Protecting the First Environment: Ecological Threats to Women, Pregnancy and Breast Milk

So let's get started this morning. My name’s Cynthia Beim [?], I’m on the board directors for the AAMP and Lynn Patrick, um, is going to go ahead and introduce our speakers this morning and we’ll let her do that. [Patrick]: Good morning everybody, I hope you all had a great time at Walter’s birthday party last night, I know I did. Yay! [laughs] I’m on the speakers committee for the convention, and when we were try-, when we were planning this convention we were thinking about who could we try to get here who is unbelievably, um, good at being able to communicate not only the important information about, um, current environmental events, but who has an incredible amount of heart, and Sandra Steingraber was the person that we came up with. For those of you who have heard her speak before, she needs no introduction. For those of you who haven't, you're

in for a really great experience. Sandra Steingraber is an author. How many of you have read "Living Downstream"? So you, you know, you know who she is. She’s also written a book called "Having Faith", which is what is the topic she's gonna talk about today which is the environmental assault on the womb and the fetus, and what what young children who are coming into this world are being challenged with. There’s actually a woman here who has a three week old baby who just came up to me and said, "I read her book before I decided to have a child." She’s here with her beautiful 3 week-old child. So Sandra Steingraber is a poet, an ecologist, an environmental activist; she's a mother. She currently is on the faculty at the Cornell University’s Center for the Environment. She has won numerous awards; she's 1997, um, Ms. Woman of the Year, Ms. Magazine’s Woman of the Year. She's an inter- internationally recognized expert on cancer and the environment. She has addressed

the UN delegates in Geneva on dioxin in breast milk. She’s been present at international treaty negotiations. She’s won numerous awards for scientific writing and the poetic use in, of language in science writing, and she's, uh, she's an advocate for all of us. We also want to welcome the public here. e decided we would open up this talk for the public so we contacted the Organ Toxics Alliance and Rachel’s Friends, 2 organizations that advocate for, um, human rights in the area the environment so they're here today also; we want to thank them for helping us get the word out. So if you haven't read this book, "Having Faith", I encourage you to read it for 2 reasons. One is because its the most accurate information about the environment and the fetus and the newborn child and women in general you know if you have

any female patients you should read this book. Um, but also because it's incredibly beautiful in its, um, poetry. I love her writing because she's so poetic and speaks so much from her heart. So, without further ado, let's welcome Sandra Steingraber. [applause] [Steingraber]: Well, good morning. It’s a real honor to be here, and I know whenever speakers are flown across state lines, uh, a lot of work has to go on behind the scenes to make that happen so thanks to all the organizers. This goes over here, ok. It’s like a little shower hat for the microphone, I guess. Um, and I’m especially pleased to have 3 week-old Parker in the audience, what a blessing, um, and I just wanna say now that I've, I, as the mother of an almost 5 year-old and an almost 2 year-old, I’m really good at

focusing throughout any baby sound, so, um, I, uh, if, and, and, and it's it's a life skill we should all practice so if Parker makes any noises we’re just gonna keep talking and he's gonna stay in the room with us. Otherwise, mothers never get to go anywhere in public. [applause] Well, I became a cancer patient at the age of 20 and a mother on the brink of 40, which i know is not the usual order that most people, um, live their lives but that's how it happened to me and those of you who are familiar with "Living Downstream," um, will recall that my own experience with bladder cancer, uh, when I was in college, which is considered a quintessential environmental cancer, meaning that we know more about the environmental links to bladder cancer than we do about almost any other kind of, uh, cancer. Um, that experience led me, 15 years later, as a, uh, biologist in residence at Harvard to go back to my hometown and begin, uh, an environmental

detective project there, um, uncovering, um, what kind of toxic wastes were, um, being imported and dumped in the local metro landfill near the house that my father built, where I grew up. What kind of solvents were in the drinking water wells, um, what kind of pesticides were being used in the corn and soybean agricultures in the downstate Illinois, um, county in which I grew up, and my personal discovery, um, relearning my hometown, which I thought I knew like the back of my hand, and seeing it as a different kind of landscape. That became the, uh, the leaping off point for a much larger discussion about the links between our environmental contaminants on the one hand and rising cancer rates on the other hand, um, so the book really became 2 books in 1. It, it was, represents my best attempt as a biologist to summarize all the links between environmental carcinogens and different kinds of cancers, um, and for that piece of it, because I was at Harvard I had access, of course, to the best medical library in the world and I had 7 research assistants

help me with that, but the other, um, after 2 years at Harvard I really did go back to Illinois and live there again and so this story, the, the narrative that drives the book is really a very intimate story of my return back home to relearn, um, my hometown again. Um, that book became an odyssey on its own, um, it went into a second and then a third printing. It came out in paperback, it came out in England, it came out in Japan and Ireland, and I ended up touring all around the world with it, um, and, uh, I was, you know, I began what was supposed to be the requisite 2 week book tour and almost two years later I was still traveling with the book, which was, um, very gratifying as an author, but it also meant to me that a question that was on my mind was also on the minds of a lot of different people, because I didn't just speak at, you know, on the Today Show and Barnes and Noble and do grand rounds with physicians. I did all those things but I also got invited to speak in church basements with Montana farmers worried about the herbicides that they're using

in their wheat fields, I got to speak with Irish sheep farmers worried about the insecticidal sheep dips they were contaminating their drinking water wells. I was able to speak with um, native women in northern Alaska who were concerned about breast milk contamination from the military, old military sites left over from World War II, which were contaminating the, the fish, uh, in, in presumably very pristine parts of Alaska. So, um, after all that I finally had to, uh, get off the road very abruptly when I went into labor with my daughter, um, in fact i gave my last radio interview sitting in a towel because my water had already broken piano and I had to cancel a lecture that night to go in to the hospital and have my daughter, Faith. And my experience with my pregnancy then became another odyssey, um, all on its own and it led me to write the book out of which I’m going to talk today, "Having Faith", named after my daughter, and, um, for this, uh, the science became even more

intimate than "Living Downstream", um, not, um not, um not- in, in the the sense that it wasn't a place anymore that was my study site. Um, it seems strange enough to turn my scientist’s eye inward and go back to my hometown an- and sit and try to do science in that setting, but now my own body was my study site. So, in fact, it was with this great astonishment when I first did the home pregnancy test and saw the 2 little lines, you know, left on that, uh, plastic wand, they call it; I always think that's interesting that they call it the wand, you know, the little, uh, stick that you pee on that the, uh, the human gonadotropic antibodies, or the antigens turn the monoclonal antibodies embedded in that plastic stick; uh, there's a color agent in there, right, so that’s how the whole mechanism works, and my first response to seeing two lavender lines in the positive pregnancy kit was “You know, my God, after 20 years of being an ecologist and studying the interactions between organisms and the environments they inhabit; now i myself

I’m a habitat," and I’m not the first woman to have that epiphany. In fact it was the midwife Katsy [?] Cook, who’s a Mohawk native in, in my home state of New York, um, my sort of adopted state; that’s where I live now, who had said that women's bodies are the first environment for all of us. So, um, my experience with my pregnancy and, uh, this symbiotic relationship of breastfeeding between my daughter and me led me to, um, to go to Cornell for 4 years and study, uh, fetal toxicology and really understand what the links are between some of the same chemicals I learned about as carcinogens. What happens when those chemicals trespass, uh, into the uterus either through the amniotic fluid or th-, across the placenta, what happens when they get into the milk-making lobules in the back of a woman’s chest wall and thereby create the first, um, toxic exposures, um, that a woman, uh, that, and her fetus, the fetus in the woman confronts, um, and my suspicion

was that, the health threats created by those exposures at the beginning of life, as the human body is just getting assembled, probably create not just quantitatively greater risks than similar levels of exposure later on in adulthood but probably unique, uh, threats, because there's an unfolding of various physiologic and anatomical processes that happen only at one critical moment of time and then don't come again. Um, so, in my studies, you know, I was o-, um very acutely aware of certain things such as that the blood-brain barrier, which actually works pretty well at keeping neurological toxins that might be cycling around in our bloodstream from entering the gray matter of our brain. The blood-brain barrier isn’t completely formed until at least six months of age and probably longer, so that tiny, tiny exposures to neurological poisons like insecticide residues prior to six months of life form disproportionately greater risks to the brain than, um,

even a much larger exposure, um, after that point in time, so these critical windows of exposure, um, for various kinds of substances became then, um the place where I cast my net. So, I want to talk a little bit about the science of that and then I’ll close, um, with a reading from a more intimate part of the book and then, uh, hopefully there’ll be a little time to tell you about some of the new research I'm, I’m interested in now on what I’m, what I'm gonna do next. Um, the first thing I wanna do is just kind of review together with you the kind of major events of a human pregnancy which I’m sure are, um, even more familiar to a-, to my, my audience today than, than to me, um, but I always find it kind of instructive for myself just to step back and, um, take a look at the major events of human pregnancy then rewind the tape and go back and take a look at what happens when we introduce toxics a certain key points in development. So just to kind of remind us all here about the basic birds and bees of the whole thing, um,

I should say here I’m pretty good at the birds and bees talk apparently because when my, um, son was born 2 years ago my daughter was 2 and a half and I wanted her to be present at the birth, so I had to do some, um, preparation, um, for her, and 1 day about a week before Elijah was born, we were playing TinkerToys on the floor together, and she announced she wanted to make a daddy out of TinkerToys and would I help her and I said sure. What do we need to make a daddy? Thinking head, arms, feet, things like that, and she said, “We need a penis, some sperm, and some testicles.” [laughter] So let's start with those sperm. [laughter] When a sperm and egg find each other in the upper reaches of the fallopian tube it takes about, um, a- it takes about a week actually for that little gondola boat to float down into the delta of the uterus and implant itself, and, um implantation then takes place when, um, about f-,

well, the way midwives and obstetricians date a pregnancy, between four, week 4 and 5 of a pregnancy, which is an odd, um, an odd way of marking time and it, it was actually confusing to me as a pregnant woman because my familiarity with this, this whole story comes through embryology. Now, of course, embryologist mark the beginning of the story with conception, in which case human gestation is 38 weeks long, but because the timing of conception isn't usually known to the woman herself, um, it’s easier for those in, who work in the practical clinical aspect of, of pregnancy, who are actually going to be delivering the babies, to ask a woman when her last period started and then date the pregnancy from that point, even though that's 2 weeks before the egg and the sperm ever got together. But because we're all so used to the, um, midwifery and obstetrical calendar I’m going to use that one t-, to mark time here. So, at week 4 to 5 of, of, um, pregnancy then implantation happens, um, which is to say it happens about a week after fertilization

happens and we, a fertilization of course happens t-, two weeks, usually, after the p-, uh, the first day of a menstrual cycle. And, um, the process of implantation is really governed by a whole series of chemical messages, a cascade of messages, because essentially what has to happen is this, um, now we call it a morula, right, which is m-, me-, Latin for mulberry, it’s a 58, uh, cell ball that has to then, um, send long siphoning tubes into the endometrial lining of the uterus and pull itself under the endometrial lining, which will grow back over the morula, so that the whole thing is really buried, um, in the endometrial lining. Then, during the process of implantation, those long, siphoning tubes have, uh, uh, send out enzymes to the very tips of the tubes and break open the spiral arteries that snake through the uterus, and these spiral arteries really turn into geysers that are just um, spurting blood into these, into like a little, uh, bloody lagoon, so that life really does begin in a pool of blood and it's

this, um, uh, blood from the broken spiral arteries that are, is gonna provide the nurturing of the morula until the placenta and umbilical cord and the whole life support system can get itself set up. [clears throat] And, and so that whole story then, the, uh, burial of the morula, the breaking open of the spiral arteries, that these siphoning tubes which are the, proto-, uh pro, become the prototype of the placenta, um, all that is under this kind of exquisite, uh, control, not so much a classic endocrine control but the creation of a para-hormonal mechanisms by which chemical messages are sent out from 1 part of the embryo, received by another cell, certain genes are turned on, other proteins and other chemical messengers are manufactured and sent out, received by neighboring cells, et cetera, so you can imagine that and the introduction of any, um, kind of chemical at this point could, um, interfere with process of implantation, leading to

risk of miscarriage, but w-, we'll get to that part of the story in a second. At about week 5 of pregnancy, um, that the im-, period implantation is over, meaning that the life support system of the, um, of the embryo has all been established so the human form hasn’t at all begun to take, uh, shape yet; the first thing that has to happen is the establishment of the extra-embryonic membranes on the allantoic sack and the amnion and the chorion, and all these other things, um, so that's all happens first. Then, organogenesis begins at about week 5 of pregnancy, so at this point a woman has probably noticed her period is about a week late, um, and continues up until about week 10 of pregnancy. So, in those 5 weeks then the, the um, entire human body takes shape, and so the, uh, at the end of week 10, you have a complete little human being the size of a paper clip, um, already inside the uterus. Then the rest of pregnancy really represents the, uh, growth and development of all those parts that have already been created so weeks

11 through 40 are all, uh, are all, the, the hallmark of that is all growth and development. Um, and then, of course, uh, the dramatic events of labor and delivery which I’m going to skip over, um, for a moment, and we’ll come back to those at the very end, um, and then commences this kind of remarkable period, which I’m sure you all know about, but which was sort of news to me as a new mother, a period of about 2 days in which the newborn is really living on air; um, the placenta has been ejected and the um, symbiotic relationship between mother and child has been broken, and yet th- um, it takes between 48 hours and 5 days for all of the, um, blood supply which had, has increased by 50 fold to go to the uterus to be rerouted up to the breasts, and, and the-, so that we say that the mother experiences that as her milk coming in, and then the symbiotic relationship is reestablished as the breast takes over from the placenta the job of nurturing the child and guiding its development, um, because there is a lot of growth factors and things in breast milk, just as there are in umbilical cord blood, um, but there's about a

2 day period of time where the um, the infant is really just living all by itself. t's born, a full term infant is born with enough water and nutrients to last it about 7 days, which is why whenever you hear the stories of, uh, earthquakes that bury people then they're pulled out alive seven days later, uh, it’s often a newborn, because they do better than e-, children or adults do, since evolution has provided them this mechanism for just kind of living on their own for a while. Uh, OK, so that's bas-, the basic story, now I’m gonna create a kind of conceptual framework for you and then we'll go back and rewind the tape, and take a look at those different critical windows of, of vulnerability. Here’s the, here's the kind of conceptual basis of the book "Having Faith": the old idea about fetal toxicology, um, dates back to Paracelsus, the medieval monk who coined the term “the dose makes the poison,” and what he was really referring to when he said that, um, was mercury, um, el- elemental mercury, uh, which at that time he was proposing

as a treatment for syphilis, and he noticed that a little bit seemed to be curative, which it really wasn't, but um, that’s where [sic] his observations, whereas a large amount could kill, um, kill a patient, so the idea that the dose makes the poison then became the kind of paradigm in toxicology that remains today. But what seems to be happening, and especially with pediatric toxicology and fetal toxicology, is that the new science is really mounting a challenge to that old medieval idea, and the new science, what it’s really showing us is that the timing makes a poison as, as much as the dose. So, there are, in other words, critical windows of vulnerability in human development, um, during which time we're exquisitely vulnerable to tiny, trace, vanishingly small amounts of toxic exposures, which create disproportionately large threats, either immediate or delayed, um, and uh, and the reason I think this mounts an incredible challenge, both philosophically and on kind of a practical way, is because

historically we have always set the so-called safe threshold levels for toxic exposures to be safe for the average hundred and fifty pound adult, um, and when we do that we're really not offering equal protection under the law for, uh, fetuses, embryos, and newborns, um, and it also turns out that there are other windows of vulnerability throughout a human life, is not just pre natal stuff on it seems that our adolescence is another time when the body is undergoing a huge amount of growth and development, um, hormonal changes are radically, uh ,uh, changing the, um, what's happening inside the body; there's a lot of DNA that's, um, that's in its uncoiled um, active form with a lot of cell division going on, and tiny exposures to certain, especially hormone-mimicking chemicals, at, at, during the period of puberty and adolescence, also appears to be, um, a window of time that we really need to be concerned about.

For example, when a girl's breast buds are just starting to develop, and you have a lot of, um, deposition of fat under the nipple, which is being directed by estrogen, and also a lot of the differentiation and growth of the, um, ducts of the breast, which eventually will, you know, be the conduits which, down which the, um, breast milk will flow, um, the, the milk-making apparatus of the breast doesn't actually develop until a first full-term pregnancy, but those ducts have to branch and differentiate to get ready; that happens during adolescence, um, and certainly, um, exposure to things like ionizing radiation during a period, the period of breast development in adolescence. Um, we, we have uh, quite a bit of evidence to suggest that that creates a much larger risk than the same dose of ionizing radiation, let's say in the form of a medical x-ray, um, not only when the girl is, um, older but also when she's younger, so it's not as though we just get, um, more and more resistant to toxic exposures the older we get, so a 6 year old or a 7 year

old girl, um, it's probably safer for her to have a dose of ionizing radiation for the chest than her 11 or 12 year old sister, and safer again, um, by the time breasts are finished developing, um, in, uh, in the mid-thirties. Which is a, something, a detail I guess I should mention, the breast actually continues its development in a very leisurely fashion during the yin and yang of the menstrual cycle, um, there, uh, the ducts continue to differentiate until a woman has in her mid-thirties, unless of course she has a pregnancy, uh, first in which case there is rapid differentiation and growth of, uh, breast tissue that happens during that time, but, uh, we women like to think that our breasts are done forming when we don't n-, notice that they're getting any larger when we're teenagers. That usually happens at about 16 or 17 or so, but in fact the differentiation and growth of those ducts go on each month during the luteal cycle, the luteal part of the menstrual cycle, all the way up through, um, a woman's mid-thirties. Alright, so let’s go back to

the fetus then. The, the um, emerging, um, evidence has been shaped into a kind of working hypothesis, now called the Barker hypothesis, named after an epidemiologist in England, David Barker, um, which says that there, um, there is a kind of fetal programming that goes on during pregnancy, um, and, um, the events of pregnancy shape the body in such a way to make it resistant, or predispose it, to later in life kind of events. And Barker's, uh, he himself does not look at toxic exposures, he's mostly interested in nutritional, the nutritional, um, profile of fetuses, and what it means for those, uh, individuals as they go through their lives. And he was able to painstakingly reconstruct tens of thousands of, um, medical records of folks born between 1911 and 1930 in the UK, um, got copies of their mother's, um,

prenatal, uh, records and the birth certificates which had birth weight and other, um, vital statistics on it, and then follow the health of each of those. I think they were almost like 16,000 individuals through their lives, and was able to demonstrate that babies who were born too small, meaning that they were, um, not premature, they were full term babies, but they were less than 5.5 pounds, and, and they were small because of nutritional problems during pregnancy, that those babies, um, grew into adults, who late in life, had significantly higher risks for things like cardiovascular disease, stroke, diabetes, um, and even prostate and breast cancer. And he was further able to demonstrate, using animal models, that, h- how, what the mechanism of those, of those correlations might actually be. And it turns out that when a fetus is nutritionally stressed, um,

the, uh, the blood flow of the fetus disproportionately goes to the brain; that's a good mechanism to protect the developing brain and, uh, during a, a p-, a period of, uh, fetal growth, um and, uh, and when n-, when nutrition is not adequate. So more blood goes to the brain when nutrition and calories are, are s-, are um, at, are limiting and, uh, less blood flow goes to the trunk, and if this happens during the critical window of time, when elastin deposition takes place, elastin is the protein that makes our arteries, uh, stretchy, um then, and, and the great arteries of the heart are all forming at that time, of course, ear-, very early in pregnancy, um, then there won't be as much elastin deposited in the arteries, um, because there's just not that much blood flow going through the trunk, and so those individuals are born with less stretchy arteries as newborns and they, that's a characteristic then they carry with them through life,

and of course having more rigid blood vessels places you at higher risk for things like stroke and cardiovascular problems. Um, furthermore, and for reasons he's not yet completely elucidated, um, the redistribution of blood flow to the fetal brain and away from the trunk during that critical time when the whole cardiovascular system is giving itself set up, causes the resting pulse rate to be set higher than it otherwise would, and a-, of course a higher resting pulse rate is also, um, a, um, a risk factor for certain kind of cardiovascular um, diseases and things like that. He’s also worked out mechanisms by which, t-, t-, to demonstrate how diabetes can also be, um, create uh, [sic] risk for diabetes can also go up during times of nutritional stress at particular points in pregnancy, so he was able to actually, um, demonstrate when during the pregnancy there wasn't sufficient food going to the mother and then when food became available again, so it’s quite elegant work, and he's been able to replicate

some of his findings in animals. So what I and other toxicological epidemiologist types are interested in is the application of the Barker hypothesis not just to nutritional status but to toxic exposures, and, so let's take a look then, let’s like I said rewind the tape and take a look at some of these windows of vulnerability and how this fetal programming might work. This story actually starts even before conception; we know that arm for example that women who smoke go into to menopause on average one or two years sooner than women who don't, and we now understand the mechanism by which this happens. Benzoapyrene in tobacco smoke actually causes eggs in the ovary to commit program cell suicide, apoptosis, so that a woman who's a smoker runs out of fertile, her fertility ends sooner because she runs out of viable eggs sooner; she shortens her fertile lifespan through that mechanism.

We’ve known that actually for quite some time; what researchers are now interested in is to ask, well ghee , benzoapyrene is also an ambient air pollutant caused by coal burning power plants and diesel exhaust and things like that; is it possible that women who are non-smokers but who are living in urban areas who have background levels of benzoapyrene that are significant, if we're seeing some of the same effects. So we're now we’re taking a look at human populations where there's a lot of benzoapyrene in the air to see what we can find, and we don't have answers yet from those studies. We do know that laboratory animals rodents grown in cages in which air pollution is, that they’re exposed to air pollution at levels mimicking levels of benzoapyrene in urban areas that we can actually, we can actually shorten fertile life span in those rodents in a very similar way as we see in smoking women. Sperm also is, are vulnerable. We know that men with

occupational exposures to things like kerosene and diesel fumes, their children have as much as ten times the risk for certain pediatric cancers than men of similar socioeconomic background but without such exposures. Again, these are preconception exposures now, and the particular cancer that we have the most evidence for with paternal preconception exposure is neuroblastoma, and we don't quite know the mechanism by which this happens, whether or not it's the semen itself that’s simply serving as the, as the vehicle by which toxic chemicals are carried into the uterus, or, more likely, there's been some kind of DNA damage in the sperm that, the sperm that does fertilize the egg, so that all of the the cells of that developing fetus carry some kind of genetic damage that predisposes it to neuroblastoma later on in life.

We don’t know if those exposures are sufficient or simply predisposing and that some later kind of exposure or some later event comes along and works in an interactive way with the earlier exposure, and again that research is still going on. Let’s go, let's go on though and assume that fertilization does take place; then we’re at that that critical window called implantation and here is where we get concerned about spontaneous abortion. We have pretty good evidence demonstrating that there's a link between solvent exposure and early miscarriage and spontaneous abortion. The problem with trying to document a lot of this stuff is that we don't have registries for miscarriages in the United States and because of the advent of home pregnancy test kits, women have radically altered the way they learn about their pregnancies over the last twenty years, and continue to alter them the better and more sophisticated these tests get. Certainly, even in the less than three years between my two kids the home

pregnancy test kits got so much better that I was able to find out I was pregnant with Elijah before i'd even missed a period; you can do it I think as close as twenty six days after your last menstrual cycle now. And, so what would have been thought of as simply a late period in an earlier time is now known by a woman to be an early miscarriage and she experiences it that way. So The anecdotal evidence of a rise of miscarriages is a little bit suspect because of that. On the other hand we have some pretty good evidence from studies in labor unions and uh workplaces that certainly occupational exposure to solvents seems to create risks for a miscarriage. After implantation takes place, then, between weeks five and ten of course is that period we call organogenesis and here is where we worry about physical malformations because this is when the human body is actually being assembled, so birth defects then are, this is the window of time that that will take place. We do have a birth defect registry in the

United States; I took a look at that data; they're not, these registries are not nearly as good as the cancer registry. You might know that Congress in 1992 mandated that we have a national cancer registry. There is no such mandate for keeping records on birth defects. It turns out that only about a third of all states keep records on birth defects and of that third only about ten states have records good enough that I felt comfortable taking a look at the data. In other words if the ascertainment in the way it’s collected is a trust, is trustworthy. And it's tricky; I mean you might think that a birth defect is the easier thing than cancer. After all, a pregnancy’s only nine months; cancers can take decades to develop but there's a couple of problems. One is that not all birth defects are evident in the delivery room, especially cardiac birth defects may not be apparent until the child is a little bit older and more active, maybe as old as a year old. So unless, if you're only basing a birth defect registry on vital statistics that come out of birth defect data, you’re only

gonna be hitting things that are like cleft palate, missing limbs, maybe hypospadias and undescended testicles but those are, tend to be very underreported as well, and all of the kind of internal malformations aren’t gonna be, you’re gonna miss those. Also, because of prenatal testing a lot of severely malformed fetuses are quietly aborted before they ever reach term and if our birth defects registries are only based on live births, we may believe we see a falling trend in some serious birth defects when actually those babies, because of the availability of ultrasound and therapeutic abortion, are simply not being born, so we're not really measuring real incidence rate by looking at the kind of prevalence. The most wretched birth defect is probably anencephaly, which takes place very early on in organogenesis when the neural tube rolls up, you know it's a flat piece of tissue and it rolls up like a piece of carpet to form the neural tube.

If the end of that tube doesn’t completely form, then your baby will be missing everything from the jaw on up, both skull and brain material, and of course that all, the defect, actually the origin of the defect has to happen very early on, probably right around week between five and six in pregnancy, and then the brain actually goes through this big spurt of brain growth development in months five and six of pregnancy as well into the second trimester but if those structures were never formed then there's nothing to grow and develop, so by the second trimester then it doesn't take a very sophisticated ultrasound to see if the baby's missing a head and that is of course is a fatal birth defect and actually creates a great risk to the woman who chooses to carry a baby to term with this birth defect because as you all know the fetal skull plays a really important role in labor and delivery, and without a fully formed skull that is, it's a big risk to the mother, and so we believe just through anecdotal information and at least eighty percent of women who receive a diagnosis

of anencephaly choose to terminate the pregnancy. And when you look at the birth defect registries most of which are based on vital statistics what you see is a falling, falling incidence rate of anencephaly in the United States, but I don't trust those data at all. When you take a look at the European data, in which birth defects that are discovered during pregnancy become part of the registry you actually see that anencephaly in parts of Europe is rising, and I suspect that we have a tandem trend here, it's just not showing up, it's just not showing up because of our blindness to the reality of abortion. We do have some evidence nevertheless showing links between pesticides and birth defects; let me talk a little bit about this. I took a really close look at the European birth defect registry just because they are so much superior to ours, and the data are pretty clear there. Women who work in farming, in nurseries, or in greenhouses have higher

risk for certain kinds of birth defects in their children and yet they're the same kind of birth defect that you see over and over again, certain kind of cardiac birth defects, cleft palates, and limb reduction deficits are among those, also undescended testicles. Those are things you see over and over again in the European data. California is probably the best, has the best birth defect registry in the United States and when you take a look at those data you see that the closer a woman lives to a farm field in which pesticides are sprayed, the higher her risk for stillbirth due to birth defects, and because there’s this kind of a dose response line that is pretty linear, it looks pretty good, we put a lot of trust in those data, so the highest, if you're a woman in California who's pregnant during an, and you live less than one mile from a farm field that’s being sprayed with pesticides during your first trimester of pregnancy, you’re at highest risk for stillbirth stillbirth due to birth defects. And in Minnesota there’s some elegant data showing that

there is a east to west gradient of birth defects in that state, so in the eastern part of the state, which is a more urban, less agricultural area they have the lowest rate of birth defects. The farther west you go, the more agricultural it gets, the rate of birth defects rises and what's interesting there is that there's a difference between those who live in farming areas and those who are actually employed in farming areas so that your risk is lowest if your family lives in an urban area away from agriculture; it’s next highest if you live in an agricultural area but you aren’t so employed, and it’s highest of all if the family lives on a farm and practices farming. Moreover, of those families who live on farms there's a seasonality to the data such that kids who are born in the winter whose conceptions correspond to the spring months of planting and pesticide use have the highest rates of birth defects of all, and kids whose birthdays fall at other points in the calendar year year have lower rates, and you see this year after year, this seasonality. And We also now have corroborating data coming in from Iowa to help back some of that up, and the the birth

defects that we see over and over again in these cases are limb reduction deficits. I wanna say a few words about birth, and I keep saying I’m going to come back to it; I promise I will, I don’t wanna skip over that sort of whole big miracle, but just a couple words on it now. The timing of birth itself can, can be a function of environmental exposures; we know that certain organochlorines such as PCBs and DDT have the power to trigger pre-term labor, which is done at still at epidemic levels in the U.S. for reasons that it’s officially declared a medical mystery, and even in women who should be at low risk for pre-term birth we see very stubbornly high levels going on. We know with PCBs that the exposure doesn't even have to cross the placenta, that the PCBs themselves can get into the muscle fibers of the uterus and alter the way calcium flows into the calcium channels of the muscle, altering, you know that there's, when in late pregnancy

as those muscles fibers get more and more and more stretched, and the balance of progesterone and estrogen until labor actually actively kicks in and the balances tip, their supposed to be, well, their muscles aren’t supposed to contract, they’re supposed to stay in this stretchy, quiet form. What PCBs do is they alter the white calcium flows and increase the contractibility of the muscle fibers themselves. We know that women who are exposed to the PCBs on the job have, are at high risk for pre-term labor, we know there are rats exposed to PCBs in late gestation can be induced to have pre-term labor, and we know that we can actually make rat uterine tissue start to contract in petri dishes through the application of trace amounts of PCB, and can actually see the way the calcium is altered, calcium flow is altered in those muscles. I guess I’ll say one more word about the small for date stuff. We, we took a look at the way tobacco smoke affects

eggs in the uterus and talked about how it can shorten fertile lifespan; tobacco smoke can also create smaller babies; you probably are all aware of this data, babies born to smoking women on average are about half a pound lighter at birth then babies born to nonsmoking women. We know a little bit about the mechanism by which this happens now, um, smoke actually, this benzoapyrene actually sabotages the protein transport mechanism inside the placenta; proteins have to be taken apart into and broken down into their constituent amino acids to cross the placenta and they’re rebuilt on the other side before they go into the umbilical cord blood, and benzoapyrene can interfere with that mechanism such that less protein is actually getting across the placenta and babies are simply born smaller when they're exposed to lots of benzoapyrene. So again, we’re interested to know whether or not ambient levels of air pollution as well as active tobacco smoke and smoking women can cause small for date infants.

Being born small is not a good thing; it puts you at high risk for sudden infant death syndrome, learning disabilities, and all the other things we we already mentioned that David Barker in England figured out, cardiovascular problems, diabetes, and things like that. Alright, so then I’ll talk a bit about breast milk and then I’m gonna stop and read for you and then we can have a discussion. I always hesitate when I get to this part of my talk, and I had a lot of trepidation when "Having Faith" first came out because as I was writing the three chapters on breast milk and wanted to begin a public conversation about breast milk contamination, I started getting all kinds of warning letters, especially from Laleche League leaders and the midwifery community. I really had to think hard about whether I wanted to even raise this topic or not, and a lot of smart people told me stories of what happened in the past every time a headline comes got into the newspaper about a new chemical contaminant found in breast milk, that women

flood lactation consultants telephone answering machine saying you know, I’m gonna wean my baby, why didn't you tell me that breast milk is poisoned, etc., etc. and that women go back to formula when they see these kind of headlines. I wanted to write about breast milk contamination from a pro-breastfeeding perspective and it felt like a little bit of a high-wire act. Fortunately, my son had the good sense to be born three weeks before I went on the book tour for "Having Faith", and so I used him as my audio visual aid during the earlier months, so that whenever I talk about breast milk contamination and if any of you saw me read at Powell’s, that was definitely an example. I always nursed my son, and whenever I gave a news conference or did an interview with the media I always nursed him so that my words could never be taken out of context [applause]. It’s kind of a public art form, I guess. My sister kinda pointed out, you know, there you are on Time

Magazine, your shirt unbuttoned, and there you are on the Bill Meyers show, your blouse is unbuttoned, and they're and so all the pictures of me from that year, I’m kind of half dressed, and, but I think, I think it worked because I wanted to make clear, I wanted to be able to say two things that are both true, and I wanted whoever wrote about me or, or talked about me saying these things to say both halves of the sentence, of not just one half. So I never wanted to wake up in the morning and after I give a public presentation and see a headline that said something like “Cornell prof says mother’s milk poisoned.” And so, here are the two true things, I think. The first is that their mother’s milk is absolutely the best food for human infants and there is no substitute for that; mother's milk is not just nutrition for infants, it’s alive. It has, of course, as everyone knows antibodies in it, but it also has living white blood cells in and immunoglobulins that come right from my blood and go

into the milk-making lobules of my breast that are passed right into the breast milk, and in that sense, biologically speaking, the act of breastfeeding is a more intimate act than pregnancy because after all in pregnancy there is no transfer of blood from mother to child but in breastfeeding there actually is, so that every disease that I’ve ever had, including the ones that I’d been vaccinated for as a child, are those memory cells which are held in the Peyer’s patches of my intestine actually migrate into the breast and begin secreting antibodies, and living and living immunoglobulins into the breast milk so that my child ends up being protected from everything that I’ve managed to fend off during my lifetime until its own immune system can get set up, but it goes beyond that. There are also growth factors in breast milk that help guide the development of the baby, and this is the piece that I don't think the public really understands very well when they try to compare well formula, OK, maybe it's enough, it doesn't

have the antibodies but it seems to work, but what they forget is that there are these growth factors that are intended as food, but they are intended to continue the development of the child, they help the gut mature in a way that can help distinguish between you know, the gut, it's tricky to be a gut because you have to allow nutrients through but recognize pathogens, so you have to be both permeable and this big fortress, and the ability to do that comes with experience and the breast milk helps guide that through these growth factors and through essentially fertilizer for good bacteria that colonize the gut, so you don’t have a lot of putrefying bacteria and those bacteria themselves turn on and turn off certain genetic switches in the gut wall. There are other growth factors that actually go to, are permeable through the got wall, go into the bloodstream and turn on and turn off certain genes in the immune system to get the immune system started.

All mammals are born immune-incompetent, and it's part of the job of breast milk not only to provide temporary immunity but to provide these growth factors to start the immune system going, so that we know that infants en who are breastfed grow into children, adolescents, and adults who are at lower risk for all kinds of different autoimmune problems, so it's not just that kids have revved-up immune systems, breast milk modulates the immune system so it's not overly active, so that if you’re breast-fed as a child, you're at lower risk for juvenile diabetes, juvenile arthritis, our obesity what's the, um, Crohn's disease, that’s what I’m trying to think of, and all kinds of other autoimmune problems. There are other growth factors in breast milk actually go right into the brain itself and help continue to guide all those dendritic connections that are being made as the whole brain continues to get wired together up until the age of three, which is why the World Health Organization officially recommends that

mothers breastfeed for at least two full years; the American association of Pediatrics recommends breastfeeding for one full year, and in spite of those recommendations, the amount of women in the United States who actually make it to one year barely registers a statistic, and part of the reason for that is the absolutely unconscionable, deceitful marketing practices of the formula companies. The other reason is the lack of ability of our own government to provide paid maternity leave for women. Breastfeeding is the easiest thing to do in the world but you have to have your baby with you to do it, and if women have to go back to work and warehouse their baby miles away in a day care center that's in buyout relationship becomes tough to maintain and it is hard, and when you take a look at the worldwide statistics on breastfeeding, you see that on the average duration of breastfeeding closely corresponds to paid maternity leave, so that in Norway, where women get ten months of paid maternity leave, the average length of breastfeeding

is nine months, and in the United States, where we don't offer any paid maternity leave and offer unpaid maternity leave of six weeks to eight weeks,you see that six weeks is about the point where most women, if they start at all, give up on it. So how then in this in this world in which we don't offer women and children paid maternity leave to be together, and when we allow formula companies in violation of international law to advertise and promote their products directly to pregnant women, how can I have a public conversation about breast milk contamination? That was the questions that were raised to me by very wise people through as I was writing the book. And, so I decided that all those wonderful things about breast milk, I would say first both in speech and in writing, so they became clear to my audience that there is no substitute for mother’s milk, that mother's milk is a human right for infants to have [applause], and then I would say that

and from that point I would say that and yet mother's milk has now become the most contaminated human food on the planet, and that's [i.e. that] an answer to solving the problem is not to encourage women to go back to bottles but recognizing the unsubstituteability and the superiority of breast milk means that we have to get these chemicals out of the environment and therefore out of women's breasts in the first place, so that mothers and babies can safely enjoy their rights under the International Convention for the Rights of the Child to [i.e. the] right to their mother’s own milk and the right to untoxified, safe, and unpoisoned food, and that’s where we need to get to [applause]. Some of the contaminants, common contaminants found in breast milk include termite poisons, DDT,

gasoline vapors, brominated flame retardants from computers and sofa cushions; that's actually the most hot, quickly, most swiftly rising contaminant in breast milk right now; PCBs, dioxins which come from garbage incineration, all these things would be kind of on the top ten list of most prevalent breast milk contamination in the developed world. And many women have breast milk contamination at such levels that the FDA would not, if if this were commodity to be bottled and sold, the FDA would not allow it to be transported across state lines because it violates levels of chemicals, of deleterious substances allowable in human food. And I want to say one other thing about this because you have to kind of think like an ecologist to understand why breast milk is so much more contaminated than all the rest of the food we eat. Remember that breastfeeding infants eat one rung higher on the human food chain than we adults do. A lot of

the chemical contaminants we worry in our food bioaccumulate as they move up the food chain and we humans like to think of ourselves as at the top of the food chain in many instenses we are, but it's not human adults that are at the top, it's our nursing infants, so that the breasts of mothers have one more chance to concentrate all the poisons, the pesticide residues, the DDT, the dioxins and the PCBs and the flame retardants that might be in foods like milk, eggs, meat, fish, on vegetables, things that come into my diet are concentrated one more time in my breasts and then my nursing, first my nursing daughter and then my nursing son, is getting a bigger dose of it, so that we see that breastfed infants, pound for pound, get four to five times and sometimes as high as fifty times more toxic chemicals in their diet then their mothers do when they're simply eating adult foods, and so there's a special vulnerability of infants by virtue of their special place, their higher place on the human food chain. And it's also true that formula

is not contaminated with all this stuff; you might think, well, cows, you know cows are eating too when they’re all, and milk is also, dairy milk is also contaminated. Yes and no. Formula is made up of a whole bunch of stuff, not just dairy; the proteins come from dairy but all the fat which is, tends to be the chemicals that we worry about, the lipophylic ones, they tend to come from plant-based sources in infant formula, palm oils and avocado oils and things like that, and those are very less contaminated, so if you take, just look at contamination levels, infant formula is the cleanest, cow's milk is in the middle, and mother’s milk is up on the top, so that it's not surprising then, if you take a look at breast-fed and infant formula-fed babies, even though breastfed babies are healthier and have less immune problems, they have less respiratory disease, they die less often from sudden infant death syndrome, they’re gonna be at a lower risk for certain kinds of leukemias, and basically have all these autoimmune benefits and IQ benefits that we’ve mentioned. They're also carrying around a much higher toxic

body burden than their formula fed counterparts, and this toxic body burden, because of the persistence of these toxic chemicals will persist, so Dutch studies show that school children who were breast fed as infants, even as short as six weeks, have four to five times the PCBs in the lipid fraction of their blood serum then their formula-fed counterparts, in other words, children who are the same age but were formula fed as infants, and I this is after correcting for socioeconomic factors and ongoing diet and things like that, so that when we model this out, it turns out that by the time you're twenty five years old, if you're a girl, about fourteen percent of your total body burden of chemicals comes from, is still left over from what you got from your mother's milk when you were an infant, and of course and this has the possibility of becoming transferred either during pregnancy or in breast milk to the next generation if you, if you become then pregnant at twenty five. So this is the human rights problem about which I think we need to have a conversation with, without allowing

formula to be held up as the answer to the problem, and this is where I always feel like I’m on a high wire when I, when I talk. Alright, enough of the science. Whenever I come to the end of a presentation I always want to close with a really joyful, really joyful part to remind us all that this is really about human life: it's not just data and statistics. So I’m actually going to read from the birth section of “Having Faith,” and see if... There’s a couple things you need to know. First of all, I’m not only a cancer survivor, I’m also adopted, and I’ve never met my own my own mother and father, I don't know much about my genetic past or my own biological ancestry, and there have been people in the therapeutic community who have suggested to me that my own deep interest in biological phenomenon and the mystery of life is a kind of overcompensation for my lack of biological not about myself and that might be true.

So, but the act of giving birth to me was an, was an incredible compensation for my unknown origins and my unknown knowledge about my own birth, certainly, and it turned out to be a very euphoric experience, although with my daughter I somehow felt I had to have her in Beth Israel Hospital, in Boston which is Harvard’s flagship medical research center, and trying to have a non-medicalized childbirth there is a little bit like trying to hold a peace rally in the Pentagon,[audience laughter] and I decided wrong venue, but it's also the hospital where I received a lot of my follow-up cancer care, and so it's kind of my lucky mitt, I guess you'd say. I actually laid down on the same ultrasound table to receive my first prenatal ultrasound that I’ve been scanned for signs of tumor, and I had to remind myself, you know, that if they see signs of growth it's a good sign not a bad sign. And so, so I’ll let you decide how well I managed to achieved my goal of non-medicalized childbirth when I read this section. I did end up

having my son in a midwife-run birth center and he was born in a bathtub in a very different kind of, different kind of setting. I’m gonna read one short sort of science section that precedes the actual, actual and these two sections are not next to each other in the book but I think it'll work if I read them one after the other. “Compared to human birth, labor and delivery among other mammals is a day in the park. A mother rat pulls her babies with her own mouth after contractions lasting only a few seconds. Kittens are born after two contractions. Elephant seals require three whole minutes of pushing. Other primates have a more difficult time of it but not when compared to what human women must endure. Gorillas, who've been heard to scream while giving birth, have labors lasting up to thirty minutes. Squirrel monkeys labor for up to two hours, but as many climatologists point out, estimating the length of the birth process in many species is sheer guesswork, as no one really knows when it starts.

Much of human labor is also relatively painless in the earlier stages; women, we are only able to record its onset because women can verbally indicate when they feel contraptions begin. Nevertheless, most researchers agree that human labor is probably three to four times longer than that of other primates. Many people assume that our babies big heads are what makes human birth so arduous. This is part of the story. All primates have heads large for their body size. In most, however, the skull is deeper than it is wide and the forehead therefore leads the way down the birth canal. The result is that monkeys are born face-up. This arrangement allows the mother monkey to pull her baby up to her chest as it emerges, but human babies are almost always born face-down because the crowns of their head serve as the leading wedge. For a human mother, pulling emerging baby up her chest would force the newborn to execute a back-bend. Further, with the baby's head turned away from her she cannot easily clear it’s airways. These are but two reasons why the midwife and evolutionary anthropologist Wenda Trevathan believes that attendance during

childbirth has been part of human heritage for at least a million years making midwifery the world's oldest profession [laughter, applause]. The prolonged nature of human birth has as much to do with hips as heads. Among four-legged mammals and even among knuckle-walking primates the sacrum is located high above the pubic bone, allowing the fetus to pass under one limbo bar before encountering another. By contrast an upright two legged posture requires a narrow pelvis with a sacrum positioned directly opposite the pubis. A birthing infant is thus forced to contend with two closely opposed and yielding surfaces simultaneously. Thus, from a Darwinian point of view, the travail of childbirth is the price women pay, not for Eve’s sin, but for bipedalism, a novel means of locomotion that has freed our hands for tool-making, fire-making, art-making, the playing of musical instruments, and manifold other clever activities should all be enough to make us fall upon our knees and thank our ancestral mothers for all they have endured over the millennia just so we can type and wave hello [laughter].

Bipedalism has another consequence relevant to birth. It requires the entire weight of the pregnant uterus be held up by the various structures that must later open and let the baby out, to wit, the cervix and the perineum. Compare the situation to that of our barnyard friends. In a pregnant sheep or a cow, the unborn baby hangs in a ball of abdominal muscle and the birth canal is located safely uphill, like the spout of a teapot, pushing a fetus through tissues that do not also have load-bearing requirements is a much easier task. Happily evolution has not left his defenseless in the face of some stiff engineering challenges. We members of homo sapiens are equipped with two remarkable adaptations that allow contradictory demands to coexist. First, our babies come with semi-collapsible heads. During the process of birth the plates of the skull slide ovet each other as the head passes through the pelvis outlet; this process is called molding. Second, human women are outfitted with the most powerful uterine muscles in any mammal. Within its fibers lies the strength to push a baby through a narrow

pelvis wrapped with materials designed to bear the weight of the prenatal world. So that fact became really important to me during one critical moment of my own labor, this idea that I was, you know, had a uterine muscle more powerful than a lion, more powerful than the tiger and it became what I kind of focused on so I’m going to skip to that part now. Here’s what labor contractions feel like to me. They come in from the sides like bands of tightness; they progressively increase in strength and intensity until they are literally breathtaking, except that it helps to keep breathing anyway. Sheila encourages me look to look out the window at the city lights. Sheila’s the obstetrical nurse here. 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 vice. The power of my own body becomes amazing to me, thrilling. I recall the unequaled strength of the human uterus. The force in whose grip I’m held is generated

by 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. My legs begin to tremble. I try to describe my perceptions to Sheila and Jeff but discover I can no longer speak in full sentences. I ask to lie down. Instead, Sheila suggests that 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, father of the baby, my husband, behind the bed so that our eyes are level. She gives us a mantra, the word “out” [laughter]. As I feel a contraction coming on, we are to hold hands, lock eyes, and shout 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 its sounds, the long, moaning vowel and 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 the back of my throat to the back of my teeth. I see the architecture of each letter: the endless cycling O, the hairpin turn of the U, the intersecting timbers of the T. “Out” is the sheltering tree in a storm, out is a bubble of air under the ice, out is the train pulling away from the station, out, the bed at the top of the stairs. Out, out, out, out. And now there is pain. I’m still being squeezed but something is pushing against my back from the inside and it hurts, and now Sheila is up on the bed holding me in a kind of football tackle applying counterpressure. The pain subsides. I cast around for the word out and find it in Jeff’s eyes. Out is the color blue, out is the bottom of a 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 shudders through me and I lose my way. Do not misunderstand me. On the scale of sheer physical torment I have experienced pain more acute than this pain; a finger smashed by a hammer hurts worse, back spasms hurt worse, so do certain orthodontic procedures [laughter], but I have never felt a more profound pain. It is like the chords of a pipe organ filling a cathedral. 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 sound that seems to be coming from my own throat, and then my lips round out, my tongue finds the roof of my mouth and the bellow becomes the word out, out, out. I emerge from Jeff’s eyes and reinhabit my body. Out, out, out and the word becomes flesh.

Slowly I become aware 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 [laughter], the lights are dimmed, a spotlight goes on above the bed; Sheila tells me I am fully dilated. Labor is over; on to delivery. If you have ever studied the anatomical charts that hang in gynecologists’ offices or inspected the plastic three-dimensional models that sometimes adorn their desks, you may have noticed that the uterus and vagina actually lie at right angles to each other. The uterus slants down and back, toward the rectum. the vagina down and forward, toward the pubic bone. Between A neat, ninety-degree turn. This arrangement requires a birthing baby to negotiate a serious curve, which some have have likened to putting a foot in a cowboy boot. The head-down, side line baby usually manages this task by rotating its body a quarter turn so it faces backwards toward the mother's rectum; it then tucks it’s chin

to its chest so the crown of the head, the narrowest part, leads the way around the bend. When the head finally emerges from the vaginal opening, it turns to the side again as the entire body rotates internally. The second rotation allows the upper shoulder to slide out from under the pubic bone and the lower one to pass in front of the rectum. That’s human birth; it’s rather like getting a large piece of furniture through a doorway. First you pivot around one way, and then you swivel it around the other way to allow its various parts to pass through. I’m thinking about all this as Sheila begins the perineal massage, which includes the application of hot compresses and warm oil. “We don’t want any episiotomies here,” she exclaims loudly to no one in particular, but I’m hoping the obstetrician catches the drift [laughter]. At this point I am uncomfortable and tired but not in any particular pain. The hot compresses are wonderfully soothing. As she works the oil in she tells me the grunting sound in my voice indicates to her that I’m ready to push. Push, now? Oh, I don't think so [laughter]. I’m enjoying this intermission too much to return to my seat. Just let me stand here in the lobby a little while longer.

As a matter of fact, I’d like to go home. [Audience laughter] Or at least let's go back to that part where I was shouting out; that was OK. Sheila lowers the head of the bed to semi-reclining and adjusts the pillows behind my back. She instructs me to grab ahold of my thighs and hold them to my chest. “Now, take a deep breath, hold it, and bear down.” It 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 pass through me like wind through a tunnel. Now, I need to push into it, not cast my consciousness away. There is no way out but through. Shifting from from passivity to action is going to require some kind of internal rotation on my own; I need to turn a psychic corner and reconnect with that stubborn, damn the torpedoes part of myself. Suddenly, I recognize a need to push. With surprise I realize the sensation has been coming and going for a while but I hadn't acknowledged it, and so I push 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 when the need to bear down becomes an overpowering desire is not, in my experience, correct. For me, the urge is more like reflex than desire. It’s like the need to throw up [laughter], you can resist it, you can let it happen, or you can encourage it but you wouldn't exactly call it desire. [Audience laughter] And, as in vomiting, I prefer to let the urge build a bit before throwing my weight behind it. [Audience Laughter] Pushing quickly takes on a rhythm and momentum of its own. I stop taking direction and start narrating the show. Once I discovered that pushing doesn't hurt as much as I imagined, I let go of all remaining tentativeness and am once again amazed at the power streaming through me. At some point the stretching tissues around the mouth of the vagina begin to tingle and burn. Soon they become numb like a foot that has gone to sleep. This is useful [laughter].

I go on, letting my body swing between resting and pushing, resting and 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’m not in the mood. I also wave away the way the mirror that someone offers. “Too many distractions, can't you see 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 or not I should receive an episiotomy. I’m listening to this discussion as though from the bottom of the 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 but I can’t hear what he is saying. He’s a minor character in a scene from a foreign film. [Audience laughter[ Now there's more discussion. I’m reading badly translated subtitles, I’m getting bored and annoyed. I hear myself say okay, then 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 is 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 and then again, and someone is saying the head is out, and then again and something is rushing through me like waterfall of snow melt down a mountain, and suddenly there's space inside me and a tremendous sense of relief and a voice saying “Sandra, here is 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 recognized from a school picture of myself in the first grade.”Oh, who are you?” Two eyes open, black as mystery; they ask “And who are you?” Thanks [applause]. Thanks to all the real babies here who provided the great sound effects at all the right moments. So I have time for questions and I think

have been instructed to ask you to line up at the microphones if you would. That way your questions will actually be recorded. It's been five days because (inaudible] [Male voice]: Yeah, by the way, my first year of naturopathic school I was at at a peace demonstration at the Pentagon, and a lot of us got arrested. It’s possible it's necessary, and we need natural births at hospitals too. Nineteen years ago, some midnight internet surfers at the primate center out here brought me a couple notebooks of research that wasn't put out in the media, and they had dozens of studies on PCB, Agent Orange, and dioxin, and contamination of breast milk. I know speciesism is almost as bad as all of the other isms of our society, and that's another issue but all I ever hear about the primate research is the benevolent pharmaceutical strides

and genetic strides that are going to help the poor in the medical system, but there's an abundance of breast milk toxicity research that's out there on the shelves, that’s not been published. Have you been able to get access to this anddid you know that there is so much of this that's out there and the monkey labs around the country?” [ Sandra] No, I didn't, and thanks for telling me. All the research that I pulled together in all my books all comes from peer-reviewed medical stuff that's, you know, available to all of us, and there's a lot of what we call gray literature out there and some of it is unpublished literature that industry has conducted but is not really favorable to its own public relations needs, so it quietly gets shelved, and a lot of it’s discontinued stuff that our own governments did including birth defect registry stuff but I found that there's there's more than enough stuff just in the peer-reviewed medical literature that I can make my case without even needing to use some of that. Probably the

closest I get is, in "Having Faith" I wanted to have a discussion about agent orange and birth defects, and some of the women in Vietnam, of course, have the highest body burdens of dioxin that we've ever seen, and there's now emerging evidence that the grandchildren of those first exposed during the American invasion of Vietnam are now suffering from birth defects. If so, this would be the first example that we've been able to document of things going down to the third generation. And, these data are not in the peer-reviewed journals; it's really hard to do research in Vietnam on agent orange and dioxin, and so it, it consists of a lot of work of U.S. researchers who went in and got kicked out before they could finish their work and as well, anecdotal studies, of anecdotal reports and observations

or physicians in Vietnam, reports from journalists who were there and, and some folks who did a study, but it was not peer-reviewed, from from Canada. So, I do make reference to that, just because in that case it seemed very important and there wasn't anything in the medical literature to really appeal to. [Male questioner]: “And this week a national study came out with agent orange still being higher than post-Vietnam war in the food of Vietnam, so third generation, but these agents are still in the food system.” Yeah, that’s, some good date in the persistence of dioxin in Vietnamese food chain stuff, so you can actually read some of that in the peer-reviewed literature as well. So that doesn’t surprise me. Dioxin has a half-life of around seven to ten years and so to determine residency time based on half-life it's about, you’d multiply by five so dioxin can remain in soils and fish and human flesh

or human fat for about a half century, so it'll be a long time before we see the end to some of that, yes. [Different male questioner] First, I’d like to thank you for the work you're doing. It’s so important and just astounds me how asleep we all are about the level of toxicity an environment and how little we hear about it all the time, so thank you for your work. The question I have is about morning sickness and I kind of always thought, not really based not really based on any data, that it's an adaptive mechanism to prevent people from ingesting toxins early in pregnancy, but from what you're saying about the lack of adequate nutrition in that five to ten week time period and then decreased elastin deposition, I just wonder what your thoughts or information you have about women who 're having significant morning sickness and really can't eat.” [Sandra] Well, I actually write about that I think, chapter two and three quite extensively, so you can take a look. I’m not persuaded

by the adaptive hypothesis, but I spent a lot of time talking about and describing. I haven't I don't disagree with it either. I just think that the data on which it hangs is actually pretty slight and what that idea has going for it is that it is true that women who suffer from morning sickness have fewer birth defects in their kids than women who don't suffer from any morning sickness at all, so on the other hand, there's plenty of women I know never had any inkling of morning sickness and of course their babies are fine you know. So,um so there’s, bit but but, but from a population level it does seem to be a sign of fetal health. On the other hand, there's no evidence that the more vegetables and other things that women with morning sickness tend to shun, but the more

you eat, the more birth defects that your baby will have. In fact the.opposite tends to be true so fruits and vegetables and especially some of the the bitter broccolis and the mustard family stuff, it seems to actually be beneficial to to fetal health and has plenty of folic acid and things in it that to prevent birth defects, so I’m not persuaded but I think it's a it's an interesting idea and it may be that as some have argued, that morning sickness is actually adaptation to avoid, not so much plant based toxins but maybe rancid meats and things like that, some more pathogen-borne problems and now, and yet the mechanism is general enough that it it affects other things too. Also, you’d think if it was an adaptation that there would be more are uniformity in the way women experience morning sickness, and when you take a look at the data on what foods women crave and what foods they shun, it's across the map. There’s almost no,

it's not like everybody can’t eat bananas or everybody can’t eat broccoli. It’s just really really personal and individual. And also, what foods that pregnant women tend to crave, it doesn't tend to be the bland foods that you would want if you, let’s say, had a stomach upset like the flu or something like that. It tends to be really highly flavored foods, so lots of women find relief, you know, with citrus or with watermelon, almonds. Tomatoes turn out to be the food, if there's any one food that sick pregnant women can best tolerate, it’s tomatoes, which of course are in the Solanacae nightshade family and have lots and lots of kind of secondary compounds so it's, it's an attractive idea and I was attracted to It myself, having suffered terribly from morning sickness, you know, wanting it to be evolutionary, because i'm an evolutionary biologist but I just didn't think the evidence was there. [Questioner]: “Sort of more my thought, though, was the issue of just lack of nutrition for that time period and you pointing out how significant that is.”

[Sandra] Yeah, the nutritional stuff, I think the window of vulnerability, I have to look at the data again, but it comes a bit later, cause theactual calorie requirements when they're, during the period of organogenesis is pretty small, so I’m not, I don’t remember off the top of my head when that those critical days are when elastin deposition happens, but I’m thinking it's later on. There’s been some really elegant research not only from England but also from the Netherlands. You know, there was a period time when when the Netherlands was occupied by the Nazis that there there was called the Dutch starvation winter where the food supplies were deliberately cut off and it lasted about nine months and there was absolute famine during this time and then and then Amsterdam and the rest of the Netherlands was liberated and the food supply started flowing again and you can actually take a look at women who were pregnant during that time those who, their whole nine months of pregnancy correspond to the Dutch famine, those who,

you know, the first half, second half that kind of thing, and trace the health of that cohort of folks who were all born I think that was in 1943 or 44. I’m not gonna remember the exact year who are now, you know, in their fifties and sixties and so you can look at the health of those folks and see what kind of cardiovascular, diabetes, obesity, and stuff like that and there are some really nice trends depending on when the nutrition stopped and at what point in gestation, and what kind of health problems they now have in their old age. Meco, I’m supposed to alternate between back mic and front mic so let’s go to the back and come back to the front. thank you. [Questioner]: My name is Barbers MacDonald and I facilitate @ support group for women under forty with breast cancer and when we’re in the group we all very frequently talk about what these women have in common, and other than the small minority who have a family history of breast or ovarian cancer, the birth control pills is one of the only things they find, that I was curious about the critical window that you described when I think you said the depth

of differentiating until around thirty you so there was another critical window. Can you speak to that all about how media plays a role in the development of breast cancer?” [Sandra] Well, that’s the new thinking right now. When I wrote "Living Downstream" I tried, and that book came out came out in 1997 so it’s six years old now and the data are probably eight years old on which that book is based and I thought by this point the picture about breast cancer and the environment would be a lot clearer and it's not. It’s just as confusing now as it was when I read that eight years ago even though lots more studies have been done, half of them show no connection, half of them show some connection but not a very strong one, and, and it's, it's really confusing and so a lot of us are thinking that that the answer is to gonna lie in timing of exposure on that the breast, you'd think it would be a kind of easy organ to study; it's on that the outside of the body, you can get samples of breast milk to actually see what kind of contaminants are in the body but in fact, it's a really tricky organ to study because

it's one of the only organs beside the prostate gland that undergoes this incredible alteration of its architecture and physiology and functions over the lifetime of a woman, and depending on her reproductive history that story is going to be very different, and so it may be that it’s not so much the amount of DDT you're exposed to as a kid but the timing of when you're exposed that Turns out to be important. Most of the studies have never taken a look at that, and the reason we, we started, are starting to suspect that timing is is everything is that we know that women who give birth early in their life tend to be protected for a lifetime, because when you go through a full term pregnancy, all of that tissue finally differentiates, and it doesn't differentiate if you don't go through a full term pregnancy ever, so woman who never is never pregnant and bears a child goes through her whole life with these kind of undifferentiated

breasts and undifferentiated tissue is far more susceptible to the effects of carcinogenIc processes than undifferentiated tissue. And so my sister, who had her first child at twenty and whose kids are now grown versus me who had my kids at forty. I walked around for twenty more years than my sister did with undifferentiated breast tissue so I extended my window of vulnerability compared to her. So, even though she did not breastfeed her own kids and I did, and breastfeeding is protective in some way that we don't quite understand, against breast cancer, the statistics show that my risk is still higher than her risk because of this protective effect. The problem with using the biology of the breast to formulate solutions to the breast cancer epidemic is you start saying things like teenage pregnancy is a solution to breast cancer risk and that teenage pregnancy of course

being, we consider it a big social problem and so I, I, I would like to be able to argue that if we got chemical carcinogens out of the environment that women could then safely choose when in their lifetimes they wanna have their have their children, because that's one of the things that we can, we can influence as, at least as much as when in our lifetimes we choose to have our kids. So those of us who have our children late in life may be more vulnerable by our reproductive histories as we walk through this world, but I don't think that the idea of our environmental protection regulations is to protect only the most fit among us. We want to protect the most vulnerable too, and women who aren't, are not having children early in life are, are are vulnerable by that fact. [Male questioner]: “I see evolution as an adaptive process, so we need to adapt to our environment and the differences in our environment. I’m wondering if you could speak to the concentration of these toxins in breast milk as, well, I’m

just wondering if you have any thoughts as to whether or not this is a part of an adaptive mechanism of evolution so that we can handle the differences that are going on in our environment.” [Sandra] Well, evolution, you know, takes millions of years to, to work and over generations upon generation, and our generation times is only twenty years at at the very least, and most of these chemicals didn’t come on the marketplace until after World War Two, so we’re only talking a couple of generations. The first evidence we had for chemical contamination in breast cancer, breast milk came in 1951, when African American women in Washington, DC were found to have DDT in their breast milk, and when you think about that that's only, that's only a half century, so that's two generations. So the people who are like my mom who was born in the nineteen-thirties, she grew up as an infant and who was breastfed on the farm as all of her

siblings were, drinking uncontaminated breast milk, and it wasn't really until, my generation, the baby boomer generation, that we started having infants from pregnancy and infancy and childhood on who had the stuff in their, in their, in their diets. And, and we are now just getting of the age, in our forties, fifties and the first baby boomers are gonna turn sixty-five in the year 2011, to see what kind of risks we have for Some of these late onset cancers and other things, so I don't think we, I think time will tell. Time will tell on the science. I don't think we need to wait for more science to come in before we begin to take action. Clearly, the protection of human life is part of medicine and part of public health, so if we've got kids in harm's way facing unknown consequences based on known exposures to chemicals that have known inherent toxicities, I think we've got enough evidence to act now even though a lot of

the, the scientific proof is going to be coming on on down the line. [inaudible question]. [Sandra] I’ve been told we need to stop and I will be able to hang around and answer more questions that, if you like; I’m not going anywhere soon and if, if anyone has questions my, I just want to say one sentence about the work I’m working on now. I’ve moved from CoNell to Ithaca College so I can work at the Gerontology Institute there and where I’m going to be casting my net is taking a look at early life exposure to environmental chemicals and risk for late onset dementing illnesses such as Parkinson’s disease and Alzheimer’s and I’m just beginning some of that work, but I’d happy to have a personal conversation with you