There are none so blind as those who will not see

Recently, I read an online article that I can’t find any more, but haven’t been able to get off my mind. It was written by a man who chose to have himself circumcised as an adult. His father was intact, and left the man intact, but apparently he had some problems with his foreskin tearing painfully sometimes during sex, so chose to have it all removed, and is now a proponent of circumcision.

Among the benefits he saw, was that he could now have oral sex performed on him, since before then, the sensations were just way too intense, and did not register as pleasure. So, he proves that removing the foreskin reduces sexual feeling. No surprise there.

In the article, he says that he cannot think of a reason why not to circumcise any sons he may have. But — and this is where the title of my post comes from — in the article he wrote, he gives ample reason why he should leave his sons intact, if he could but view it this way. When he told his father that he was going to have himself cut, his father was incredulous, and just sort of shook his head in amazement and disbelief that his son would do that. What? You mean that his father may have actually liked being intact, and may have liked having a foreskin, and may not have had any pain or discomfort from being whole? Okay, so the son didn’t — I’ll accept that as true; but does it necessarily follow that his future sons would wish to cut like their father, rather than uncut like their grandfather? The man writing the article was glad to be circumcised; fine. But that was a choice he made for himself. Can’t he let his own sons make that choice themselves, rather than forcing it on them as infants? What if his sons grow up and are mad that they are cut? — there are plenty of men who were circumcised as infants who are sad or angry about it, or are at least curious as to what it might have been like to be intact. There are also men who were talked into being circumcised as adults who now regret their decision.

One thing is certain, once it’s done, you can’t undo it. [Well, there are those who attempt surgery or stretching to re-approximate their foreskins, but that takes time, and it's still not the same as being uncut.]

So, open letter to this man who chose to have himself circumcised, and is now planning on making that choice for his sons: Remember your father’s dumbfounded reaction, think of how he shook his head in disbelief, when he found out that you wanted to remove part of your penis. Realize that he never regretted having his foreskin, and can only wonder why on earth you would want to remove yours. And realize that just as you are different from your father, and are glad to be circumcised, even so your sons may be different from you, and be glad to be intact.

Join me on facebook

I haven’t been blogging as much lately. Every so often, I think back to when I blogged every day for over a year and I wonder, “How on earth did I do that?!?” But I’ve been doing other things, including being on the Board of Directors for MS Friends of Midwives, home-schooling my children, trying not to be on the computer as much but still being on it too much, etc. I’ve been reading as many blogs as ever, and probably even more, when you count all the links and articles and blog posts that get shared around on f/b by my birth junkie friends. And there are a lot of interesting things I’ve been reading, but either I haven’t wanted to write a full blog post about it, or I have just gotten spoiled to the ease of sharing things by clicking “share” and “OK” and then I’m done. So, I’ve taken the plunge and decided to start a fan-page on f/b for this blog. [For some reason, the theme song from "The Jeffersons" is going through my mind -- "I'm moving on up!" :-)] I’ve already got the blog linked so that whenever I post something here, it will appear as a note there; but I will probably be posting a lot more links and things there that I found interesting, but thought my “normal” (as opposed to “those interested in birth”)  friends would think were over the top. Now I feel like I have more freedom to share links that I liked, without worrying about what others will think when I post articles on things like placentaphagy and stuff. So, if you subscribe to my blog and/or like it, you can “like” me on facebook to get even more.

I laughed until I cried!

A Man’s Guide to HomeBirth on Dr. Momma [Update: it was removed from Dr. Momma, but here it is in full.]

This is hilarious! Simply hilarious. I’ll give you a taste, but you must read the whole thing:

These are the items that men need to assist in a homebirth (not in order of use by the way): a black-light, princess wand (any type of wand toy will do,) fun-house mirror, catchers mitt/fishing net/soccer gloves, pocket watch, thesaurus, gum, woman who has witnessed a live birth, six pack of beer (or favorite alcohol), shovel, bucket, 1 dozen eggs, shredded mozzarella cheese, shower shoes, swimming shorts, push-up/pull-up bars or a wheelbarrow, old table covers (plastic holiday ones are best,) 1 big steak (or other red meat,) and 1 big cliche. Most of these items are for preparing for the birth, while a few are for the actual birthing….

So when I came down the stairs and was informed that she was in labor at 9am-ish, I felt ready this time since I just slept for 10 friggin hours. Alas, after hanging around downstairs for about ten minutes, my eyes rolled into the back of my head and I went and took a nap. On a side note, this is where the doula’s biggest strength lies – they are highly trained to withstand the Hypno-Fog. It was after that nap during the Hypno-Fog stage that I discovered that women who are about to go into labor cast this area-of-effect spell that can drop a man to the floor in a matter of minutes….

Pregnancy, Prematurity and Pumping

First up — I was invited to do a guest post on the “Breastfeeding with Comfort and Joy” blog on my experience with pumping breastmilk for someone else’s baby. The post was inspired by this video, entitled “Prescription Milk,” which focuses primarily on the importance of babies — particularly premature babies — getting human milk for their nutrition.

It was so touching that the mother featured in the trailer chose to celebrate and memorialize her daughter’s brief life, by continuing to pump milk even after her own baby died, so that other babies might live.

My personal experience was that I had over-supply issues, so being able to pump extra was a blessing, instead of having to try to minimize my production. Some mothers may not be able to pump enough milk to feed their babies, but there isn’t enough donated milk to supply all the babies who need it. If you are currently pregnant or breastfeeding, or know someone who is, please look into becoming a milk donor through the Human Milk Banking Association of North America, your local hospital, some other organization, or (like I did) just giving a friend bottles or bags of milk. You have to be screened to make sure you aren’t carrying any diseases that may be transmissible through breastmilk, so get started on the process as soon as you can.

Pregnancy is the perfect time to start preparing yourself for breastfeeding. The best way to do that is to talk to women who have successfully breastfed, and watch women breastfeed. I emphasize, “successfully breastfed,” because so many women tell horror stories of how awful breastfeeding was, and how they ended up with sore, cracked, even bleeding nipples, or how they “tried to breastfeed, but I never could make enough milk,” or some other unsuccessful breastfeeding experience. You wouldn’t ask a poor man how to become a millionaire; you wouldn’t ask a teenager for tips on a successful marriage; and you definitely wouldn’t ask me for tips on how to run fast or throw a baseball. ;-) You would instead seek out someone who had been successful in whatever it is you were wanting to succeed. Likewise, don’t ask someone who had a horrible time breastfeeding for breastfeeding tips (even if the lactation person she saw at the hospital said she was doing everything right, or she is otherwise sure she did what she was supposed to do). Or if you do, don’t be surprised if you, too, have a horrible time breastfeeding! Instead, seek out those who had an easy time, who were successful, who had no pain, who nursed as long as they wanted to (and/or longer than they expected). If you don’t know anyone that fits that description, or feel awkward asking to watch them as they nurse their babies, don’t despair! There is a book filled with beautiful and intimate breastfeeding images, along with clear and simple text, to help you see what a good latch really looks like and how to achieve that.

Get the book now, while you’re still pregnant, read the text, study the pictures, take it with you to the hospital (or just keep it at your bed-side table if you’re having a home birth), and start breastfeeding off not just correctly but confidently. As World Breastfeeding Week draws to a close, let’s not just celebrate breastfeeding, but help support women as they breastfeed, and remove hindrances that would keep them from success.

~*~

Update — I just noticed that WP has added a “like” feature to posts — that’s cool! :-)

World Breastfeeding Week 2010

“If a multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers’ needs, the very announcement of their find would send their shares rocketing to the top of the stock market. The scientists who developed the product would win prizes and the wealth and influence of everyone involved would increase dramatically. Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence…” — Gabrielle Palmer

It’s World Breastfeeding Week, starting today. Check out this link for more information, and if you want to join in, help celebrate and/or raise awareness, you can change your facebook profile picture for this week to an image of yourself or someone else nursing. For more quotes about breastfeeding, click here.

Oh, and please remember your phrasing — it’s not “the benefits of breastfeeding”… it’s, “the risks of formula-feeding”! Breastfeeding is (or should be) the norm, so it is what formula should be judged by, and not the other way around. Since breastfed infants have lower risk/rate of ear infections (and many other diseases and even death) than babies fed by formula, that is not a “benefit of breastfeeding,” but rather is “a risk of formula-feeding.” Words are powerful, so let’s use them powerfully.

Also, be sure you read this awesome new NICU breastfeeding policy — “Breastfeeding IS our babies’ food!” — which will undoubtedly help save babies’ lives (for example, premature babies fed artificial formula have, I believe it is, twice the rate of necrotizing enterocolitis than babies fed their mother’s milk) and help improve breastfeeding rates.

Are you having trouble breastfeeding, or are you worried about breastfeeding in the future? Have you experienced or been told “horror stories” about breastfeeding, including cracked and bleeding nipples, and a latch so painful it takes your breath away or reduces you to tears? Let me tell you that that is not normal, and certainly not inevitable. Have you ever wondered why American women have so much pain and trouble breastfeeding, when breastfeeding is a normal and natural function of the body, and women in other cultures don’t have these problems?

The answer is often an incorrect latch, brought about by women not growing up seeing successful breastfeeding. We unconsciously imitate what we see or have seen; and what we tend to see is bottle-feeding, since “nursing in public” is often frowned on, so even if women do breastfeed in private, they will give bottles in public. Babies fed by bottle are held differently from babies fed at the breast… then if women hold their babies in a bottle-feeding position even though they’re breastfeeding, the baby won’t be able to latch on like he should, which will usually lead to pain for the mom and frustration for the baby. It doesn’t have to be this way, though. Breastfeeding with Comfort and Joy can give you the right “mental picture” of how breastfeeding should be, and with its clear, simple text, help you prevent or overcome difficulties with nursing.

Showing that there really is only one race — the human race

Absolutely fascinating story complete with pictures: a Nigerian couple has a pale-skinned baby with blond hair and blue eyes. She’s their third child, and the other two are the same color as the parents, namely fairly dark-brown. No mix-up — the woman had a C-section, and the baby was this color at birth. Neither of the parents knows of any white ancestors, but it seems that they both must have had one which ended up working its way through the genes unnoticed, until one baby received both genes for light skin color from the parents at the same time — rather like my brother’s red hair when there are no red-heads in either family for as far back as we know. Genetics is absolutely fascinating. One race, people: the human race. Sure there are different characteristics that are predominant in one group of people over another (just as you probably all know some family who all have beak noses or skinny faces or broad shoulders or whatever), but we are not fundamentally different from each other. This is one more example that demonstrates that.

A flawed study published in “a second-tier journal”

That was the conclusion of Dr. Nicholas Fogelson about the much-publicized recent meta-analysis on home-birth, in a comment on Science & Sensibility’s post about it. [Honestly, I didn't know that the AJOG was so poorly respected. Makes me rethink what studies I'd look at, if it was published there.] In the S&S post, Amy Romano questions whether the meta-analysis was even appropriate, in light of the huge de Jonge study of over 300,000 planned home births in the Netherlands. She writes,

Lack of statistical power could not possibly be the rationale for conducting a meta-analysis on the safety of home birth. [The de Jonge study] contributed 94% of the data on planned home birth in the meta-analysis (321,307 of 342,056 planned home births). That study found virtually identical rates of neonatal death in both the planned home and planned hospital births, with relatively narrow confidence intervals.

The blog “Birth Sense” has two posts on this study: a prologue of sorts and then a discussion of the 12 studies included in the meta-analysis. And despite Dr. Fogelson’s comment that AJOG is a “low-impact” journal, many news sources apparently didn’t get that memo, and had no problem trying to make a huge impact with the sensational headlines that “home birth is three times as deadly as hospital birth.”

I have read numerous blog posts and news articles about this study and will include links to them below, but I want to comment on some things. First, since the study isn’t going to be released for a few more months, I haven’t read it (I know it’s available by request, and I presume for a price or if you have a subscription), so I’m not sure what I can add to what those who have read it have said. In some ways, what I’ve read has raised more questions than answers. The main question is, what were the inclusion criteria? From some sources, I’ve discovered that the original study had to have been published in English (a common enough restriction — gotta make sure the doctors don’t get bogged down in any bad translations from reading foreign language studies!), and also to studies that reported outcomes of mothers and babies in both home and hospital births (apparently the reason why the Johnson & Daviss 2005 article on CPM births, published in the BMJ was not included — they didn’t have a hospital “control group”).  But I wonder, did they not have any exclusion criteria for the size? They included one study that had 5 women in each group — a total of 10 women studied! If I may say so, “Good grief, Charlie Brown!”

Additionally, they included the Pang study, which itself was flawed, in that it reported not only planned home-births (with or without a qualified attendant), but it also included unplanned home-births — this despite a title that declares that it looked at planned home births. Nor was the study limited to the “term” period, but included births as premature as 34 weeks. Since I don’t have the meta-analysis in front of me, I can’t say how heavily it influenced the conclusion, but “garbage in, garbage out” — if the data going into the study is wrong, you can’t reach the right conclusion.

In all meta-analyses I’ve read, there has always been a discussion of inclusion and exclusion factors; if there are others besides the ones I’ve mentioned above, I’d like to know — out of curiosity, if nothing else.

Some of the articles I’ve read have touched on problems researchers may have in reconciling different studies, which may all have different designs, or look at different populations, etc. Again, I don’t have the study, so I don’t know if Wax and associates looked at all the different factors and did an appropriate exclusion or analysis of differing studies. Some differences among studies that I can think of that might need some statistical calculation or exclusion of some births (which may or may not have been included in any of the cited studies), include prospective vs. retrospective study design; inclusion of term, preterm or post-term births; cross-over (women planning a home birth who transferred to the hospital, or women planning a home birth who gave birth precipitously outside of the hospital); whether babies with congenital anomalies were excluded; whether the mothers were properly matched in the groups — same general age, income, health, parity, etc.; whether twins or breech or post-term babies were included or excluded (many studies are limited by design to “singleton vertex babies from 37-42 weeks gestation”); cause of death (for example, excluding accidental deaths by smothering or car wreck would be a good idea, I’d think, if possible); whether there was a trained birth attendant; quality of the original study, and undoubtedly many other things I can’t think of.

One of the confounding factors that some of the articles I’ve read, is that some of the studies examined only the early neonatal period (up to 7 days), while others examined the full neonatal period (up to 28 days). Which reminds me of another factor I should have included in the paragraph above — perinatal deaths including stillbirths, and also possibly intrapartum deaths. Several of the writers have noted that the largest study, the Dutch study, was not included in the actual analysis of the most loudly trumpeted conclusion, namely, that home birth carries a 3x death risk for babies when compared to hospital birth. The largest study which had almost 95% of all of the births in all of the studies, and showed no difference for neonatal death, was excluded for the purposes of  neonatal death. It seems that it is because that study only went up to 7 days. Was there not some sort of statistical analysis that could be done to extrapolate deaths that may have occurred from days 8-28, so that this study could have been included? Or, an analysis that could have excluded deaths from 8-28 days in the other studies? As I said, I have more questions than answers. I’d love to read the study for myself (and the Birth Sense link has links to all 12 of the included studies — some of them are abstracts but some of them are the full studies, so I may start by reading those), but I wonder if any of the questions I have would be answered if I did read it.

Now for the links that I read, in addition to those I cited above (some of them include other links to other articles, as well) — obviously, most of them are going to be favorable to the “this meta-analysis is junk” viewpoint, but not all of them are:

Now for some links to other home-birth related stuff that is not about this flawed study:

  • The Unnecesarean’s blog post on a new study in this month’s issue of Obstetrics & Gynecology that says it’s important to distinguish between planned and unplanned home births [and I'm just in the mood right now, due to lack of sleep, to say cheekily, "and next, they'll tell us that water is wet, and the sun is hot!" :-)]; but seriously, it’s because many times “unplanned” home births are to women with known risk factors that may cause problems with either themselves or their babies
  • the NHS write-up of the de Jonge (Dutch) home-birth study
  • High Tech vs. Nature’s Way,” an article from Minneapolis-St. Paul
  • The College of Physicians and Surgeons of British Columbia “Resource Manual” on planned home births

Ahhh, now I can close out some tabs on my browser.

Oh, and Dr. Amy, I’m pretty sure you’ve been waiting for me to write this up since I know you read me (not to mention you probably have “home birth” on your Google Alerts, and probably regularly add other keywords to make sure you don’t miss any internet discussions), so if/when you comment, just remember that you have to stay on topic. No cut-and-paste jobs like you usually do, m’kay? Oh, and before you bluster that the studies which showed that home birth is safe only in the countries of the study (like the Netherlands and Canada), because of how their midwives are integrated into the health system, I want you to answer a question: if that is true, why don’t you try to integrate midwives into the health system in America, rather than trying to elbow them out? That would solve that problem. :-)

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