Kangaroo Mother Care Saves Lives

Read the full article here — premature babies on their mothers’ chests have better outcomes than those placed in incubators. This is particularly important in low-income countries who simply don’t have the resources to have all the “bells and whistles” that can help preemies survive and thrive.

Circumcision Aftermath

A few months ago, I wrote a post entitled Circumcision Guidelines. One of the people who commented was Akram, who said this:

I am a Muslim.I was forcibly circumcised at the age of eight.I was lying in a ward full of women and children after my circumcision.The experience scarred me deeply.It led to great psychological trauma and behavioural problems in later life.I can write in greater detail if you like,Kathy.

I asked him if he wanted to write me, and I could include it as a post, and he consented, saying this:

I was eight years old when I was circumcised.Circumcising an older boy is particularly problematic as he feels a lot of shame and pain.I suppose,for an infant it is simpler,though still not desirable.
I was taken to a hospital to be circumcised.Some hints had already been dropped.I had a vague idea that my penis would be cut,but did not know how.A very shy child,I had refused.So when the day came,I was informed that it was for a medical check up.At least my circumcision was performed under anaesthesia and by a surgeon,so it was safe.However,when I regained consciousness,I was on a stretcher,my penis was heavily bandaged and I was lying in a ward full of children and women.Most children are circumcised as infants,so it was a fairly novel experience for them too to see that this had been done to an older boy.I was extremely angry and embarrassed.I had felt as if I had been violated.This was child molestation.This was akin to rape.Hundreds of people knew what had been done to me.They talked about it,they made jokes about it.When the bandages came off,I could not accept what had happened.Even now when I look at my penis,it feels unnatural.I have never forgotten it though a very long time has passed.If people must do it to their kids,at the very least they should spare them the shame by getting it done as quickly as possible.

He has also posted comments on other circumcision posts:

Kathy,this was very informative.I’d like to add here that I had a foreskin until I was eight years old.Never had any problems with hygiene.My foreskin,mercifully was not retracted forcibly.I did not see my glans until my circumcision.Many years after my circumcision,my penis feels raw and sore where it was cut.Also feels dry.Yet another reason not to circumcise.

~

It is really tough when circumcision is done for religious reasons.It becomes so much harder to avoid then.No rational arguments work.Every boy has to undergo this mutilation perforce then.It is not only cruel,it is also illogical.

~

Excellent arguments Kathy.Circumcision can be botched so easily.I have read of one boy who was mutilated to such an extent that he had to undergo a sex change operation and was brought up as a female.When he grew up,he had another sex change operation to become a male.Imagine the trauma.His whole life destroyed just because of circumcision !

Read this article and save $200,000!!

Oh, that’s an eye-catching headline! How many times have you read such an attention-grabber, only to be disappointed by the contents of the article? This may be one of those times. Or, perhaps the article sounded good or horrifying, until you read rebuttal comments after it which changed your perspective? Happens to me a lot.

Often it seems like articles do not live up to their headlines; or things are said in a way that is… not outright lying, necessarily, but perhaps deceptive. I won’t accuse anyone of deliberate deception – it may be that a person is so blind to his own biases that he doesn’t even see that he is being deceptive. And quite a few articles may present only one side of a story. For instance, I could write an article about owning a cat. It could be completely truthful, but not necessarily “the whole truth.” For instance, I could talk about how nice it is to have a companion, how that petting an animal lowers blood pressure, and that it is calming to have a cat jump up into your lap and start purring. All totally true. But I may leave out things like hairballs and smelly cat litter. Oftentimes, the one-sided-ness is made necessary by time or space constraints; or because a person only wants to look at one aspect, and is not intending for it to read like an encyclopedia or doctoral thesis.

Several months ago, I read an article that suggested that a multi-vitamin with folic acid could lead to a higher incidence of cancer. [My own research into that suggested that the link was not strong, and that folic acid is a necessary and beneficial part of the diet (or a multi-vitamin) and while it may increase some types of cancer, it may reduce other types, as well as have other health benefits. Of course, folic acid is now well-known to play a role in dramatically lowering the risk of your baby developing anencephaly or spina bifida or other neural tube defects, so on balance I’d say, “bring me the multi-vitamins!”] Anyway, on this particular article, the author had a list of foods and the amount of folic acid they contained, based on 100 calorie quantities, in decreasing amounts of folic acid. Several common items were high on the list, like lettuce and celery. Quite frankly, the article made it sound deceptively easy for a person to get the RDA of folic acid. After all, 100 calories is not very much! Or is it? It turns out that “100 calories” of lettuce was about 8 cups of lettuce; while it was something like 7 cups of celery. Certainly people do not commonly eat that much of those items. Nor do people try to get all their daily folic acid (or any other vitamin or nutrient, I daresay) from a single source. However, the overall tone of the article and impression from the article was that supplementation was not necessary since it was so easy to get all you need from dietary sources. But when you dig a little deeper, you find that that is not exactly the case. It would have been less deceptive to have the amounts of folic acid listed in a typical serving size or a typical amount eaten — say a couple of stalks of celery — rather than a standard “100 calories.”

Speaking of serving sizes, that’s another thing that can be deceptive, unless you read the fine print. I remember being surprised the first time I found out that a single 12-oz. can of Coke had 2.5 servings in it. That means that one serving is about 1/2 cup. If all a person drinks is half a cup of a soft drink per day, then they’ll probably be just fine; but how many people drink a whole can (or an even larger bottle!), thinking that they’ve only consumed the amount of calories and sugar in a single serving?

I recently watched the documentary Super Size Me for the second time. Among the other interesting things was a couple who drank 4 or 5 two-liter bottles of Diet Coke per day. The man had a half-gallon jug which he would drink two of on a regular basis, and sometimes more. I don’t care if it is “diet” and doesn’t have any calories, that can’t possibly be healthy for you! [Not to mention the possibility of aspartame causing cancer or otherwise being a dangerous additive.] I’m aware of the drawbacks of the documentary — it is possible to eat only at McDonald’s and to consume less than 5,000 calories per day, although that was his average daily intake. I wonder how many times Morgan Spurlock (the guy who did the experiment on himself) got only a hamburger for a meal. Sure, it was funny (but gross) to see him literally get sick after eating an entire super-sized meal, but it didn’t have to happen that way. The “rules” of his experiment was that he would only eat from McDonald’s (including water), that he had to order everything on the menu at least once, and if he was asked (but only if he was asked), he would super-size a meal. Very early into the experiment, he got a super-sized meal and his stomach couldn’t handle all that food, because he wasn’t used to it. I wonder how much of his food choices was for dramatic effect. He could have slowly worked his way up to eating a super-size meal, and he could have gotten water instead of soft drinks almost every time (getting soft drinks only once apiece), and he could have eaten mostly salads without dressing rather than a hamburger meal, and he could have gotten the desserts only one time apiece, but I daresay that he had several milkshakes throughout that month and had soft drinks more often than not. However, since he didn’t disclose his actual food diary for that month, we can’t know what he ate. Still a great documentary that makes you think about the role of food, sugar, and junk food in health and overall well-being, but if you “read the fine print” — if you dig a little deeper — if you listen to alternative and/or opposing views, it might change your perspective on it.

Here is a similar article, from the New York Times titled, “Why a Big Mac Costs Less than a Salad.” The article is about the federal government subsidizing various aspects of the food industry, and the claim is made that they subsidize most the foods we’re supposed to eat the least of — meat and dairy. There are many rebuttal comments below — several drawing attention to the disproportionate way these percentages are represented — they are the correct height but not the correct volume, so the “base” of the pyramid (meat and dairy) looks much larger than it should be. Other comments include questions of bias for the particular group that came up with this “subsidy pyramid,” and how they arrived at their figures; while some just decried the ideas of subsidies at all. One astute person commented that for the price of a Big Mac (about $4 in NYC), you could buy all the ingredients necessary to make a very nice salad (or several very nice salads). Another person said that based on the figures, federal meat subsidies may have lowered the price of a Big Mac by six cents at the most. One thing that was not said, which may or may not make any difference, is that dairy and meat farms may have higher “production costs” than vegetable farms. With big tractors and other farm implements, one man can take care of a whole lot of plants, but there may be a limit to how many cows one man could take care of. It may not be, but that was a possibility that sprang to mind.

So, I’m telling myself as much as you — read critically, even if (perhaps especially if) you like what the person has to say. They may be telling only part of the story.

Oh, how to save $200,000? Don’t buy a Rolls Royce. 🙂

Amazing Vernix

I just had to share this link — the “summary” would be (drum roll, please) that there are antimicrobial agents in vernix and amniotic fluid. The authors theorize that if more babies were allowed to have the vernix kept on their skin and/or rubbed in, that there would be fewer infections that sometimes can be dangerous.

Your Laugh for the Day

If this doesn’t make you laugh, there’s something wrong with you. 😉

Sex Education

In my opinion, sex education is anything that someone learns about sex. This may include things things related to birth, since sex is how babies are made.

I remember seeing puppies and kittens being born when I was a child, and don’t remember ever not knowing that. I do know that I was a little sketchy on how babies were made, and distinctly remember an imaginative picture popping into my mind of something going from the daddy into the mommy… through a kiss. However, I don’t remember a big, “Oh, wow, so that’s how it happens,” when I found out the details of intercourse. Growing up around a lot of families, I was around for a lot of diaper changes for a lot of baby boys and girls, and always knew that boys had a penis, but we didn’t talk much about things like that. With two older sisters and a mother, I was aware of menstruation, but my mom never had “the talk” with me. One day she made some comment about me developing breasts and asked if I had started my period yet. I told her yes, and that was basically that. I don’t remember buying or wearing my first bra, but I do remember being a child and having a regular heart checkup (I had two heart surgeries to correct a defect by the time I was three years old, and had thorough checkups for several years after that), and when the doctor stuck those things (EKG monitors? — whatever it was, the gel was cold) on my chest, and I remember thinking that sometime in the not-too-distant future I would be developing breasts and then would be really shy about having a bare chest with those monitors on it. Being of a curious mind and always liking to have facts, I researched sex (and related concepts) using the dictionary and our set of encyclopedias [not that I was a geek or anything ;-)]. Plus, with older sisters and their friends and mine, I got knowledge (some of it actually factual!) about sex, although we mostly gossiped about people and talked about cute guys and our own PMS. In school, one day the high school (which was probably about 15 students total — yeah, I know, really, really small), we were divided up into boys and girls, with the boys going with the (male) principal to the gym, and the girls staying with the (female) biology teacher in the classroom. I don’t know what the boys were told, but we discussed female anatomy, the menstrual cycle (and that was the first time I found out that slippery, egg-white looking cervical mucus was a sign of fertility since it happened around the time of ovulation) and also I think conception and pregnancy. Then of course, there were the songs — love songs, mostly, but some more suggestive than others; and others that weren’t exactly love songs that were mildly to very suggestive. And movies and music videos and books that also talked about and/or showed sex and love. That’s sex education, too.

But a constant current through all that was the expectation and realization that sex was reserved for marriage — this was reinforced primarily in church, but it was also a given in our household and school. I don’t remember too many conversations about it; it was just understood. The principal of the school was also the pastor of our church, and we were given moral instruction in both school and church, with many a sermon that had the topic of sex as either a main point, or a supporting point. [Not that it was talked about every Sunday; but we all knew what adultery and fornication were, just as much as we knew what stealing and lying were; and when such topics came up (our pastor liked to preach expositorily, that is, start with the first verse of a particular book in the Bible, and preach through to the last verse), they were dealt with.] Apparently, not all people liked it though. I remember one time a family had been coming to our church for a few weeks in a row and seemed to like it, and then the next Sunday the preacher (a visiting preacher, but nothing that we wouldn’t have heard from our own pastor) started talking about sex and how it should be reserved for marriage, and telling us teenagers that we needed to keep ourselves pure, etc., and the family got up and left. I don’t think it was because they disagreed that unmarried people shouldn’t have sex (in fact, they dressed more conservatively than most of our church, which was pretty darn conservative by most people’s standards!). Rather, I think they got miffed that the topic was brought up at all. It made me wonder if they didn’t want their children to hear the term “sex” at all, and I wondered if they thought they could keep their kids from knowing anything or doing anything wrong, if they just never told them and kept them so insulated. I’ve since read of a family whose parents thought that and were sadly undeceived by finding out that their children were having incestuous sex. They didn’t even know it was wrong, because they had never heard anything against it. Perhaps that could be considered “sex education” too — education by the lack of it?

So why am I writing this? Because it’s been on my mind a lot lately, and today, I read this article about sex-related lyrics in popular songs, and how it may affect the thinking and actions of young women. I’ve discussed “abstinence only” sex education versus “comprehensive” sex ed several times with different people. It probably comes as no surprise to you that I favor AOSE as opposed to CSE. However, I think that a major flaw with AOSE is that too much of the time, it is “too little, too late.” Can children, teenagers, adolescents, young adults and adults remain sexually chaste? Certainly! But is it likely that children who are immersed in a sexually-saturated culture will remain virgins if the only “sex education” they get is one class at school that tells them not to have sex, while they are watching sexually explicit TV shows and movies and listening to sexually explicit songs while their friends are all talking about their sex lives? No, not likely at all. It is certainly more likely that they will remain chaste if they grow up as I did, which is with “sex is reserved for marriage” permeating through most of the environment. [Sure, I watched sitcoms and movies and listened to music, but my parents were choosy about what was allowed on TV, although I had more leeway with the radio, since I could listen to it in private while the TV was in the center of our home.] And a problem with “comprehensive” sex ed is that some children may be taught too much, too soon, and be rather encouraged to have sex. Sure, they’ll be told to wear a condom when they have sex, but the failure rate of condoms with normal use is far from stellar and condoms don’t prevent nearly all STDs, and the more you have sex, the more likely you are to get pregnant or acquire a disease statistically speaking, so increasing the rate of sex may offset any decrease in pregnancy that condoms could provide.

Now, being a mother myself, I wonder what is the best thing to do for my children. Of course I am going to raise them to the best of my ability to believe as I do and to instruct them that sex is reserved for marriage. Yet, what else should be said, and what should be kept from them? I’ve heard some people say that their children know all their own anatomy — that they deliberately teach them penis, testicles, clitoris, labia, vagina. My sons know what a penis is, and call it by the correct name (and don’t know that it makes my mom and my sisters cringe to hear it); but they don’t know what testicles are. I’ve just never had an occasion or need to tell them. They also don’t know what a brain is, what earlobes are, nor that the joint between their arms and hands is called a wrist. [We looked at the skeleton today, and they didn’t know.] Should they learn sexual anatomy (for males and/or for females) now? Perhaps. In some ways, I think it is better to tell them when they’re innocent, so that they will have an understanding of these things without the sexual connotations of them — such as I did with just sort of always knowing that boys had penises, and how cats had kittens. They do know that they’re boys and Daddy is a boy and boys have penises; and I’m a girl and girls don’t have penises. [A few years ago, my older son saw a girl get her diaper changed for the first time, and he sidled up to me and said, “Mommy! her pee-pee’s broken!”] I don’t have a problem with the boys watching birth videos, and have even encouraged it from time to time (unless I thought a particular video was going to be a C-section or a scary vaginal birth). Once my older son asked me how babies come out of their mommies’ tummy, and I told him that there is a place between their mommies’ legs for the babies to come out. Simple and truthful; but I don’t know what I’ll say when he asks how babies get in the mommies’ tummy in the first place. Part of me wants to just go ahead and tell him (as G-rated as I can make it), so he’s not a horny teenager the first time he thinks of it, but accepts it rather innocently; and part of me is afraid of further questions on to the exact how and why of it all! Our cat is neutered so we don’t have the option of him happening to see cats or dogs mating or giving birth.

What do you all think? What were you taught? Do you think it was good or bad? What are you doing with your own children? Do you think your children will remain virgins until marriage? Do you want them to, or think it’s not really that big of a deal? How old were they (or how old will they be) when you tell them about sex, conception, birth, sexual anatomy, etc.?

“We’ve never heard such a ruckus”

That was the quote from the Senate Chairman when talking about the recent Mississippi legislation (that died in committee), that would have made all non-nurse midwives illegal in our state. With over 5,000 phone calls, the response was unprecedented. While that may not seem like a lot of phone calls, apparently, it was! Considering that our whole state population is somewhere around 2.5 million, that is 0.2% of the population calling (assuming that each phone call was by a different person, which we know was not the case, since many people called every Senator, or at least, every Senator on the committee).

What started the bill? I’m not sure, but apparently, there was a midwife (perhaps living in Louisiana, perhaps just down in that area of MS) who attended a birth in which the baby died. It’s possible that it was just one of those things, but it’s also possible that she was not as well-trained as she could have and should have been. Since I know no details, and have only a rough idea of what happened, I most certainly cannot pass judgment. Regardless of what happened or “what might have been,” this case led the Board of Nursing to get with a legislator to introduce a bill to make non-nurse midwives illegal. As far as I know, nobody knew about it until it had already passed the House and was in the Senate. Then we spread the word, and “raised a ruckus,” and got it defeated. Yay!

Now, to work.

Last Tuesday, I was part of a group that met in Jackson to begin work on crafting our own legislation to introduce next year that will make CPMs recognized and licensed, and will create a review board to oversee them. I’m not totally sure how that will work, because I’ve just never dealt with that aspect of things before. However, there were some TN CPMs at the meeting that talked about how it worked in their state. You can join the Yahoo group MSFriendsofMidwives to see the latest version of the bill and to stay informed on the process.

Currently in Mississippi, there is only one CPM, although there are several out-of-state CPMs who serve various parts of MS, and many other midwives who could become credentialed and licensed. With licensure and certification not having been required to practice in MS, it could easily be seen by midwives as being an unnecessary use of time and money to get that piece of paper, when there was no risk to not having it and very little if any benefit to getting it. I suppose that saying that you’re a CPM might get you a few extra clients, but it wouldn’t alter your legal status, and you probably couldn’t file for insurance repayment either (I suppose it might be possible, but I highly doubt that without the legal recognition that insurance companies would recognize you either). Under the legislation that will be proposed next year, CPMs would be legally recognized, and current non-certified midwives who can demonstrate that they meet the NARM criteria would be grandmothered in.

So, benefits of the legislation would be that midwives who are currently operating legally and safely in the state will continue to be legal birth attendants, and will also be recognized by the state. I asked about legislation that would make Medicaid be able to pay for such midwives, and was told that the legislation doesn’t specify that, but once CPMs are recognized, that such a step may come in the future — I don’t know if it would need to be a law, passed through the state legislature, or if it’s just one of those things that once they’re legal, they can get set up to file claims, or petition Medicaid to recognize CPMs. Another benefit would be that with credentialing perhaps comes a higher degree of respectability and also recognition. There is a certain something that comes with proof that others recognize the work you’ve done, whether that’s proving you can survive med school and get M.D. after your name, or that you’re a certified piano technician, and become a member of the PTG.

One downside of this particular legislation is that it would make non-certified and non-licensed midwives illegal. Those working on the legislation believe that any measure that allows non-CPMs to practice would be defeated. I can see that, based on the bill that was just defeated, that would have made all midwives (except CNMs) illegal. Yet, midwifery has been unregulated for so long in our state, that I can also see that enough legislators might support the bill, even if it did not criminalize non-licensed midwives. But, it seems prudent to take the safe track. I do wish that legislation such as what is in Oregon could pass, with licensure being optional but having benefits; however, those with much more experience and knowledge about midwifery and legislation are making the suggestions, so I’m going along.

“Why would anyone not want certification??” I can think of a few reasons. Some just don’t like government interfering in your business — it’s simply a libertarian issue. “Government is there to keep the peace, and that’s about it — everything else should be left free and open,” some might say. With certification comes regulation — in some states, non-nurse midwives have become legal, only to be basically legislated out of existence by the laws that made it practically impossible to operate. It’s sort of like the hospitals that have labor tubs, but women can’t use them if their water is broken based on a theoretical but totally unproven risk of infection; and they can’t use them if their water hasn’t broken, lest their water break in the tub, and nobody know it. As long as rules and regulations are sound, then there is minimal problem with them; but when they get to be stupid and over-reaching, they can cause more problems than they solve. In Arizona, the law says that home-birth midwives cannot attend VBACs. If you agree that VBACs should not take place at home, then you’d probably agree that this is good legislation. However, if you think that the risk of adverse events is so small that HBAC is a reasonable choice for women to make, then you’ll probably disagree with the legislation.

John Stossel is in a series of articles discussing the downside of certification (not mentioning midwives at all, and only briefly mentioning doctors). Here are two articles, “The Right to Work,” and “Licensing Madness,” as examples. He makes a pretty good case that certification serves to protect established industries at the expense of those who are equally competent to provide certain services (braiding hair, yoga instructor, writing wills), but don’t have the money (or don’t want to spend thousands of dollars) to certify just for the right to do what they already can do, especially if they’re doing it on the side, or are starting to build up a business. He points out that market forces will serve to weed out incompetent florists at least as well as (if not better than) the lengthy and expensive certification process. When it comes to businesses such as these, I’d have a hard time coming up with a counter argument — the “risk” of a bad florist is that you waste $30 on an ugly flower arrangement, in which case, you’d go tell all your friends and family and neighbors and co-workers to avoid that flower shop, and the florist would soon go out of business. But an incompetent midwife may lead to dead or injured mothers and/or babies, so it’s easier to say that doctors and midwives and such should be regulated and certified.

Still, there are probably some very good healers that could not be certified because they are alternative practitioners. For example, Chris Gardner, who wrote the book The Pursuit of Happyness, which was also a movie by the same name with Will Smith playing him, has an interesting history. If you remember the movie, he became a stockbroker while being homeless much of the time, with his son in tow. That’s only part of the story. When he was in the Navy and for several years afterward, he worked for and with a doctor. While my memory of what all he did is a little fuzzy, he had “great hands,” meaning, he was proficient in the medical work he did. He never went to one class of med school, but he had what it took to do what he did, including operate on people, teach med students how to do the right things — he even had work published in medical journals! But, because he wasn’t a doctor and hadn’t gone to med school, what would have been a promising medical career was necessarily stopped. He didn’t have enough money to become a doctor, and the doctor who employed him couldn’t afford to pay him more. “So, big deal — that’s just what you’ve got to do to become a doctor! We can’t have just anybody calling himself a doctor!” Well, true, but this also kept him from applying his skills and healing a lot of people. Sure, it kept some quacks out of the business of medicine, but it probably keeps some who would be very good doctors from doctoring.

There are definite upsides and downsides to this. Regulation helps to keep bad practitioners from starting a business, although it does not entirely eliminate bad practitioners. However, nothing can. While capitalism is a strong influence in keeping bad practitioners out of business (because people will not willingly spend their money on bad goods or services), they can for a time prosper. And if they’re schmaltzy enough, may be able to keep people blind to their incompetence or poor products or services to stay in business for a while — Bernie Madoff was a master at this (of course, he also blinded them with greed, which is another tangent and topic entirely). We’ve all known people who were certified, licensed, bonded, insured, and/or regulated who were really bad practitioners of their craft or trade. It happens. There are bad apples in every barrel. Regulation can make it so that people don’t have to do their own work to make sure people are really competent, which can be a good thing, or a bad thing if they are lulled to sleep and think that everyone who produces a piece of paper is competent.

As you can see, I’m conflicted about this — mostly because if you’ve got a bad midwife, we’re not talking about losing a little bit of money by not being more conscientious, but perhaps losing your baby’s life. Given enough time, the truly bad will probably be eliminated simply by market forces, but what may happen during that time? How many babies may die? Not something to be talked about lightly. However, we cannot protect people from themselves. Some people are going to choose things that others may think are “woo” (acupuncture, acupressure, magnets, copper, feng shui, craniosacral therapy, chiropractic care, herbs, vitamins, supplements, etc.) — we can’t stop them from doing that. And if a woman thoughtfully considers the matter, and chooses a non-certified midwife, or even just has a few friends over to attend her birth, can we really stop her? Should we? At what point does “society” get to dictate who attends her birth? Recently, there has been a national conference on VBAC (which since you’re birth junkies, you’ve probably heard about, unless you’ve been living under a rock). A similar argument has emerged from the pro-VBAC community, namely, that women have the right to choose how to give birth, and should not be forced into a C-section, even if there is a risk of uterine rupture and perinatal mortality. Does someone else get to choose how women give birth, or is that something that each woman should be able to choose for herself?

I think highly enough of women and our intellect to say that if a woman understands that she is hiring as a midwife someone who has only attended ten births, hasn’t really read too much about birth complications, and has never handled a postpartum hemorrhage or a “slow to start” baby, or any other complication, that she should still be allowed to hire that midwife, knowing the risks. I would want someone more qualified than that, but some women are comfortable with that level of skill and knowledge. Unless the midwife misrepresents herself or her skills, then I just don’t see that “we” should try to save the woman from herself. Others may disagree — it comes down to where on the “libertarian” continuum you find yourself.