The Epidural: Less Satisfying and More Painful Birth?

Pregnancy and birth are filled with many unpredictable features, whether this be your first go at the rodeo or 5^th.

Pain experienced during labor is also unpredictable. Pain may be manageable without medication, or it may become severe and exhausting.

If you find yourself calling the United States your home, then you are among the majority if you opt for epidural pain relief during labor.

Ladies in the U.S. have fewer options for labor pain management than our counterparts in other industrialized nations (such as the UK and Canada). It is uncertain if the excessive use of epidural analgesia is a true preference in the US or if it is simply chosen because of the lack of other presented options.[*]

Interesting, none-the-less….

What is certain is that epidural use is nearly always an elective procedure. Although it can be a useful tool in supporting a laboring mother, the use of epidural medication expands the chance for complications, this does not occur in drastic numbers. Each family has their own comfort level with side effects and risk – what one family may consider safe, another may become uncomfortable. (you can learn more about risks associated with epidural use here and here) 

Everyday, devoted and loving soon-to-be mothers opt for epidural anesthesia pain relief during the birth of their babies.

I was among them, choosing an epidural with my first daughter because I thought it would help with pain and allow me to have a more enjoyable experience. In actuality, I experienced agonizing break-through pain and a cascade of interventions that I wasn’t anticipating (urinary catheterization, artificial rupture of membranes, internal fetal monitoring, use of synthetic oxytocin). 

Was my disillusionment with epidural anesthesia in the minority? 

Higher Pain Recall Among Those Opting for Epidural Analgesia

A remarkable finding from a longitudinal study (2009 BJOG) regarding women’s memory of labor pain found that mothers who opted for epidural analgesia reported higher pain scores at all time points versus those who went without.[*]

Another study (2006 JPOG) substantiates the above findings and also goes to on to provide data that women who received epidural analgesia not only had higher recollection of intense pain at two months and one year but also had greater difficulty forgetting pain 10 months later.[*]

If a mother chooses an epidural in most part to experience a labor that is less painful then one without anesthesia the data above can be sobering.

Research also suggests that pain experienced during labor is not entirely a negative experience, with more then 1 out of 4 women (28%) assessing pain as more of a positive than a negative – suggesting that coping with pain is a rewarding experience for some women.[*]

Lower Satisfaction Among Those Opting for Epidural Analgesia

Although women and care providers may assume that effective pharmaceutical pain relief during labor will ensure a more positive birth experience, there is mounting evidence that the opposite is true.

Several studies have shown that women who use no labor medication are the most satisfied with their labor and birth (times being assessed at time of birth, six weeks and one year after birth).[*][*][*][*][*][*]

Also worth noting, women who cope with labor using non-medical alternatives such as water birth, massage, positioning, focusing and breathing done with the support of another person report more satisfied than with standard pain relief given during childbirth.[*]

Natural techniques utilize a woman’s own strengths and places her in control of her own body. They also have been assessed to improve obstetric outcomes compared to pharmaceutical relief.[*][*] 

Interestingly, the influence of pain relief on satisfaction is not as powerful as the attitudes and behaviors of the mother and caregivers involved. Consider a 2002 study published in the American Journal of Obstetrics & Gynecology which concludes four factors that appear to override pain experienced in labor:[*][*]

1. Personal expectations

2. Amount of support from caregiver

3. Quality of caregiver-patient relationship

4. Mother’s involvement in decision making

This reaffirms the main key to satisfaction and managing labor pain effectively, is to ready yourself in advance – arranging continuous support, accurately understanding pain control options (and the interventions involved) and having an active role in the decision making process.[*][*]

****

As much as some might like to discount natural childbirth as a progressive trend among a small number of women, research affirms that women who opt for epidural anesthesia experience more pain, have a more difficult time forgetting the pain, and experience less satisfaction overall.  

Women do not decline an epidural simply to “win a medal” – instead information on different types of pain relief are assessed and balanced against other goals such as walking, pushing effectively, or minimizing maternal/neonatal side effects and/or risks.

How much of an effect an epidural medication can have on a newborn or mother is not easily predetermined and can vary based on dosage/mix of pharmaceutical drug combination, the length of labor, and each individual.[*]

Opting for an epidural anesthesia is one method (among many) that can aid in relief of pain and discomfort during the labor process. This type of pain relief requires a mother to give some control to the hospital staff. It does involve risk and additional intervention.

The decision, rightfully, rests for each woman to make. In due course, researching the procedure and talking others who have may be able to offer different perspectives could help a mother decide on what is right for them.

As the data suggests, most women who choose unmedicated birth (and prepare for it) find the pain intense but manageable and they are happier with their experience afterwards.

Ultimately, what can be said, each woman should use the insight into herself to be the best guideposts in directing her toward a positive decision regarding pain relief during labor.

"You gain strength, courage and confidence by every experience

 in which you really stop and look fear in the face."

- Eleanor Roosevelt

Witness to Normal Birth

It was about the best thing I ever experienced.

The minute she came out, I was born again. It was like we’d just been born together.



paper dolls photography



If you are privileged enough to have witnessed a woman giving birth naturally in a place she has chosen, what will you have seen?

You will first be in awe of her strength.

 

And you will think – for how could you not – what a phenomenal creature a woman is. But you will only have seen this astonishing sight if you have understood that if you disturb her in her work, she will be thrown off course. One must sit quietly and patiently, almost invisible, breathing with her, not disturbing her internal rhythm. And you will see that the pain of her labor seldom overwhelms her.

A deep significance to the mother, the momentous quality of pain, as she is surrounded by the deep sense of inwardness, forced to recognize her independence, her loneliness, selfhood, becoming conscious of her own existence. Paradoxically, this actual self-consciousness exposes a woman to her wholeness, her strengths and her endurance.

Nature would not have organized labor to be intolerable. It is the limits of our human understanding that wish to control all that is surveyed, that has conquered women by making them labor in the most tortuous environment constructed.

Let us bring them into harsh rooms with bright lights. Let us make them lie on their backs on hard narrow beds. Let us tether them to machines so they cannot move. Let us make them stay silent. Let us restriction their eating and drinking. Let us expose their most private parts and threaten them with cold steel. Let us make them push their babies upwards, against the pull of gravity. Let us monitor and measure and chart every move they make. Let us swab, wipe, prod, poke, irate, confuse and frighten them as much as we can.

In these conditions, labor swiftly becomes unbearable and pain relief becomes a woman’s only hope. Get me an epidural, cut it out of me, anything, make it stop. Please help me!

This is not the natural cry of a woman in labor bringing a child into the world, although if you have only ever witnessed labor and birth in a medicalized setting you might be inclined to think so. Her only hope for salvation lies in the anesthetist who numbs the pain or the obstetrician to remove it.

And a woman spoke, saying, Tell us of Pain.

And he said: Your pain is the breaking of the

shell that encloses your understanding.

Even as the stone of the fruit must break, that

it’s heart may stand in the sun

so must you know pain.

- Gibran

Altered passage and excerpts can be found in:

Normal Childbirth: Evidence and Debate. Chapter: The Role of Pain in Normal Birth and the Empowerment of Women (Nicky Leap and Tricia Anderson). Pages 25-39. 2004. http://readinglists.lib.monash.edu/items/5BB0FE73-9C52-D121-1760-8D2D7F4AACC9.html

Mommy Needs Wine

Mothers who unwind in the evening with a drink or two are definitely not alone.

Shoot, I was one of them. 62 days ago.

My personal reasons for completely abstaining from alcohol stem from my own childhood experiences with a parent who drank, my own addictive tendencies throughout life and a very intense passion inside me to be a better person.

My history with drinking was already sketchy to begin with; resulting in several run-ins with the law and one DUI at the ripe age of 21. Once I got pregnant, obviously, my drinking habits changed (as well as many other questionable habits like smoking and eating horribly).

After having two children fairly close together in time, I found myself free again to join my husband for a few drinks after work while cooking dinner and unwinding from the day.

Seems pretty ordinary, I guess… drinking is basically encouraged for parents (more on that a little later).

But I always found myself the next morning feeling a tinge of guilt. I would think to myself, “I could be a better mother if I just didn’t drink at all…”. What was holding me back? The routine…the effects of relief (both physically and mentally)…the encouragement from other women parading wine as completely acceptable?

I’m not saying that some moms aren’t absolutely fine with drinking 2 or 3 drinks a night. I just knew in my bones that I wasn’t one of them.

Then one day, I had it in me to choose something else other then drink a few glasses of wine. Just a random Thursday. Nothing special. That weekend, I started running and exercising to deal with any stress I had (I now run 5 nights a week).

My husband still drinks and thinks nothing of me choosing not to. I guess I can rack that up to me not having as big of a problem as I thought I might have had. I do imagine if I just went with the flow and waited a few more years, I probably wouldn’t have been able to stop the way I did. You see, the thing about addiction is it’s progressive.

I do find myself now more aware of the marketing toward moms (especially of young kids) and women in general…

Is being a mom so hard that a glass of wine (or two or three) is needed at the end of the day just to feel sane again?

I imagine alcohol producers are betting on it.

Have you heard these slogans yet???

Mommy’s Time Out :

"We All know that being a Mommy is a difficult job. A Mommy's Time Out is a well deserved break."

Mommyjuice :

“Balanced, fruit-forward wines that bring just a bit of peace after the chaos of everyday life as a parent."

What about facebook pages like:

I So Need A Glass Of Wine Or I'm Gonna Sell Kids (over 133,000 likes)

Moms Who Need Wine (over 93,000 likes)

Moms-who-sometimes-need-to-go-out-with-girlfriends-&-drink Secret Society (an open page)

I’m definitely not condemning mothers who drink alcohol in a safe and appropriate manner, but in my experience, when someone says they’re drinking because they need stress relief that should be a red flag.

Drinking to cope with anything (the stresses of motherhood included), in my opinion, is not a skillful way of living a life. Yeah, it’s comical – to a point, and then it just becomes sad.

For some of us, we were simply given the example of damaging ways to cope with life by our parents – and so commences the beautiful masterpiece of life repeating itself.

I think the most powerful catalyst to stop the cycle of any destructive coping mechanism is the motivation to give your children a better parental model than you had growing up– at least that is what has provoked me to make, not just this change, but many changes in just the last 4 years.

How empowering and rewarding is it when you recognize that you are giving something of yourself that you never knew was in there?

I hope these words meet you in a place that sparks that desire in you -

“Don’t worry that children never listen to you;

worry that they are always watching you.”

- Robert Fulghum

Good Health Depends on Your Bacterial Ecosystem

There are 7 billion humans on planet Earth today with each one of us a walking ecosystem.[*][*]

It is difficult to comprehend that the majority of cells in the human body aren’t even human – with bacterial cells out numbering human cells 10 to 1.[*]

Micro-organisms reside in (just about) every part of our bodies. With over 100 trillion (yeah, with ‘t’) bacteria, these teeny single-celled organisms account for nearly five pounds of our bodily make-up. Our mouth alone is comprised of several hundred species of bacteria – each tooth with its own mini-ecosystem.[*][*]

Scientists (within a multitude of disciplines) equate the bacteria inhabiting the human body as another functioning organ - providing vital tasks critical for human survival.[*][*]

Our Vital Relationship with Bacteria

The science on the critical function of microbes in human health is in its infancy.

What we do understand is that in healthy bodies, bacteria does not cause disease – instead, they coexist in synchronization with their host.[*]

One example among of many, staphylococcus aureus (with several strains linked to the drug-resistant infection called MRSA) can be found in the noses of about 30% of healthy people not causing any illness.[*]

And although bacteria has been seen as the bane of human existence for last century, the knowledge that is accumulating is increasingly viewing them as our fundamental life partners.[*]

Researchers working on the Human Microbiome Project (HMP) report that microbes in our body contribute more genes that are responsible for human survival than humans contribute. Our human genome carries approximately 22,000 genes, while the micro-organisms residing inside us contribute 8 million unique protein genes (360 times more then the human host).[*] 

The genes that are contributed by bacteria are critical, not just for our health, but our survival. For example, bacteria located in our GI-tract contain genes that allow humans to digest AND absorb nutrients that would otherwise be unavailable. Other microbes produce valuable compounds such as vitamins and anti-inflammatories (which regulate some aspects of our immune response, such as swelling) that our genome cannot manufacture.[*]

The old belief that these microbes are freeloaders or invaders is quickly vanishing and being replaced by a new holistic understanding of health.

There are several papers already published, and many more in process, that are drawing the first links between our bacteria and common ailments like irritable bowel syndrome (IBS), unexplained fever in children, obesity, depression, asthma, even ache. Scientists are even attempting to understand how our bacterial makeup contributes to chronic conditions such as cancer and possibly autism.[*][*]

The Significant Origins of a Bacteria Fingerprint

Method of Birth

When we are in our mother’s womb, our gut and body is sterile of bacteria and microbes. Each sterile newborn born vaginally encounters their first exposure to the make-up of their microbial world by means of what their mother is has been exposed to during her life (environment/diet/pets/antibiotics/etc) via the vagina. This event plays a primary role in training the immune system to distinguish ‘good’ bacteria from ‘bad bacteria. Babies that are born surgically via cesarean obtain a different encounter during birth which is fundamentally different from their counterparts which confers a predisposition to food allergies and asthma later in life.[*][*][*][*][*][*][*][*][*]

Although cesarean surgery is necessary for a small amount of pregnancies, it is very much clear that medical reasons alone cannot justify why more then one in three women in America require major abdominal surgery to give birth safely.[*]

Breast milk versus Artificial Supplement 

After a child’s birth there are certain bacterial components, particularly in the intestinal tract, that are deficient and underdeveloped. There is a fixed amount of time to develop an infant’s internal flora properly.[*]

Breast milk, not any other artificial supplement on the market, fosters the colonies of beneficial microbiotic flora that assist with nutrient absorption (particularly iron) and immune system development (specifically sIgA in the first 30 days of life).[*][*]

The distinctive bacterial fingerprint that a breastfed infant has lowers the incidence of diarrhea, influenza and respiratory infections while also providing protection against the later development of allergies, type 1 diabetes, multiple sclerosis and other illnesses.[*][*][*][*][*]

Once past infancy, the composition of the mother’s milk changes according to the child’s specific needs-in fact, the composition of breast milk changes not only daily but hourly! While the time between feedings become longer, the mucosal and bacterial protection continues long after that nursing session is over.[*][*]

An infant’s diet early in life definitely affects his/her individual microbial fingerprint.[*]

The World Health Organization (WHO) states exclusive breast milk is the best food for a newborn, and should not be substituted, since it meets all the child's physiological requirements during the first six months of life (with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond).[*][*]

Anti-bacteria Assault  

According to the CDC, 18 million courses of antibiotics are prescribed for the common cold every year…with an additional 50 million courses prescribed for viral respiratory infections.[*]

It is worth noting that in some of these cases, the prescription is medically warranted – however, the CDC estimates that 80% of the cases it is NOT.[*]  

There are over 10 million antibiotic prescriptions given to children. Every. Year.[*]  

Numerous studies confirm that the use of antibiotics modifies the bacteria in our bodies, some contend that this can last for 6 months, a year, and some even say permanently.[*][*][*]

Obviously, the short term effect of this modification is welcomed (to eliminate unwanted, harmful bacteria), however there are often unwelcome side effects. Particularly in children, adverse consequences experienced can range from diarrhea to abdominal pain. A few studies have even reported higher instances of irritable bowel syndrome, asthma, repeat ear infections and type 1 diabetes.[*][*][*]  

Some of the most popular antibiotics prescribed even come with an infamous black box warning – causing tendon rupture or, most recently, having the ability to block neuromuscular activity (causing fibromyalgia-like symptoms).[*][*]

What is extremely disheartening is that patients (and parents) are rarely informed of the risks associated with antibiotic use (especially repeat use).

And when it comes to doctors, not all are created equal. Those of who have been in practice longer, have a larger patient base and have trained outside the US or Canada are much more likely to prescribe antibiotics inappropriately. For every year a doctor has been in practice, the rate of improper prescribing increases 4%![*]

The key to responsibly using antibiotics:[*]

Ask what antibiotic is being prescribed

Ask if there is an effect alternative

Ask what side effect you should be alert for

Ask when you should expect the unwanted condition to resolve

Ask when you should call is something unexpected happens or if recovery seems delayed

 

Conclusion

We need to become more aware of our symbiotic relationship with the bacteria within the body. This starts with not stereotyping all bacteria as bad. In fact, although a few may be problematic, these account for far less than 1% that exist in our body.[*]

Bacteria are our allies. Our evolution and existence depend largely due to the relationship that has been maintained and preserved for centuries.

They are essential to basic bodily functions: digesting food, producing vitamins, aiding immune response, sustaining good health.[*]

Take care of your ecosystem – it sure takes care of you!

To start learning more, check out: NIH Human Microbiome Project Website

Putting the Herd (Immunity Debate) to Rest

Understanding infectious systems (and debating them) requires a person to be able to reason about highly complex biological structures, of which, contain hundreds of demographic and epidemiological variables.[*]

It seems commonplace in debates/discussions concerning herd immunity that extrapolating demands on others are made – particularly to maintain specific elimination thresholds (one example easily comes to mind: non-medical vaccine exemptions should be void to maintain herd immunity). 


Elimination Thresholds and the Dynamics of Immunity

Two authentic hazards arise when debates concerning herd immunity/vaccination rates place consistent emphasis on maintaining elimination thresholds (ie 90-95% vaccination rates)

(1) the debate begins to distract from the fundamental extreme dynamics of epidemic theory, particularly to herd immunity[* pg297]  

(2) the debate portrays a human life as a instrument in medicine that can/should be utilized in a societal defense against viruses/bacteria/disease. (the dismissal pertaining to an individual’s choice regarding a medical procedure)

For this post, I will only be addressing the first point (the complexities relating to the influences on herd immunity). To learn more about the second issue you can read this post.

I feel the need to address this particular point because in common debates regarding herd immunity (pertaining to national vaccination programs) a fundamental cornerstone of epidemiology is continually dismissed: the extreme dynamic consequences of the intrinsic nonlinearity of host-agent systems.[*] 

In laymens terms – this shit is complex.


Does Herd Immunity Exist?

Absolutely.

There is no denying that herd immunity is an extremely potent natural phenomenon which is altered by a multitude of influences (which I am going to attempt to list briefly a little later). In the presence of a national vaccine program, it is purposefully manipulated with the intention that the recognized gains will out weigh any known disadvantage(s) that might occur (financially, safety, policy, etc). [*]

In the United States, we rely on the ACIP to examine new (and current) vaccination campaigns of which must be weighed very cautiously. To intentionally modify the current existing herd immunity against a non-fatal, acute childhood disease can carry unfortunate characteristics such as protecting one population while actually placing another group at higher risk than before (ex varicella campaign).[*][*][*][*]


On the other hand, there are campaigns that historically have provided success. So far, the only infection to be eradicated worldwide is smallpox (variola major -WHO 1977). This accomplishment generated much optimism in the philosophy of eradication thresholds that other infectious diseases (such as measles and pertussis) were targeted.  Unfortunately, this thinking may have been misguided for many reasons: smallpox was unique given its low communicability, the high average age of infection, the ease of diagnosis and the stability of vaccine storage conditions.[*]


It is also important to reveal, that there are complete absences of herd immunity seen in several diseases (some of which we currently vaccinate against such as rubella, diphetheria, pertussis).[*]

The blanket justification of herd immunity in support of elimination thresholds for vaccination on the current US vaccine schedule has the very real potential in becoming a crude and one-dimensional debate.


The Fundamentals

When speaking of herd immunity in relationship to a national vaccination campaign, one must be specific to which disease they are discussing and they must show an understanding to the intricate nature of influences of immunity within the individual and within a community.

To begin, a foundation must be understood. Epidemic theory considers three variables: agent, host and environment (each of which has many components/interactions/influences in-and-of themselves).

Agent
An agent is any infectious pathogen. These vary in biological makeup, size, transmission, and habitat. In the construction of mathematical models of epidemics and herd immunity, all possible variations in all aspects of the agent's behavior (particularly in relation the host and the environment) must be taken into account.[*]

Host
The classification of a host is relevant when an agent invades a foreign entity (aka the host) resulting in a defensive immune response with the purpose of protection. Immunity attained can range from temporary to permanent. [*] 


What is of particular study is the host’s response with antibodies specific to the infectious antigen. These seropositive individuals are those who have current infections or who have experienced an infection in the past – moving them from the category of ‘infected’ to ‘recovered’.[*]    

Of course, when referring to the context of herd immunity, one must consider both the individual hosts and the population as a whole.

Environment
Consideration and concern is given to the environment and vicinity in which both the host and agent dwell. This can range from geographical heterogeneity to seasonal variations (again, for both host and agent).



Mathematical Modeling – SIR Model

Epidemiology gives birth to herd immunity theory when the first mathematical model examined how infectious agents affected large populations over time.[*][*][*]

Obviously, for ethical reasons and financial reasons (hopefully the former out weighs the later), experimentation or field trials are prohibitive – making mathematical modeling critical in making theoretical predictions of how a disease will spread and can be useful for evaluating control strategies (particularly in the case of a bio-weapon attacks).[*][*]

The Mass Action Principle (SIR) has been widely applied and accepted in epidemic theory since 1927 – when Kermack and McKendrick published 3 papers outlining and describing a mathematical model in which they considered a fixed population with 3 compartments: susceptible; infected; recovered (SIR).[*][*][*]

Susceptibles (S) – Individuals that are susceptible have, in the case of the basic SIR model, never been infected, and they are able to catch the disease. Once they have it, they move into the Infected compartment.[*]

Infected (I) – Infected individuals can spread the disease to susceptible individuals. The time they spend in the infected compartment is the infectious period, after which they enter the recovered compartment. [*]

Recovered (R) – immune to the disease or otherwise removed from the population. Individuals in the recovered compartment are assumed to be immune for life. [*]

In the SIR model, vaccination is equivalent to complete removal (aka transfer to the Recovered compartment). It is assumed that vaccinated individuals can not infect or be infected. [*] 

The above described SIR model is helpful although it is written using an equation that implies a deterministic model (no randomness with a continuous time). [*]

To account for this, the SIR model is the basis for other similar models (SEIS, MSIR, MSEIRS) that make small adjustments in its parameters that attempt to alleviate certain ‘real-world’ problems, for example:[*][*] 

SEIS  - considers the exposed or latent period of the disease (a person is not immediately infected).

MSEIRS – considers an infection that does not leave a lasting immunity in which individuals that have recovered will return to being susceptible again, moving back into the S compartment.

MSIR – considers a disease where an individual is born with a passive immunity from the mother.

Although mathematical equations are very useful in understanding basic principles and the interplay between variables, their assumptions can lead to oversimplification.[*][*]

My concern centers on the simplicity of many mathematical models, particularly in the face of such biological complexity. Especially useful tools in modern complex theories incorporate multiple algorithms and concepts of TCS (theoretical computer science), however these tools are not yet utilized and relatively unknown in epidemiology.[*][*]



Complexities of the Herd

There are several assumptions made in the formulation of the above mentioned equations. These assumptions have benefits and disadvantages.

Benefits may include being utilized for a general guide to risk assessment or a supportive piece to compare alternative policies/intervention – a wide-ranging compass to help make epidemiological decisions.

However, it is clear that to make the forecast more realistic, it is necessary to introduce more details in the disease dynamics. Models that incorporate even the most elaborate derivations omit important features.[* pg 296]

Here are a handful of features to begin to take into consideration that influence the dynamics of disease, immunity, transmission, and recovery.[*]


Geographical heterogeneity
This refers to gender (i.e. male-female ratios), age, and factors correlated with residence. Because of existing heterogeneity, estimated elimination thresholds vary between local communities – significant local differences in population dynamics arise which, consequently adjust estimates.[*][*]

Areas of similar dynamics and variation pertaining to heterogeneity:

• Age-Structured populations

• Variable infectivity

• High contact probabilities

• Persistence of pathogens within hosts

• Variations in infection risk by age group

• Limitation of application to a closed population (no immigration or emigration)[*]

• Demographic turnover (birth or death).[*]

Host genetic factors
A particularly new dynamic gaining more comprehension is the role of host genetic factors – this dynamic is critical because mathematical models rely on and individual within the population as having an equal probability as every other individual of contracting and transmitting a disease.[*][*][*]
Research is continuing to learn strategies to identify host genes responsible for resistance/susceptibility to particular agents and the relationship between vaccine efficacy and genetics.

Areas of similar dynamics and variation pertaining to host genetic/immuno factors:

• intra-host dynamics

• Maternal immunity

Spatial epidemiology
The most fundamental of these is the problem of defining the spatial location of the entities being studied. For example,

In regards to the study on human health, spatial position of humans can pertain to the area or point with where an individual/group live, or with a point located where they work, or by using a line to describe their weekly trips. Each variation has dramatic effects analysis and on the conclusions obtained.[*]

Other issue arise in the application of spatial analysis which includes the limitation of mathematical knowledge problems in computer based calculations.[*] 


Antigenic shift
Antigenic shift is contrasted with antigenic drift (a natural mutation over time). The issue with antigenic shift concerns our lack ability to forecast ability of viruses to alter their genetic makeup (quickly creating mutant antigens) and bypassing the antibody barrier a host/community.[*]


Phylodynamics
Viral phylodynamics examines how epidemiological, immunological, and evolutionary processes impact viral genetic variation.

Dynamics of transmission is considered at the level of cells within an infected host, individual hosts within a population, or entire populations of hosts.[*]

Currently, it is understood that viruses within similar hosts, such as hosts that reside in the same geographic region, are expected to be more closely related genetically if transmission occurs more commonly between them.[*]

Areas of similar dynamics and variation pertaining to phylodynamics:

• pathogen population genetics

• evolution and spread of resistance to immunity/medication

• Strain (biology) structure and interactions

Seasonal variations
There are several biologically distinct mechanisms in which seasonality and climate change impacts host-pathogen interactions. Strong pressures on population dynamics are exerted by temperature, rainfall, seasonality and climate change – responses can range from simple annual cycles to more complex multiyear fluctuations.[*][*]

Although scientists are only beginning to understand how seasonal external drivers influence the majority of host–parasite systems, empirical evidence strongly supports the strength and mechanisms of which seasonality alters the spread and persistence of infectious diseases. [*][*]

To present two examples for further understanding:

Agent: rotavirus.
Seasonal affects: winter peaks; timing shifts with latitude[*]

Agent: meningococcal meningitis
Seasonal affect: wind speed and low humidity affect respiratory/aerosol transmission[*]

Areas of similar dynamics and variation pertaining to seasonal variation:

• alterations in immune system defenses (weakened during winter and during harsh weather)

• periparturient rise (pregnant women lowering their own immunity to prevent harming the fetus)

• diseases that are cyclical in nature

• diseases that are seasonal in nature

Ending the Debate on Herd Immunity 

Agent-Host-Environment: This relationship is complex and depends on such factors as a precise course of infection (not only with an individual but within the demography of the host population). Other factors include duration of immunity (natural or artificially acquired), maternally derived protection, age-related changes in the intimacy of contacts – not to mention a prevailing level of genetic and spatial heterogeneity in both susceptibility and resistance to infection.[*]

There is no denying that mathematical models aid in defining details associated with infectious systems. Adjustments made to incorporate dynamic influences have the ability to make useful generalities and estimates – particularly to elimination thresholds and the course of infection within a population.[*] 

However, the science and intuition built on decades of practical epidemiological experience still often fail to predict outcomes/implications of vaccination programs.[*]

Each vaccination campaign entails a massive disruption of the previous balance which results in a destabilization of epidemiologic patterns for many years.[* p297]

...are vaccinated individuals the ones stepping outside the herd?

Herd immunity existed prior to vaccination.

Preceding national vaccination programs, epidemiological patterns of immunity/disease existed for the greater good. With each national vaccine campaign, epidemiology is modified (benefiting some and disadvantaging others).

While it is perceived beneficial that some vaccinated diseases have diminished over time (such as measles, chicken pox, rubella), it is very likely that these infections existed in a precise biological niche that was very much intentional – benefits in which our understanding can not yet comprehend.[*]

How exactly can the herd immunity debate end? 

(1) Accepting that the encompassing complexity of infectious disease (and nature in general) is not something human understanding will be able comprehend in entirety. Yes, artifical modification (via vaccine) can impart benefits – but it also exposes populations/individuals to disadvantages (many of which cannot be forecasted in advance) – implementation of vaccine programs must not be taken lightly nor forced upon a population without individual consent. 

(2) Above all else, voluntary consent married with adequate comprehension of each vaccine is fundamental as national vaccine campaigns develop and progress. This is whatshould be the underlying principle in discussions on herd immunity – NOT mandatory vaccination.

This post is dedicated to those families that have been deliberately and maliciously accused of ‘free riding’ off of vaccine-induced/artificial herd immunity – especially those who have been told this by a medical professional in hopes of altering a consent of vaccination.

I like to believe all parents are doing the best they can. Please choose what works best for your family while honoring the rights of others to make that same choice.