Link it all

We’ve never met one of those mythical she-monsters, but thus spake zuska reminds us that nobody is a sexist bastard because she is female, though one may be sexist despite being female.  And that female sexist bastards are also a product of the patriarchy and to be pitied.

Mutant Super Model explains why you don’t have to be Sarah Palin in order to be a feminist.

WE MISS CITIES SO HARD

Please do not use electronic devices until told it is safe to do so, first day of class instructions by Not of General Interest.

Texas isn’t the only state attacking education these days, but we really do not want this guy for president.

Thank you for this post, Kate Clancy.  Also Micro Dr. O reiterates a post she’d made before that we agreed with then and agree with now.  And we wonder if the attackers are pro-life because they don’t seem to believe that pregnant women should be allowed to make educated decisions about their own bodies.  I always thought the ability to choose (what to do with her own body) is a feminist statement even if the choice made is irrelevant to the subject of feminism (or at least second order, as obviously all choices are influenced by environment).  I wonder if the attackers would argue that home births should be illegal, since that seems to be the direction their arguments point (included with:  should we also lock up pregnant women who smoke or drink, two activities that aren’t as ambiguous in terms of fetal and maternal health?).

Also, I would be betraying my social science if I didn’t point out that the choice to vaccinate or not is nothing like the choice to home vs. hospital birth.  (Chapter topic:  Potential Reasons for Government Intervention:  Negative Spillovers.)  The vaccination choice strongly affects herd immunity which has negative consequences not just on parent and child but also on the elderly, other children, people with weakened immune systems etc.  The birth choice at most hurts mother and unborn child.  Possibly there may be stresses on public finance systems later, but it is unclear whether those costs will be larger for the unnecessary interventions and increases in prematurity due to over-medicalization (which are less likely in the European countries whose comparative statistics are discussed) vs. home-birth mistakes.  It is hard to say and I doubt anyone has done a good cost-benefit analysis.  We care about vaccination because it has these large spillover effects.  We should allow individual choice (with full information) in the birthing decision.  NPR did a really neat story recently about how just forcing doctors to document when they scheduled a birth before 39 weeks and why decreased neonatal intensive care usage.  We might think government intervention would be justified in that case because doctors are often making the choice for women based on their vacation or Superbowl schedules (Amitabh Chandra has a fantastic paper on that topic), and this is a “nudge” intervention– not actually outlawing <39 week interventions or even saying the justification has to be a good one, just that they have to write down the justification.

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18 Responses to “Link it all”

  1. First Gen American Says:

    I totally agree with your distinction. If you do dumb things that only hurts yourself…you should have that right. As a person with a child with a weak immune system, I totally agree. If your dumb actions are affecting the safety of my child, all bets are off.

    However, I think I side more with Dr. Isis on the home birth front. You’re not just affecting yourself. You’re also affecting the safety of your kid and setting a bad example for other moms who think it may be safe too. Just like the immunization myth, the more people who do it, the more likely it is that a group of naive people will blindly follow like sheep without doing their own research or being full aware of the risks involved. Having personally seen these types of myths spiral out of control in my own industry, it has to be addressed at the get go. We falsely believed that facts and data would squash the myth naturally but that’s just not how hysteria about public safety works. People do believe what they read and if someone says immunizations cause autism, it must be true..especially if a celebrity said it. It doesn’t matter that there are 800 more reputable sources that say the opposite.

    With both of my children I couldn’t deliver naturally and they would be dead if I didn’t have the proper hospital care. I can’t imagine doing this with one’s first child having no prior history of whether you have a chance to deliver naturally. The only advantage I see is possibly being a cleaner environment. I did get an infection with my first birth. Hospitals are horrible germy places.

    • nicoleandmaggie Says:

      No certified nurse midwife will allow a birth that should be in the hospital to be a home birth. They also have contingency plans for when a birth needs to move to a hospital, and they do bring some of the machinery needed for many types of emergencies to your home (also for monitoring, though they mechanically monitor less frequently). There is a slightly larger risk from a home birth in that it does take longer to get to the hospital, but with a good CNM, you would have made it to the hospital before any sign of danger (or would never have a home-birth) and your children would not be dead.

      With a very good CNM, many things that lead to emergency c-sections are not emergencies at all– they can get umbilical cords unwrapped from necks (this is pretty common and not life threatening if the medical professional knows what to do), they can deliver unexpectedly breach babies. Most OB-GYN no longer have these skills.

      Women who do home-births are not all stupid anti-vaxers. Certified nurse midwives are not baby killers. Dr. Isis and the other women have a LOT of misconceptions about what exactly a CNM does and what they will allow. They seem to think that all women having home-births are having unassisted home births or that CNM have no idea what they’re doing. We saw a video of an unassisted home birth in Bradley class and it was terrifying– the natural childbirth people do not recommend it. (Actually we saw two of those videos, but the not terrifying one was herself a CNM and lived out in rural Bolivia or something so she was the only person around to deliver babies.)

      The risks are actually pretty similar… very small for both CNM-assisted home-births and hospital births (statistics out there vary considerably, but that’s my read). You’re almost guaranteed to have a complication with a hospital delivery (because of germs, over-monitoring, lack of monitoring– the CNM stays with you the entire delivery unlike an OB, medical mistakes, etc. there’s a HUGE literature on this in my field started by Amitabh Chandra, a bachelor without an axe to grind either way), but not a life threatening one. I didn’t (I also spent exactly one hour in the hospital before DC came out… and she almost gave me an episiotomy that I didn’t need and they said I had to labor on my back instead of squat like I suggested), but I don’t know a single other person who has delivered IRL who didn’t have some kind of complication at the hospital that was CAUSED by the hospital (I take that back… a few other people in my Bradley class had uncomplicated births because they knew what to avoid– the people from the Bradley class who had c-sections also knew that was the right choice because they had full information and knew what to ask for).

      The people who tell the worst horror stories are telling horror stories that are IN the Bradley natural childbirth books as things that can be avoided through patient advocacy, practitioner patience, allowing the woman to move or drink water etc.

      I disagree that more people doing something will automatically lead to more people doing it. Horror stories from home-birthing will result in fewer people doing it, not more. Happy stories will result in more people doing it. Just like the vax rates in LA shot up when the measles hit. Horror stories are much more available and need a lot of happy stories to balance them out. If home-birthing is so awful, then more people doing it should cause fewer people doing it in the longer run. Given that the people doing it are for the most part people who care deeply about the health of their children etc.

      Fetal alcohol syndrome and complications from prenatal smoking are more dangerous than making the choice to home-birth with a CNM. Should we make those illegal?

      I’m not advocating home birth. I’m advocating that people be respected for that choice. The circumstances for each person are different. I don’t want to have a home birth, but given the doctor quality in my area and the rules of the system (which doesn’t allow midwives in hospitals) etc. that doesn’t seem so crazy as it did before the one good OB/GYN in town (in whose office I would wait up to 3 hours for an appointment) moved to Australia. Right now I’ve got the GP who actually delivered my baby, but if she’s busy with something else, the back-up out there is really scary (and there’s one doctor who should no longer be allowed to practice– he’s on a lot of woman’s birth plans, “not under any circumstances”). There aren’t a whole lot of options in a small town in a mostly rural area. But there are two highly regarded midwives with long track-records. I would not judge anyone who made that choice. Especially given the cost difference between the two choices and the low rate of health insurance in the area combined with the low average salary in the area.

      • nicoleandmaggie Says:

        Also… since my first birth was 5 hours from water to baby out, I’ve been told the second one may end up being an unattended car birth.

      • First Gen American Says:

        Unfortunately, my medical care is also very small towny. When I was trying to deliver my baby, the nurse got into an argument with my doctor when he recommended a c-section. It got me all confused because she was saying that if he was a midwife, he wouldn’t give up so quickly. In hindsight, she was totally wrong and just led to hours of more unnecessary labor because I believed her. There was no way that 10 pound baby was coming out of me, but she was so biased about midwives that she was allowing it to affect the professionalism of her job. I think the doctor’s vs nurses politics allow them to favor and advocate midwives because they feel like they are more like their peers vs superiors.

        I’m still not buying the risks are the same or lower and surely don’t want to be relocating myself across town in case of emergency no matter how short a drive it is but I respect your opinion on the matter too. Good healthcare is hard
        to find and of the hospitalization experiences I’ve had, 2 out of 3 ended up resulting in errors. Even my son’s umbilical cord needed to be re-operated on because it wasn’t tied correctly the first time. When you have those odds stacking against you it’s reasonable to want to research if there are lesser evils out there.

      • nicoleandmaggie Says:

        Those are terrible experiences! Very similar to the kind of thing that we heard about from some of the folks in our Bradley class who were there for their second child rather than their first. They weren’t there because they wanted to be epidural-free per-se (many class members were planning on epidurals), but to have more knowledge and more confidence to make their own decisions during the experience since their first experience had been traumatic. I strongly recommend Bradley classes to anyone.

        My 4’7″ grandma delivered my 11 lb father (I suspect she had untreated gestational diabetes). But back in the early 20th century in Europe they knew better how to deal with such things. It is very difficult today to deliver a large baby because they make you labor on your back with your legs up which is not good positioning for a large head, they don’t let you move, they don’t let you eat or drink in the delivery room (except ice chips if you’re lucky). Most doctors don’t know perinatal massage. All these things make labor with a large baby more difficult. My sister and I were both big babies too, though not quite 10lb. My mom had a horrible experience with a doctor delivering me, and a wonderful experience delivering my sister with a CNM in a birthing center (I was there!). (We’re kind of built to give birth though– birthing hips, short easy labors etc.) Some doctors and CNM are better than others at determining how the baby is stuck as well.

        The risks are higher with (an assisted) home-birth, but not that much higher. They’re small with both; in cases where they are large, a CNM will move the patient to the hospital.

        “I’m still not buying the risks are the same or lower and surely don’t want to be relocating myself across town in case of emergency no matter how short a drive it is but I respect your opinion on the matter too. ”
        If this is what you believe, then our opinions are not at all different, but you do disagree with Dr. Isis. I respect other women’s choices about their bodies, even though I did not choose a home-birth myself (and hope not to have to in the future). She explicitly says she does not respect those choices.

      • Rumpus Says:

        I feel sorry for anyone and everyone that has issues with their healthcare providers. Unfortunately I think it’s pretty common.

  2. Rumpus Says:

    I have to say that I miss cities too, even though I’ve also had problems in/with them. The smaller the “town”, the less cool it tends to seem.

    Unfortunately, with respect to babies (delivering, potty training, feeding, and more) it certainly seems like the usual middle-of-the-road experience with American medical professionals has lower quality in certain aspects with respect to decades past. The greater experience at, and increased safety of, c-sections is great for those patients that need c-sections, but I find it chilling to hear that some babies may be born early for convenience, as well as the possibility that some number of those women are having technically unnecessary surgery. Maybe the early birth won’t have any effect after the first week or two, but as much as I’m intrigued by technological gadgets I’m loathe to send a child to the NICU for convenience..or as I’ve heard, for a reduction in the chance that the doctor could be sued for negligence. I don’t blame the doctors though, not as a whole. They tend to do their jobs as best as they know how, so we need more (and more effective) research and education…then hopefully we’ll all get better care. Unfortunately, there’s never enough research.

    I also know someone with a premature baby and even after clearing the majority of the hurdles of having a premature baby, the parents will be worried about reduced immunities until the one-year-old vaccinations.

    • nicoleandmaggie Says:

      Yeah, I do wish the Republicans had pushed more for malpractice reform during the health care debates… the solution is not as cut and dry as it initially appears (just putting monetary size limits down is problematic), but if politicians had been working together I think they could have gotten somewhere on that issue.

      The doctor who moved to Australia was the only one in town who did VBACs (one of the many reasons for the 3 hour waits at appointments). Obviously she only did them for women who met certain criteria, but despite the fact that multiple c-sections are dangerous and first c-sections are given out like candy, no other doctor in town will do a VBAC because of the costs to insurance for the liability issues. They never get punished for doing more intervention, just when they do not enough. We want them to do the right amount, but all of the incentives except women’s health are aligned to favor more intervention. Many people forget that a c-section is a SURGERY that involves cutting into flesh and exposing it to outside germs no matter how small the incision. Surgeries are dangerous and should be done only when necessary. C-sections are miraculous when they’re needed, but they are definitely over-used.

  3. becca Says:

    When the C-section practices of Bangladesh are worrying people (http://www.pbs.org/newshour/updates/asia/july-dec11/csect_08-09.html) I think that overall the pendulum is too far in that direction. Homebirth is considered “common” at 1/200 births? Really, you can’t find something more menacing?

    I see homebirth as a somewhat understandable reaction to doctors who perform unnecessary procedures in society, and a very understandable reaction from individuals who have personally experienced any major complication from an unnecessary procedure.

    That said, I’m pretty convinced they *are* more dangerous, if you define homebirth in a certain way. The Wax et al meta-analysis that was the source material for Dr. Isis included e.g. a US study that includes *all births that take place at home*- it doesn’t matter if you were waiting for the ambulance and didn’t make it, or if it was a screened population, doing a preplanned birth with a CMN- it all got lumped together. And don’t even get me started on the fundamental weirdness of finding an increased *neonatal* mortality rate without an increased *perinatal* mortality rate. Something is rotten in the state of Denmark with that study. Like, arsenic bacteria level rotten.

    If you define homebirth more carefully (as you do, or indeed as the original Ms. article described), I’m not positive it’s more dangerous, but even if it really is 2-3X worse… I’d still support someone’s right to choose it. And smoke and drink, for that matter (incidentally, the data on drinking during pregnancy do NOT suggest unambiguous EVIL. Instead, drinking large quantities ARE extremely bad, whereas the kind of people who choose to have a glass of wine with dinner even while pregnant are also the type who have fewer complications. It’s less likely the wine is protective than it’s simply a more advantaged population, but the alcohol is probably not detrimental)

    • nicoleandmaggie Says:

      Yes, large quantities of alcohol (the ones linked to FAS) are bad. We don’t know that much about small quantities. The data are pretty damning on the cigarette smoking, however. Since we don’t know what point the alcohol becomes dangerous, we should just lock up all women who even touch a cup that contained alcohol, just to be on the safe side, right? (See the parallel here with different types of home births?)

      Maybe I’m just pro-choice, but I don’t want the fact that I’m pregnant [edit: I'm not pregnant at this moment] to mean that other people have a right to say what *I* choose to do with *my* body. Impregnated or not. I understand that pro-lifers tend to believe that the fetus is more important than the mother’s right to make her own decisions about her body, but that has an interesting history discussed most prominently by 19th century misogynist Horatio Storer. His book is worth a read. Back to the point, pregnancy doesn’t mean people have the right to touch my stomach, to ask me rude personal questions, and they definitely don’t have the right to legislate me or tell me I’m not allowed to make my own decisions.

      Unattended home births have historically been dangerous. I read somewhere that something like 10% of births have dangerous complications (I don’t know if that statistic is the natural rate of complications from earlier times or includes hospital induced etc. it’s just the number that sticks in my mind). I still would not begrudge any woman’s right to choose where and how to labor. Her situation is not my situation. I may or may not understand her choice, but it is her choice and her body.

      I would think that waiting for the ambulance but didn’t make it would include an *awful* lot of preemies. We have three sets of friends who had perfectly healthy pregnancies until sudden unexpected pre-term labor. Lumping in that kind would argue that women should be locked in the hospital right at the point when doctors consider the baby to be worth saving (sorry: my dislike of doctors not taking miscarriages seriously is showing here). Of course, hospitals are inherently germy and dangerous places, and that would cause even more doctor-induced complications. But that’s ok because when medical professionals screw stuff up, that’s normal. Giving women the agency to screw stuff up themselves is unconscionable (eyeroll).

  4. Comradde PhysioProffe Says:

    Funky Bubtlings of the Urgbarbled.

  5. MutantSupermodel Says:

    I love living in a city too though I wish it wasn’t as sprawly. I don’t think I’d do very well in little town far away from a big city. The smallest town I’ve lived in was Berkeley and that was definitely not far from awesomeness. :)

    The flight information is great. I’d instantly love my professor.

    Your feelings on Rick Perry are my exact same sentiments– for every single candidate on the Republican ballot. Our forefathers are probably turning in their graves SO hard over these idiots, they caused the earthquake in VA last week.

    Thanks for the love. :) Freaking Sarah Palin.

  6. Zee Says:

    We briefly considered a home birth, my husband was very strongly against it. His reasoning? We have carpet and that shit is going to be messy.

  7. hush Says:

    Amen: “the choice to vaccinate or not is nothing like the choice to home vs. hospital birth… The vaccination choice strongly affects herd immunity which has negative consequences not just on parent and child but also on the elderly, other children, people with weakened immune systems etc. The birth choice at most hurts mother and unborn child.” YES!

    Vaccine deniers truly are a breed apart. I enjoyed this piece about how vaccine-rejectionism has less to do with concerns about children’s health, and more to do with how parents view themselves:

    http://autism-news-beat.com/archives/49


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