Last day of 2009

Wow — hard to believe it’s already here! At the risk of sounding terribly clichéd… where has the year gone?!?!?

There have been some big changes in obstetrics — that’s right — ACOG has changed its name from “American College of Obstetricians and Gynecologists” to “American Congress of Obstetricians and Gynecologists.” That is big news, because “college” refers to academics, or “A body of persons having a common purpose or shared duties”; whereas “congress,” of course, refers to sexual intercourse. No, seriously — that is one of the definitions of “congress”! — check the link. 🙂 [Ok, I admit it — I did read Dave Barry’s “2009 in Review” column recently, and that sounds like something he would say. He must be rubbing off on me. :-)] But I suppose they mean one of the other more common definitions, such as “A formal assembly of representatives, as of various nations, to discuss problems,” or “A single meeting, as of a political party or other group.” I don’t like the political overtones of the name “Congress,” and don’t really know why they changed their name — it seems that academics is more of a high ground than politics, so why shift focus from that?

In other ACOG news, they finally realized that women in labor do not suddenly lose all their competence when it comes to eating, drinking, and being able to vomit without inhaling, so they are now magnanimously allowing women in labor to consume “modest amounts” of clear beverages. In a condescending quote, Dr. Barth upholds the restrictions on eating solid food in labor (which includes fruit juices with pulp and soup), by saying, “As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common.” This is logical?? — “We’re restricting food because most women don’t want to eat anyway.” No – it’s circular reasoning (and also quite false). If women don’t want to eat in labor, then why have a formal restriction? Just don’t force-feed ’em! And if they do want to have something light, like soup, you ought to have a better reason than, “Trust me, dearie, you might end up throwing this up, so although you’re starving now, you’ll thank me later when you dry-heave bile and pure stomach acid instead of this yummy chicken soup!” Not all women want to eat during labor — I didn’t my first time, but did the second. I threw up the first time (and, gee, would you know it — I managed to keep from inhaling that vomit every single time, just like when I threw up with morning sickness, and just like I threw up as a child from a stomach bug — imagine that!) — threw up the entire large meal I had eaten just prior to labor starting, and then threw up the sips of apple juice the midwife urged me to take; but didn’t throw up the second labor nor have the slightest bit of nausea. Wow! Imagine that — maybe my body knew that it couldn’t handle labor and digesting Chinese food the first time; but likewise knew that I needed energy during my second (24-hour) labor, so I was hungry and thirsty like normal, ate whatever appealed to me, and didn’t throw up. Isn’t that just so weird?? [Not.]

In another statement on elective inductions, ACOG recommended that no elective inductions be done prior to 39 weeks, also saying, “A physician capable of performing a cesarean should be readily available any time induction is used…” Those of you who are around inductions (doulas, friends, L&D nurses)…

And once again, continuous electronic fetal monitoring for the low-risk mother/baby dyad is recommended against, since it doesn’t seem to help neonatal outcomes, nor lower the risk of stillbirth, nor lower the likelihood of cerebral palsy, but does raise the risk of C-sections. “The false-positive rate of EFM for predicting cerebral palsy is greater than 99%. This means that out of 1,000 fetuses with nonreassuring readings, only one or two will actually develop cerebral palsy. The guidelines state that women in labor who have high-risk conditions such as preeclampsia, type 1 diabetes, or suspected fetal growth restriction should be monitored continuously during labor.” However, women who are induced and/or given epidurals usually or always need continuous monitoring, in case their babies take a sudden turn for the worse, which is more common in drugged than natural births.

So much for ACOG changes — now for something that remained the same: demonizing CPMs and home births stayed at #2 on the ACOG Legislative Agenda. I guess a 99% share of the market isn’t good enough.

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Open Letter to Dr. Amy

Recently on The Unnecesarean blog, you have participated in many discussions, saying lots of different things, occasionally including some things I agree with. However, one thing that stuck out most to me was your insistence that natural childbirth (i.e., not receiving pain medications) made no difference in a woman’s birth experience — basically, that the stories of countless women who have told stories of how wonderful and empowered they felt after having given birth drug-free were bunk and hokum. Your proof of that? Just your own experience. Really? — That’s it? — “I did it, so your experience will be exactly like mine”? What else would you apply this narrow-minded view to?

I recently had a miscarriage, and the experience was shockingly normal — that is, it was neither dramatic nor traumatic for me, and was not even terribly emotional nor upsetting. I was a little sad, but would not say that I “mourned” or “grieved” unless those terms could be used in a mild form. But I would never tell someone who had a different reaction to a miscarriage that she shouldn’t feel the way she does — that she should feel the way I do/did, and handle things exactly like I did. Some of my friends have mourned their early miscarriage the way others have mourned a mid-pregnancy loss, a stillbirth, or an even later loss. I didn’t. Some of my friends have had D&Cs. It wasn’t necessary in my case. One of my friends experienced such heavy blood loss that she was air-lifted to the hospital (it was rush hour in a big city plus there was road construction — otherwise an ambulance would have sufficed, or her family may have even been able to drive her). Nothing like that happened to me. One size does not fit all.

Some might think that women who are pro-life will experience more grief than those who are pro-choice. [I’ve heard many pro-choicers say that the fetus isn’t really a baby until birth, so it is not too big of a stretch that a woman would feel more grief over losing a “real” baby than a “potential” baby.] Yet that is not necessarily the case. I believe that life begins at conception; yet I know of two women for sure who are both pro-choice (one of whom actually had a prior abortion), who both mourned more for their miscarried babies than I did. Perhaps the length of gestation may have something to do with it; yet I know of women who mourned more for their early-pregnancy loss, than others did for later losses. Some women may feel deep grief if they see the fetal or embryonic remains; others may get a sense of closure, and find it to be a healing experience. Some women may feel more loss for a planned and/or wanted baby than for an unplanned baby — yet that is not necessarily the case. When I was pregnant the first time (unplanned and certainly not the best timing, in my estimation), I had a miscarriage scare due to a negative pregnancy test after a prior positive one. Although I had not wanted to be pregnant, I immediately felt a strong maternal protectiveness for the baby I was carrying. Some women may even grieve or mourn more for a miscarried baby they had not planned on conceiving, because of the initial negative reaction they had to finding out that they were pregnant. They may have guilt added on to grief.

There is also a wide variety of reactions when it comes to natural childbirth. There are a lot of women who intend on giving birth drug-free, but end up taking drugs. Some of these women decide that natural childbirth is “for the birds,” and plan on having an epidural as quickly as possible in subsequent births; other women approach their next birth more determined to go natural, even taking steps like planning a home birth to make it more difficult for them to be offered and/or to acquiesce to drugs. Not every woman who gives birth drug-free will feel empowered; but many will. Some women feel empowered from choosing a C-section. Some women who have drug-free births go on to have epidurals with subsequent births — some of these may regret the decision, but others may regret not having had an epidural during previous births. To each her own.

But, the bottom line is, do you not see how preposterous it is for you give your one, single anecdotal experience as if it were a gold standard? — and thereby to completely dismiss all other women and their birth stories who have a different tale to tell? In future, it would behoove you to say, “I’ve given birth both with and without drugs, and could not tell any difference, except that it was more comfortable to have the drugs; but other women may have difference experiences.” That’s a much more credible response, especially when said amongst hundreds of women who would strongly beg to differ about whether or not drugs affected them during their birth!

Twin Home Birth Story

Click here to read Robin Elise Weiss’s story of the home-birth of her 5th and 6th children — identical twin girls. A lovely story!

Follow the Money

“Follow the money” is a catch-phrase that people (including myself) often say, as they point out some problem that they perceive — “look to see who is benefiting monetarily.” And there is a certain element of truth to that — greed is a powerful force. People will do a lot of things for money. So it is wise to “follow the money” and make sure that the people who are selling something (literally or figuratively) have anything to gain by it.

A frequent accusation against people of one stripe or another (and probably both, if the truth were told!), is that the person can’t be believed, because he is making money off it. For example, scientists employed by Exxon or other gas companies are frequently disbelieved by the folks at Greenpeace, because of course the scientists would say that their company isn’t causing environmental problems, or else they’d lose their job! But then, what about scientists who are employed by environmentalist groups? — the same thing could be said about them! After all, if being “environmentally conscious” doesn’t actually do anything or help the environment, then why should they exist?

Then you’ve got the whole swine flu and Tamiflu stuff — H1N1 doesn’t seem to be as bad as was first believed — follow the money? where? The vaccine manufacturers, sure. The maker of Tamiflu, which may not be as good as it first appeared? Certainly. All this hype, lining the pockets of… but wait a minute. What if there had been no hype and no hysteria, and the disease really was as bad as was predicted, only nobody had talked about, it to avoid mass hysteria (sort of like not shouting “fire” in a crowded theater)? Then what? Conspiracy theory would fault… probably the same people, saying they wanted thousands of people dead, so that everyone else would line up for shots and drugs. Or blame the eeeevil government (here or there or somewhere else) for covering things up, to kill off the weak, who just end up costing the government money with food stamps and medical care, or cost all of society in larger medical bills. Or whatever.

It only takes a couple of facts to make a really good conspiracy theory. In fact, the most believable ones have the fewest facts… but the most suspicion. Facts are stubborn things, and can trip you up because they might be able to be disproven; suspicion is impossible or at least difficult to allay. It’s easy to start a rumor that somebody fathered a child with a mistress — but that can be proven or disproven with a paternity test. But did Lee Harvey Oswald act alone? Ah, the suspicions!

Recently, a scientific panel concluded that mammograms are not warranted until a woman turns 50, and then only every other year — that the risks of mammography (including radiation exposure, false positives, medical error, finding slow-growing cancers that would never cause any problems but treating them anyway, etc.) are not worth the benefit (the rare younger woman who would actually have cancer). Personally, I’m not a big fan of mammograms, and hope never to have one — perhaps the technology will improve to the point that mammography will become a relic of the past, by the time I turn 40 or 50. But I have a friend whose mother died of breast cancer, who, in her early or mid-30s gave herself a “birthday present” of a mammogram, and will probably have one every year or every other year for the rest of her life.

When the news hit that this panel had made this conclusion, I thought, “Good! Less radiation!” but then I started wondering if there might be some “dark side” to the recommendation (perhaps I have an unhealthy dose of skepticism??). On one forum (not birth-related) that I’m on, someone started off the conversation on this topic by saying that she had previously been against mammograms (mostly because of the radiation exposure, and being a pretty “natural living, whole foods” kind of person), but now that they were being recommended against, she was sure that there was something nefarious about it! She said that had this panel come out saying that “mammograms are bad and should be discontinued because they cause cancer,” then she would have supported it; but she didn’t like the reasoning they gave, so had some alternate explanation for it. I think she blamed insurance companies, because if mammograms are beneficial, they have to pay for it; but if they’re “not supported by the evidence” and “not necessary,” then that’s less money they have to pay out, and more money in their pockets. “Follow the money,” she said.

Only problem is, this works both ways! I bet she or somebody else had previously complained about mammograms being done for no good reason, and pointed at doctors who made money off of mammograms, saying, “Follow the money!” Who makes money by mammograms being standard? Presumably the doctors who order them, the technicians who perform them, the medical equipment companies who make the machines (and the X-ray films, and the developing machines, and whatever other paraphernalia that goes with them), and perhaps other people or companies as well. Who makes money by them not being used? Insurance companies spend less, but so do consumers (who don’t have a co-pay). What if, for the past decade or two, doctors have been colluding with scientists to fudge the data, to make it look like mammograms are beneficial, and, finally, the jig is up! Could be. Why not? Most doctors do what they learned in med school, and what they might occasionally read about in journals (assuming they read any), but mostly just do what everybody else is doing; and what everybody else is doing, is following “the guidelines” of recommending mammograms starting at 40. They may even have thought they were doing the right thing, but never critically examined the evidence (or, the evidence may have been false or misleading, or nonexistent), just doing what they were told to do, by those whom they trusted. Think it couldn’t happen? If not, how did episiotomies come to be seen as needful or at least beneficial 100% of the time? and pubic shaves? [However, as someone pointed out in one of the articles or blogs I read about this, even though the science does not support things like elective C-sections and inductions and other birth-related non-necessary things, insurance companies are still paying for them, so that doesn’t necessarily mean that insurance companies will stop paying for mammograms in younger women.]

A similar controversy arises over C-section rates. Some people claim that doctors like to perform C-sections because they can get done faster and make more money per birth, while others claim that a vaginal birth is really the quickest and easiest birth for doctors to attend. I can see it going both ways, and “the truth” may depend on the situation. If a doctor comes into a hospital and is with the woman 10 minutes before the baby is born, and his job is done in another 10 after the birth, then that is much less time than would be spent on a C-section, which takes about an hour, depending on circumstances. But, if the doctor is going to be interrupted at supper, or dragged out of bed in the middle of the night to attend a vaginal birth, he may very well spend more time driving back and forth to the hospital, and/or waiting for the mom to finish dilating or to push for a couple of hours than he would spend on a quick C-section. And he’d make more money since he used his surgical skills, rather than just receiving the baby in a vaginal birth. So, a doctor might have a reason other than a true medical reason, to speed up a birth or to call for a C-section — both in making more money, as well as in being able to go home and just relax.

“Follow the money” may have some truth in it. However, there are two very important caveats that immediately leap out at me. First, not everybody who stands to gain from something will do something wrong just because there is the possibility of money. True, “a bribe blinds the eyes of justice,” but there is a thing called integrity, which some people have. Let’s not be too quick to condemn our fellow man, just because he receives money. And usually, the person who creates something or provides a service actually benefits others. Plumbers and electricians come to mind. They could be crooked, but just because they stand to earn money by fixing your toilet or wiring your house doesn’t mean that they will sabotage their job, so that you’ll call them back. [And, actually, while you can make a quick buck by being crooked, you’ll also be quickly put out of business as word gets around that you can’t be trusted; the real way to get money is by being honest and trustworthy, so you get repeat business and referrals — that’s a steady income stream!] Also, many people do things out of charity, or altruism. Many people will provide a service for free, or at a reduced price, to those who cannot afford it. Or just because they’re nice. And this includes doctors. Don’t you sometimes do things without money, just because it’s the right thing to do? or just because it’s nice? Are you motivated solely by money? Would you do something you knew to be wrong, if someone offered you a few hundred dollars, or a few hundred thousand dollars?

What if I told you that the American Cancer Society, despite their high-sounding words about being “dedicated to eliminating cancer” was a bunch of hooey? What if I said that they had a vested interest in cancer being common and prevalent, because if cancer were actually defeated, then there would be no more reason for them to exist, and they’d be out of a job? What if instead of fighting cancer, they were actually dedicated to fighting alternative medicines or therapies that actually cured cancer?  Sound wacky? I’ve heard it! And who’s to say it’s wrong? After all — “follow the money”! The ACS gets a lot of money every year in donations, after all!

No, I don’t really think that the American Cancer Society is a corrupt organization. But based solely on “follow the money,” it could be! Based solely on “follow the money,” there is ample space for either proponents or detractors of annual mammograms to point fingers at the other side for being wrong. As well as global warming (there is a lot of money available for “going green,” — just ask Al Gore; but there is probably enough money for corruption on the “skeptic” side, as well). And just about everything else, as well. But just because there isn’t a lot of money doesn’t mean that a person or organization is right or not corrupt, either! After all, many panhandlers will take your money you give them for food and use it to buy liquor. A lot of people have a vested personal interest (monetary or not) in a particular ideal. I daresay that most of the people involved in Greenpeace or other environmental organizations do not make a lot of money from it, but they are as deeply committed to the environment and the ideals of the group as if they stood to earn millions from it. It doesn’t make them wrong; but it doesn’t necessarily mean that they’re right, just because they don’t make money from it.

Some people are just jerks who like to screw around with people — take the guys that are always introducing viruses and worms and trying to hack data. Some of the programs are done just for the heck of it. Sure, some of them are done to steal people’s financial information and to make/take money; but not all of them. Some people are just mean, and do it because they get a thrill out of screwing up people’s lives, or getting away with something, or just because they like to make a mess bogging down email servers. Childish. Low. But just because they don’t make a dime off of it, doesn’t mean they’re fine, upstanding citizens. Nor that just because Norton and McAfee make a lot of money on virus protection, that they’re somehow colluding with the hackers, to provide a reason for people to buy their product.

I’m sure “follow the money” is accurate some of the time. But not all of the time; so be careful what conspiracy theories you read about. Just because someone makes money doesn’t mean they’re unethical, any more than if someone does not make money, that he’s correct. Yes, money can be a very powerful draw; but sometimes, the money trail could be hidden (deliberately or accidentally), so just because you can’t see it, doesn’t mean it isn’t there. And it doesn’t always have to be “filthy lucre” — it could be power, prestige, or some less tangible asset. Accusations can be very powerful, though. And all the worse because often they can’t be disproven. How could you disprove the accusation that the American Cancer Society was actually happy that cancer kills thousands of Americans per year, because that meant that more money would likely be given to them? You couldn’t. So, be careful. Just be careful.

Would’ve, Could’ve, Should’ve

It’s so easy to play “Monday morning quarterback.” Take any situation, and say, “Well, if that had been me…” or, “If I had been in that situation…” And you may be right. Some people are just wired differently — are able to come up with a witty comeback, or are able to think more clearly or more quickly, or able to react faster or better than others. But you may be wrong — most likely, you would have reacted in exactly the same way as the person you are (unknowingly) criticizing.

There have been several instances on the My OB said WHAT?! blog in which comments have taken that turn — doctors making rude or nasty comments, or even downright sexual harassment, and several women have said things along the lines of, “If my husband had heard that, they’d probably have arrested him for assault, for punching the doctor’s lights out!” or “I’d’ve kicked that doctor in the face!” (for saying x, y, or z when he’s between the woman’s legs while she’s pushing.” Although I don’t think I said anything along those lines, I know I thought it, or agreed with those who did say it out loud. And yet… would I have? Sure, it’s easy enough to say when I’m reading it on a computer screen, in the comfort of my home, and the full force of the hurtful, rude, or harassing words comes through loud and clear, with no other “background noise” to drown it out. But what if I were really in that situation? How would one go about kicking someone in the face, when she’s numb from an epidural? or with her legs up in stirrups? — not exactly an easy position to get out of quickly.

Some of the women who had submitted the comments originally replied to some of the comments, saying that the “could’ve, should’ve, would’ve” comments were actually hurtful. I know that none of the commenters (or those who did not comment, but thought the same things — like me) intended for the words to hurt. For myself, I would say that when someone said, “I’d’ve kicked that guy in the face!” that she was really meaning, “that guy deserved to be kicked in the face for what he said!” Most of us probably tend towards non-violence against our fellow man, so we probably would not really have physically acted out what our immediate, visceral reaction was. Or if we were in the room when a husband did punch a doctor in the face, we might be shocked and/or horrified (even if we would have been shocked and/or horrified at the comment or action that provoked the violence).

It’s so easy to say things. It’s much harder to carry through with them. It’s easy to say, “I would never have given in to the pressure to have an unnecessary [C-section, induction, augmentation, epidural],” but much harder to actually do — especially when you’re in that particular situation, facing that particular pressure. There is an element in which it is good to hear these kinds of stories, and play through them in your mind, so that if you’re ever faced with it, you may be better prepared for a certain reaction. “Practice makes perfect.” But far better to keep these things in mind while you’re screening your midwife or doctor, or during your prenatal visits, so you can completely avoid situations like these. That’s not fool-proof by any means, unfortunately. Sometimes you can do all the “right” things and still end up on the wrong end of the stick.

If you’ve been in situations like these, please, please, please go to The Birth Survey and report the health-care provider, so that others can be forewarned and forearmed. If you’re looking for a provider, go there to see what others have said about doctors or midwives who are options for you. And if someone you know is pregnant or of childbearing age, be sure to tell her about The Birth Survey so she can get a good match for a care provider. Otherwise you or someone you care about may end up saying, “I should’ve picked a different care provider, and I would have if I only could have known.”

Men vs. Women

First up — sleeping men can’t hear a baby cry, but sleeping women can. I know, I know — pick your jaws up off the floor, because that is so shocking! 😉 What about you — who hears the baby first in your household?

Researchers believe it is women’s maternal instincts — whether they have children or not — that kick in when they hear any young child cry that wakes them up.

Meanwhile, men are more likely to jump up at the ring of car alarms, a buzzing fly or howling wind. Men can also go right back to sleep after having been woken up much faster than women.

I remember once or perhaps twice that my husband heard the baby and/or got up to get the baby first. However, I’m pretty sure that it was because he happened to be already awake. Possibly it was because I was sick or otherwise exhausted and sleeping soundly. While this may sound like whining, it’s not — he works, I stay home, so I think it’s just a normal and equitable “division of labor,” especially since… I could take a nap during the day… I was breastfeeding so had to feed the baby anyway… and I could operate on much less sleep during the day at home than he could at work (and particularly driving). In fact, we’ve changed “who sleeps on which side of the bed” with great frequency — it’s always just automatically been that I sleep on the side nearest the baby/children/crib/door. When we go to a hotel, or stay at someone’s house, or rearrange the bedroom furniture, I get “whichever side is closest to the door,” regardless if that’s the right or left side of the bed.

Speaking of which — sort of off-topic, but I’ve always wondered…

Secondly, from the Journal of the International Association of the Study of Pain [who knew that there was such a thing?!]: Women get accustomed to pain, and men don’t.

Strikingly, females reported more pain than males at the outset of the first exposure to pain, but then experienced less pain and annoyance than males as a painful stimulus was sustained and with repeated stimulation… Notably only females demonstrate adaptation and habituation that allow them to experience less pain over time.

Merry Christmas!

The Santa suit was sooo cute, but Keith *hated* the hat!

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Merry Christmas, Everyone!

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Totally unrelated poll: