth defects that are pretty good, so for example in the state of California, living within a mile of an agricultural field where pesticides are used will raise the risk of particular kinds of birth defects in the mother. Also, home and garden use of pesticides is-- there is some new, provocative data showing that that's problematic during pregnancy. The California birth defects monitoring data also shows

that women who are-- seventy five percent of women who are pregnant have exposures to pesticides during the course of pregnancy. This is more than just residue on food. This is things like being exposed to garden pesticides or pesticides used on pets or living near agricultural fields where you're actually the exposure is direct. Now, if the exposures to certain kinds of fetal toxicants happen during the period of brain growth development, again that's month months five and six you can actually arrest the migration of those neurons as they attempt to get wired up correctly. You've all probably heard that lead can have this effect; prenatal exposure to lead makes kids stupid. The way, the means by which it does so is it paralyzes the migration of neurons during the second trimester in the brain. Mercury can have the same effect. Methyl mercury, which we are primarily exposed to by eating fish, can actually

cause just in the way lead can, can actually cause these neurons not to migrate at the key point in time, placing the child at risk for learning disabilities later in life, lowered IQ, and perhaps behavioral problems and this is a new and emerging area of research that we don't have very good data on, but there's some preliminary, provocative evidence showing that both lead and mercury exposure before birth um can predispose that individual to aggressive and violent behaviors, hyperactivity, and attention deficit disorder and maybe some kinds of learning disabilities such as dyslexia. I wouldn't stand very firmly on that data yet but I think it's a hypothesis at this point worth pursuing that certainly has caught the attention of the PTA and all of the burgeoning work and activism around children's environmental health and I'm very pleased to report that a not only are a lot of new groups springing up to try to deal

with this issue, but a lot of older groups such as the Four H Club and the PTA, groups that interact with children and are aware of the growing incidence of learning disabilities and behavioral problems in school are now beginning to ask what role that-- do very early environmental exposures play in creating th problems that we see once kids are in school. Now, when the baby is actually born, the timing of birth can also be a function of the environment, so if you think of your own birthday, my birthday is August 27th, the date I'm sort of fond of, we like to think it is our destiny or maybe a function of the astrological charts but in actual fact the environment can actually play a role in when the baby is born and that's because there are, there are chemicals known to interact with, known to interact with [baby fussing] the actual uterine tissue, in the muscle tissue in the uterus. You know, I'm going to try to nurse him and talk, I think that'll actually work better.

So here's the audiovisual part of the presentation. [unintelligble], no, I think I can bounce this way. OK, so what PCBs do when they enter the body of a pregnant woman, they not only cross the placenta and interfere with brain growth just away mercury or lead can, they also can actually go into the uterine muscle itself and trigger contractions earlier than the uterus is supposed to contract, so you can trigger premature labor through exposure to PCBs. We know this because women who work in industries where PCBs-- where they're exposed to PBCs are at risk for premature labor. We know that animals exposed to PCBs in the labratory give birth earlier than they're

supposed to in controlled situations and we know that when you take mammalian uterine tissue and grow it in a petri dish and add PCBs in trace amounts to it you can actually make that muscle tissue contract. And we think we know the mechanism by which that happens and for you out there who like the physiology of it, essentially what happens is that PCBs alter the way calcium flows through muscle tissue, and calcium is required for muscles to contract. So you actually encourage the contractiveness of uterine muscle tissue in the presence of PCBs. Now that's important because premature births are actually rising in this country; we can keep pretty good pretty records on this because of course you can always come up with a due date, and the birthday of the child is a matter of vital records so you can easily research this, and what you see is that premature birth is rising among all kinds of women and mothers. Now some of this is happening as older mothers are having babies and we old mothers are more at risk for premature

labor than younger ones, and some of it's happening because of infertility treatments because multiple births are more at risk but even if you look at young women between the ages of twenty and thirty five, singleton births, you still see rising rates of prematurity and prematurity is the number one cause of disability in this country and it's the second killer of infants right after birth defects, so even though it doesn't sound as bad as let's say, you know missing limbs or something like that as a structural birth defect, it's a terrible, it's a terrible and serious problem. Kids who are born prematurely are at higher risk for learning disabilities, higher risk for asthma, sudden infant death syndrome and all kinds of things and at the very least they're going to require a lot of extra dollars in terms of medical care, educational care, and social services to raise these born-too-early children throughout their adult lives. Now a word or two about breast milk and then I'm going to do some reading for you. Two things

are true about breast milk. One of them is that it's absolutely the best food for babies; obviously I believe that. Breastfed children are at lower risk than their formula fed counterparts for all kinds of things and probably you've all heard that breast milk contains antibodies of living white blood cells so the breast milk certainly provides temporary immunity to the child, so therefore breast fed babies are less sick, sick less often and sick less severely than bottle fed babies. That I knew before I wrote the book. What I didn't know, which I document in here at some detail, it actually takes me two chapters because I got so kind of jazzed about it. Breast milk also contains factors that help guide the baby's own immune system in getting set up, so it's not just that the baby is born immune incompetent and this is temporary. The role played by breast milk. There are things in breast milk that help jumpstart the immune system. It not only revs it up, it also keeps

it from overreacting so it works actually to dampen the immune system sometimes. Thus, breast fed babies are less likely to have allergies, they're less likely have all kinds of autoimmune problems, such as lupus, Crohn's disease, rheumatoid arthritis, diabetes. They're less likely to be obese and they have better blood pressure; there seems to be agents in breast milk that actually help guide the development of the cardiac system. Breast fed babies are also smarter than bottle fed babies, meaning that when they become children, years later, they outperform kids fed on formula by several IQ points and they do better in school, they have lower dropout rates. At first I looked at this data with very skeptically because it's also true that there are many differences between mothers who breast feed and mother who bottle feed and one of the biggest ones is a class difference. Our maternity leave policies are so terrible in this country that women who are not professional women don't have guaranteed maternity leave, they don't have a private place to express breast

milk in the workplace; so if you're an assembly line worker or working in the trades you really don't have much alternative except to go back to the bottle at some point. Well, it's just very, very difficult for those mothers. So, to do any kind of study showing a benefit on intelligence of breast milk you would really need to correct for the socioeconomic factors. So I looked at these very skeptically and I did become convinced that actually there is something biological about breast milk that helps guide infant brain development; you can take a look at my evidence in the last few chapters and see if you agree with me on that. So now what I want to do is read from three parts of Living Downstream. The first and last selections are going to be quite short and the middle one will be a little bit longer. The first one is, comes from chapter four and it is about, well, let me put this in context. It's about my experience of having an amniocentesis but the research--

the part I'm not going to read. The research that I was doing while-- during the month that I underwent this procedure, I was actually investigating the contamination of amniotic fluid with pesticides, mainly DDT, dioxins and PCBs, that's it's not just, it's not just that these things cross the placenta; they're actually found in that liquid bubble wrap that the baby lives in and swims in and actually swallows. So doing all that research when I myself went back to Boston to have my amniocentesis done and this is a procedure in which about a shot glass full of amniotic fluid, thirty cc's is removed through a big needle that goes right through the belly of the pregnant woman and then that fluid is analysed for chromosomal defects. So I was thinking how strange it was that we were looking so closely for these rare chromosome problems when most women probably have contaminated amniotic fluid and we're not

really looking at environmental contaminants in amniotic fluid which may play just as important a role in the destiny of that child as whatever's in the chromosomes, so that's what was on my mind when I went in to have this test. The only other thing you need to know about this passage is that, and this is explained earlier in the book, I have this peculiar habit whenever I undergo medical procedures, and that's this. I tend to choose some biological process I'm especially fond of and think about everything I know about that process while the test is going on. For example, I've gotten through plenty of colonoscopies while thinking about photosynthesis. [laughter]. I just happen to really like photosynthesis, and so what you hear me thinking about in here is hummingbirds; while the needle goes in I start thinking about hummingbirds, so you'll hear my internal monologue sort of juxtaposed against this external description. I hope that helps it make sense. All right.

"Suddenly the tiny room fills up with women. The obstetrician walks in and greets me warmly. A technician and the chief stenographer take their places and begin flipping switches and unraveling the assembled objects. The mood is bouyant; they begin quickly, the dome of my belly is bare to the ultrasound probe, which looks like the kind of spoon that you eat Japanese soup with. The probe locates a pocket of fluid safely away from the body of the fetus. The needle slides in about two inches below my navel, a second later I feel a sharp cramp, muscles do this when they are stuck with needles. Everyone else is watching this moment on the screen of the ultrasound monitor. I am not. I am thinking very hard and very deliberately about hummingbirds. The nests of hummingbirds are constructed of spiderwebs and dandelion down. They're lined with lichens and moss. They usually contain two eggs. I glance down briefly; the syring is half full of fluid already. The eggs are the size of

peas; when the baby hummingbirds hatch, they are said to resemble wet bumblebees. The first syringe is replaced by a second. Hummingbirds fly over the Gulf of Mexico from the Yucatan in a single night; it's a distance of five hundred miles. Some of them probably came across last night, assuming the high pressure system over New England extends all the way down there. The second syringe is taking longer to fill up. In truth, I don't like hummingbirds. Up close, they're too impossibly small with too much nervous insect-like whirring. Still, the entire Gulf in a single flight is impressive. The needle is out, we're done. The mood is still upbeat. The obstetrician hands the pair of vials to the technician who holds them up to the light, like glasses of fine wine. 'Nice color,' she says. 'Do you want to hold them?' and she passes the vial, hot as blood, into my hands. The fluid inside is pale gold, it seems to glow. 'It's like liquid amber,' I sputter. 'It's like an amber jewel.'

It occurs to me that amniotic fluid might be the loveliest substance I've ever seen. The obstetrician touches my arm.. 'That's baby pee,' she says. 'We like it yellow, it's a sign of good kidney functioning.' I look at the vials again. 'Oh, right,' I say. The obstetrician is finishing up. She reminds me to drink plenty of water. 'Drink plenty of water.' Before it is baby pee, amniotic fluid is water. I drink water, it becomes blood plasma which suffuses through the amniotic sack and surrounds the baby, who also drinks it. And what is it before that? Before it is drinking water, amniotic fluid is the creeks and rivers that fill reservoirs; it is the underground water that fills wells, and before it is creeks and rivers and ground water, amniotic fluid is rain. When I hold in my hand the tube of my own amniotic fluid, I'm holding a tube full of rain drops. Amniotic fluid is the juice of oranges that I had

for breakfast, the milk I poured over my cereal, the honey I stirred into my tea. It is inside the green cells of spinach leaves and the damp flesh of apples. It is the yolk of an egg. When I look at amniotic fluid, I am looking at rain falling on orange groves, I am looking at melon fields, potatoes in wet earth, frost on pasture grasses. The blood of cows and chickens is in this too, the nectar gathered by bees and hummingbirds is in this too. Whatever is inside hummingbird eggs is also inside my womb. Whatever is inside the world's water is here in my hands." That's chapter four. Marianne, I'm going to hand him back to you now. Now on to birth. So,

you should know that I was doing my research on how PCBs affect the timing of labor while I went to labor myself and, some of that discussion is actually here in chapter nine but the part I want to read to you is actually the part of labor where that was the last thing on my mind. There's a couple things I think you'll need to know. One is my husband's name is Jeff, so you'll see him in here. My obstetrical nurse is named Sheila, she makes an appearance in here and then you need to know that there's a terrible medical-- surgical operation that ends up happening to a lot of pregnant women called an episiotomy, which is the cutting of the perineal muscle between the vagina and the anus right when the baby's being born. Obstetricans do this routinely to widen an opening in the birth canal and then they sew it up when it's over. Midwives almost

never do this because they tend to be more patient and know how to keep their hands in their pockets in a way that obstetricians don't, I think, and for that reason I actually chose a very different kind of birth of my son Elijah. It was in a midwife-run birth center and it was precisely because I wanted to avoid having another episiotomy, which I found an incredibly mutilating experience. I'm not going to discuss the mutilating part of it here; this is the sort of wonderful part of Faith's labor. "And here is what labor contractions feel like to me: they come in from the sides, like bands of tightness. They progressively increase in strength and intensity, which I do not mean as a euphemism for pain, until they are literally breathtaking, except that it helps to keep breathing anyway. Childbirth books all describe contractions as ocean-like waves with lulls between the peaks, but to me they feel more like the periodic tightening and loosening of a corset. Sheila encourages me to look out at the city lights, find one, she says, that attracts me.

I do, and cast my attention out the window toward my chosen dot of light as the contractions intensify further. Now my pelvis feels as though it is caught in an ever-tightening vise. This is when I recall the unequalled strength of the human uterus, the power of my own body becomes amazing to me, thrilling, the force in whose grip I am generated is my own muscle. I am both the squeezer and the squeezed, both the boa constrictor and the mouse caught in its coils. The sensation of being squeezed verges on the overwhelming, but the real labor of labor is the involuntary work of doing all the squeezing. As the contractions clamp down with more force, my legs begin to tremble. I can no longer speak in full sentences. I asked to lie down; instead Sheila suggests I kneel in the middle of the mattress and hold on to the head of the bed, which she elevates to vertical. Next, she stations Jeff behind the bed so our eyes are level. She gives us a mantra, the word 'out.' As

I feel a contraction coming on, we are to hold hands, lock eyes and chant out until the pressure subsides. Right away the word pleases me, out, out, out. I say it fast, I say it slow. The more I utter it the more it comforts me, out, what a perfect syllable. I explore each of the sounds, the long moaning vowel, the finality of the consonant. I notice how my lips first dilate then contract, how the tongue slowly rises up to the palate as the jaw closes, out out, out. I listen to the shape of the sound as it uncurls from the back of my throat to the back of my teeth. I see the architecture of each letter, the endlessly cycling O, the hairpin turn of the U, the intersecting timbers of the T. Out is the sheltering tree in a storm, out is the bubble of air under the ice, out the train pulling away from the station, out there at the top of the stairs, out out out and now there's pain; I'm still being squeezed but something is

pushing against my back from the inside and now Sheila is up on the bed, holding me in a kind of football tackle, applying counter pressure. The pain subsides. I glance around for the word out and find it in Jeff's eyes. Out is the color blue, out is the bottom of the lake. Fish swim through the word out. It is peaceful inside the word out. Out is deliverance, out is love, out is God, and it goes on like this, the three of us shouting out, out, into the hours of the night until a deep shuddering pain descends through me and I lose my way. Do not misunderstand me. On the scale of sheer physical torment I've experienced pain more acute than this pain. A finger smashed by a hammer hurts worse, back spasms hurt worse, so do certain orthodontic procedures, but I have never felt a more profound pain. It is like the chords of a pipe organ filling a cathedral, it is like an earthquake.

Somewhere in the distance I hear Jeff's voice and navigate toward it. Now I hear other voices, Sheila urging me to keep it together, a kind of bellowing that seems to be coming from my own throat, and then my lips round out, my tongue finds the roof of my mouth, and that bellow becomes a word out, out, out. I emerged from Jeff's eyes and reinhabit my body. Out, out, out, and the word becomes flesh. Slowly I become aware that the room is filling up. In a corner, the obstetrician is washing his hands. A Harvard medical student chats about a paper she once wrote on midwifery. The lights are dimmed. A spotlight comes on above the bed. Sheila tells me I am fully dilated. Labor is over. Now on to delivery. Sheila tells me the grunting sound in my voice indicates to her that I am now ready to push. Push? No, I don't think so. I'm enjoying this intermission too much to return to my

seat. Let me just stay out here in the lobby a little while longer, as a matter of fact, I'd like to go home, or at least let's go back to that part when we were all shouting out together,. that was OK. Sheila lowers the head of the bed to semi-reclining, adjusts the pillows behind my head, she instructs me to grab a hold of my thighs and pull them toward my chest. Now, take a deep breath, hold it, and push, which is the most ridiculous suggestion I have ever heard. Sheila and Jeff confer. Jeff leans down and explains the concept to me in zen-like terms. Before, I needed to let pain push through me, pass through me like wind through a tunnel. Now I needed to push into it, not cast my consciousness away. There is no way out but through. After meditating on this for a few moments I recognize the need to push. With surprise I realize this sensation had been coming and going for a while but I haven't acknowledged it, so I pushed, and everyone takes their places. Jeff is at my right side, Sheila moves between the foot of the

bed and my other side, and the doctor and his assistant stand quietly in the background like a Greek chorus. The idea that there comes a point in labor where the need to bear down becomes an overpowering desire is not, in my experience, correct. For me, the urge is more reflex than desire. It's like the need to throw up. You can resist it, you can let it happen or even encourage it, but you wouldn't exactly call it desire. [laughter] And as in vomiting, I prefer to let the urge build a bit before throwing my weight behind it. [laughter] Pushing quickly takes on a rhythm and momentum of its own. I stop taking direction start narrating the show. Wait, let me rest a minute... alright, here it comes, OK, now. Once I discovered that pushing doesn't hurt as much as I imagine I let go of all remaining tentativeness and once again am amazed at the power streaming through me. At some point the stretching tissues around the mouth of my vagina become numb, like a foot that has gone to sleep.

This is useful. I go on letting my body swing between resting, pushing, resting, pushing. Then I hear the two doctors exclaim in unison, 'Wow, look at all that hair." A voice asked me to reach down and touch the baby's head as it crowns. I obey, but I am not in the mood. I also wave away the mirror that someone offers. Too many distractions, can't you see that I'm trying to work here and then, without warning, I am ordered to stop pushing. At the foot of the bed a big conversation ensues as to whether I should receive an episiotomy. I am listening to this discussion as though from the bottom of a well, as though to a radio station that keeps cutting in and cutting out. I catch about every third word. Finally I hear myself say I would rather have a first degree tear than an episiotomy. I watch the obstetrician shake his head; his lips are moving. He is a minor character in a scene from a foreign film [laughter]. Now there is more discussion. I am reading badly translated subtitles, I am getting bored and annoyed,

I hear myself say OK, just do it. It is a decision I will curse for months to come and as soon as I feel the scissors sliding into my vagina I know it. But there's no time for regrets now; I'm carried off by an enormous pent up desire, yes now, it is a deep deep desire to push, yet again and someone is saying the head is out and then again, and something is rushing through me like waterfall of snowmelt down a mountain and suddenly there is space inside me and a tremendous sense of relief, and a voice saying Sandra, reach down and grab your baby and a tiny perfect body appears in my hands. Spiky feathers of wild, luxuriant black hair, dusky skin greased with vernix that is smooth as the finest lotion, lips I recognize from a school picture of myself in the first grade. Oh, who are you? Two eyes open, black as mystery, they asked and who are you?"

Alright, this last one is only a couple paragraphs long and this is from the last chapter of "Having Faith," , which is the third of the three breastfeeding chapters. Consequently, Faith is quite old in this chapter and one of the things I didn't realize when I began nursing her was that I would still be nursing her as a toddler. In fact, what I remember very clearly when I was an infant when she was an infant and I was sitting in the pediatricians office nursing her as this little flannel-wrapped bundle, I was sitting next to a mother of about a two year old who was also nursing and at one point he popped his head up under her blouse and said "Other side!" [laughter] and I was really shocked and I made this little mental note to myself that when they're old enough to talk about it it's time to quit. and then i you know as all of rules to when you're hearing those are happening now

and because actually as she got verbal quite early on, about fifteen weeks [i.e. months] she was kind of a chatterbox about fifteen months um and and I actually found it really delightful to hear her understanding of what the breast was, what the milk was, and what it meant to her, and she said things to me like "Mommy, your milk is your music," and she also at one point said, in the middle of winter, when she said "Mommy, your breasts smell like summertime." What lover would ever say that [laughter]. And I found this um sensual relationship I had with her which was completely not sexual at all, but, but something very different and unique, like nothing else I had ever experienced with another human being. I found it quite wonderful and I began to realize it was only our fetishization of the female breast is an artic for mail letter that makes us feel uncomfortable only see children and join them and says the children can talk and think about it and have memories about things like that

So here's one scene from the end of the book when Faith's relationship to me as her nursing mother makes her have a realization about her whole place in creation and that was one of those unexpected benefits of breastfeeding I never anticipated. "Summer 2000 in upstate New York was one of the coldest and wettest on record. Even by August area lakes haven't warmed up enough for swimming, so when a hot sunny Saturday finally arrives Faith and I head for the county Four H fair; it's one of my better ideas. When I was a kid I loved the Four H Club and had a fairly illustrious career as a member. I received blue ribbons for both my rock collection and my sewing project, but I always knew that whatever my achievements in geology and sewing, they could not compete with the prestige of the agricultural projects. The annual Four H fair was first and foremost a showcase for the farm kids, whose projects had titles like "Feeding and Fattening for Market a Beef Steer."

Little has changed. A trickle of visitors is viewing the tables of wood carvings and canned peaches while crowds are to be found at the pole barn at the ends of the fairgrounds. The building's mooing sounds immediately attract Faith, so we walk there ourselves. Now I have to insert something here. Faith's word for breast feeding-- all kids who are old enough to talk about it have their own word for it-- and Faith's special word for breastfeeding is "nums," which she referred-- which, which refers both to the milk, the act of drinking the milk, and the breast itself. It's all kind of one thing, nums. What she notices first about, about the cows is their big poops. The next thing she notices is even more exciting, big nums, big big nums [laughter]. The goats are similarly equipped as are a couple of the sheep and soon she's checking out all of the animals for mammary glands. "Bunny nums?" she asked as we perused the ribbon-adorned route [?] of hutches. I assure her that mommy rabbits do have them but they're very small. "Chicken nums?" she asked at the poultry display. I hesitate, then launch into a quick discussion of vertebrate

taxonomy introducing the concept of mammals' she looks bewildered. Oh, I've explained too much. Meanwhile, the proud preadolescent owner of three champion hens asks if we want to feed them some crack corn. Faith watches silently as they frantically peck up the kernels. She finally says in a whisper, "no nums." We make another loop around the stalls where the large animals are quartered; suddenly she stops. "Mammals? she asked pointing at a brown Jersey named Daisy. "Mammal," she asked again, pointing at a calf. "Mammals," she enquires of the goats. Her eyes light up. marmion our cd players pointing at me and then in a moment of epiphany like Helen Keller learning the word water she looks down at her own shirt and then announces triumphantly to all within earshot "Faith a mammal! Faith a mammal!" Thanks a lot. [applause]

Sandra would be more than happy to answer questions. Go for it. [inaudible] [inaudible question] So, the question is, is there a length of time that would be a minimum for the benefits. [Sandra} No, I think the benefits go on and on with the most crucial benefits in the earliest weeks of pregnancy--of infancy. There's that first early milk that's called colostrum, and there's almost

no really calorie benefits in it. It's yellow in color 'cause it's got lots and lots of vitamin A in it and all kinds of immunoglobulins and white blood cells, and those decline as nursing progresses and then the sugars and the other part of breastmilk that's the nutritional requirements go up, but there's always some immune factors in breast milk. that never declines to zero. So for example, you can actually cure, in some cases, conjunctivitis, pinkeye, by squirting breast milk in the afflicted person's eye. I actually did this for my own daughter and found it to work even when antibiotic creams were not working, and when I-- it was especially recommended to me by a pediatrician, I should say, I didn't just somehow come up with this idea on my own but I did a little research on it, I'm an invetereate researcher about anything, and I found that the ancient Egyptian doctors used to recommend

grayson no Even an adult can be evidently helped by this, and some others claim you can actually help middle ear infections by the application of breast milk; that I can't vouch for, but the contamination of breast milk, of course, is a huge concern of mine, because the other truth about breast milk, besides all its great benefits that I told to you, is that it is the most contaminated human food on the planet, and that's because it exists one rung up on the human food chain higher than it's inferior pretender, infant formula, so breast fed children who are only breast fed six weeks as infants, when you measure their body burdens of PCBs as four and five year olds, they have many times the PCB body burden than those who are bottle fed. Breast fed kids, let me just personalize it, because of the biomagnification

that goes up the food chain, my son Elijah received every day forty to fifty times more dioxin than I do on a pound-for-pound basis because all the dioxin in the adult foods that I take in are concentrated one more time in my breast before I give it to him. And of course of the way we regulate toxic chemicals in this country it doesn't, it doesn't account for the nursing infant, so that's why a lot of women's breast milk would actually be illegal for sale if you actually bottled it and tried to sell it. You couldn't transport it across state lines because it's so contaminated. Now, remember the other thing I said about breast milk is also true, that even though it's so badly contaminated, breast fed children still out perform bottle-fed babies on every test of health, motor development, brain development, immune-- you know they can mount better antibody responses in response to vaccinations, so we've compromised breast milk but not so badly that it's a worse food than formula, so we still should breast feed, but

why should a breast feeding baby be filled up with toxic chemicals to, to, as the price to pay for these great benefits? I think breastfeeding should be a zero-risk activity, so I'm not interested in questions about breast versus bottle, I think all of us should be breastfeeding advocates. I'm interested in getting contaminants out of the environment and therefore out of women's breasts in the first place because women's breasts enjoy an exquisite communion with the outside environment; whatever's in the environment will find their way into the breast. I'll try to be brief. on and there you [unintelligible question] [Sandra] No, I don't take a look at that. There's a lot of things I don't look at in "Having Faith" because it's not intended to be this huge encyclopedia, it's primarily a story and what I do take a close look at is mercury found in fish,

which is actually a more toxic form of mercury than the elemental mercury that we have in our fillings, which does evaporate and enter our bloodstream, that's true, but methyl mercury in fish is a more potent neurological poison and that's because when elemental mercury from coal-burning power plants, which is the number one source of mercury in our environment, when their mercury goes into the atmosphere and then settles into the mucky bottoms of rivers and streams, these anaerobic bacteria called methylating bacteria combine the mercury with a molecule of carbon and thus, you get methyl mercury, and that is a poison many times more powerful than the stuff in our teeth. That finds its way up the food chain, so by the time we eat a salmon or a tuna or a swordfish, the concentration of methyl mercury in the flesh-- it does concentrate in muscles, you can't just trim the fat off and get rid of it. It's many many millions of times higher than the water the fish swim in, and

certainly, fish very high on the food chain like swordfish pose a known risk to fetal health when pregnant mothers eat those fish, so that's the biggest issue I take up in the book when it when I take up the issue of mercury. [unintelligible question] [unintelligible question] [Sandra] Well the venue that I chose for having the birth I think was the biggest change between Faith and Elijah. I did a lot of the research for the book "Having Faith" between my two pregnancies and I was actually in the process of writing "Having Faith" when I was revising the manuscript, so I think the book takes advantage of the fact that although it was written retrospectively, after the pregnancy was over, so that gave me the sort of perspective that one has in writing about something after it is over

but also because I was reexperiencing it again it also gives it the immediacy, and I actually corrected some things, like I felt-- once I was pregnant again I really had misrepresented the experience of having morning sickness, so I went back and revised that part, because I think I had only remembered certain parts of it, and in fact this picture of me on the cover, I was just pregnant with Elijah when it was taken, I was trying really hard not to throw up in this picture, and Faith was was actually really angry with me and had just pulled down her pants and ordered the photographer out of our house, so I don't know how he shot this very loving picture;[audience laughing] it's an example of how photographs don't really tell the truth, I think, but I think the big difference is I gave birth to Faith in a hospital, I gave birth to Elijah in a in a birth center and honest to God if I were to have a third child I would probably have it at home. [inaudible question] [Sandra] Well to the second question no I haven't not yet.

The question is about industry-sponsored criticism of my books, both present and past. As for "Living Downstream", essentially the story in a nutshell is it got a very bad review in the New England Journal of Medicine, and that was disappointing to me, because I admired the New England Journal very much, because I admire the New England Journal of Medicine very much and also the book had gotten very good reviews in all kinds of other medical journal, like the British Journal of Medicine, Nature, Scientific American, places like that, so when I read it was really really disappointing disappointing. One, it never mentioned the fact that I'm a biologist and have a Ph.D, it just says that I was somebody with cancer who felt very emotional about the disease and so it was hard to take. But what can an author do about a bad review? So I was willing to shove it off, and so I was actually doing grand rounds with physicians at the University of Vermont Medical School when a physician asked me to comment on that bad review, 'cause they all subscribe to the New England Journal,

and I said "what can an author do about a bad review?" and then they all kind of looked at each other and said "You haven't been reading your email, lately, have you, or reading the newspapers," and I actually I hadn't because I'd been on a long book tour at that point. Anyway, it turned out that the author of the bad review was the head of toxicology at the W.R. Grace Chemical Company, whose practices I actually criticize directly in the book, so my conflict of interest is more than just philosophical with him, and furthermore, the New England Journal didn't identify him as such anywhere in the review. He was just described as a medical doctor who had reviewed the book. And so, this was all in the papers as it turned out, because a physician with Physicians for Social Responsibility found out who Gerry Brook really was and some folks leaked it to the press and things like that, and so the story went around and around within the Providence, Rhode Island newspapers, it was in the Toronto papers it was even in the papers in London

and finally the New England Journal apologized in the pages of the Washington Post for having sent the book out to somebody that they claim at first they didn't know that he was affiliated with Grace and he claimed that they did know, so that part of the story isn't clear to me. If they knew and what they knew and when they knew and all that, but in light of that, the New England Journal did clarify its policies on conflict of interest and I think, I think the world's a better place for that and for the lesson it taught other medical journals. For me was a just a terribly stressful and kind of awful time. [inaudible question] [Sandra] Yeah, the question was about the Birth Defect Registry data with special attention on California, which I think has the best registry data, and whether people have gone ahead and used that data to make some links, and they have, actually, and I discuss them quite at length I think in chapter five

of that book. I think it shows that living near toxic waste sites, being exposed to certain kinds of chemicals during certain key points in development, and also with a special emphasis on pesticides, that there are provocative connections from that data that are corroborated by even more carefully, well designed studies that were conducted in Europe.