Let's go for a ride

I did not know there was a Carnival of Feminists. I may have to follow this a while. The next one is due out on October 8, but September 23 isn't so long ago.

"Feminist Foucault: The Health care Panopticon
9 of our featured bloggers focused on the health care system and analyses of power and control."

Enjoy.

Talk about your transferrable skills

My older son had a bump cut off his birthmark yesterday (simply to prevent rupture and bleeding, not because of suspected malignancy). We didn't know when we arrived for the appointment that they'd be taking the bump off. It was scheduled as a consultation.

When they sprung the news that it would be best to remove the bump, my son's eyes widened. I fell back on my doula training: What are the risks of removal? What are the benefits? What happens if we do nothing? Son, do you have any questions?

When it came time for the injection of numbing medicine, I sat facing my son, holding his hand, telling him how well he was doing. Throughout the procedure I could see tears wetting his closed eyelids. I breathed with him and had him breathe steadily. The doctor began to echo my encouragement: "You're doing great."

And when the doctors and nurses had left the room and he was still a little anxious, I said, "You know, you can cry if you want. It's okay." And he did. It was short but it certainly perked him up.

Then we went for Bubble Tea.

The Intersex Baby

Yesterday's NY Times Magazine had a nice article on the debate surrounding whether to construct (literally) a physical gender for intersex babies. I linked to a lot of information on the subject in a previous post; this article lays things out much more cleanly.

Medical convention has traditionally held that the phallic structure must be at least 2.5 centimeters long on baby boys and shorter than 1 centimeter for girls. And since it’s easier to surgically construct a vagina than to make a penis, children with anatomies that fell in the middle were almost always raised as girls.

Did you know that your clitorus had to conform to length maximums?

It seems the real issue is summarized here:

[W]hom are these operations serving? ... The vast majority of adults — parents and doctors included — find intersex bodies, especially sexualized intersex bodies, unsettling. Karkazis, the medical anthropologist, heard from clinicians she interviewed of numerous cases of parents who initially decided against surgery but changed their minds when their children started to explore their own sex organs, often around the age of 2. “Masturbation in little girls with clitoromegaly” — abnormal enlargement of the clitoris — “is a situation I’ve encountered quite a few times, and that’s actually pushed many parents toward surgical intervention,” one doctor told Karkazis. “The little girl was masturbating, and the parents just fell apart and were back in the office the next week for surgery.”

This is about adults' discomfort with sexuality. Which is not to say that an intersexed child would not face rough years in the middle school showers. But the interviews and data reported in the article at least, indicate that children whose bodies are left alone emerge more emotionally, psycholigically and sexually whole than those who have surgically constructed (or otherwise altered) sex organs.

One person, however, did not have an operation, and she alone looks fit and confident, sitting with great posture and seeming at home in her body. She grew up in a Catholic family, and when she first saw another naked woman up close, at age 12, her initial thought was, What’s wrong with her?

The good news (as reported in the article) is that last month the American Academy of Pediatrics journal Pediatrics published a consensus statement by the 50 members of the International Intersex Consensus Conference. Their recommendation was to assign intersex babies a gender as early as possible, but not to do surgery to conform the physical appearance of the body to that gender. This leaves open the possibility of a child's more easily changing gender as she or he grows up.

Placental Scab?

I have been meeting regularly with my clients whose baby was stillborn. The last time we met, I asked about the mother's bleeding. She said it had slowed down a lot and then she had a burst of red blood and heavier flow at day 11. The mother of a friend told her that was to be expected because the scab where the placenta was comes off around day 10 or 11.

I have never heard if a placental scab. Nor of its release triggering postpartum bleeding a week and a half post partum.

If anyone can enlighten me on this subject, please do.

My reaction is that it sounds plausible, but not exactly as my client relayed it. It makes sense that the body would make a covering for the raw area where the placenta attached to the uterus. After all, that is a lot of surface area to leave open to infection otherwise. But the scabs I'm used to thinking of are hard and inflexible. They would not do the job on a uterus that is shrinking in the days postpartum. And it seems that one would notice scabby tissue leaving the uterus more than clots and lochia. I certainly don't recall seeing scabs when I wiped.

So perhaps a scab in function, but with a different design. Something softer and more dynamic. More like a big clot. In fact, what about exactly like a big clot? I can't remember my postpartum bleeding well enough to recall whether I passed more clots roughly 10 days after delivery or if my bleeding increased.

I like the idea of it anyway. Another example of our bodies taking care of and protecting themselves.

Some doctors really are geniuses

I was excited to see that Atul Gawande was given one of this year's MacArthur Foundation "Genius" Fellowships. His writing on the challenges of modern health care -- from conveying the importance of autopsies to grieving families to treating something as tricky as chronic nausea -- was my favorite thing in The New Yorker (we let our subscription lapse).

If you enjoy thoughtful and eye-opening essays on medical education and life in the hospital, you really should check out his book, Complications: A Surgeon's Notes on an Imperfect Science.

I was also pleased to see one of my favorite writers, George Saunders, named as a fellow.

Update part II

Sorry. I should probably just split my knitting off onto its own blog. But my book blog is floundering as it is. A third blog would really tank.

On the occasion of my younger son's fourth birthday yesterday, I took a few photos of the sweater I'm making for him. It's based on this pattern from the Spring Knit It! issue:



Having a son who is infatuated with all things "rescue," I am modifying the motif to an ambulance and changing the color scheme to gray, red and white. On the back of the sweater, which is as far as I've gotten so far, I'm putting a big red cross like the aid workers wear. He will either love this sweater or have moved on to superheroes by the time I finish it!



I'm pleased that the sweater includes my first attempt at fair isle knitting as well as intarsia.



I've decided I'm fairly fearless as a knitter. I enjoy the challenge of new techniques and have yet to see something that seems too hard to try.

I wish I could have that attitude about all aspects of my life!

p.s. The cardigan is finally dry. I just need to get buttons sewn on it. That necessitates a trip to the fabric store, unfortunately, which means it could be weeks before I actually finish the darn thing.

Knitting update

I have had a lot going on in my knitting universe. I have been too busy to get the photos uploaded, though.

When we were on vacation (remember? vacation? four short weeks ago?) we went a hundred and fifty miles out of the way so I could visit the Michigan Fiber Arts Festival. Yes, I bought yarn there. No, I haven't photographed said yarn. I will. In the interim, you can visit the vendor who got most of my dough. The Shantung Silk is lovely, lovely, lovely. I have enough for a summer top. Feel free to point me in the direction of the right pattern.

My garter stitch cardigan is done. DONE! This is the first adult-sized sweater I have made. It fits. I like it. I can't wait to wear and photograph it. Unfortunately I finished sewing it together Monday night and promptly blocked it. Ever since then it has been totally soggy. The danged thing is still drying! And it is a heavy sweater, especially when damp, so I can't exactly put it on a hanger to let both sides try at once. I've been using the kitchen table and turning it every 12 hours or so. Gotta get a drying rack.

And finally, the new projects. About six months ago mother asked for a red scarf to go with her black leather jacket. [I did not know my mother was even the kind of woman to own, let alone accessorize, a black leather jacket.] I got very excited and had big plans for this scarf. I wanted a varigated red yarn that I could use in a fair aisle or mosaic pattern with black. The effect I wanted was a black design on a flame-like background.

I still think it's a great idea. And someday I hope to make that scarf. In the past six months, however, I have realized my short knitting life has not yet given me the knowledge to design such a scarf.

Also, when I showed the awesome yarn I found to my mother, she was less than thrilled. When I took her to a knitting store with me, I quickly learned that softness is her first priority. So out with the varigated wool, in with cashmerino.

After no fewer than six false starts, I have settled on a width and pattern I like. Basically, it's squares of stockinette stitch on a moss stitch background.



I took this photo a few days ago. Now I have 5 squares completed and the thing is really starting to curl in on itself. On the bus the other day a woman asked me if it was a sock. I was hoping there'd be enough moss stitch to counteract stockinette's curl. Now I'm just hoping that blocking will flatten it out.

Either way, I am very pleased with my prettly little stockinette stitches. Now that I am correctly purling, my "v"s line up nicely.

You thought your father kept you in line?

You didn't know the half of it. According to researchers at Pennsylvania State University at Altoona paternal pheromones delay the start of girls' first menstrual cycle (menarche).

Apparently this is seen in other animal species. It is thought to reduce the likelihood of inbreeding. Why, then, earlier menarche when half- or step-brothers are present? I guess to promote cross-breeding.

This leads me to many questions the researchers didn't answer. What about a house with no father but many full brothers? What about a father AND many brothers? What about a step-father?

The measurable delay was about three months. It seems like this is hardly helpful in preventing in-breeding. Three years, maybe. Not three months. But then we have to remember that these are in some ways relics of our simian past. Now we have social taboos and words like "incest" that work to optimize genetic mixing. In a way it's impressive that the chemicals and receptors from our more primative regulatory system are still present.

Deep introspection

The story many of us in the "natural" birth arena tell ourselves is that there is a whole-family, mother-friendly, optimal way of managing pregnancy, labor and delivery. This is not just an alternative to mainstream birth views. It is the profoundly right view. It favors less intervention over more, mothers as partners in their care, the body -- not calendars or clocks -- as accurate timekeeper for an optimal delivery.

And our agenda in following this paradigm is the mother's and baby's well being.

"Our" view is in opposition to the mainstream, medical model that views pregnancy and birth as crises -- and lawsuits -- waiting to happen. It is comfortable subjugating a body's natural timeline and processes to procedures that, however undelicately or insensitively, produce a live baby at the end.

When a family believes in the natural birth paradigm and all it represents, then is betrayed by that model, what does that say about it? In the end, the family whose baby dies in utero at 41 weeks gestation sees the medical model and its promise to extract a live baby at whatever point the family wants, and says, "Of course." They feel foolish to have trusted their caregiver, their baby, their instincts, her body.

Can we blame that family for saying that next time they will induce labor at 38 weeks? It seems impossible to expect them to do otherwise. Fool me once, shame on you; fool me twice, shame on me.

Help me, friends. Tell me again why it is that let families gamble with their babies for a shot at an empowering birth. Isn't a live birth ultimately most important?

I have said before that natural birth is the closest thing to a religion that I have. But I look at mainstream religions and see they offer something my religion doesn't: an ability to explain and comfort in the face of this kind of loss. If my religion can't withstand a fundamental challenge, perhaps the other sect -- the hospital-trained one -- really has all the answers.

It certainly has two new converts.

Grief is more intimate than joy

Perhaps the biggest thing I learned at this weekend's birth was the two sides of grief. There is the public part, which I have always thought was so important. To be among friends and family who share your sadness or keep company with you in your sadness is so important to healing.

What I witnessed this weekend was grief's private side. It took away a mother's voice so that she could only speak in whispers. It doubled over the father with noiseless screams. The physicality of descriptions I could use is so appropriate: wracked with sadness, convulsed with sobs.

These parents created a labor and birth space no one could invade. In a room full of people they stayed, forehead to forehead, in a cocoon all their own, communicating with their eyes and their kisses. No one dared disturb them. This intimacy is what we doulas try to help parents achieve at a birth. Grief facilitated the process far better than any doula ever could.

When they get past the immediate grief, I think they will be pleased with the birth they gave their baby. Though the labor was induced, it lasted only about 12 hours. And the mother waited until transition to get an epidural; she labored well with the pitocin contractions. Best of all, she caught her own child and pulled the baby onto her belly with the help of her spouse. This was something they wanted to do even before they learned that their baby had died. Theirs were the first hands to touch their child.

Send your loving thoughts to this family as they figure out how to move into a future that was supposed to include a baby and does not.

It's a half an inch of water and you think you're gonna drown

Oh friends. Send loving thoughts this way. Tonight I'm going to the hospital with a woman who will be delivering her full-term stillborn baby. So, so sad.

I'll take two aspirin; you call me in the morning

I met with my second October client last night. It was a very good meeting. I was a little nervous about it because I knew the father half of this couple, but had never met the mother half. And it was the father half who was initially most interested in having a doula. I was afraid the mother would be skeptical. "And I need a doula why?"

Not to worry. They are both delightful and I expect a very nice birth with them.

While I was at that meeting I got a phone call from my overdue client who said she was having irregular contractions. Following my emphatic instructions to let me know when something changes (instead of calling only at the moment they're ready for me...at which point I have to hustle up child care, get home from work, etc.), she was just checking in.

We talked again after my meeting and I said she should let me know if she needed me overnight. I said it could also be the case that the contractions would fade away at some point. Or else they'd get stronger. It's kinda one or the other. I'm guessing it was the former because I didn't hear from her over night.

If this had been 20 births ago, I'd have spent a restless night waiting for the phone to ring and spinning out plans for child care coverage. I believe I am finally learning that it often amounts to nothing, all that agitation and planning. Especially with first babies labor often takes a few starts and stops. I suspect tonight I'll be called out for the real deal.

Last night I was able to knock down a couple of ibuprofen (the first week back to work after vacation is a bitch!) and drift off to a sound sleep. I'll keep you posted.