What would you pay for a dozen eggs?

In last week’s New York Times, there was an article about women going overseas for embryos. An increasingly affordable option for infertile couples is to “import” embryos from other countries and have them introduced into the woman’s uterus in the U.S. or to travel to another country and have the procedure performed there. “Fertility tourists” is how these people are referred to in countries such as South Africa and Italy.

I am not able to find anything on the economics of egg donation for the women in these countries who choose to do so. I know it can be a fairly lucrative business for young women in the united states. A single “harvesting” can have between a $5,000-$15,000 payoff. Rebecca Mead wrote a great article for The New Yorker, “Eggs for Sale,” on the whole business of human egg collection and commerce.

But what about women in Romania or Germany? Are they paid handsomely for their hormone manipulation and abdominal punctures? I fear this is another case of Americans’ treating other peoples as mere resources, as means to a cheaper end, as with clothing manufacture or gem collection.

And yet, I don’t know what I’d do if I was still trying to conceive a child instead of mothering a near-seven-year-old. I certainly couldn’t afford the cost of in vitro in the U.S. Maybe a vacation to Cape Town and an undeclared import on the return trip would be just the way to spend a few February weeks.

As an aside, in vitro fertilization in Romania allowed a 66 year-old woman to give birth to a pre-term daughter two weeks ago. I do not think anyone was done favors in that situation.

What Really Happens with Paternity Leave

What with looking for lice and sketching out an outline for my book on menstruation, I have found it hard to keep my blogging paced to my thoughts. Here are a few things I’ve thought about lately.

First, in the book Taking Sex Differences Seriously (Encounter Books, 2004), author Steven E. Rhodes devotes his first chapter to exploring (exposing?) the different ways male and female faculty spend “maternity leave” time. According to the Chronicle of Higher Education (though you need a subscription to read the full article),

“Researchers for Mr. Rhoads interviewed 184 assistant professors nationwide -- 109 men and 75 women -- asking whether they took paid leave after the birth of a baby and how much child care they did during that time.

"Only 12 percent of the male faculty members took paid leave, compared with 67 percent of the women. But ‘while those males who took leave had ample opportunity to participate in child care and did so more than males who took no leave, they still did significantly less baby and toddler care on average than females in either group -- those who took leave and those who did not,’ according to the book.”

Apparently his conclusion is that it may actually be unfair to give male academics maternity leave, especially if they are using it to get ahead in their scholarship rather than care for their children.

I can’t say I’m surprised to learn that men did less child care than women. Yet even if a father wasn’t caring for his baby directly, he might have been doing a lot of the supporting work – cooking, cleaning, errands, caring of older children – that freed up the mother to care for the baby and herself.

I would hate to see regression in our family leave policies based on how much academic work male faculty completed while on leave. On the other hand, it is frustrating to see yet another venue in which a seemingly gender-blind system is actually disadvantageous to women.

Maybe that’s enough of my thoughts for today. I’ll save the rest for later.

Except that: J.K. Rowling had a baby over the weekend. The baby was delivered by an independent midwife. As said midwife is one of only three such women in Scotland, I speculate whether her privileged position has something to do with non-muggle lineage…

Hazards of the Doula Heart

Over the weekend I spent some time caring for a fellow birth professional who is laid up for several months with a leg fracture. Just light housekeeping and some visiting with her -- essentially a postpartum visit without the newborn. The next day she called to tell me her daughter had just been diagnosed with an advanced case of head lice. (Is your scalp itching? Just the word lice makes mine itch.)

My spouse was out of the house at the time so I asked my older son to look through my hair. One quick glance at my scalp – apparently his first ever such examination – and he said, “Gross! It’s like a thousand goosebumps.” So I had to wait for Spouse to return to see if he would inspect me. He was equally unwilling and gave only a half-hearted flip through parts of my hair, hitting maybe every 1-2 inches with any kind of attention.

Unless you know me well, you cannot understand the irony in this situation. For I absolutely love any and all types of fussy body grooming, particularly when dermatological afflictions are involved. Peeling sunburn? Call me. Zits that need squeezing? I’m your gal. Dandruff scalp? Hold me back. So to have an excuse to scrutinize each millimeter of head skin, only it’s my own and therefore inaccessible, was agony.

Nonetheless, I made the best of a bad situation and positioned myself in front of our bathroom mirror. I resolutely tipped and twisted my head and during a patient, fifteen-minute inspection examined nearly ¾ of my head (with the help of a hand-mirror).

The result? Several suspicious white objects that on closer inspection turned out to be: couscous, toothpaste (or WhiteOut) and sweater fuzz. Oh, also a piece of blue glitter. Thankfully no nits or lice. And lest you worry, I do wash my hair every day. I think all the items I listed can be traced directly to my children.

The good news is that I was feeling a little itchy today, so I think I get to do another exam tonight!

News Roundup

Not much to report today other than this interesting note on Alaska doctors hashing out what will appear on the state's abortion web site.

FYI, Michigan's abortion section appears here (and continues here).

My latest book idea

"The Lore of the Rag," (not to be confused with The Lord of the Rings):

A non-fiction collection of anything and everything you ever wanted to know -- and then some -- about menstruation.

Chapter 1: The Biology of Menstruation
Chapter 2: Menarche (including factoids about cultural rituals to recognize girls' first periods, the fluctuations in age of menarche due to environmental factors, images of those horrible "educational" books about puberty you get in middle school; also, anecdotal accounts of women's first periods)
Chapter 3: Menstruation through the Ages (historical information on how women dealth with and what they thought about their monthy bleeding)
Chapter 4: Extreme Menstruation (including Guiness Book of Records'-type data on longest continual, youngest and oldest menstruaters, and Ripley's Believe It or Not tales of menstral surprise: towns where all the women begin bleeding on the same day, etc.)
Chapter 5: Culture and Menstruation (or Ritual and Menstruation: how do modern cultures recognize this aspect of womanhood)
Chapter 6: Variations from the routine (more medical information on abnormal menstruation, its causes and treatment...including meditations on what "normal" menstruation is...discussion of how stress and other factors (starvation, etc.) affect menstruation)
Chapter 7: Menopause (the same combination of medical, anthropological and anecdotal information as in other chapters).

Please, someone, write this book (or let me know if you already have). I'll never get the chance, but I'd love to read it. By the way, if it sounds interesting and you haven't read Natalie Angier's Woman: An Intimate Geography, you should.

In the meantime, here's the web-based Museum of Menstruation.

Big Doins in Brazil

You’ve probably heard by now about the seventeen pound baby born in Brazil. Not surprisingly, he was delivered by Cesarean section (half the babies in Brazil are). Not surprisingly his mother was diabetic. In fact, his size makes one wonder how much prenatal care the mother received. My experience is that the babies of mothers with diabetes of any type are monitored closely for size.

An interesting counterpoint to the high Cesarean rate in Brazil is the videotape “Birth in the Squatting Position.” In ten minutes this film, with hardly any narration, shows a handful of women delivering spontaneously and without assistance in a full squat. They use a specially designed chair that has a soft place for the babies to land. The chairs and the delivery “technique” (namely leaving women alone) were promoted by a Brazilian obstetrician. Every woman I’ve worked with who’s seen this video in her childbirth class has been impressed by it.

A Series of Unfortunate Events

The past week has brought us a streak of oddly bad luck. Not hugely bad. Not irreversibly bad. But bad nontheless.

It began with my spouse's accidentally teaching our two-year-old The F Word last Wednesday and culminated (well, hopefully culminated) yesterday with a neighbor's house being raided by LAWNET because it had a meth lab in the basement.

In between those bookends we also had our basement drain back up and flood a small puddle into the basement, the driver's side window of the car we park on the street smashed out in a random act of vandalism, Husband sprain his toe falling on the ice on his walk into campus AND Husband break a tooth, necessitating an $800 crown (of which insurance will cover exactly $0).

See? Nothing on par with a major health crisis or a natural disaster. And yet the cumulative effect, especially when coupled with the near zero temperatures and the kids' incessant runny noses, is to make me feel like hoping the next plane for the Carribean.

Breast Beware

The office I work in for my day job subscribes to The Chronicle of Higher Education. The December 10, 2004 issue excerpted a series of e-mails from their “Academic Job Search” forum on whether the breastfeeding mother of a 7-month-old should ask for pumping breaks while she’s interviewing for faculty positions.

The responses are worth reading. Some are supportive of the mother, including one from a chair who said they have honored such requests in the past and think nothing of it.

Many of the reponses, however admonished the mother to "keep things in perspective" and not let this little period in her life jeopardize her academic career. I was stunned. I always think of universities as one of the more progressive major institutions in our country. And here are the very people teaching in and getting degreed by them saying best keep motherhood in the closet.

Birth Support Dream Team Member #1

If you haven't heard of Dame Edna by now, then you probably wouldn't want her on your Dream Team.

Addendum

After I was in bed last night I realized I'd never included the "gift" in yesterday's post that inspired me to write it in the first place. Namely, that the whole notion of blogging came to me through former clients. They also introduced me to the concept of zines.

And a former client also dubbed me with the nickname Doulicia.

Safe to say, without my doula clients, this blog wouldn't even exist.

Simple Gifts

A completely unexpected benefit to my doula work has been the new music, writers, ideas and information I’ve gathered as a result of it.. It reminds me of living in the college dormitory. You could walk room to room and find something new in each one: designer perfume, The Cure, euchre, college republicans, “century club,” Kahlil Gibran. (If I seem sheltered, trust me, I was! Still am, I suppose.)

So it has been with births and the families I’ve met. From one family, I learned that Nora Jones was the singer I’d been enjoying on the radio. They played her first CD at during labor and I can’t hear “Come Away with Me” without thinking of them. The mother, an anthropologist, also introduced me to the writings of Robbie Davis-Floyd, as well as several other writers on Western reproductive anthropology.

At another birth, I read the mother a story while she drifted off to some well-earned sleep after getting her epidural. The story was “Mimsy Were the Borogoves” and its author, Henry Kuttner (writing as Lewis Padgett). Not being a scifi reader, I suspect I’d never have encountered the story. I am so glad I did.

I got to listen at one birth while the father read his wife poems, including one by Billy Collins (“Litany”) that perfectly captured their playful relationship.

A father told me as we awaited his daughter’s arrival that in Hebrew lore, babies in the womb are taught the entire Torah, but then right before they are born, an angel touches them right between their nose and upper lip (the evidence is that little dimple we all have), the babies go “Ooh!” and forget everything. Then they get to spend their whole lives relearning it. [ed. If I have botched the parable beyond recognition, I apologize. I think that came out at about hour 22 of labor!]

My bedroom is slowly becoming a memento of the births I’ve attended. I have a plaque that one mother made me, a beautiful picture from another. I have a pile of books I’ve either been given by families or have bought myself after discovering them at births.

I can’t find the quote I’m thinking of but somewhere I remember reading that you can never come into contact with another entity and leave the encounter unchanged. As far as births go, that is certainly the case. Obviously there are the memories and the birth experiences themselves. But I never foresaw that my physical environment would change as well. It is such a sweet surprise.

New Pregnancy and Labor Diagnostic Tools

Remember, I’m for LESS intervention in labor, not more.

That said, a fetal EKG in the works sounds like a promising labor development to me. It could help identify true fetal distress (instead of monitors that are picking up maternal heart rates), and it’s an external monitor, instead of one that screws its probe into the fetus’s scalp.

Also, last week JAMA published an article that indicates preeclampsia screening by means of a simple urine test could identify women at risk for the condition months before clinical symptoms occur.

Who Doesn't Miss Carrie?

We heard last week about another friend whose baby died in the first trimester.

Before I ever got pregnant I had my father’s attitude toward miscarriage. Let’s call it “Scientific Objectivism as Alternate Reality to Emotional Pain.” I would say, well that probably means something was wrong with the embryo anyway, so it’s just as well.

Then I got pregnant. And then I terminated a pregnancy at 20 weeks.

Now when I hear about someone who miscarries I want to clean off my dresser top and light my little doula meditation candle and send love and comfort into the universe for the woman and her family.

A major disappointment of today’s medical care is that most obstetrical practices don’t want to see you until you’re out of the treacherous first trimester. The message this has always sent to me is “your pregnancy doesn’t count unless you can get it past week 12.” (I’m not the first person to feel that “miscarriage” is a blaming word; “spontaneous abortion” is another term for the same thing and though it brings up the culturally charged word “abortion,” at least it focuses the action on the fetus).

Unfortunately, the most support many women will need in their reproductive lives is during those first 12 weeks when the vast majority of spontaneous abortions occur. In terms of emotional assistance and help making sense of a scary time, doctors tend to get involved a little late in the game.

I haven’t seen any appealing print materials on miscarriage. The ones that actually have useful things to say are printed in black and white with line illustrations by the same person who did your middle school puberty pamphlets.

The internet has lots of good information. If you enjoy the company of other women who’ve been through the loss wringer, there are blogs such as chezmiscarriage and alittlepregnant, among many. For information, you might consider SharedJourney.com, for chat groups, silentgrief.com. A good list of on-line support resources is available at babylosskit.com, though the site is nauseatingly “gentle.”

I’m big on rituals and ceremonies. For unwillingly unpregnant women, finding a rite to acknowledge the pregnancy, their baby’s death, and their role as grieving mothers can be very therapeutic. No site I could find was devoted to rituals for mothers of spontaneously aborted babies. But these had some good thoughts: here (based in Judaism), here (based in Zen Buddhism), and here (atheistic).

If you are in the midst of a miscarriage or are healing from one, I am so sorry for your loss.

My Proposal for Birth Injury Malpractice Reform

Why not create a national compensation program for families/individuals with birth injuries and/or congenital disabilities?

I could imagine suing if I was faced with a lifetime of expensive treatments, medicines, and therapies for my child. It would be my only way to cover expenses. If, instead, I knew before birth that a federal program would provide not only medical care, but appropriate education and care for my child, most incentive to sue would go away.

The only other two motivations I could imagine for a lawsuit would be vengeance and trying to prevent the situation from occurring again.

Education could go a long way here. If women are given honest information before conception, during pregnancy, during labor, if they are consulted, made partners in their care, treated as intelligent people, then they may be more accepting of unforeseen outcomes. They could come to see that many "bad outcomes" are simple bad luck and unavoidable, rather than a reflection of negligence on the part of their caregivers.

When babies are born with problems (and without), parents should have access to their files, to honest information. I had a client whose son was born blue, limp and quiet. He was whisked to the warming cart and doctors "worked on him" for 15-20 minutes while everyone else sat in the most awful silence I've ever witnessed. After a while, a nurse wrapped the baby up, brought him over for the mother to hold briefly and said he was going to the NICU for observation.

By all observations and reports the baby is fine today. He was fine the next day. Apparently he was fine when he went to the NICU. But my client said nurse after nurse would come in and say "Boy, your little guy had a rough start!" Only after a visiting nurse repeated this phrase to her at home did she said, "What do you mean?" The nurse said "Do you have any idea what happened to your son in the hours after he was born?"

She only knew what I was had been able to report to her: that sometimes babies inhale meconium and it can irritate their lungs...That her baby was breathing on his own with only blow-by oxygen at five minutes...That a pediatrician friend thought it was great news that he went home after observation...

The nurse urged her to get her son's hospital file and ask her doctor about any part of it she didn't understand.

If there was this much confusion and silence with a "routine" complication (aspirated meconium) and an essentially well baby, imagine what happens when things truly dire.

An even farther step in reassuring patients that their caregivers are qualified, responsible, and not likely to repeat mistakes would be to open hospital and birth center files. Atul Gawande wrote a great New Yorker article last month about health centers sharing information. Imagine if you could know how your hospital's care stacked up nationally.

As for vengeance and wanting to bankrupt the bastards that ruined your life and your child's, I don't know what to say. Anger is a part of grief. Involving the care team in the family's grieving might mitigate those desires some...And if nothing works, there's still the lawsuit option.

[ed. I'm completely unsatisfied with this entry. It in no way matches what's in my head. But I really need to get to sleep!]

Malpractice 101

For weeks and weeks I have been wanting to really tear into the whole medical malpractice issue. I keep putting it off, however, because it’s such a meaty one. I can’t do it justice in just one post. And I’m no expert, so I need to do some brushing up first.

That said, I just read (on a new favorite site, www.overlawyered.com) a tidy description of how malpractice insurance rates and runaway jury awards have driven many OBs out of practice in southern Illinois.

If you want an example of how malpractice cases proceed, read this story about a six million dollar judgment against a doctor, midwife and nurse. A baby is born in Kentucky with cerebral palsy. A lawyer for the family sues everyone present in the delivery room.

(NOTE: This is why doulas should carry malpractice insurance. Even if you aren’t “responsible” for the birth, you will be named as a defendant in the case. It’s how these things are done. It’s simply thoroughness on part of the family’s lawyer. And unless you plan to represent yourself in court, getting your case dismissed will cost you hundreds to thousands of dollars)

Then comes the opportunity to settle. In this particular case, the doctor(‘s insurance company) and the nurse(‘s insurance company) chose to settle rather than go to trial. Remember, SETTLEMENT IS NOT AN ADMISSION OF WRONGDOING. Rather it is often just the smartest financial decision to make. A settlement is a negotiation; both sides usually get something they’re after. Going to trial is an all or nothing gamble. And, as the doctor’s attorney noted, “When a baby is born with birth defects, it is easy to generate sympathy with a jury, making [the doctor] vulnerable to a verdict whether she was guilty or not.” Do you feel lucky? Do ya’ punk?

(NOTE: By the way, just as settlement is not an admission of wrongdoing, A PLEA BARGAIN IS NOT AN ADMISSION OF GUILT. For the same reasons you might settle a case to keep the wild card jury from deciding your financial fate, you would accept a plea bargain rather than let a group of emotionally volatile strangers make decisions about your freedom. Criminal procedure and the screwed up American legal system is the topic for another day, another blog, etc. But I couldn’t resist pointing this out).

So only the midwife goes to trial. The jury is asked to do two things: decide whether the parents of the disabled child should “win” and, if so, assign percentages of responsibility to the parties.

The jury does not know that the hospital was dismissed or that the two other defendants settled. It decides that the midwife was 40% responsible. It then decides how much money the family should receive for the harm done to it. Forty percent of that final figure ($6 million in this case), is what the midwife(‘s insurance company) is responsible for.

I will save for another day my proposed solution to the malpractice dilemma.

News Roundup

A Romanian woman has delivered the first of two twins at 29 weeks but probably will not deliver the second one until term.

Researchers have found that babies born to women who live in areas with high air pollution, especially particulate matter, have slightly lower birth weights than those born to mothers living in cleaner air. In the United States this means that racial minorities, especially African American and Latina women, are disproportionately at risk. And it certainly means that the poor are more at risk.

I also found this profile of California midwife Faith Gibson interesting. She talks about how she observed the difference in treatment black and white women received in the L&D unit of a Florida hospital in the 1960s. “White women were brought in to the maternity ward, given narcotics, put in a gurney and strapped to an IV. Black women were left to themselves, no drugs, no IV, until it was time to deliver.” Ironically, what was intended as a convenience for the white women seemed unnatural to her. When she became pregnant, she asked to deliver her baby “like the black women did.”

Peggy Vincent has a similar observation about the difference in how white and black women labored (or were allowed to labor…or were forced to labor) in her book Baby Catcher. It’s a must-read for any of you who are birth story junkies.

Finally, I found a profile of a Minnesota nurse midwife who is a man. I know I posted a month or so ago about “doulads” (male doulas – you heard it from me first). In there I mentioned that the male nurse who was there when my older son was born is now a CNM in the Toledo, Ohio area. So that makes at least two CNMen that I know of.

Fear and Loathing in the Birth Center

In the last two weeks I’ve come across two interesting editorials that pointedly represent the differing reactions families can have to medicalized births.

In the first, New York Times health columnist Jane Brody describes her newborn grandson’s post-partum brush with death and concludes that “all babies should be born in well-equipped hospitals, with neonatologists at the ready and a neonatal intensive care unit down the hall.”

In another, appearing in Slate, freelance writer David Dobbs thanks his lucky stars that Cesarean birth was an option for his first son, but then lobbies hard for continued VBAC options.

As I think back over the two pieces, what stands out is the authors’ opposite reactions to fear and risk. For Brody, the small risk of complications that accompanies every birth should mandate hospital deliveries. Dobbs, on the other hand, acknowledges the elevated risk of VBAC but puts it in perspective: “If a woman accepts a 1-in-200 chance of a rupture and emergency Caesarean, she has a 75 percent chance of avoiding another C-section altogether.”

I wonder if Brody’s wish to put all births in NICU-equipped hospitals and many women’s preference of Cesarean birth over VBAC might be another manifestation of our culture’s heightened value on security after 9/11. If we are willing to let our government hold individuals in terrorist investigations indefinitely without evidence of wrongdoing (habeas corpus? Hello?) and without notifying anyone on the rationale it might keep us a little safer, then a hospital or Cesarean birth is hardly an inconvenience in the interest of safety.

Putting Things in Perspective

I may have mentioned a midwife friend (on the West Coast, not in Michigan) who went and did a month’s service at a medical mission in rural Guatemala last year. She came back and said it was hard to listen to her patients, middle-class women, complaining about minor pregnancy discomforts or worrying over details of their intricate birth plans. “It’s hard to be sympathetic when I’ve just seen a Guatemalan woman with a prolapsed uterus, who only came to the clinic to have her son’s tumor removed. She didn’t even consider her condition worth treatment!”

As I read accounts of women birthing or trying to keep their children alive in the wake of the tsunami, I get a sense of what she meant.

Don’t get me wrong. I think birth is a sacred event and a rite of passage. I agree fully that birth has been medicalized to the harm of women and babies. I believe women should be in control of their births and making informed decisions about their care. After all, I am a doula.

But when I think about poverty, malnutrition, famine and natural disasters, I confess I would not want to be pregnant, or laboring, or mothering a newborn in any of those situations. If I had been eating only rice and living in a slum with an open sewer in the street, being able to refuse an IV in labor would be low on my priority list.

On many occasions I have heard a doctor or nurse console a mother facing unwanted interventions by saying, “as long as you have a healthy baby in the end, it doesn’t matter how you got there.” It always makes me bristle. “IT VERY MUCH MATTERS!” is what I want to scream at them.

But when I step way back, I think my attitude is completely contextual. In other words, as a white, North American, middle class woman, OF COURSE I am going to think the process matters. It does. But only because I have grown up with a Western sense of individuality, priorities, self-determination, affluence.

Were I a rickshaw driver birthing a baby in the dark, on an island hilltop off India, hours after a tidal wave nearly killed me, I would only care about having a healthy baby in the end and living myself. It would not matter how I got there.