Tuesday, June 28, 2005

Men('s blogs) are from Mars, Women('s blogs) are from Venus

I frequently ask my spouse whether he has read my post for a given day and, if so, what he thought of it. I also whine to him not infrequently about how other blogs get so many comments, but mine gets so few.

I have said before that a large part of what I enjoy about reading and writing blogs is the opportunity to interact, albeit in a highly structured manner, with people on topics of interest. When I don't get comments on my blog, it feels akin to saying something at a cocktail party and having everyone stare silently at you for 3-4 seconds before someone else jumps in with a graceful recovery line.

So the other night, completely unsolicited, my spouse offered that I could improve my blog by offering more "consistent" and focused content. He said he'd noticed that I sometimes wander far from my birth/pregnancy theme. Moreover, a fair bit of my posts lack a real punch and are more just narrations.

At first I felt defensive. After all, this blog is a very personal project. I don't take to having it criticized.

But as we talked about it, I realized that many of my favorite blogs suffer both the faults my spouse had identified in mine. Some have no theme at all, but are so well written they're worth the daily visit. Others have a loose theme, but include a lot of ancillary and/or personal information. Some posts are strictly rambling, each paragraph a new thought or news item.

What I like about them is getting to know the writer behind the posts. This is as important, if not more important, than the actual content of the blog. And like people you meet face to face, there are those blog people whom you want to know better, whom you keep hanging out with.

I like it that Barb is a midwife. I love reading about her relationship with Sarah, her gastric bypass surgery, her daughter in a bad relationship. Dr. Andy has interesting things to say about medicine but what about his interest in ultrarunning?

I shared these things with my spouse and we stared at each other for a few seconds. You could practically hear the gears turning. Finally I asked, "What do YOU get out of the blogs you read?"

"Analysis, insight, critique," he replied.

Ah! The lightbulb went on. We read blogs for different reasons. Well!

I tried to find something on-line about whether there are types of content or posts that men prefer more than women. I couldn't find anything. So you heard it here first: women blog and read blogs to increase their communal sphere; men read and write blogs to traffic in information for power purposes.

A generalization, yes. But one with some truth behind it, I believe.

Enough about that. I'm on vacation from work this week and enjoying some time home with my kids. Tomorrow I'll be visiting the couple whose baby is 10 days old. I need a haircut. What else? I guess that's enough for now. I'll head back to my planet. And Spouse, who's watching The National (Canada legislates same sex marriage!), can return to his.

Sunday, June 26, 2005

Boy Baby Births Declining

Did anyone hear this story on Morning Edition last week? Fewer male babies are being born in the United States today than 60 years ago.

Male babies are still slightly more common than girls – in 2002, 1048 boys were born for every 1000 girls. But their rate relative to girls is declining. In 1942, 1055 boys were born for every 1000 girls.

A small difference, admittedly, but if you multiply it over the entire U.S. population, there are 850,000 fewer males now than there would be if the 1942 ratio stayed intact.

No one knows why male birth rates are declining relative to female birth rates. Among the hypotheses are the influence of environmental hormone mimics, and the prevalence of single parenthood. Apparently women whose partner does not live with them at the time they conceive are more likely to birth a daughter than women whose partner lives with her at the time of conception.

The news story pointed out that this could be bad news for women who already feel there aren’t any available men to marry.

It didn’t raise the fact that women are on the rise. We’re still in the minority, yes. But we haven’t come this close to matching men body for body in years…if ever! And don’t forget, we tend to outlive them by several years.

Think of the potential!

Thursday, June 23, 2005

Cord Blood Redux

A few weeks ago I posted about the increasingly popular practice of storing infant cord blood. I have always had my suspicions about the necessity for this, balanced by my fear that any day now one of my sons will get sick and I'll regret not saving some of their stem cells.

I'm feeling a little better after reading this Los Angeles Times article. It had information I'd not heard on the actual demand for cord blood:

The current uses of the stored stem cells are limited, and the private banks have little to show for their work so far.

The three largest cord blood businesses in the United States have collected more than 230,000 samples, generating at least $300 million in revenue from anxious parents. Just a few dozen cord blood samples have been used, primarily for children with leukemia who could have been treated with equally effective alternatives.

At Family Cord Blood Services, just one sample has been used out of the more than 9,000 collected over the last eight years. The child died.

"This is purely a commercial business," said Dr. Eliane Gluckman, a French hematologist who performed the world's first successful cord blood transplant in 1988. It is "just for profit and not for benefit."

And guess what? There's an alternative. Public cord blood banks.

These banks are typically nonprofit. They don't charge parents for harvesting or storing the cells. The public banks resemble blood banks, stockpiling donated cord blood and offering it to anybody in need of a transplant. The banks cover their costs by charging about $20,000 for each sample. As part of an accepted medical procedure, the blood is usually covered by insurance.

Because cord blood can be used with a lower degree of genetic matching than bone marrow transplants, it is ideal for transplants from unrelated donors.

In May, Congress voted 431-1 to spend $79 million to make searching easier by linking public cord blood banks in a national network.

There are about a dozen public banks scattered across the United States. Worldwide, such banks have provided cells for more than 5,000 cord blood transplants.

In other words, more people benefit -- including the child whose blood is collected -- by having a public storehouse of blood from which to draw possible matches. If the child ends up needing stem cells, she can access thousands of donated samples instead of just her own privately stored collection. In the meantime, a nation of people have access to her blood as well as others'; even if she doesn't need to access her cord blood in the course of her lifetime, someone else who needs to may do so under the public system.

Interestingly, the article quotes several people for whom banking cord blood was more akin to getting a Silver Cross pram than an act of protection and preservation.

For Clayton Frech and his wife, a movie actress, banking cord blood for their new son was as essential as buying an infant car seat.

"It's a pretty common and accepted practice in the circles we run in," said Frech, who runs a party-supply business in Los Angeles.

"People don't know exactly what we'll need this for," he said. "It seems better to play it safe and conservative and have some of these cells in storage."

A similar article ran earlier this week in the San Francisco Chronicle. The most interesting thing I learned from it was this:

But what generally isn't clear from the private banks' ubiquitous marketing materials to pregnant women -- in magazines, maternity stores, doctors' offices, direct mail and on the Internet -- is that genetic diseases, such as sickle cell anemia, can't be treated with a child's own cord blood because it already contains the disease.

Many transplant doctors also are hesitant to use a child's own cord blood for nongenetic diseases, such as cancer.

"In children with cancer, I would definitely not use" a child's own cord blood because it was probably contaminated with the disease at birth, said Dr. Joanne Kurtzberg, director of the pediatric blood and marrow transplant program at Duke University Medical Center.

Between these two articles I feel comfortable putting my cord blood conflicts to rest. Which is different from dismissing my fears that a family member will one day need cord blood. As with every parent, the fear of losing a child is part of my marrow. It is good to know that should the situation arise in which we turn to stem cells for a cure, there is a public bank -- egalitarian and anonymous -- that we can turn to.

It is also a good reminder for me to make another deposit to the American Red Cross blood bank, which we're much more likely to need a withdrawl from sooner or later... and which helps many more people on a daily basis than cord blood ever will.

Wednesday, June 22, 2005

Deconstructing the Family Birth Center

There are two hospitals in town, "U-M" and "St. Joe's." They are in hot competition with each other for pregnant patients.

A few years ago St. Joe's addressed a hole in its services by opening a NICU. Last summer it upped the ante when with a newly constructed Family Birth Center. U-M has countered with its plans to build a new women's and children's hospital to the tune of $498 million. St. Joe's already has a fundraising effort underway to update its NICU.

Clearly St. Joe's is winning on the marketing front. If you go to its Family Birth Center page you'll see this description:
Our personalized “warm and friendly” nursing care has kept generations of families coming back again and again. Couple this with an experienced medical and nursing staff who deliver nearly 4,000 babies annually, and you’ll see why St. Joseph Mercy Hospital is the hospital of choice when it comes to having a baby.

New delivery and ancillary rooms opened in July of 2004 provide a comfortable home-like setting for the birth of your baby. The area features 12 modern Labor/Delivery/Recovery rooms, two with Jacuzzi tubs and 10 with Jacuzzi showers. After baby arrives, you’ll finish your stay in one of our private mother-baby rooms.
Oooooooh. By comparison, U-M says:

The Women's Hospital Birthing Center is designed to care for both low and high-risk pregnant patients throughout their labor, delivery, recovery and postpartum (LDRP) hospital stay. The Birthing Center is comprised of three units designated Women's East, Women's West and 7 East Mott.

The East unit is dedicated primarily to the peripartum management of high-risk patients. The east unit functions as an obstetric intensive care unit that has three triage rooms, eight LDRPs, three operating rooms and a three-bed post anesthesia care unit.
A little dry, eh? U-M's website also offers a slideshow tour of the facilities.

We all know a fair bit of distance exists between marketing's version of reality and what people actually experience.

St. Joe's "Family Birth Center" is beautiful. Lots of natural wood, earthy colors, art on the walls, which have recessed and track lighting. But for the nursing station, it could be a corporate headquarters.

And yet...

You rarely see anyone in the halls. It is remarkably quiet, especially in comparison to how I remember the hospital's old labor and delivery unit being. For me, L&D floors have an air of excitement and happiness about them. This unit felt very emotionally flat.

Worse, there is a locked security door between the family waiting area and the patient rooms. The door also stands between the patient rooms and the public restroom. I must have passed through it 14 times during my stay.

And how can you put tubs in only 2 of 12 rooms when hydrotherapy is one of the best ways to manage labor pain?

Compare with the university's hospital. The halls make a rectangle with the nurses station and family waiting area in the middle. It is easy for friends and relatives to pop back and forth between the room and the waiting area. They have access to light refreshments while they are waiting. The pregnant mother can stop by and say hello as she walks the halls.

The halls, by the way, are lively. Nurses, doctors, patients, families are moving around, chatting with, smiling at, and generally connecting with each other.

Patient last names are posted outside the rooms, making it much easier to find where you're going. When a mother is admitted, her name is written on a yellow card. After the baby's born, another name card gets posted, this time in blue. Mother and baby charts hang on special rails outside the rooms, mothers in pink, babies in blue. At a glance you can tell whether the mother has delivered or not and how many babies she had.

At St. Joe's -- probably in stricter compliance with HIPPA -- there is no identification outside the rooms other than the room number. It can be hard to remember where on the corridor you're located. I'm sure more than one laboring mother has been surprised by a lost stranger walking into the wrong room.

Environment aside, however, there is one primary reason I remain skeptical of the "Family Birth Center" label. It has to do with those operating rooms that are part of the birth center. Construction doesn't come cheap. What is the fastest way to start making good on your investment? Get insurance companies to send you there money! In other words, get a lot of your family birth center women into your family birth center operating rooms.

If you think pressure to perform surgery is just a fabrication of the natural childbirth cult, be sure to read about this obstetrician.

I applaud hospitals' efforts to accomodate laboring and birthing mothers' needs. Hooray for the jacuzzi tubs. Thank you for putting art, fabric and hardwood floors in labor rooms.

Nonetheless, we need to remember what lies behind the polished finishing touches: an institution that needs to make money...first by having you choose to birth there, then by offering surgery as a lucrative safe route to a healthy baby.

Tuesday, June 21, 2005

In Lieu of a Real Post

Check out this week's Grand Rounds. There's a compelling (if overly venemous) post attacking a Salon article on the vacciene-autism debate. I'm still not sure which side to believe, but it points out that whatever it is we're advocating, we'd better have our methodology straight and our quotes in context.

Also, as one who's marched through the rite of passage that is the Bar Exam, I have lately been enjoying reading this blog about preparing for the 2005 bar exam (just weeks away!).

Finally, check out PostSecret and think about what your secret would be.

I have several posts in the works, but they're taking too long to get up today.

Wednesday, June 15, 2005

Feelin' Like a Doula Again

It's been quiet for several months on the doula front. But now I have a client due this Sunday and am starting to meet with another client due in early August. Both are first-time moms. Both think they'll deliver early. Funny, I have yet to have a client who says, "I just know I'm going to go two weeks past my due date! I can tell." But the optimists abound.

Both women are planning to deliver at the Cathloic hospital in town. I haven't had a birth there in nearly a year and that birth happened precipitously, five minutes after I arrived. It was my first time in the newly built birth center. What I'm trying to say is that I'm completely unfamiliar with the facility.

This isn't a big deal, really. I just like knowing where everything is -- bathrooms, "nourishment" rooms, places to catch a nap -- at the U Hospital. It can save a little time and keep me from getting in the nurses' way with my questions and wanderings.

I believe I have finally learned why shoulder dystocia is such a big deal. I thought it might have something to do with impaired gas exchange. But that never made sense. If the baby's head has been delivered, shouldn't it be able to start breathing? I've heard babies cry one their head is out but their body is still in. Though if the body is still in the birth canal it's probably too squeezed for the lungs to expand much.

That still leaves the umbillical cord. Can't gas exchange continue to occur through the cord for some time after the head is out? Or does the conversion from placental gas exchange to lung has exchange occur instantaneously upon the baby's drawin the first breath? If not, then there seems to be little different between a head that's crowning slowly and gently, minute after minute, and a head that's come all the way out. My attempts to find illustrations of dystocia(such as here and here) don't show the cord in a compromised position.

I asked a local midwife who said it's pressure in the circulatory system that is of such a concern. Blood can't return from the baby's head because the pressure is too great. This midwifery site summarizes the situation better than I can.

So it's a circulatory system issue, not a respiratory system one.

I have also learned the correct way to spell cemetery, thanks to my spouse. Apologies for those who were offended by my persistent misspelling of it two posts ago. Spelling is not my forte. Indeed, I had to look up "persistent" and "misspell" just to write this paragraph. But I like to work on it, so please point out other errors if you catch them.

Tuesday, June 14, 2005

Does Ur c1it rock hARd cassandra?

It only makes sense. Now that medication is helping men “Get hard in 15 min”* with “an afterburner for your schlong”* to the tune of millions of dollars, attention is turning to female sexual dysfunction (FSD...not to be confused with FDS). There is a great article here summarizing the many interests at play.

The drug companies are eager to make a killing similar to what they’ve done with Viagra, Cialis, and Levitra.

Some feminists say it’s about acknowledging the sexuality of post-menopausal, post-ovarian removal, or other women who are looking to “get their groove back.”

What troubles me, however, is that, “Most candidate drugs, however, focus on what clinicians say is by far the most common disorder: decreased interest in sex, also known as hypoactive sexual desire disorder (HSDD).” This does not, necessarily, seem like a medical condition in need of treatment.

Biologically, sex exists to perpetuate the species. Usually the interest in sex coincides with the ability to reproduce. Witness your pubescent boy. Five years earlier, when his penis is merely urine transport tubing, kissing revolts him. Once the gonads are functioning, however, behold the change. Not the most elegant example, but probably the most familiar.

Likewise, post-menopausal women, or women whose ovaries have been surgically removed, are not capable of reproducing. There is no biological “purpose” for sex at this point. It makes sense that the desire to engage in it would wane.

I would argue the same is true for women with babies. It is not an optimal use of the body’s resources to conceive a new child at the time it’s still feeding and caring for another one. Any wonder new mothers laugh when the OB asks at their six week post-partum checkup what kind of contraception they’re using.

Tiefer worries that women will feel compelled to start taking drugs, even if they're comfortable with their decreasing sex drives, once they become available. "I'm pro-sex," she says. "I'm pro-porn, I'm pro-vibrators. ... But sex is a hobby. It's fine not to do it if you're not interested." (And certainly, an abusive husband like Laura's isn't a reason to put a woman on drugs, she adds.) Tiefer has founded a group, FSD Alert, that takes a feminist view of female sexual problems and puts more emphasis on sociocultural, political, and psychological factors.

There are other foes of FSD as a medical problem. In a series of articles over the past few years in the British Medical Journal, Ray Moynihan, a freelance journalist based in Sydney, Australia, called it the "corporate-sponsored creation of a new disease." He implicates the media for what he says are titillating but sloppy stories.

Just this week a study of twins concluded that at least 34% of what determines whether a woman has an orgasm during sex is genetics. Researchers were eager to point out that this genetic underpinning could “help produce drugs to treat female sexual dysfunction.”

For women (women, not their sexual partners) who experience and are disappointed by changes in their desire or ability to have an orgasm, medication may be the way to go. Hopefully women who do not mind their existing or changing levels of sexual desire and pleasure will not be subjected to media and relationship pressure to medicate themselves into a second adolescence.

*taken from this morning’s spam subject lines

Monday, June 13, 2005

Eternal Rest in a Small Town

My parents still live in the town where I grew up. It is now well on its way to becoming a bedroom community for the Ann-Arbor-Plymouth-Livonia-Detroit metropolitan sprawlidor. Twenty years ago it was just a small town with about 5,000 people most of whom were farmers or blue-collar laborers of one variety or another.

I graduated with a little over 100 students, many of whom married each other and set up home down the street from their parents.

On our way to visit my parents yesterday we drove by the city cemetary. If you get buried in town, this is where you go. So it should not have been surprising to me to recognize so many surnames on the headstones. And yet it was.

As we rolled past them at 40 miles an hour, last names came and went quickly, triggering a high speed slide show of memories and associations: the lunch lady at elementary school, the mother of a nursery-school classmate who was held back a grade in Kindergarden, many parents of friends of my parents, the brother of a high school burnout, a few years older than I, whose son now goes to the same elementary school as mine, our childhood dentist.

From funerals I attended before leaving town, I knew the locations of names I could not see from the road: my mother's best friend(cancer), her son-in law (suicide), a classmate from our junior year of high school (suicide), another classmate from our junior year (car accident).

If I didn't know who was buried at a particular marker, I at least recognized the name and could place it securely in the tangled web of relations that is the fodder of small town gossip and the underpinning for any local's sense of identity and place.

I compare this to the anonymity of the bodies in the Ann Arbor cemetaries I walk through or drive past. I could spend the rest of my life here and still most of the names would remain unfamiliar to me.

I did not know until we drove by the cemetary yesterday that as thankful as I am for my life away from that town, it is comforting to think of my cremains, some of them at least, spread there in it, among all the proper nouns of my first 18 years' life story.

Thursday, June 09, 2005

3 births, 2 deaths, 1 opinion

Birth was in the air yesterday. Two women I know, due next Wednesday and Thursday respectively, had their babies yesterday. The first had her eleven pound son at home, a happy follow up to her first son's pre-term hospital birth a few years ago. The second had her fourth child (weight unknown), a daughter, at the hospital after only a few hours of labor.

Earlier this week a baby was born to a woman whose post-menopausal reproductive system was jump started with ovarian tissue transplanted from her twin sister. The new ovarian tissue not only revitalized her shrunken uterus, it also produced eggs, one of which went on to get fertilized naturally and become a baby girl.

In Texas, a man has been given a life sentence for killing his pregnant girlfriend's twin fetuses at her request. Under Texas's fetal protection law, a person is defined as existing from conception. Hence the father's efforts to effect an abortion at 5 months' gestation placed him in the same legal status as someone who murdered a five month old infant.

Pregnant women should be protected from violence that could harm them or their fetuses. The fetal protection law, however, bypasses the mother all together and focuses exclusively on her gestating offspring. The man in this trial was not tried for battery, even though he stepped on his girlfriend's uterus. He was tried for extinguishing the life developing inside her uterus.

Considering that doctors who perform abortions, as well as women who self-abort, are exempt from this law, it has weak moral footing on which to condemn some individuals to a lifetime of incarceration. If kiling fetuses is wrong, ANYONE who does it should be punished. If, rather, it's wrong to abuse a woman so severely that she miscarries, punish the violence against the woman.

If, however, you seek to codify the life-begins-at-conception tenet of abortion foes, then write a law like the fetal protection law, that sends a young man to jail for helping his girlfriend abort an unwanted pregnancy.

Wednesday, June 08, 2005

I'm a doula, you're a doula, he's a doula, she's a doula...

Wouldn't you like to be a doula too?

I am noticing "doula" increasingly used as a synonym for "helper" in non-birth settings lately.

Today I saw this article about a "doula teen mentoring" program in Cadillac, Michigan. It does not, as the name implied to me, provide mentors for teenaged doulas. It provides mentors to pregnant teens.

More than a year ago, death doulas, who are companions for terminally ill people, came to the fore in the New York Times.

Obviously birth and postpartum doulas don't have a copyright on the term. In fact, we borrowed it from the ancient Greek name for a woman's servant. But it is precisely this original meaning -- being a slave or helper to a woman, typically a woman of power within the household or community -- that makes it such a fit for people who provide professional labor, birth and postpartum support.

In the uses above, the reference for doula is modern. It's assuming familiarity with the responsibilities of today's doula -- the accompanying, waiting, encouraging, loving -- and transferring it to another area, death or mentoring.

In the big picture, this is splitting hairs. I think death doulas are a great idea. I hope the Doula Teen Mentoring Program is a success. The world would be a better place if "doula" was a global ethic instead of an emerging profession.

Yet it confuses the work of birth and postpartum doulas to have other types of helping slip easily under the same heading. It's hard enough getting people to understand and appreciate our work, without having other endeavors share the same name.

Tuesday, June 07, 2005

Snowflakes and Lactivists

I am so behind on my reading. Today I caught up with my usual round of blogs. If you don't regularly do so, I encourage you to check out Dynamic Doula today. She writes about a fantastic hospital birth and compares doctors who breach their patients' trust with physical/sexual abusers who "groom" victims for abuse. You might also read Navelgazing Midwife's post about a woman whose unassisted childbirth (UC) ended with a dead child and police questioning.

The past few days' New York Times have had plenty to keep my blood boiling.

First, this article about conservative Christians who are "rescuing" leftover IVF embryos (snowflakes) by "adopting" them.

The adoption terminology irritates the fertility industry, abortion rights advocates and supporters of embryonic stem cell research, who believe that the language suggests - erroneously, they maintain - that an embryo has the same status as a child.

But for some conservative Christians, that is precisely the point.

"I think appearing with Snowflakes kids is a potent symbol, and I think it illustrates the truth, which is that the embryo is just that child at an earlier stage of development," said Bill Saunders, director of the Family Research Council's Center for Human Life and Bioethics.
My friends, this is eight slippery cells away from treating sperm and eggs as nascent humans. You thought Monty Python was joking when they sang "Every Sperm is Sacred?" Soon there will be volunteers from the radical right to "receive" sperm that would otherwise get wiped on a towel or washed down the shower drain, lest those children "at an earlier stage of development" be denied their opportunity to live. Women, watch that you don't deny each month's ovulated egg its chance at fertilization.

"We really felt like the Lord was calling us to try to give one of these embryos, these children, a chance to live," Ms. McClure said.

Mr. McClure, though, disliked the fertility business, which he felt created extra embryos that were often destroyed or aborted. He feared that paying fees to receive the embryos would be helping an industry "that I have real problems with."

He consulted a Southern Baptist church elder, who advised him, " 'If you want to free the slaves, sometimes you have to deal with the slave trader,' " Mr. McClure said.

If you want to free innocent babies from their involuntary status as a political prop and lifelong indoctrination by religious crazies whom do you deal with?

Then I got irritated seeing that Barbara Walters was made uncomfortable by seeing a woman breastfeeding a baby. Now it's hard to get whipped up over Barbara Walters. Probably nothing could be more alien to someone of her generation, class and status than using one's breasts for nourishment. But still, I was pleased to see that mothers held a nurse-in at Walters' ABC studios.

That these women were called "Lactivists" amuses me to no end. How creative. Makes me wish I was still nursing so I could be a lactivist, too. Though that would be making a political prop of my baby, too, now wouldn't it?

Monday, June 06, 2005

An Older and Wiser (and Kinder and Gentler) Doulicia

I turned thirty-six over the weekend. Little to report there other than I enjoyed some carrot cake, dinner out with my family, a pot of mums from the kids and Journey's Greatest Hits from Spouse (against his better judgement, bless him). I bought myself my first "cami." Lookout world! I'm on the downhill side of thiry and wearin' spaghetti straps.

Last week I got hired by the couple I interviewed with recently. She is already in her 39th week, so we are having prenatal meetings left and right, getting me up to speed on her birth hopes and concerns. She is with the nurse-midwife practice that delivered my younger son. I am eager to have a birth with that practice again. It's been nearly a year.

There are two hospitals in Ann Arbor and each has one main nurse-midwife practice that uses it for deliveries. The UM Nurse Midwives deliver at the university hospital and the IHA Nurse Midwives deliver at St. Joseph Mercy Hospital. The UM Midwives have three or four times the staff of the IHA crew, which just expanded to three nurse midwives. So as you would expect, I only have about 1 client in 4 of those who are using CNMs that is with the IHA practice.

The power went out -- the result of a big storm -- as I was leaving for last night's prenatal meeting. My clients had power and I forgot about the outage until I pulled in the driveway and saw my husband reading by candlelight at the kitchen window. It was a good excuse to get to bed earlier than usual and enjoy sleeping with the windows wide open. Too bad one neighbor had a generator running loudly. Otherwise I would have easily been able to imagine I was at a remote lake up north, what with the darkness and the silence.

Our seven-year-old alarm clock woke us at six this morning. Sun shining cheerily. Birds calling for mates in the back yard. Still no power, but no need for it really, on a gorgeous spring morning at the start of my thirty-seventh year.

Thursday, June 02, 2005

The Lesser of Two Evils

When I was pregnant with my second child, I was surprised to learn that a group B strep screen had been added to the standard prenatal test menu.

Group B streptococcus bacteria (GBS) can kill newborns. The problem is, at any given time 10-30% of women are colonized with it. It comes and goes from the vagina and usually causes the carrier no problem. If the newborn develops an infection from GBS passed during delivery, which happens in 0.5-1% of the cases, the baby has one in twenty odds of dying and higher odds of permanent disability from GBS-caused meningitis. (Data source: Centers for Disease Control)

The midwives handed me a pamphlet with this data in it and I tried to do the math while I was sitting on the bus: worst-case scenario, there’s a 30% chance I am a carrier. If I’m a carrier, there is a 1% chance of my passing GBS to my baby. 1% of 30% is 0.3%. And if my baby gets GBS, there is a 5% chance it will die. 5% of 0.3% is? 0.015%

I, sitting there on the bus holding my group B strep pamphlet, not knowing what bacteria were growing inside me, had a hundredth of a percent chance of having my baby die of GBS. Put another way, out of 100,000 pregnant women – nearly enough to fill the football stadium near my house, only 15 would lose their baby to this bacterial infection.

Until ACOG adopted the CDC recommendation for routine GBS screening, obstetricians and midwives determined whether a mother would receive antibiotic treatment based on certain risk factors (prolonged rupture, maternal fever, etc). Research demonstrated that it was far more effective to use prenatal screening as the means for identifying babies at risk, than using signs during labor.

The dilemma for natural birth proponents is that if your GBS test comes back positive, you have to have IV antibiotics during labor. In many hospitals an IV means no hydrotherapy. Not only that, but to ensure enough time for the medication to be effective, you need to have it in your system several hours before the baby is born. With one fell swoop, women lose the option of laboring at home until very late in labor, the chance to avoid an IV and the possibility of using a tub or shower in the hospital.

As always, this is a small price to pay for protecting your child from death. On the other hand, it’s completely unnecessary for the 199 babies out of 200 that never contract GBS from their GBS-positive mothers. Many women who use a doula are looking to avoid hospital interventions wherever possible. What do they do about the GBS screen?

One option is declining the test in the first place. If the hospital doesn’t know you are GBS positive, it doesn’t have grounds for the IV antibiotics protocol.

Another option is to get the screening and pray you’re negative. Though, interestingly, about 10% of women who test negative will have GBS at the time of delivery and 30% of the women who test positive for GBS will have cleared the bacteria by the time they deliver.

A final option, it seems to me, though I have never asked whether this is an option or not, would be to have the baby get the course of antibiotics after it is born, rather than giving them to the mother during labor. After all, this is what they do when a GBS-positive woman delivers before she’s had the antibiotic in her system long enough. And they do this with babies who, regardless of their mother’s GBS status, are born after labors with a lengthy rupture and/or maternal fever. So why not omit maternal antibiotics in the first place (in those instances where the mother prefers to labor without an IV) and treat the baby? Other than the needle stick to the baby, is there a reason to space her and not the mother? I am asking this in seriousness, since I honestly do not know.

I often get asked by families what my thoughts are on this. I tell them it is a frustrating situation to be in, but a situation (when they’re debating declining the test) they have to come to terms with nevertheless. If they get the test, they have a 10-30% chance of testing positive and receiving the treatment that comes with it. If they don’t get tested, their child is 99.7% likely to be untouched by GBS anyway.

The odds are in your favor, I point out.

Then I tell them that when I rode the bus and did the math and looked at that pamphlet detailing what could happen to my child IF…I decided to get screened.

Wednesday, June 01, 2005

Breast Exam or Fashion Advice?

It has been two months since I saw the breast doctor about my fibrocystic breasts. At the time I thought about a whole post dedicated to the visit. To the many, many minutes spent alone in the cool examining room wearing only the hospital-issue gown. To the intern who took my history, examined me, reassured me and who returned after those many minutes with THE doctor, who said things that were unnecessary if he’d read my chart (“don’t smoke, limit your alcohol, limit your red meat consumption…”). To my attempts to cover my breasts with a size XL gown whose arm holes hung open to my hips and whose neck closure, even when tied shut, made a sloppy “V” down to my navel, while the doctor and I had a conversation about my red meat consumption. To the dynamic of being a woman, nearly naked, having her breasts rubbed by two professionally dressed men who didn't let her dress before getting lecturing her.

All of this was par for the course, somehow, sadly, and not shocking enough to merit a post (though I did comment on all of it in detail on the Patient Satisfaction Survey they asked me to complete).

But one piece comes back to me again and again. And I need to purge it here.

Among the doctor’s seemingly useful suggestions for preventing the pain – including taking additional Gamma-Linolenic Acid from sources such as Borage, Black Currant or Evening Primrose Oil – was wearing a supportive bra. But not just ANY supportive bra. “Go to Victoria’s Secret,” he said, “and get yourself some good, supportive bras.”

Like these?

I can give him the benefit of the doubt and say he was just trying to be helpful. What woman today hasn’t heard of Victoria’s Secret?

On the other hand, when a man has just looked at and palpated your breasts, and you are a slim but saggy-breasted woman to start with, the suggestion that you take yourself to Victoria’s Secret sounds either like a criticism (“Honey, you’ve got to make the most of what you’ve got”) or an overture (“Slide those B-cups into a black lace push-up bra, and maybe a matching thong, and you are in business, Sweet Thing!).

I prefer Jockeys. See?

They’re the kind of bra you get your ironing done in (and with a washboard stomach to boot). You smile happily in them. You don’t suck your red-shellacked finger while tousling your hair and lunging to one side.

Last night I cleaned out a corner of the basement and uncovered my one “pretty” bra, which I traded in for nursing bras and then my Jockeys three years ago. Remembering the kind doctor’s advice, I put it on this morning. I can’t get over the little party hats that are poking through my shirt above where gentle mounds usually rise.

Support or not, I can’t get over the feeling I’m not wearing this for my fibrocystic breasts. I’m wearing it for the doctor, and my husband, and the straight men in my office – even those who don’t care about cup size – whose idea of proper, or at least appealing, breast shape comes from mainstream media. From Victoria’s Secret. Which, incidentally, is where the bra that I’m wearing today was purchased.