The Deranged Housewife

Reproductive coercion outside the domestic relationship

noreply@blogger.com (The Deranged Housewife) — Mon, 02 Sep 2019 15:32:00 +0000

Image: joinonelove.org

The image at left is designed to set the scene for what reproductive coercion might look like between a man and a woman in a romantic relationship. It’s fairly easy to define what that looks like, right? But what happens when the person doing the manipulating isn’t the romantic partner, but the care provider? Is it as easy to identify then? Are we hesitant to call it what it is?

“We’ve all heard this scenario: mom receives the happy news that she’s pregnant and all is well until the anomaly scan. A little too early to tell, could be something, might not be. As much as you like your doctor, you aren’t comfortable with making a decision before you have all the facts and he is going on about how your baby surely won’t have any quality of life and you feel pressured to terminate. You’re not sure what to do - you mention seeking a second opinion and he gets mad, which makes you feel even more pressure to make a decision. What if he’s right? More importantly, what if he isn’t?”

Or….

“We’ve all heard the scenario: mom is getting close to delivery and just wants this baby out! She agrees to a cervical check to see how things are going, but this one is super painful and feels different than all the others. Later she experiences some light bleeding and loses her mucus plug, which scares her. Afterward, she realizes her doctor did a membrane sweep without her permission, without so much as a word of explaining what she was doing ahead of time.”

According to ACOG, “Reproductive coercion is a form of domestic violence where behavior concerning reproductive health is used to maintain power, control, and domination within a relationship.”

Reproductive coercion in a romantic relationship can be defined as:

poking holes in the condoms to increase the likelihood of pregnancy (and can be done by either the male or the female partner)
refusing to wear a condom or lying about birth control use
otherwise tampering with birth control

It also involves manipulating in some way the outcome of her pregnancy and includes:

pressuring her to remain pregnant
pressuring her to terminate a pregnancy

But did you know that it can also happen outside of the domestic relationship and often takes place in the doctor’s examination room and in hospital maternity wards every single day. While many women have been pressured by their partners to terminate pregnancies, unfortunately it’s not unheard of for doctors to do it to patients, too, especially when a terminal fetal diagnosis is involved.

Don’t be afraid to seek a second opinion. If you’re facing a tough diagnosis but aren’t absolutely sure if you want to terminate, go somewhere else. If your doctor balks at this idea, it is a RED FLAG.

Since reproductive coercion in a romantic relationship includes altering the outcome of a pregnancy, I think it’s safe to say that this is probably the most common form you’ll see in a doctor-patient relationship. Why are we not seeing it for what it is? If it’s considered manipulation for a woman’s boyfriend to alter the outcome of her pregnancy in a way she doesn’t want, why not a doctor?

It probably looks a little like this:

The pregnancy has been going textbook perfect and delivery is imminent. Suddenly there are a million things going wrong, she is literally one day overdue, and before she knows it she’s been booked in for an induction she said she didn’t want but feels like she has no choice in the matter.
Mom is being induced and isn’t sure why and the doctor won’t really answer her questions about it. She also has no idea what to expect or what they’re going to do to her.
The pregnancy has been going great and the doctor has assured her she can walk around in labor, go into labor on her own, and will try her best to honor everything on mom’s birth plan. Then suddenly mom is pressured to induce, is told that she can’t get up out of bed, can’t walk around, and none of her birth plan wishes are honored.
The doctor pressures mom repeatedly during the pregnancy to induce, even in the absence of any medical condition, gives conflicting or confusing advice about what could be happening, and uses intentional language to scare, manipulate or coerce the patient.

This poor woman's doctor is coercing
her into an induction with confusing
fluid level measurements, is arguing with
her about her due date and refuses to change
it even though by the mom's calculations
it's significantly off, and has even
gone so far as to involve her family
physician to manipulate her into
consenting. She went on to have a lovely
birth after standing her ground
and stated that the only augmentation
she had was having her water broken.

Just like in a romantic relationship, it can include:

getting angry, impatient or condescending when you ask questions, want more information or time to think it over or express a desire to seek a second opinion
pressuring you to terminate when you don't want to or aren't sure, and using manipulative, condescending or threatening language if you refuse, want to wait or seek a second opinion
pressuring you to consent to a cesarean when you have reasonable requests to avoid one and threatening you if you don't
pressuring you to consent to vaginal exams when you don't want them, and threatening you if you refuse
pressuring you to make a decision without all the facts and refusing to give you unbiased information to make the best decision for you
refusing to administer permanent birth control because of age, marital and childbearing status even when you have expressed a clear desire to not have children or are done having children
being forced to have a court-ordered induction or cesarean when you are of sound body and mind and have refused

Threats can look like:

calling the police to have "welfare checks" without serious justifiable cause
calling the police to have you forcibly removed from your home
threatening to call CPS on you if you refuse interventions
threatening to drop you from their practice even though you're making perfectly reasonable requests

I can’t tell you how many times I’ve heard this scenario happen: moms who have no idea why they were induced and they felt like they had absolutely no choice in the matter. You often see these people on internet forums, asking other moms “is this right? Is this normal?”

“I am almost 39 weeks and at my last OB visit the doctor said my cervix is only finger tip and the baby is floating. The doctor also told me that there is an 80% chance of a c-section because the baby is not engaging and my pelvis may be too small. This is my first child and I really do not want a c-section.” - prncssjenjenn

“I am currently 38 weeks and 4 days pregnant. My little girl is 7.5 pounds. I am 1.5 cm dilated and experiencing no contractions of any sort…I had a doctor appointment on Wednesday and she told me that if I did not go into labor by September 12 (my due date) they would induce the same night or the morning of the 13th.” - AutumnRMcG

“I am 40 weeks pregnant and my doctor is already talking about inducing labor at week 41 if there is no baby. I object to this as I have no medical problems thus far and during my non-stress test, the baby is doing perfectly. I am not understanding her reasoning…I do not want to get into a boxing match with my doctor, but my husband and I both feel that when the baby is ready she will come. Again, I have had a perfect pregnancy and no reason to be talking about an induction. What is the best way to handle this?” - palesa2678

The underlying emotion in all of these comments (and many more in addition to these) is stress. It becomes a game of “how can I trick this baby into coming as soon as possible to avoid making my care provider mad/being asked one more time to induce/made to feel guilty/basically being forced into something I don’t want to do?” It’s stressful enough just to read their comments; it’s even worse when you have to live it and think about it 24/7 until your baby finally arrives and every appointment potentially turns into a battle of wills. Why is just saying no not an option? Why is it so hard?

The point is, no one can predict what can happen: sometimes things unfortunately do happen and no one could predict or prevent it. Sometimes none of your fears or the doctor’s threats come to fruition, thank goodness. But the time it takes to get through that event can really mess with your head and coercion, manipulation and bullying don’t help. No one has a crystal ball, not even your doctor.

If ACOG can readily define what reproductive coercion looks like in a romantic relationship, why can't they do it in a patient/doctor one? At best they offer platitudes about "guidelines," "recommendations" (which do not translate into "rules and regulations," contrary to popular opinion) and patient autonomy, and essentially give doctors a choice as to whether or not they choose to follow them. Unfortunately, it would seem the patient herself is not afforded the same luxury.

More reading: ACOG Practice Bulletin 664, Committee Opinion on Refusal of Medically Recommended Treatment During Pregnancy

Are you in an abusive relationship with your OB?

noreply@blogger.com (The Deranged Housewife) — Fri, 30 Aug 2019 00:46:00 +0000

Originally published May 2010
Edited August 2019

I am convinced that some women are in abusive relationships and don't even know it.

Studies show that one in six women report being mistreated,
but I suspect that number is actually much higher.

Most people automatically think of romantic relationships. You may say you'd never tolerate emotional or psychological abuse from a partner, yet you may put up with it for nine months from one of the people who is supposed to care about you the most: your obstetrician.

I have heard some pretty awful stuff over the years (many screenshots have been taken). I don't think it's too difficult to draw some comparisons between an abusive spousal relationship and one between doctor and patient. I've taken some basic points from websites that detail spousal abuse and replaced the word 'partner' with OB.

Some of the biggest ones are:

• Does your OB frequently criticize you, humiliate you, or undermine your self-esteem?

Examples I've heard include medical staff making inappropriate comments about the baby's father, (if they all have the same father, or assuming that you don't know who he is); when women are harassed and mistreated after home-birth transfers and it's assumed you've had no prenatal care even if you have; being treated like a child or talked down to. Sadly, in my experience the worst of this came from female physicians.

• Are you afraid of your OB?

This one reminds me of a woman who was about to be induced with Cytotec, but had read warnings about uterine rupture and was very nervous. She decided to stand her ground about the induction, but yet was "afraid of making her OB mad."

I still remember the nervousness I felt when I decided at 37 weeks to change my plan to a VBAC. I was afraid of making my OB angry so I took my husband with me for support, thinking the whole time how utterly ridiculous the whole thing was.

• Do you sometimes feel trapped in the relationship?

Is your doctor initially supportive and then changes his mind at the last minute? Makes you think you have no choice but to stay with him? Little do women know that they can find care late in a pregnancy - it can often be difficult and stressful, but it's not impossible.

Brainwashing and mind control are also hallmarks of emotional and psychological abuse. (Replace the word 'brainwasher' with OB)

• The OB keeps the patient (victim) unaware of what is going on and what changes are taking place.

I once heard a comment that basically amounted to, "Forget about reading those pregnancy books; I'll tell you everything you need to know." Limiting access to outside information by creating a false sense of security often convinces women that they don't need to research birth because their doctor will give them all the details. My doctor tried this with me when I asked him about having absolutely no urge to push. He basically said, "We'll help you when the time comes," and that was all that was said about it. Puzzled, I thought, That's not much of an answer, and left there feeling confused and doubtful.

My next favorite is "you can't always believe everything you read in blogs." I don't think I need to mention names of certain former physicians that shall remain nameless...

Other tactics include not explaining procedures before they happen but as they happen, when you basically feel like it's too late to say anything. Birth is such a chaotic, busy event that sometimes you don't even realize things are happening until much later.

• The OB creates in the patient (victim) a sense of powerlessness, fear and dependency.

In obstetrics this is often accomplished by threats (the dead baby card) and coercion to get you to comply. I've heard of women denied pain relief for episiotomy after a natural birth because it's assumed they don't want drugs for that part, either. I've also heard of nervous dads being manipulated to influence mom into compliance, which undermines her confidence.

Many women who seek a VBAC are also told "their doctor won't allow them," "I really want one but I can't," or "I trust my doctor when he says VBAC is a bad idea." Studies have shown that women are often swayed by their care provider's preference on whether to have a repeat cesarean or trial of labor, which means many women may be choosing a repeat cesarean when they don't even have to out of a feeling of complete powerlessness.

This often includes having your complaints of emotional distress or physical pain denied by gaslighting (how many of us have been told by our nurses, "it's not that bad!"). Studies have shown that both female and male doctors often do not take female pain seriously, which can be a major factor in maternal deaths when red flags are ignored.

And I think we've all heard the comment "I would've died had my OB not (fill in the blank)." While sometimes that is absolutely true, let's be honest - sometimes it's not. As women we often tend to overshare and don't skimp on details, and when you find out the patient thinks the doctor who basically caused all of her complications through his own actions really saved her life, it's pretty cringeworthy.

• The OB puts forth a closed system of logic, and allows no real input or criticism.

"In other words, what he says goes." At the time of this edit, there has been much talk on Facebook about OB's who refuse doulas in the delivery room. Never mind that doulas have been shown to reduce your rate of cesarean.

While I don't doubt that some physicians have had bad experiences with doulas, a good doula realizes her place in the room: to solely support the mother, not to offer medical advice. Unfortunately the choice to ban them altogether means you're also doing a disservice both to the good doulas out there and to the patients who desperately need them.

• Your OB has a great capacity for self-deception.

He can not only fool you into thinking he supports you and your wishes, but also convinces himself that what he does is not wrong, but required and very necessary - even to the point of putting mother and baby at increased risk. (Unnecessary inductions and unnceseareans are a prime example.) Jennifer Block brings this up in Pushed: A doctor did for a cesarean because the patient's fluid levels were low, and afterwards cheerfully announced when Block asked, "Oh, her levels were fine!" Another example: Block asks the doctor if he thinks the induction will work, and he says, "No." So why are you doing it?

A friend of mine recently recounted her birth story of her only child, and when she asked about walking around and other coping techniques, her doctor told her it would be no problem. That all went out the window when it was time to deliver, and later she realized her doctor had absolutely lied to her. Basically they did everything to her they said they wouldn't.

• He/she projects the blame for his (relationship) difficulties onto his patient (partner).

I see this a lot in comments (from both medical professionals and the general public) about mothers dying in childbirth, because they're "fat, old and unhealthy." Unfortunately this is not always the case, and even so, does not account for so many maternal deaths.

"I think we've been inadvertently placing blame on mothers for these outcomes, and I hope this kind of work helps shift that narrative." - Stephanie Leonard, PhD

And just like in abusive romantic relationships, the patient/OB relationship can sometimes culminate in obstetrical violence. Kimberly Turbin is a mother who sued her physician for a forced episiotomy despite the fact that she had barely started pushing and repeatedly told him to stop. Remarkably the entire event was videotaped and the physician ended up surrendering his license. Ironically Turbin herself is a two-time rape survivor who already told staff ahead of time that she wanted permission before they touched her.

Caroline Malatesta also successfully sued an Alabama birth center after the violent birth of her child in 2012. Among her complaints were that the birth center had billed itself as a natural birth-friendly facility when it was anything but. Malatesta said that she was forcibly held down by a nurse and the baby was prevented from being delivered until the doctor arrived, despite her screams to stop. As a result she experienced permanent nerve damage and chronic, debilitating pain.

Demi Ruben Dominguez died after her doctor forcibly removed her placenta, despite her obvious pain and distress.

"The nursing staff documented that during the placenta extraction, the patient was screaming in pain and moving around in bed, and in his note, [the physician] described her as 'agitated,' and did not consider or record consideration summoning the anesthesiologist to add medication to the patient's epidural infusion prior to attempting to extract the placenta." - People Magazine, August 27, 2019

Her doctor had manually tried to remove the placenta and perforated her uterus, after which nurses noted that she was losing blood and looked pale - but the doctor refused to act. Both the patient
and her baby later died.

Other examples may include forced cesareans and membrane sweeps without consent (that some women may discern feels different than a normal vaginal delivery but otherwise are not informed that's actually what's taking place).

A controversial topic to many, this type of physical abuse has led to the term "birth rape." It's extremely important to note that rape does not always have a sexual connotation, but can mean several things:

To seize, take, or carry off by force
an act of plunder (to rob, despoil or fleece), violent seizure, or abuse; despoliation (stripping or taking by force); violation.

Synonyms listed include "violate," "strip," or "ravage."

Some sexual assault victims do not agree with this terminology; some absolutely do and felt that their traumatic birth was like reliving their rape all over again. Unfortunately some women have still experienced mistreatment despite fully informing their care providers that they were sexual assault victims.

While some criticize those who use the term 'birth rape,' we are forgetting that abuse comes in many forms, and are devaluing the traumatic experiences that these women had - much like abuse deniers try to devalue the trauma of sex abuse.

I'm not even sure how to tell women to avoid an abusive OB, because it's easier said than done to just switch providers. Often the new doctor is just as bad or worse than the first one. Gaining knowledge, information and perspective on your situation can be helpful in encouraging you emotionally and physically, as well as knowing when your doctor is giving you a line of BS. And speaking up when you feel violated, unsafe, patronized or mistreated in any way is absolutely crucial.

Even after three pregnancies, I'm still learning how to do this.

Why I don't go to the OB anymore

noreply@blogger.com (The Deranged Housewife) — Sat, 27 Jan 2018 19:35:00 +0000

As the news of team doctor Larry Nassar's sentencing makes headlines and his victims are finally being heard, it makes me fearful of their futures as they potentially enter their childbearing years. How will they ever trust a doctor again to care for them?

Awhile back I visited my gastroenterologist for a yearly follow up, and the assistant taking my medical history gasped when I said I hadn't been to an OB since my eight-year-old was born. She asked me why and I'm not even sure I responded. A friend gasped when I told her the same thing, and that I hadn't had a mammogram despite being 43, and she said her doctor has been ordering them for her since she was 35 despite being low risk.

To the intake nurse who was shocked and probably thought I was being irresponsible with my health: do you really want to know why I haven't gone? How much time do you have?

My very first gynecologist when I was college-aged was nice, she took the time to answer my questions and explain procedures. She also treated one problem effectively; the other, not so much. Not much questioning going on, just creams and this that and the other that made it worse.

The second guy, more cream. A cream that basically makes it feel like you're lighting fire to your skin. Not even sure what he felt he could accomplish with that. When I relocated out of state and saw someone else, the nurse gasped audibly when I told her what he gave me and couldn't imagine why he did that.

Soon I would start having children. The next practice I was in involved a doctor who had only recently had his license reinstated, I found out later, because he had made inappropriate sexual remarks to a patient. He's also the same guy who inaccurately told me that my child was vertex, even though I knew he wasn't, and argued with me. This was probably a major turning point in my pregnancy because we could've likely attempted a version at this point (they never offered, not once). But no, he remained breech, undetected, until I was about 37 weeks. Another physician in the practice did an internal on me - which now I wonder was really her stripping my membranes despite my child not being in a head down position - and determined that he definitely was breech, which was confirmed by ultrasound two weeks prior to my delivery.

When I had the baby, the first thing I said when my primary OB checked on me in the hospital was, in a super groggy state, that "all my children would have to be born this way." How naive and uneducated I was, and he knew it, because he didn't correct me.

When I got pregnant with my second, I was still naive and uneducated. He presented me with a choice at my first appointment: have a repeat cesarean or try for a VBAC. What little I had heard about VBAC sounded dangerous, and I told him so, that I felt I would just have another cesarean because "that was safer." He didn't correct me.

When I was nearing delivery with my second, I had an epiphany. Not only was she not breech like her brother, but I was more informed in my delivery options and just pissed off enough to exercise them. I remember vividly the appointment where I told my husband he had to come with me to break the news to my physician, who would not be happy. As if he was my daddy or something. The doctor already had a bit of a nervous stammer and it came out even more during that appointment. My husband was not pleased and shortly after that expressed his outrage and hatred for the doctor, who literally told me "I have one patient on her fifth cesarean and she is doing fine" when I confronted him about why he was downplaying the risks of repeat cesarean and making VBAC sound so terrible. That was his idea of informed consent. In response to this mystery patient that probably didn't even exist, I said, "Well, I don't want that to be me."

One of the midwives in his practice, upon hearing my plans, said, "I do not want to be doing this." Whatever happened to those caring, supportive midwives I kept hearing about?

I finally left that practice at the beginning of my third pregnancy, when another midwife in the practice basically made it sound like it was "my choice" to go through with it, despite the possibility of catastrophe. In other words, my fault. I left there in tears and never went back. It was not my first horrible interaction with her.

The next physician's group employed no midwives. Just doctors who bullied, coerced and lied. The lead physician in the practice examined my "little problem" and immediately tested me for herpes, even though I knew it would be negative. It was. He also didn't tell me what he was doing it until he had literally torn a piece of my labia off and it was over. He billed my insurance, I'm sure, but never asked me for permission to do the test.

At one point during that pregnancy I felt there was one doctor in the practice I could trust. That trust quickly eroded when, during a particularly lengthy conversation, she was having a tough time getting me to give up my hopes of avoiding another cesarean and then admitted she herself had had three of them. And then billed me for a 'consultation,' despite not having told me of what she was doing and the fact that my insurance was supposed to cover my office visits in full. This same office had billed me one other time for observed swelling as being "outside the scope of pregnancy care," despite it being quite common in pregnancy, in summer, and especially after the patient is being forced to wait in the lobby for over an hour to be seen.

One doctor in the practice worked hard to get me to consent to a cesarean for high blood pressure a week before my due date. I really wanted my baby to come on his own, hopeful that it wouldn't be a surgical birth. I quickly refocused and hoped it wouldn't be a cesarean done by her, praying that she wasn't on call. She had already scared me into thinking he was big after taking almost no time to measure me properly, sending me for an ultrasound where the lovely technician basically told me very politely that my doctor was full of crap.

When I was admitted for observation, the same doctor called my room repeatedly to harass me. When I finally answered the phone after several tries, she angrily asked, "Do I have to come down there?" like I was a disobedient child.

A resident had been counseling me yet again on the dangers of VBAC and told me the rate of rupture was 10%. I cringed inside and found myself shriveling in fear, as if I couldn't possibly stand up to their tactics. I remember thinking to myself, if I am going to preach to countless women about being advocates for themselves and their babies, it needs to start with me. I then told him he had his decimal point in the wrong place.

This same practice also had at least one nurse on staff who was downright nasty, even making a negative comment about my baby after he'd been born. I don't even remember what she said, but knew it must've been bad if the old lady receptionist apologized on her behalf, embarrassed.

When I came back for my six week checkup, I felt off. Not depressed, but just blah. The physician blankly stared at me and asked, "Are you depressed?" "Not that I know of," I answered, but wasn't exactly sure what to tell him. He told me he was obligated to ask and then ordered bloodwork and went on his way. The blood work revealed that I had a thyroid problem, which he also didn't know anything about, and I went untreated for probably another 18 months.

So I haven't been back. It's been over eight years and I know I should go, but I'm terrified. Waiting to be asked, "why'd you wait so long?" and subjected to a battery of bullshit I probably don't need, same as before. Only now it's a new game to play: when can we schedule your mammogram? I hate to tell that friend who's doctor ordered them at age 35 - but that's not even evidence based care. So when you transition out of childbearing to perimenopause, you're basically trading one set of fears over bad care for another.

When my online friends would talk about having a close-knit relationship with their OB or midwife, who is caring and listens to them so well, I realize I have never had that, not once. That I can't relate to that on any level whatsoever and now have an overwhelming sense of needing to watch my back. As if navigating the waters of "birth outside the box" wasn't stressful enough, now you have to worry about menopause and cancer this and cancer that. Being subjected to the same crap time after time despite countless studies - some of which that are at least a dozen years old - that suggest it's not really the best way, but seemingly take decades to implement, all the while receiving gasps and stares because you're dangerous and irresponsible. It makes me want to punch the Susan Komen Foundation in the face.

So this is what I want to tell someone when they ask why I don't go. And there are millions of women who have had it much worse than I. I know there are good, caring and supportive care providers out there but as of yet, I just haven't found them. I'm hoping that Larry Nassar's victims will.

Cesarean Awareness Month: Check your emotions at the door

noreply@blogger.com (The Deranged Housewife) — Tue, 05 Apr 2016 18:00:00 +0000

April is here again, and this year Consumer Reports magazine is doing a series of terrific, thought-provoking graphics on the rising cesarean rate. Aside from this being Cesarean Awareness Month, it's a great time to talk about it since the rate continues to rise, and especially as the nation is attempting to get single-payer healthcare off the ground.

However, this is also a topic that provokes a lot of emotion in people; that's understandable. As someone who has had two cesareans herself, it still makes me bitter to think about decisions I could've made differently, ways I trusted my doctor when I shouldn't have, and just how I could've managed my care better throughout the whole process. When I start going down that road, though, I realize a couple things: none of it matters anymore since I can't change it; my choices have led me on a complicated, sometimes stressful journey to this point; and I can direct my energy into advocating for women and educating people about the subject.

Ultimately we as women have to put those emotions aside when we examine raw data that leads us to one conclusion: the cesarean rate is too damned high. All kidding aside, it continues to put moms and babies at risk, sometimes in ways that are clearly apparent from the onset, and sometimes far into the future. How can we change things? By looking at the data, being open-minded about statistics and what they mean, attempting to understand why it's not necessarily a good thing and what can be done about it. Freaking out and attacking people, or feeling like you've been attacked when you clearly haven't, doesn't really fit into that equation.

Case in point: today on FaceBook CR shared this graphic.

Source: Consumer Reports FaceBook page

Right off the bat, the first comment mentioned something we've all heard before: My child and I would've died had we not had a cesarean, and it doesn't make me any less of a mother.

A couple things: where in this graphic does it mention that you're less of a mother because you had a cesarean? Where is it even implied?

Either this person has been repeatedly approached or attacked by a-holes who advocate for nothing but vaginal birth (which is possible, but really) or she has some underlying issues regarding the defensiveness of her cesarean (which in and of itself is okay - it's okay to grieve the 'loss' of a vaginal birth that you may have preferred or desired, and no one should tell you to just get over that).

All it is is a statistic. A number that reflects that things have changed since 1970. Nothing more, nothing less. Consumer Reports is not in the business to make people feel bad; they just present the numbers and hopefully make us think, why? What's going on here?

Instead of showing emotions and having temper tantrums, we need to ask, why is this? What has changed since then? It's not a neat and tidy answer that can be best summed up in a few words, so you as the listener have to be open-minded about what you may hear if someone tries to explain it to you.

Aside from ongoing dialogue on a basic level such as this - with the understanding and acceptance that even laypeople who are not physicians can quantify and understand the risk factors and weigh the risks and benefits - there needs to be a continued dialogue between doctor and patient. Informed consent in making these choices is often a huge problem, and if patients have not done their research they have no information to compare it to. Just saying "I would've died" is not enough, in the sense that you may not be aware that your doctor has a high induction/cesarean rate, prefers all his patients to labor with epidurals, does not support VBAC and turns around and writes "cesarean done by maternal request" in your medical chart that you will never see, even though you very much did not want that c-section but did what your doctor thought was best.

That is not to say that all doctors are unethical slobs who just want to speed the process along, but no one can deny that it is a problem. Overmanagement of care and excessive treatment can expose both mothers and babies to increased risk, and without access to information through campaigns such as these, you may never know the difference. No one should be sharing information with the intent to shame someone, but neither is putting those shocking numbers out there calling anyone's motherhood capabilities into question.

Secondly, challenging someone on the ideology of "my child and I could've died had I not had a cesarean" is bound to open up a can of worms. No one should be made to feel like they have to explain or justify what happened, and sometimes yes, that cesarean was very much warranted and mom very much was in control of the situation.

Sometimes, however, when they do explain, it's clear there was more at play and the reasons behind it were likely caused by the physician himself, a phenomenom that is not unique to obstetrics. This is an important crossroad that we need to consider, especially as we attempt to move towards universal healthcare. It reveals the motivations of some physicians and should call into question our relative difficulty in questioning their authority. Therein lies the problem: in order to understand the rising rates, we must go back a step and understand the primary reasons they happen in the first place. We need to be our own advocates, do our homework and ask questions. Instead of getting mad, we need to stop feeling blamed and look at this data objectively, asking ourselves, Why is this happening? What has changed?

Why it's illogical to tell women to nurse in the restroom

noreply@blogger.com (The Deranged Housewife) — Wed, 24 Feb 2016 14:42:00 +0000

Now that I'm no longer nursing, it seems that I'm even more acutely aware of public bathrooms: specifically, what if I were nursing here right now? Logistically, nursing in public with three kids was sometimes difficult, especially since I was not up on baby wearing and how awesome it is.

I once attempted to cram my toddler in one of those insanely huge race car shopping carts into the bathroom with me and he wouldn't fit. Do I leave him outside basically unattended? Do I leave the door open so I can see him, and therefore the rest of the world could theoretically see me, too? Then I thought, what if I were nursing? Egads, that would potentially be a logistical nightmare, since women are typically expected to feed their babies in stalls instead of disgracefully doing so in public.

What about handicapped stalls, especially when there's only one available? If women are supposed to breastfeed in bathrooms, is it ethical for a nursing baby to take up that stall space instead of an actual handicapped person?

What about places with only one bathroom? If nursing should only be done in there, then most people are not going to appreciate waiting in line for a single stall for a baby to feed (both sides!), while everyone else has to pee. But you said I should go nurse in the bathroom, right? So you'll have to wait until my child is finished eating. Sounds gross, I know.

As far as single stalls, this lovely photo was taken at one of my favorite grocery stores - they only have one bathroom, and in this case I think an employee did not have enough time to properly clean it. Either that, or a poor customer thought she did a better job than she did. Most of us wouldn't want to sit there to relieve ourselves, much less nurse a child there. Still think a baby should have to eat in the bathroom?

When there's only one bathroom available, who takes precedence? The person who has to pee, or the baby who is screaming loudly? Tough call. Some would suggest mom and baby stay home, which doesn't seem fair, really, when life must go on. The rest of the family doesn't stop eating just because there's a nursing baby at home that keeps mom from going grocery shopping; errands don't stop needing to be done. Staying at home is a great option for those who don't feel like ever leaving the house until baby is weaned. Child won't take a bottle? Then you have another problem. Can't pump more than half an ounce no matter what you do? But just pump! Because pumping is so easy, surely everyone should be able to do it (says the woman who pumps Niagara Falls at every sitting). Sadly it isn't that easy, nor should a woman be forced into doing something potentially stressful and unnecessary when she could just bring her baby with her.

I find that people are so quick to give solutions to a problem that isn't that they rarely think about the next step: it's like they expect every public restroom ever to have a place to sit down (besides the toilet) and rest and be spotlessly clean. They expect there always to be a bottle and for that baby to always take it, without issue. The lengths women (even myself, regrettably) go to to avoid offending someone - even to the point of never breastfeeding, sadly - is pathetic.

Improving birth by breaking the silence

noreply@blogger.com (The Deranged Housewife) — Thu, 30 Jul 2015 15:43:00 +0000

The topic of childbirth is one that women - often those who don't even know each other - often freely engage in. We find ourselves sharing the most intimate details with strangers on what is often the happiest day of our lives. And for some, one of the most traumatic.

But it seems like if your outcome is anything less than happy, women suddenly don't want to hear about it. And when you question the actions of your doctor, or express anything less than total and complete gratitutde to your doctor, then you're attacked, criticized, made to feel like you're selfish for wanting something more or think you're smarter than the physician.

And yet, sometimes these stories still make it out, have a voice, are heard above the din. When "Kelly," the mom who had an episiotomy and was cut at least a dozen times by her physician, told her story, many women did come out of the woodwork. They shared their equally horrifying experiences, told her she wasn't alone, said the same thing had happened to them. It was terrifying and yet vindicating at the same time, knowing that finally these women are confident enough to talk about what happened to them. And with the number of them growing as more and more comments were added and the article continued to be shared, it was clear there were more of than them than not. And it was abundantly clear, even to those who are not involved in birth advocacy, that there is a shocking pattern of abuse in obstetrical care.

If you ask your mother, grandmother or great-grandmother what her birth story is, she may or may not be able to tell you. She may not remember any of it, drugged into oblivion with medication she may have felt at the time she neither wanted nor needed. While things have improved somewhat since then, it's not all that much, considering you still hear these horror stories. Women were given few choices then and to some extent, still aren't, with sometimes well-meaning and sometimes downright cruel care providers making choices for them on their behalf. These pictures continue to give us evidence of that.

I have seriously told women who were not
comfortable laboring at home to either labor in
the parking lot or the lobby but not necessarily
check in. That way you're close to the hospital,
but still on your "own time." How pathetic is it that
women even have to resort to doing this?
I can totally understand where she's coming from.
Photo used with permission from ImprovingBirth.org

Isn't that the truth. Remember Nurse Jenna's
post lightyears ago about "why you need
Pitocin in labor?" This was basically her
justification of it - they need to free up
beds. It's all your fault that you're not
laboring at home longer, even though
we care providers make you feel like it's
the most dangerous thing in the world to
do so. (To read the article, click here.)
Photo used with permission from ImprovingBirth.org

Coercion can often be another hallmark of abusive practices. And as some find out, they agree to the procedure only after much pressure and bullying, only to read in their chart later something entirely different.

The "maternal request" cesarean is often the result of
mom agreeing to a c-section after finally giving in to
bullying, scare tactics, and tremendous pressure to do so
from her physician.
Photos used with permission from ImprovingBirth.org

I am not at all surprised that this is a female physician. I
had similar experiences with one in my OB's practice and
found many of them to be far more condescending and
rude than the male doctors.
Photo used with permission from ImprovingBirth.org

When people say "Just trust your doctor" I think
of situations like this one and it makes
me want to throw up.
Photo used with permission from ImprovingBirth.org

I urge you to go through Improving Birth's FaceBook gallery. Maybe there is a situation that speaks to you or you have one to share - please do so. Maybe you personally have never experienced this and were completely unaware that such a thing existed. It is time for women to stop being shamed into silence and forced to accept something that is "normal" when it really isn't.

More information:

Improving Birth - Advocates for Evidence-Based Maternity Care

Submissions will be accepted again soon - to submit your entry, click here.

How to survive a family vacation out west

noreply@blogger.com (The Deranged Housewife) — Mon, 20 Jul 2015 19:45:00 +0000

A few months ago, I started planning a vacation out west. A real extravaganza, we'd be gone for about three weeks and would plan on tent camping most of the time. Yeah. As the date approached and more and more people started asking us about our travel plans, I began to wonder: Am I *@&%^^@ crazy??

The view from our hotel

The magical date came and we set out from my parents' house in Ohio. I had a great deal on a hotel in downtown St. Louis through Travelocity or some such website, and was pleasantly surprised at how posh and super fancy it was for country folks like us. LOL What I didn't realize: it had no free breakfast and no pool. But never mind, the amazing view of the Gateway Arch from our room! more than made up for it (as did the totally awesome bathroom) and the kids didn't mind. Because I didn't want to spend the money on dinner, I made sandwiches in our room and ate fresh fruit that I had packed. Whew.

As far as meals on the road, I had planned on making as much "real food" as possible so we could avoid eating out and fast food all the time. In theory, this was great - especially as my stepdad had bought us a cast iron skillet (lid sold separately), we had a cranky campstove and lots of still frozen food in the cooler. Frozen water bottles will help keep things cold, they said. Uh huh. Until it thaws, the cookstove doesn't light (out of white gas, I see!) and the temps are so intense absolutely no one has any appetite. That didn't quite work out as planned.

Here's what I found:
Freezing food ahead is a good idea, at least in theory. Sometimes it doesn't always work out and stuff will go bad despite your best efforts. Super hot temps, kids getting in and out of the cooler, not enough ice, etc. The frozen water bottles worked for a little while but are not as practical as ice, since once they thaw, there is virtually no place to refreeze them. We missed at least one meal because of not enough fuel in the stove. (I advise bringing extra fuel so you don't get taken for a ride when you run out and the only option is some remote gas station that charges double the price.) Aside from that, realize that if you're not staying in the same spot more than one night or for the duration of your visit, lugging out the gear and food, plus setting up the tent, cot, sleeping bags and whatever else you have can be a giant pain in the butt and you just might say screw it. One other thing: when it's 86% humidity, no breeze is blowing and the temperature is in the 80s despite it being almost nine p.m., no one may even feel like eating anyway.

You may find yourself searching out Walmarts and grocery stores a lot to avoid the hassle of trying to keep food cold for longer periods of time. All I wanted was cinnamon rolls for breakfast, but I think three cans of them exploded on us in the process. (The one that didn't accidentally got dropped on the ground during cooking - totally not my fault.) Premade pizza crust with toppings worked well in the cast iron skillet, once we knew not to turn the flame up too high on the stove, and cooking stuff over a campfire works to slowly heat things up but otherwise takes forever. Making your own doughs may sound like fun, but again, if you're setting up and taking down camp each day and getting on the road, you're probably not going to feel like whipping up homemade pizza dough.

I also found it difficult to heat food in a cast iron skillet without a lid. If you need one while on the road, they sell them reasonably at Cabela's and probably any other outfitter store. It was easier to keep the bugs out of our food and keep stuff warm. While they sell the skillets at Walmart, they do not sell the lids there. You can also use glass lids or foil, too, though.

As far as staying in campgrounds, few required reservations. That doesn't mean that you shouldn't call ahead, either, though. I made almost no reservations while camping because I wasn't necessarily sure where we'd be. We chose to camp at KOA's most of the time, and for the most part they're large enough that they have plenty of room. However:

This may not include areas that are close to national parks, like Yellowstone. We stayed at the KOA in West Yellowstone, which is actually in Montana, and it was crowded. Very crowded. At first it was kind of a turnoff, but the people milling around and doing fun activities (which will cost extra) was almost like a little community. There are bears around, but usually outside the perimeter of the campground because, again, it's so crowded. We were able to call ahead a few hours and reserve a spot, and by the time we got there I think they were full (I did see some empty tent sites but I'm wondering if they were reserved). Cabins are fun, but I'm guessing that close to Yellowstone they were probably reserved months in advance. And even tent camping in that area will cost you: it was probably more than $60 a night just to set up our tent, which is the most we paid to tent camp the entire time. But you are close to the park and there is tons for the kids to do, plus a very cool gift shop (which had some items in it that I didn't see in the park's gift shop).

Camping in Yellowstone itself may sound like fun to some, but I chose not to simply because my kids are a mess when they eat and I didn't want to deal with meeting a bear face to face. Bears, as well as other predators, can be a problem if you don't take precautions. Because I wasn't sure what we'd end up doing, I did research camping in bear populated areas, and there are usually guidelines posted in the campgrounds within the parks on how to properly store food and anything scented - this means soaps, detergents, perfumes, anything. It may sound like I'm being paranoid - after all, we saw not one bear on our trip - but when you've never camped in those situations before and have three little kids in tow, it's always a good idea to be prepared. And never, ever, bring food into your tent. Depending on where you are, even pop-up campers won't keep you safe if there is substantial bear activity going on (but chances are if it's that bad you won't be allowed to camp there anyway.)

As far as camping in Yellowstone, don't expect to just show up unnounced and get a good spot. I've been told that these places fill up sometimes a year in advance, so if you want to camp there, plan well ahead. You might get lucky, but I wouldn't take chances with it as it could put a real damper on your trip if that's what you were hoping to do. (This link has more detailed info on making reservations at the major parks, and suggests less than a year window, but it's still several months ahead of your actual visit.)

The only bear we saw was in the
campground giftshop

As far as Yellowstone itself, it's wildly impressive but extremely overcrowded in some areas. This is one of the downsides. People everywhere, including in all the parking lots leading to the sites along with the way. There are bathrooms strategically placed throughout the park, but when we went through there were sometimes lines fifteen people deep for a unisex bathroom. Some sites we had to avoid altogether because there simply was no place to park, which was disappointing. The gift shop was pretty crowded but has fairly reasonable prices, and the attendant told me that crowd was nothing compared to what they normally get.

Which means that if you're looking for wildlife, you may not see any until you get to the less populated areas of the park. We saw a few bison along the road when we first entered, but the herds are usually further away from the more populated areas. If you see bison close up, don't be a dumbass: stay in the car. Zoom in with your camera or just look from a distance, because these huge, seemingly docile creatures will charge humans that are getting into their territory. There is a rather disturbingly impressive video in the visitors center that illustrates this point nicely.

Other dangers I added to my mental list included cliffs, dehydration, poisonous and dangerous insects and animals, and boiling hot springs. Don't overresearch it - trust me - just know that while it is possible to be paranoid to the point of not enjoying yourself, these are very real dangers that have claimed the lives of both young and old indscriminately. That's all I'm going to say about that. Keep a close eye on your kids, insist on holding little ones' hands, and try to enjoy yourself. The vast majority of people injured or killed in the park(s) do so because they either weren't paying attention or were being stupid. Some have said they saw children hovering dangerously near the edge of the Grand Canyon, shoving and horseplaying on the boardwalks of Yellowstone - park rangers will spare no feelings in yelling at you if you choose to wander outside designated boundaries.

LOL What??

As was the case with The Grand Canyon, Painted Desert and Badlands, you cannot just whiz through these parks - if you're pressed for time, you may want to choose which sites in particular you're interested in or skip them altogether. If you decide to go through, an America the Beautiful Parks Pass ($80) is a pretty cool option. They can be purchased at probably any National Park (although check the list online to be sure) and can get you in either for free or discounted admission to all national parks for up to one year.

Definitely bring a paper map. And maybe a laptop. If you don't have cell service (which is pretty common once you head into parts of Utah, Arizona, Yellowstone and Montana) that GPS isn't going to do much good. A road atlas is a must. And if you're taking six gagillion photos, you may need to dump them onto a computer or the Cloud if you run out of room on your phone. It also helped me to have an actual computer to continue to pay bills, etc. and have more of a physical connection on the trip than with just my phone. WiFi, even in hotels and campgrounds, may totally suck, so be prepared. Our hotel in northern Arizona frequently crapped out on me and kicked me off the network.

You will likely have overage charges on your smartphone, unless you already have a mega huge data package. Because of my particular plan, the Verizon rep told me it would actually be better for me to pay the overages than switch. You can also go into Cellular (under settings) and turn off the apps and stuff that hog the most data in order to avoid overages, which just means you won't be able to use things FaceBook or Pinterest while on the road.

If you're traveling out west, get gas frequently. Even if you feel like you don't need it, it's probably still a good idea, especially as you head into more remote parts that either have gas for twice the price or none at all. Thorough car maintenance before leaving is also a good idea, because once we were cruising down Utah highways we realized, hey, it's been about twenty minutes since I've seen another car.

Definitely check the forecast before you leave. For several weeks, I would check the weather for the various parts of the country we planned on visiting. Not that the weather will be that way when you get there, but it helped me to prepare as far as packing. We brought a heavier jacket, fleece, pants and long sleeves for the nights in Yellowstone, which can get into the 40s even during the summer. Obviously not everyone did this, because we saw a lot of people bundled up in Yellowstone sweatsuits, which the park must make a killing on from people who aren't prepared for their wild weather.

If you're using ideas from Pinterest (or anywhere on the internet, really) test them first. What works for one person may not for another, and depending on where you are, it may not be the best idea. Those wax cotton pad firestarters may be awesome, but I used scented candle wax - which was all I could find - and if I were camping in Yellowstone, I definitely would not have used them. We lugged them, with the recycled egg cartons - halfway across the country and when we finally did use them, the wood wouldn't burn. There may be burn restrictions in place out west, in which case you may not be able to have a campfire anyway.

These solar powered mason jar lights sounded like a great idea - dual purpose not only for lighting up the tent at night, but keeping matches dry. Unless you're white water rafting and bringing all your gear along or leaving it out during a thunderstorm, I think we'd be hard pressed to find a reason for our matches to get wet. Not only that, but my solar lights were way too small for the diameter of the mason jar and I just stuck my matches in a ziplock bag for the same effect. Solar technology in general, I've found, pretty much sucks in the long term (as in after a few days of regular use), as I read review after review of expensive solar-powered lanterns from perfectly reputable companies either not working straight out of the package, not holding a charge, or fizzling out after a few uses. I did use some solar stakes I found for a $1 at Walmart to light the tent at night, but I think one totally stopped working and the other decided to stay lit when we didn't need it, which meant it went out before the night was over. What did work for us was inexpensive glow stick lanyards, which come with a string to hang from the ceiling of the tent (ours has a hook there for a lantern) and are two for $1. Some campsites aren't actually dark enough to really need them, though. And of course bring batteries and lots of flashlights.

I also suggest not only going through all your gear before you leave, but if you're buying a new tent, get a good one. I read tons of reviews and finally settled on one that ended up being out of our budget, but was worth it. One reviewer rated it favorably in high winds and rainy conditions, which is exactly what we faced while out west - those storms can come up fast. When you're struggling with the rain fly at 1 a.m. (hello, Tucumcari, NM) you want something that will withstand the blast, and some tents definitely fare better than others. If you plan on doing any serious camping in the future, spending money on good gear is definitely worth it.

TripAdvisor was a very helpful website along the way (they even have an app). From campsites to parks and hotels, they offered the most comprehensive reviews I could find, which was an awesome tool to help guide us in unfamiliar territory. Blog posts from others who've done it also helped me a lot (which is why I'm writing this post). The GasBuddy app wasn't as helpful as I thought, and I ended up deleting it in order to save space on my phone. The white noise app wasn't too bad and offers lots of different choices for background noise, but some campsites and cabins have electricity if you're really desperate and need a white noise machine or fan to get you to sleep.

I have pretty much nothing bad to say about KOA campgrounds. They are awesomely family-friendly and usually have all kinds of fun things for kids to do. There are lots of others out there, but KOAs are usually pretty easy to come by, you'll meet nice people and they are generally reasonably priced. They also have pretty cool cabins that are about the price of a hotel room or less that have electricity (some even have bathrooms and TV). We decided to check one out while in South Dakota and I'm glad we did, since we got a whopper of a thunderstorm that night.

You will probably drive each other nuts. Face it - if you're in the car a lot, this is bound to happen. I put a big bag of activities together, from car bingo (which they hardly played with) to journals, books, coloring pads, and homemade word searches (click here). Of course, DVDs are probably essential and I changed out the music on my iPhone to liven things up (which actually helped keep me awake while driving through the night to get home, who knew). For those moments, it might be helpful to say a prayer, take a deep breath, pull over at a rest stop (several have playgrounds, woot!) and take a breather before getting back on the road. Have a plan, but don't overplan, and be prepared for things to not always work out - but by all means, take everything in, learn a ton about our country,
and have fun!

You should be worried about pharmaceutical ethics: except when it comes to vaccines

noreply@blogger.com (The Deranged Housewife) — Mon, 23 Feb 2015 17:42:00 +0000

In just a few short days the panic of measles has died down to barely a murmur in the news. The baby named Gryffin, who mother incited mass panic with her social media rant (and whose grandfather Alan Hibben is apparently a Canadian pharmaceuticals bigwig, oh well) has tested negative, predictably, and is presumably doing fine. Other infected individuals have apparently gone off into the sunset to convalesce uneventfully, since we haven't heard a damned thing about how they've fared since then; it's as if no one cares anymore (unless they die, of course).

Meanwhile, a few other interesting articles have surfaced (some old, some new) that haven't been getting the attention they should in light of the heated arguments and loss of friendships over whether to vaccinate or not. One such article was posted by Huffington Post Canada, who seems to be drinking less KoolAid over the vaccine debate than their American counterpart: "Merck has some explaining to do over its MMR vaccine claims." Yes, yes they do have some "explaining" to do: but will they?

The article, originally published in September, leaves me wondering: has anyone followed up on this situation and whistle blower claims - which state that:

"It [Merck] "failed to disclose that its mumps vaccine was not as effective as Merck represented, (ii) used improper testing techniques, (iii) manipulated testing methodology, (iv) abandoned undesirable test results, (v) falsified test data, (vi) failed to adequately investigate and report the diminished efficacy of its mumps vaccine, (vii) falsely verified that each manufacturing lot of mumps vaccine would be as effective as identified in the labeling, (viii) falsely certified the accuracy of applications filed with the FDA, (ix) falsely certified compliance with the terms of the CDC purchase contract, (x) engaged in the fraud and concealment describe herein for the purpose of illegally monopolizing the U.S. market for mumps vaccine, (xi) mislabeled, misbranded, and falsely certified its mumps vaccine, and (xii) engaged in the other acts described herein to conceal the diminished efficacy of the vaccine the government was purchasing."

In an additional lawsuit, Merck came under fire for not only monopolizing the market on their mumps vaccine, but selling an overpriced product that was ineffective as well. The suit contends that Merck predicted a mumps outbreak would occur - and it did - especially in highly vaccinated populations both in 2006 and in 2009-2010.

And only what, five years later, we're hearing about this. After assuming "I'm sure they've all been vaccinated, you need to get vaccinated!" over and over again. Well, what if they were? "Oh, sometimes that happens, they're not 100 percent guaranteed." I'm sure it's never because the manufacturer knew they were selling a defective product, right? "Oh, you're such a conspiracy theorist!"

I find it pretty crappy that American news outlets didn't pick this up and trounce it all over the place. There is a virtual treasure trove of articles about ethics violations and conflict of interest between drug makers and studies, all from perfectly reputable sources that are trusted by most Americans, and yet, here we are. Still calling non-vaccinating parents "stupid" and expecting them to actually trust the same companies and regulatory bodies that are fudging numbers, touting flawed or seriously questionable studies when it comes to other medicines on the market. But that study that proved vaccines cause autism? Yeah, that one was debunked. So get over it.

For the record, I vaccinated my kids. I think one of them still needs another dose of varicella (whoops! eye roll) and if it were up to me or I had the energy to fight it, I'd probably say screw it and we'd proceed as normal. I am increasingly skeptical of vaccines, though; not because of autism, or Jenny McCarthy (gag) but because of stuff like this: that I'm supposed to question and be afraid of the ethics violations of drug companies and the FDA, just as long as it doesn't come to vaccines. Okay, that makes perfect sense.

It seems that when parents genuinely do have concerns about these companies or the far reach of the FDA when it comes to vaccinations, they're belittled, criticized, sworn at, and practically threatened with death or jail: they should die, their kids should die, they should be jailed, blah blah blah. I've heard it all. What they don't realize during their foaming-at-the-mouth rant is that they sound as bad as people who claim vaccines killed the dinosaurs (or whatever ridiculously implausible anti-vaccine rant you can think of). Besides, all that's been done before: during the American smallpox epidemic, refusers were often vaccinated at gun point or jailed because of their beliefs. And even then, they realized that duh, we can't really send a government-employed official out to hunt you down and vaccinate you against your will, so they stopped doing it by force (at least if you're a civilian). (Although there are some reports that claim people in Malawi were recently held at gunpoint during vaccination campaigns, but I can't corroborate that yet.)

Forbes Magazine - whose articles on vaccines often read like paid propaganda, in my opinion - warns us all to be wary of the FDA and the recall of generic Wellbutrin's 300 mg dosage, a drug primarily used for depression and smoking cessation. It was found that increasing numbers of patients were reporting drug ineffectiveness with the 300 mg dosage, and patient advocacy groups were ignored when they gathered hundreds of complaints from the get go. The FDA's response was essentially to blame the patient, since they do have mental illness after all, and claim that they had "faith" the drug was working as it should.

We should be scared to death
about the FDA ignoring
complaints about a generic drug -
but not about anything else?
Photo: Egahen/freeimages.com

Instead of conducting their own studies, the FDA then asked the manufacturer to look into the claims that the generic drug was not truly equivalent to the name brand. Even after they were forced to look into it themselves, they were slow to admit there was, in fact, a difference. Not only that, but they had to admit they only studied the 150 mg dosage, and didn't study the efficacy of the increased dosage at all, only assuming that it would work the same way. What was equally shocking: they received countless complaints and knew there were problems, but did absolutely nothing about it until they were forced to and could not contain the "problem" any longer.

This is, however, not the only case of bioequivalents not really being equivalent. The same is true of Synthroid and levothyroxine, used to treat thyroid disease, and some patients complain of a return of symptoms when being put on the generic drug. Most are told "it's all in your head" and insurance companies refuse to pay for the name brand preferred, even when it's clear the generic doesn't work for that particular patient. (If you want, you can read more here, but it's complicated.)

In this case, thousands of patients can be under treated for thyroid disease - which can lead to a host of other autoimmune diseases if not treated properly - not only keeping them feeling miserable, but eventually driving up healthcare costs in the long term. In the case of generic Wellbutrin, the author of the Forbes article rightly points out the toll is probably great: the number of people who, despite having mental illness, are perfectly capable of advocating for themselves and understanding their medicine isn't working; the number of patients who aren't able to advocate for themselves who are just further medicated into oblivion; and the patients who may have likely committed suicide because they were being inadequately treated. No doubt when that comes to light, there will be lawsuits, as there should be: and there are billions of dollars paid out to injured parties because of medication problems and recalls.

But why not vaccines? While there is the Vaccine Injury Compensation program, it seems like much is done to discredit and remove any possible link between vaccines and injury of any kind, autism or not. I personally don't know that I'd call it autism, per se, but in some children, no matter how "rare!" it is, there are still adverse reactions, some quite profound. You cannot expect parents to inject their children with a drug - and yes, it is a drug, with the possibility of creating side effects like any other drug - and poo poo their questions or concerns over it just because it doesn't happen to the majority of children. When you look at kids who are exhibiting marked, profoundly different behaviors shortly after vaccination that they never did before, you cannot simply dismiss them and encourage parents to remove their tinfoil hats of disbelief and forge full speed ahead into the most aggressive vaccine schedule this country has had to date.

Nor can you dismiss them from questioning the motives of "Big Pharma" and the FDA when it comes to vaccine efficacy and safety - because after all, this is the same entity that declared generic Wellbutrin 300 mg (and a laundry list of other drugs over the years) perfectly effective and "safe."

More reading:
Patients vindicated! Generic Wellbutrin withdrawn - The People's Pharmacy

When the media totally gets it wrong

noreply@blogger.com (The Deranged Housewife) — Wed, 21 Jan 2015 22:47:00 +0000

When the media starts talking about a topic you are acutely aware of or one that's personal to you, you are more aware of when they get it wrong. In my case, birth advocacy and thyroid disease awareness are two subjects that are close to my heart and something I know a lot about.

So it's utterly depressing and maddening when you come across an article that is just so bad and misleading that you want to scream at the top of your lungs.

When the news does a terrible job covering a topic you're
intimately familiar with, it makes you wonder how
they handle all the other stuff.
Photo credit: jayofboy/freeimages

This one - The Daily Mail's "Australian woman gives herself a Cesarean section" - is pretty horrendous. You immediately conjure up images of serious peril; something has gone horribly wrong and she's in dire straits with no sign of help anywhere, right? Wrong!

Apparently, this is an article about a maternal-assisted cesarean (definitely not the same as performing the surgery on yourself, as the Mail implies), something that is verrrrrry slowwwwwwly catching on in the birth community. By slowly I mean probably at a snail's pace, because we still don't hear very much about it. The woman, disappointed over the fact that she could not have a VBAC with the twins she was carrying, decided that she wanted more of an active role in the birth and presented her case to her OB, who - not surprisingly - flatly refused. Apparently after he did more research, (gasp!) he changed his mind. (double gasp!)

"'(The doctor) was quite willing once he realized the risk of infection wasn't as high as he perhaps first thought,' Mrs. Wolffe said.'"

Amazing. An OB that listened the patient, while still yielding to necessary medical intervention, and they both had a positive outcome. I am speechless.

However, that's not the problem. Further down in the article, a video accompanies it captioned 'Live Cesarean: graphic 2013 video of birth broadcast on Twitter." Okay… except that's not the Australian woman's birth they're showing. In fact, it's from a hospital in Texas, something the Mail doesn't exactly explain beforehand and most people from their UK readership didn't pick up on (including, apparently, all the American accents in the room).

How this had anything to do with this woman's birth is beyond me, but it sure makes for great fodder for readers to totally attack her - everything from her looks, to her birthing practices, to a "DIY birth" (which it obviously was not). Some even criticized the weight of the babies, for whatever reason. At any rate, it did nothing to advocate for alternative choices in birth and only made the mother look like a total freak (if you trust the people commenting).

Thanks for totally misleading your readership, Daily Mail. Not that that's anything new, apparently…

Dr. Samadi's commentary on Fox left a lot to be desired,
namely the idea that there is more than one way of
treating thyroid disease - not to mention that many
doctors are neither well-versed in or willing to treat more
complicated cases.

January is Thyroid (Un)Awareness Month
Like bajillions of other Americans, I have thyroid disease, and it's a topic I've written about a lot. I've also basically forced myself to get educated on it in order to understand what was happening to my body, because I found that my doctors were not always that knowledgable. Apparently these guys are no exception.

Dr. David Samadi is apparently one of Fox News' resident doctor experts, which in and of itself isn't bad - except he's a urologist commenting on thyroid disease. Since the two aren't obviously related, I was puzzled why he was weighing in on the subject. While I realize they have time constraints on the broadcast, they really do reflect a serious problem with misinformation and an overall lack of education on the subject, which can often leave patients untreated or improperly medicated.

While I do give him points for mentioning more than just the TSH, it's important to know what to do with the results. Just this week I heard a patient say how enthusiastic their doctor was about ordering tests, even though she'd admitted there were some she had never heard of, but then also admitted she had no idea what to do with the results of the bloodwork. That doesn't help you very much as a patient, but at least she was being honest.

Another expert, NYU Medical School internist Dr. Mark Siegel, gives a very watered-down, extremely over-simplified and perhaps even dismissive explanation. His commentary also left a lot to be desired, and outraged a number of people in the comments who have firsthand experience with the disease.

"Here's the good news…[this] is so treatable… if you have low thyroid, I can give you something called levothyroxine. [It] just replaces the thyroid and you're back to normal. It's a great, great medication."

Yes. Well. If you do well on levo, that's your business. Not everyone does, and while some prefer the name brand equivalent, Synthroid, some would rather choose neither and use Armour Thyroid instead - but you usually won't catch a single mainstream physician mentioning that in an article about hypothyroidism. Whether it's intentional or not, Synthroid is usually the only drug mentioned, which misleads patients into thinking Armour has been pulled from the market or simply doesn't exist anymore.

And wouldn't it be great if it were "just" that easy! Just pop a pill and you'll feel like a million bucks in no time. For some, it works great and they're on their way, but for others, it's a constant battle to get a physician to treat them adequately and even take them seriously.

When you catch them screwing up on a topic you're familiar with, it almost makes you wonder what they're telling you about all the other stuff.

Pinkwashing the breastfeeding and breast cancer studies

noreply@blogger.com (The Deranged Housewife) — Sat, 11 Oct 2014 15:01:00 +0000

It's October, the time of year where you're likely to see a proliferation of those pink ribbons on every item imaginable. You may see pink washing in a number of obvious places, and then in some not so obvious ones.

I saw this meme on FaceBook the other day. Wow, those figures are pretty convincing, aren't they? Or are they? I don't think I would've even noticed had I not just read an article - from a reputable source - that presented very different numbers.

I think I can safely say for all of us that breast cancer is pretty much every woman's worst nightmare. And while it is true, that some studies have found a correlation between reduced risk and duration of total nursing time as well as number of children breastfed, it is not conclusive. Despite everything - the money poured into awareness campaigns and research, "not much research has looked at links between breastfeeding and a lower risk of particular types of breast cancer in particular women."

That also doesn't mean it's an absolute that you won't get breast cancer if you breastfed, long-term or otherwise. I still remember a college professor of mine detecting her cancer literally while she was nursing her baby (who I believe was two at the time). In fact, one of the women commenting on the thread where this was originally shared said she'd been diagnosed with it while nursing her fourth child.

One thing that bugs me a lot about this meme is the complete lack of sources. Where is this information from? The first rule of thumb we learn in any basic composition class is "Always site your sources." When pressed for further data or information, the moderator of the page where this was shared kind of shrugged it off and figured the American Cancer Society would have more information. While I don't think she was the creator of this graphic, she was passing along incomplete information and didn't even realize it.

In fact, the American Cancer Society has something very different to say:

"For every 12 months of breastfeeding (either with only 1 child, or as the total period of a time for several children), the risk of breast cancer decreased by 4.3%, compared to women who did not breastfeed. Risk decreased by 3.4% for each child breastfed, compared to women who did not breastfeed. This lower risk did not differ by women's age, race, numbers of births, age at birth of first child, family history, or country of residence." - American Cancer Society Expert Voices (click here for full article text)

Something this meme doesn't address are the types of breast cancer impacted, which can be important - because some studies show that breastfeeding can offer protection from certain types of cancer more than others. As the article suggests, the studies are inconclusive, but so far seem to show more risk reduction for hormone receptor-negative cancers, which are more aggressive. While there is some evidence that breastfeeding can impact rates of hormone receptor-positive cancers, (which are the most common and are 'fueled' by estrogen), in my own reading I found it difficult to determine statistically how much protection was offered, and was concerned that advocacy groups and the general public are simply lumping the two together as one.

It took me awhile, but I was finally able to find the source for this meme's data, a study done in Sri Lanka on a very small group of women (100 cases with cancer, 203 controls). (It's also interesting to note that this study found a correlation between past abortion and cancer rates, but we won't even go there.) Unless you're from Sri Lanka, this could give women a very false sense of confidence.

That's not to say that there isn't some very promising, important data to consider, like these studies:

• Delaying childbirth may reduce the risk of an aggressive form of breast cancer - from December 2012. Studies have shown that delaying the age of your first birth by at least 15 years after your first menstrual period could reduce the risk of rare but aggressive triple-negative breast cancer, by as much as 60 percent. While uncommon, it does not depend on estrogen to feed it, and is therefore unresponsive to conventional drugs like Tamoxifen. It accounts for roughly 10-20 percent of breast cancers.

• Breastfeeding can reduce the risk of certain types of breast cancers. Recent studies have shown that breastfeeding can reduce the risk for estrogen receptor-negative and progesterone receptor-negative cancers, in women who had three or more children and did breastfeed. Risk was elevated in multiparous women who did not breastfeed. This type of cancer often strikes younger women and has a poor outlook. (The study also showed that in women who never had children, their risk decreased by 40% for hormone receptor-negative cancers, but went up by the same amount for hormone receptor-positive cancer.)

Race can also be a factor in hormone receptor-negative cancers: African-American women who had four or more children but never breastfed are 68% more likely to get this type of cancer, compared to women who had only one child but did breastfeed. Studies showed that with each child breastfed, the risk declined. The study also showed that among African-American women who had given birth four or more times, there was slight protection against hormone receptor-positive cancers, regardless of whether they breastfed or not. The same was found for white women.

"The higher incidence of ER-/PR- breast cancer in African American women may be explained in part by their higher parity and lower prevalence of breastfeeding relative to white women." - Julie Palmer, ScD, MPH, senior epidemiologist at the Slone Epidemiology Center and professor of epidemiology at Boston University School of Public Health

• A Canadian study showed promise for those with a family history of breast cancer - specifically those with the BRCA1 gene (which is more often hormone receptor-negative), stating that breastfeeding for a year could reduce their chance of cancer by 32%, and with "each year of breastfeeding, it reduced their risk by 19%. "With two or more years of breastfeeding, that risk was nearly cut in half. Researchers "calculated that just five women with the BRCA1 gene needed to breastfeed for a year to prevent one developing cancer." It's important to note, however, that these benefits were not observed with women carrying the BRCA2 gene (which is more frequently hormone receptor-positive).

An earlier US study found, however, that among women with a family history of breast cancer, there was a 59% reduction in risk of getting premenopausal breast cancer, but did not specify which type. (Most likely it is hormone receptor-negative.) The study also noted the duration of breastfeeding did not seem to make a significant impact, and noted "the reduction in risk was similar whether women breastfed for a lifetime total of three months or more than three years." Nor was there a difference noted among women with no family history.

Personally, I think it's important to look at several things when presented with statistics: first, what is their source? Is the study old, and have newer, more accurate studies come out since then? What population did they study? What factors did they include, or exclude?

For instance, an interesting study was conducted by a Chinese researcher at Yale University, which was entirely comprised of Chinese women, mainly because he claimed they have substantially longer breastfeeding rates than the United States. His research (which was published in 2001) looked at three studies conducted in the 1980's, not long after China adopted their infamous one-child policy. Given what we now know about cancer rates and multiparous women and their breastfeeding habits, it is a wonder he could find any woman who had managed to give birth more than once to even do the study. (The one-child policy applies to roughly a third of the population, but the overall parity rate of Chinese women as of 2013 is about 1.5 children, suggesting it has become a cultural standard to have lower birth rates overall.)

While he found a "50 percent reduction in breast cancer risk among those women who breastfed for more than 24 months per child, compared to women who breastfed their children for less than 12 months," it's interesting to note that according to this article, China's breastfeeding rates have "plummeted since the 1970's" when infant formula was introduced. In the 1980's, when these studies were conducted, breastfeeding rates in China were at their lowest.

While this might be good news for Chinese women, it is hard to tell if it correlates to Western women for a number of reasons. Dietary and lifestyle differences can also impact cancer rates, and vary widely between East and West populations. And while this study was published in 2001, as of now roughly 58% of Chinese women exclusively breastfeed their newborns, whereas it drops sharply to around 14% by five months, making it on par with the United States. (And by month six, it nosedives to an alarming 2%.) As of 2013, it was declared that China's breastfeeding rates were "among the world's lowest."

The researcher claimed, "In Chinese society, it is socially acceptable to breastfeed for a long time." Could it really have changed that much in a little more than a decade?

Either way, we need to be careful not only in how we share the data, but how we interpret it. When reading these kinds of statistics, pay close attention to what sources, if any, are listed. Likewise, realize that there could be flaws, unanswered questions or stipulations in those numbers that are not reflected in a meme that merely spews out numbers without proof, leaving the reader with a false sense of confidence and security about a very serious topic. It's important to not take the data as a personal attack as long as it's shared appropriately or dismiss the benefits of breastfeeding for both mom and baby. Likewise, studies should be shared without judgment or hostility. Whether in sharing or interpreting this data, it's so important to get the facts straight and understand the caveats that could seriously impact our understanding of our own level of risk.

_____________
Sources:

Breast cancer risk reduced by 50 percent by breastfeeding for two or more years - Yale News

The Chinese government really, really wants babies to breastfeed - Quartz.com (a good piece that is particularly damning of the heavy influence of infant formula in the Chinese market)

Breast cancer risk and hormone receptor status in older women by parity, age of first birth, and breastfeeding: a case-control study - PubMed

Multiple childbirth linked to increased risk of rare, aggressive 'triple-negative' breast cancer - ScienceDaily

Lactation linked to reduced estrogen receptor-negative, triple-negative breast cancer risk - ScienceDaily

Breastfeeding reduced risk of ER/PR-negative breast cancer, results find - ScienceDaily

Delaying childbirth may reduce the risk of an aggressive form of breast cancer, study suggests - ScienceDaily

Breastfeeding for a year cuts cancer risk by a third - Telegraph

Causes of high incidence of breast cancer in African-American women identified - ScienceDaily

A glimpse into 1950s parenting: The A-ha Moment

noreply@blogger.com (The Deranged Housewife) — Fri, 26 Sep 2014 20:04:00 +0000

When we think of typical 1950s parenting, we picture dad coming home from work, belt in hand; mom is perfectly made up and ready for bridge club, remote, distant, and oblivious. But when I came across an article from 1957
in an old magazine I bought at an antique store, it made me smile to think there were parents even then who "got it."

"I wish I had stopped a little oftener to think, "Does this really matter? Is it more
important to them than to me?"

There were the Dr. Spocks and other experts who warned you about the dangers of spoiling your babies, how to introduce solids by four weeks and all kinds of other "advice" that is truly horrifying to think of today. Sometimes you wonder if these "experts" even had children themselves. Even Dr. Spock, in his twilight years, regretted the advice he dispensed and backpedaled on his own message. It's sad that for some, it took a lifetime to realize; for others, like the author of this article, thankfully we stopped to realize a bit sooner that maybe there is more to life than spanking, yelling and rigid, unbending schedules. Hopefully we can all find a happy medium.

Reply turned post: The Beauty of OB

noreply@blogger.com (The Deranged Housewife) — Thu, 18 Sep 2014 17:35:00 +0000

You often see posts like "Confessions of a Labor Nurse," or "Why You Need Pitocin in Labor" (I think poor Nurse Jenna removed that post a long time ago) and they're supposed to be touchy-feely, feel good pieces that make you come away with a renewed sense that childbirth is such a special time, that your care provider really does care about you and your child and they only want the best for you. Which sometimes comes at a high price, we know. Sometimes an induction, a cesarean, difficult labor and delivery - they all can happen and are often a rite of passage before entry into motherhood.

It's hard for me not to be cynical about it. But to cut to the chase, sometimes I think the true beauty of OB is that women still want, and manage, to give birth at all after being subjected to the institutional abuses and misuses that are so typical of modern obstetrics.

That isn't to say I'm critical of lifesaving measures, or that I'm saying, "All cesareans are unnecessary!" I'm more critical of abuse of care and intervention that is misconstrued as good care, when really, it's excessive and sometimes pointless, sometimes causing the problem you're trying to prevent in the first place.

But I feel like all these posts have an overtone that says, "You should be thankful. Now shut. up."

The author of this article over at Huffington Post is an L&D nurse. I'm not, and I'm not trying to compare my experiences with hers. But as I see so often in these posts, they really don't get to the heart of the matter. They sort of gloss over, or completely miss, whole areas that are often untouched in our culture of women. The idea that women often come home without a baby, or sometimes never come home themselves, is incredibly tragic. No one is arguing with that. Modern obstetrics has saved many lives, both mothers and babies, and yet the place we are in today is proof of how its overuse can taint our perception of things so much we can't see what's really going on.

Often the women who are missing, shattered or empty, as the writer mentions, are not only the ones who never survive childbirth or come home to an empty crib. They are often women who look normal and whole on the outside, with perfectly healthy children. We cannot discount their experiences and just assume that everything is perfectly normal and right because we can't see anything broken, or lost. If a woman is subjected to horrible treatment in labor, sometimes resulting in physical injury, how many times does an attorney refuse to handle her case if she seeks prosecution? Because she and her baby both appear healthy and happy on the outside? If no one is physically maimed or dead, they don't even want to talk to you.

The author mentions staying healthy in pregnancy and waiting for active labor as ways to have a healthy delivery, avoiding induction unless for a medical reason. But unless you know what some valid medical reasons are (and more importantly, aren't) anything that comes out of your doctor's mouth is therefore a 'medical reason' and before you know it, the Pitocin is flowing. Staying healthy is relative, unless you're an illicit drug or alcohol user, and even the healthiest, most informed women can still be subjected to dubious care at times. Oftentimes it never seems to be enough. And often has nothing to do with you and everything to do with an impatient, overbearing care provider who is set in his/her ways and refuses to change.

She mentions the case of a teenage mother who was induced, with no success, and then sectioned. As a result, she hemorrhaged and her uterus was removed. They lamented, rightfully so, over the fact that she would never have any more children. Do they ever lament over how some teen mothers are degraded and insulted because they're young and often unmarried? Or do they consider for a moment that this young mother's complications were caused in part because of the induction, which carries a risk of postpartum hemorrhage? Why do these happy sunshine articles never, ever candidly discuss what goes on behind closed doors, the whispered conversations or blatant remarks when they don't think a patient is listening - or when they don't care if they are?

Yes, it's great to do all the "right" things in your pregnancy to encourage the best outcome possible. And sometimes, those things happen despite your best efforts. But when you look at these figures, it's hard to see the "beauty" in OB, only the ugly side that makes it seem like the deck is stacked against you.

For the original graph and accompanying post, click here.

Source: Evidencebasedbirth.com, Rebecca Dekker, PhD, RN, APRN

Birth History: Death in Childbirth

noreply@blogger.com (The Deranged Housewife) — Thu, 22 May 2014 15:39:00 +0000

In the days of our great-grandmothers and beyond, childbirth was often a dreaded, formidable time. Hospitals were usually avoided as places where only sick people went, usually never to return. The possibility of death while giving birth loomed over a woman as she came closer to her due date, overshadowing any joy of her upcoming arrival.

Among the greatest risks to a woman in childbirth were childbed fever, toxemia and postpartum hemorrhage; the last two of which are still a major cause of maternal deaths worldwide today.

Childbed fever, or puerperal fever, is an infection of the female reproductive organs and was one of the most common causes of death in childbirth prior to the early 20th century. It frequently took the mother's life within days of giving birth and was extremely painful. And it was almost entirely caused by the hygiene practices of the birth attendant - which included midwives and physicians.

It's important to make this distinction, because many times people tend to think of midwives of that time period as uneducated, inept, or practicing witchcraft in an unsanitary, ramshackle house. While there were some that did, there were many who were very capable, some even experiencing fewer deaths than their physician counterparts.

A Lysol ad from 1937, referencing
infection control both in hospital births
and those that take place at home.

It is also worthy of noting that, unlike with neonatal mortality rates, maternal deaths were more likely to happen among women in higher socioeconomic classes: likely because they were more apt to go to hospitals to give birth or have the finances to pay for a private physician.

Dr. Ignaz Semmelweis is often credited with understanding how childbed fever was transmitted: he theorized, correctly, that midwives and physicians were spreading the streptococcus pyogenes bacteria through improper hand washing from patient to patient. He proposed that physicians wash their hands in a chlorine solution prior to delivering a child, an idea that offended fellow doctors. Despite his repeated attempts to educate healthcare workers on proper hygiene, they often ignored his requests and refused to believe they were, in fact, contributing to the problem - even as maternal deaths were decreasing among those who practiced Semmelweis' hand washing guidelines.

When he first introduced the protocols in a Vienna obstetrical clinic in 1847, the rate of childbed fever deaths in the doctors' wards was three times higher than that of the midwives' wards.

Decades before Semmelweis' work, physician Alexander Gordon made similar observations as early as 1790. His ideas were not well-received and he was essentially run out of practice. Later, physician Oliver Wendell Holmes came to the same conclusions, only to be equally rebuffed and ignored.

It literally took decades - roughly half a century - before physicians started admitting that perhaps they were indeed the cause of infection and deaths in so many women. And even then, it wasn't until around the 1930s when cases finally started to become scarce, due in part to better hygiene practices, more sanitary birthing conditions and the introduction of antibiotics and sulfa drugs. During Semmelweis' work in Austrian maternity wards, handwashing alone led to a dramatic lowering of maternal deaths.

It was 1925 when my great-grandmother delivered her last babies, a set of twins, at home. The doctor was called in - who I later discovered had questionable hygiene practices. Even then, after much was known about controlling the spread of infection, obviously some continued to disregard it. In my opinion, it's not enough to say "Women died in childbirth before modern obstetrics. You should be thankful your physician does X, Y, Z to make sure you and your baby is safe." Most of us know that maternal deaths were far more common, but do we understand why? One birth blogger who spent an unusual amount of time criticizing the natural birth movement wrote about 'those headstones in a graveyard of all those mothers and infants who had died because of natural childbirth.' (Paraphrasing a bit here, as it's been a few years ago since I read that. But still, that was the gist of the message.) One thing I have noticed: when discussing maternal deaths, many sources will completely gloss over the cause, as if it was just an unfortunate problem that happened for no reason.

Today:
Puerperal fever is still a risk of childbirth today, but in many cases we have different names for it. Although rare, it does still claim the lives of women. No longer known as 'childbed fever,' it is not unusual for women to develop fevers during labor, which are usually treated with imminent delivery, cesarean section (which alone can increase risk of infection) and antibiotics at the first sign of a problem. Chorioamnionitis, an inflammation of the fetal membranes, is caused by a bacterial infection that tends to occur in longer labors. Among the risk factors are repeated vaginal exams and internal fetal monitoring.

It is true that in many ways, modern obstetrics has saved countless lives of both mothers and babies. But you have to have some perspective on the reasons why many women died - reasons that were primarily iatrogenic in nature - death brought about by the very people who were supposed to save them.

Links:
Childbirth in Early America - Digital History
British maternal mortality in the 19th and 20th centuries - National Center for Biotechnology Information
The Attempt to Understand Puerperal Fever in the Eighteenth and Early Nineteenth Centuries: The Influence of Inflammation Theory: National Center for Biotechnology Information

Birth History: A Dysfunctional Culture

noreply@blogger.com (The Deranged Housewife) — Sat, 17 May 2014 23:04:00 +0000

May is Pregnancy Awareness Month, and while I've covered some of these topics before, I've been planning to put them together in more of a series for quite some time now. There is so much to learn while pregnant, and it can get quite overwhelming when you're faced with decisions that range from the mundane to the life-changing. So much of how our medical community views pregnancy, however, is still deeply rooted in old traditions and practices, some of which were, and continue to be, groundbreaking in the field of obstetrics. Some, on the other hand, not so much.

I once heard someone say how hard can it be? You go to the hospital and push out a baby. If only it were that easy. And if you go behind the scenes much, it's probably never been that easy, for reasons that are often not clear to us until we experience childbirth ourselves. Even then, without some historical perspective, we may not realize just how dysfunctional maternity care in this country still remains, probably a century later.

Many maternity care practices were nothing short of barbaric and humiliating, yet were seen as standard practice and therefore somehow acceptable. Whether it's having your hands tied down in labor, being given pain medication that you feel you don't want or need (as we see in Peggy Vincent's Baby Catcher) or given prophylactic episiotomies and forceps births (we'll get to that later), it's all been considered status quo in "modern" obstetrics. And yet, as we see with new guidelines on episiotomy, VBAC and other protocols, it can be painfully slow to implement these changes.

You can't begin to understand the 'typical' mindset towards birth today unless you understand its history. It is a bright spot in some places, in others very dark and tarnished.

You might want to read:

Birth: The Surprising History of How We Are Born

Buffalo offers nation's first abortion clinic/birth center in one facility

noreply@blogger.com (The Deranged Housewife) — Fri, 28 Mar 2014 18:15:00 +0000

By now you've probably heard about the nation's first abortion clinic and birthing facility all rolled into one, located in Buffalo, New York. Not surprisingly, it hasn't been without controversy.

At first, the idea of it did bother me. But I began to realize that to me, at least, that's not even the issue.

When talking about this groundbreaking facility, many people - both those who are pro-choice and pro-life - focus primarily on the abortion aspect. The fact that it's opening a door, albeit a small one, to women who want to 'birth outside the box' has pretty much gotten lost in the discussion.

Some articles, like this one, do touch on the birth aspect but in a very general sense. Of course the writers at Cosmo probably have no idea what it's like to give birth here. But this area, which comprises an eleven-county region, has, according to the Yellow Pages, at least six facilities that offer abortion, which no doubt translates into dozens of care providers. How many freestanding birth centers do we have in the area? One. How many in the entire state? Three.

Three freestanding birth centers in the entire state.

Image: Fernando Audibert/stock.xchng

I'm sure there are other states that have zero birth centers in them. But I bet even those states offer abortions, even those that "set limits" on doing them. But they're still doing them. Where are those places that have tons of freestanding birth centers? Or hospitals that are truly, instead of just on paper, designated as 'mother and baby friendly?' Why is the outrage over lack of access to home births, birth centers and non-traditional birth in general seemingly boxed into a very small corner and only discussed by relatively few people in comparison?

I'm sure it wouldn't be hard to find a number of pro-choice people who think home birth is dangerous, VBACs are reckless, and that hospital birth is the safest option for pregnant women. The sheer volume of abortion facilities tells me that even with limitations, there is probably more access to abortion than there's ever been.

However, if you're giving birth in Western New York, you may have obstacles depending on what kind of birth you want. While Buffalo is indeed a major city, there are also outlying rural areas that are up to an hour away from the city. One hospital has gone on record as saying they'd "get a court order at 2 a.m." if they had to, to prevent you from having a VBAC, but it's hard to say if that's true or just a scare tactic. If you're giving birth in that hostile environment, you may not be emotionally strong enough to take that chance.

Other options include a home birth, which not everyone is totally comfortable with. I know some who've birthed in their midwife's home close to the hospital, but again, the midwife can only see so many patients.

I've heard people say they labored in the parking lot outside the hospital, knowing they'd be hooked up to monitors if they went in too early. Others willingly drive an additional 45 minutes to an hour away in another county to give birth at a "friendlier" hospital with a lower cesarean rate (but a much higher rate of births attended by midwives). Judging from the data, it's quite clear in a number of areas that evidence-based practices are not being performed.

So far several of our hospitals still allow VBAC, but in my experience it was hard to find overwhelming support from doctors (and even midwives) when choosing one (and the numbers speak for themselves). Many women, I'm sure, are easily swayed not to even bother attempting one if their doctor isn't enthusiastic about it. Besides myself, I know only a handful of women who've VBACed. The rest just look at you like you're crazy.

It saddens me deeply that among my friends and acquaintances, most of us have had cesareans, some multiple times. I myself have had two. Among the three women I've talked to recently, I realized that between us, we had ten cesareans total. If I widen that scope, it racks up pretty quickly - to the point where vaginal birth seems to be somewhat of an anomaly.

Why? One reason is likely because of inductions. That one act - inducing labor - can trigger a domino effect that can make your chances of vaginal birth slim, at least around here. I've known women who were induced simply because of their geographical distance from the hospital, with the doctor joking, "You don't want to give birth on the New York Thruway."

Here's how a few facilities in the Western New York region (which comprises eleven counties) stack up: (For the sake of boredom we'll look at two counties.)

Data is from 2012. Note the rate of induction,

which is substantially higher than both state and local averages

(down only slightly since 2011). This hospital serves a number of rural

women in outlying areas surrounding the city. VBAC rates are much lower

than the already predictably low state average. The cesarean

rate actually increased slightly in that time period.

When I first gave birth, it was at this hospital, and not a very happy experience. Maybe things have improved a little since then?

Across town, induction rates are just as bad, as compared to
state averages. Relatively few births (22 in all) were
attended by a midwife. Episiotomy rates dropped only slightly
from 2011, as did the cesarean rate.

Located in a fairly remote area, your choices are
further limited in neighboring Niagara County. We can
reasonably assume the VBACs (and probably all breech
births in this entire data set) were unintentional. Still higher than
state average episiotomy rates persist, more than half of
women have labor augmented (which increased from 2011),
cesarean rates are high (which also increased, from 35.5%) and for
some odd reason, they had a relatively high rate of
cesareans performed under general anesthesia. No births
were attended by midwives.

The c-section rate went up from 51.4% in 2011. There
were no births attended by midwives in both 2011 or 2012.
According to the ICAN VBAC policy database,
VBACs are banned at this facility, and they have one
of the highest cesarean rates in the state.

A rather alarming episiotomy rate (that was 42.9% in 2011).
"We don't often deliver babies, but when we do,
they're mostly by c-section."

It's such a hurdle, to essentially change the birth climate of an entire city, and even more so, the entire region - and like anything else, when change finally happens, it's often painstakingly slow. I bet most women in need of an abortion would know where to find one, but for a normal, let alone natural birth, they'd probably have to search, maybe even fight for it. With the overwhelming number of clinics throughout the state (New York City alone has dozens) that serve those who wish to have an abortion, it still seems clear that that is their primary focus, not how to have a happy childbirth. If we're going to recognize reproductive rights, we can't ignore the needs of the laboring mother.

Why my child will never have a cell phone

noreply@blogger.com (The Deranged Housewife) — Thu, 16 Jan 2014 18:28:00 +0000

I feel kind of sorry for my children. Because surely I must be the meanest mom ever.

My oldest is at the ripe old age of 10, and already is asking when he can have an iPhone. I basically tell him "never." Well, maybe not never - but I first emphasize to him that he is, after all, only 10. Then I remind him that I pay over $1,000 a year to have that phone. So far that seems to deter him, but I don't know how long it will last.

Why not? Everyone else is doing it!

I somehow managed to go about well into adulthood without having one. I was already married before we purchased our first cell phone, a dinosaur of a Nokia that was functional but beyond that, mostly a pain in the butt to use. That was probably ten years ago.

Obviously technology has improved greatly and most of us are a long way from that old flip phone. As a mom, writer and whatever else I do I cannot imagine living without my smartphone, that honks a reminder to me when I need to be somewhere or sounds the alarm for the kids when it's time to head out the door. It's been great planning directions en route, not getting lost at crucial moments, calling ahead for pizza or sending a quick text to tell relatives we made it home from our long trip.

Call me old fashioned, though, because I just can't see how those applications that make the lives of adults easier can be applied to a kid who still sucks his thumb or watches cartoons on Saturday mornings. Why complicate things that just don't need to be complicated?

I can see how some parents would find them useful for certain things, probably for things I cannot relate to. For instance, we live in the country, so my child isn't around town by himself taking the subway. He's not at after school programs without me, or at any of that stuff that some other families might do. Don't get me wrong, we do have a life.

Several times my son has told me about the basket on his teacher's desk: it holds over half a dozen phones each day while he and his classmates are in school. Why they bring them, I don't know. I see one child's mother every day in the parking lot, without fail, so it's not like there are complicated pick ups and drop offs that mean mom and daughter won't see each other much. In fact, it seems like quite the opposite when I see them together, as if apart from school, they never leave each other's side. Even if her mother forgot about her, the school would take her back inside for shelter and wait with her until her mother showed up. And guess what: they'd let her use their phone to call home, just in case.

He has told me that several kids have shown him games on their phones, which leads me to ask about what else is on their phones: can they access the internet? He says yes - that sometimes they watch YouTube videos. I want to make sure he's not exaggerating, that perhaps there are some parental controls on their phones because hey, they are kids, after all. But then I think to myself, don't count on it. I remember the days when VCR's and DVD's first came onto the market - and hearing how the preschool-aged kids could operate and manipulate them better than their own parents.

Aside from bullying through social media, the latest concern are photo apps like SnapChat, whose novelty seems to be that it can take photos and share them with others and then quickly delete them. Only the problem is that it doesn't really delete them, especially if you know how to do a screenshot. Supposedly the sender will be alerted if a screenshot is taken of their photo, but who cares - the damage can still be done. Some are worried that the supposed disposability of these photos will make users think they can send photos without consequence. It seems, though, that when it comes to the Internet and it's possibilities, both positive and negative, that nothing can be sent without some consequence.

(And guess what, folks - there's a new app that can bypass the screenshot notification - as well as a few new tutorials on line about how to take secret screenshots of SnapChat pictures. Wonderful!)

And the makers of SnapChat, as well as other popular brands like FaceBook, Twitter and YouTube ultimately care little about the content that might be visible to your pre-teen, but rather seem them as a marketing tool and little else. How hard is it to just lie about your age when you get an Instagram account? (By the way, there are literally millions of FaceBook users under the age of 13, which is probably a conservative estimate.) How hard is it to even find the privacy settings, much less fully understand them, before blasting your photos to the entire universe? As many have said of sites like FaceBook, it's like they want you to "overshare," and you realize little just how much info you're giving away over a given period of time.

Images: marketingland.com
At least 20 percent of teen users have 600 or more FaceBook friends.
How many of those 600 people do they actually know?
Thankfully the vast majority of them make their settings private, but a good portion do not.

Again, when you consider the minimum required age to use FaceBook (wink wink, nudge nudge) is 13, and how utterly ridiculously hard it can be to keep on top of all the changes, settings and everything else the website throws at us (hey, did you know we can use your photos for public use in ads on our site? Thanks!) I imagine some people either fail to see the scope of what they're sharing and with whom or just throw up their hands and say screw it because it's so overwhelming.

We can also see trends in what kinds of information teens are sharing, perhaps without even thinking (and let's face it, adults do it too).

Image: marketingland.com
We make it pretty easy for people to find us
when we share this kind of information.

I think it's fair to say that we shouldn't just call out teens for this potentially risky behavior; adults do it, too, sometimes unintentionally. And if I hear one more sanctimonious adult say, "Who cares, I have nothing to hide" one more time, I'm going to slap them.

How many times have we seen inspirational or uplifting photos that say "If such and such a photo gets one million likes, X will happen." Within mere days or even hours of posting, they've already reached half that goal or more. That can be great if you want to share something, and can be devastating if you don't. Like the gossip grapevine, word travels fast - even faster if it's spread through Twitter, FaceBook, Instagram, or through whatever flavor of the month app people are using. It was noted that among one recently publicized teen suicide for social network bullying, the perpetrator obtained nude photos of the victim through an online chatroom, only to send them to just about everyone in her school. When she moved to another district - guess what, he continued to send them to students at her new school.

Because of the advent of social media, it also means that all those typical teenage habits can be instantly photographed and shared with everyone. Gone are the days of "remember when we toilet papered our teacher's house and then got drunk? Good thing no one took pictures." Unfortunately sophisticated camera phones, coupled with instantaneous access to the internet, mean those memories are documented in real time and then, moments later, can be broadcast everywhere, many times with disastrous consequences.

As technology changes and our boundaries concerning it are bent, shaped and sometimes broken, it's increasingly important to educate not only our children, but ourselves, in all the new ways it can be used and abused. Respecting not only yourself, but other people's boundaries, even if it seems harmless and in good fun, are becoming more and more important as well. I once had some strange creep blatantly take my picture in the grocery store check out line. Who knows where and how that ended up?

As more and more stories of teen cyber bullying hit the internet, one thing I cannot understand is why people consider it a form of punishment to take away the cell phone of someone who is being bullied. Sure, if my kid were the one bullying someone, you can bet their phone would probably end up under the tires of my vehicle in a dramatic display of just what I thought of their behavior. But I'm beginning to think it's equally important to take a stance when your child is on the receiving end, if not for one important reason: your child's mental health. Receiving hundreds of text bombs a day, scanning updates on FaceBook from people you once thought were your friends who are now gossiping about you, seeing constant reminders in your face all the time, can have their lasting effects. Limiting that contact, and then redirecting into a more positive interaction, can potentially help them to see the negative, detrimental effects that it can have on their lives if left unchecked. Deleting the account, deactivating it, or putting the phone away for awhile might be worthwhile as you focus on something else that is more productive. As adults, we see our FaceBook friends do this all the time: announce they're taking a leave of absence to get away from toxic environments, or just to get work done or pursue other things that are more important and then poof, they're gone for months. Maybe forever. Why can't we encourage our children to do the same?

I like the idea that this teacher came up with: show a picture of herself illustrating how fast something can be shared on social media. It's important to remember this is just one fan page that may have shared the image, at any given point in time. There could be many, many others - including this blog and whoever reads this post!

Image: FaceBook/Time 4 Learning Timeline photos

The above photo received over 600 shares and nearly 8,000 people liked it -
this particular time it was shared. How many times was it shared on FaceBook
in total? Huffington Post estimates this photo was shared at least 16,000 times
and liked by more than 600,000 people. That's like the size of a small city.
Or, a large college campus….

Aside from the lesson learned in the example above, this article highlights how manipulating this photo - sometimes with funny results, sometimes not so much - can further lead to trouble.

Have your kids had a bad experience with social network bullying or experienced negative consequences from cell phone use?

Breastfeeding and jury duty

noreply@blogger.com (The Deranged Housewife) — Wed, 23 Oct 2013 14:13:00 +0000

Only twelve states exempt breastfeeding women from jury
duty.

I live in New York State and have been summoned for the dreaded jury duty twice. Both times, I panicked - not because I wanted to shirk my public duty, but because I was the sole care provider for a breastfed infant. I lived hours away from family, had some neighbors - but they either worked or had their own kids to care for. What was I going to do?

Thankfully I was exempted. Maybe they think I'm still breeding, because they haven't called me back (perhaps I'll jinx myself by saying this).

Unfortunately this Missouri mom wasn't so lucky - her state does not have a breastfeeding exemption, and the judge gave her two options when she showed up in court holding her seven-month-old son: put him in childcare or bring someone with you to watch him while you sit in court.

The judge apparently said she could take breaks to pump (and someone else said 'to feed' the baby but these are two entirely different things), but I don't see how this would help her if her child refuses to take a bottle. I'm also curious where she would be allowed to pump: a judge's posh quarters, or the nasty public bathroom down the hall? Hmm... sounds like a tempting offer.

Only twelve states exempt breastfeeding mothers from jury duty. This is pathetic. And while Trickle's state recognizes 'undue physical or extreme financial hardship' as a reason to excuse someone, I'm almost sensing here that the court thinks that because she's a stay at home mom with presumably no income to lose, that there's therefore nothing lost because she's not earning a paycheck from a "real job."

Judge Marco Roldan, who is presiding over the case, said in the past he's exempted potential jurors because of a death in the family (did they provide a death certificate? *eyeroll*) or teachers who were scheduled to give mid-term exams. Seriously? You're joking, right?

Of course, like any other mothering/childbirth/pregnancy/breastfeeding topic, it comes with no shortage of public outcry, usually from people who understand little about the mechanics of the subject. So as a former breastfeeding mother who has spent ... let's see.... roughly 6 1/2 years of her life nursing a child of varying ages, I can say that it's definitely not easy, especially when there are ridiculous limitations like this creating even more roadblocks to a successful breastfeeding relationship.

When you realize how engrained infant formula has become for decades - since probably the 1940s and 50s - it's not a wonder that many people just don't get it or even understand what the norm is for a breastfed baby. And this being Breast Cancer Awareness Month and all, let's not forget that recent studies have shown that breastfeeding can reduce cancer rates - yet we put up more hurdles that discourage or inhibit a mother's ability to nurse her child.

Many moms, myself included, cannot pump. It's not a sign that something is wrong with you; it's totally normal to be able to successfully breastfeed a baby but be able to pump next to nothing, even with a good pump. It doesn't matter anyway if the child refuses the bottle; some mothers try countless nipples (and they do come in a myriad of shapes and sizes) with no luck.

As far as childcare, when you're a full-time stay at home mom, you probably feel there are few reasons to really need it. I still don't have a regular babysitter whom I trust not to text the entire time she's watching my kids, and mine are 9, 7 and 4. I live hours away from family members, and many of the moms I know are either working by now or have kids of their own to watch; I cannot imagine handing off my baby to them for several hours a day for the duration of a trial (which can either be short and sweet or drag on for weeks, if not months). If you're paying for childcare, usually you have to agree to it long-term, and it can be hard to find one that will agree to short-term care. And of course, daycare is extremely expensive to boot.

The judge's other option was to bring someone with her to court so she could nurse the baby on breaks. I hope she has really, reeeally good friends, because I personally know no one who would've been willing or even able to do this for me. Again, I'm sure many, if not most, of Trickle's friends either have infants of their own to care for or, if they don't, are working. Even if she could find someone, are they going to hang out all day wandering the courthouse, waiting for the next feeding? Perhaps set up a Pack-n-Play on the front lawn? Would she have to endure more financial hardship by providing additional monies for gas and activities if the babysitter decides to drive all over town day after day keeping baby occupied?

It all seems ridiculous and overly complicated when it doesn't really need to be: just exempt the breastfeeding mother.

More reading:
Jury duty is sometimes a trial for nursing moms - Best for Babes

Doing the unthinkable: questioning Breast Cancer "Awareness" Month

noreply@blogger.com (The Deranged Housewife) — Fri, 04 Oct 2013 22:30:00 +0000

Right now, as I type this, a college friend is going through what we can only guess are the final throes of brain cancer. It has been a horrible downward spiral to watch, dragged out over the course of several years, that - like most cancers seem to - started out as a battle initially won and then proved to be much, much worse.

Why is that? Have you ever noticed that "survivors" often end up getting cancer a second time, this time much more aggressive than the first? I am so sick of "pink ribbons" I could scream: namely because it seems few people really understand the truth behind them, or the often subversive, misleading marketing behind it. But how dare you ask? How dare you question it?

It's a reality that many of us probably think about, dread, pray will never come knocking at our door. It seems every time you turn around, someone you know or a friend of a friend has it. And it also seems that while advancements have been made, the medical community knows just as little about it as they always have.

Years ago when I was writing for a newspaper, I interviewed a top cancer surgeon at a nationally esteemed cancer facility. He told me that around the turn of the century, there was little they could do for cancer patients, and death from it was often brutal. You were basically just left to die, he said.

I was thinking today of my friend and wondered, if in some ways, that's not still true. Treatment options might work - or at least appear to - and then wham, a recurrence hits you like a ten ton truck several years later. This seems especially true with breast cancer, everyone's favorite 'pet project.'

And I just realized - it's October! Hey, Breast Cancer "awareness" month. Yeah, you're aware of it. But do you really know anything about it? What your risk factors are? How much money is poured into research that is inconclusive, misguided or redundant? The financial toll is one thing; the human toll is unspeakable.

Take a moment to consider:

• A company can merely slap a pink ribbon on a product that makes you think they're "doing something" for cancer research, when in fact they may not be donating anything at all
• Products that contain known carcinogens (like personal care products) are often touting that cancer awareness ribbon

The documentary "Pink Ribbons" alludes to the fact that many studies are irrelevant and seemingly poorly organized. In one such study, a commenter responds that while an effort was made to do studies on breast cancer among black women, all the subjects were white. (Seriously?!) How is that making the best use of the millions of dollars funneled into "research" every year? If that's the best they can do, should we be more inclined to just hope for the best and take our chances?

Sometimes the treatment sounds scarier than the disease itself, and yet even if you're questioning traditional medicine at this point you're almost too scared not to seek it, even if it won't be successful. The last I knew, our friend has been reluctant to admit this might be the end, and I'm not sure who is worse - her tenacious (but completely understandable) struggle for survival or the doctors who keep pumping her full of this that and the other, doing surgery after surgery, instead of just addressing the truth head on. The same thing happened with another friend of ours who succumbed to brain cancer nearly 18 months ago. Literally days before he died, there was a medication switch, as if in some last-ditch effort to save him from one of the deadliest brain cancers there is. Why? To practice on him like some kind of guinea pig?

We've been so hopelessly exposed to chemicals in food, pesticides, plastics and who knows what else that of course, there's no surefire paper trail of where it comes from so all we can say for now is "Who knows?" and move on. It doesn't explain why some people get sick and some don't. I personally think the effects are cumulative, no doubt starting with our parents, grandparents, maybe even great-grandparents. Slowly, generationally, we are a nation of sick people - with everything from ADD to cancer, obesity, hypothyroidism, diabetes and a host of other things that seem to crop up in larger and larger numbers. When a company can produce products that cause cancer and then fund cancer research, it should make you seriously question where priorities lie, both in ourselves and in the industry that fuels this paradox. And why won't they tell you when they've got too many fingers in one pie, or conflicted interests that show you your health is really not their top priority?

Our age of quick fixes and 'feel as little pain as possible' living has far removed us from the idea that, really, there are no guarantees in life.

More reading:
Flawed research appalls cancer patient
Medical research studies: Are too many using flawed designs?
Conflicts of interest often under-reported in clinical trials
Clinical trials flawed by biased reporting

"Overachieving" moms, unite!

noreply@blogger.com (The Deranged Housewife) — Fri, 30 Aug 2013 22:18:00 +0000

Lately I've loved being in the kitchen,
doing a ton of baking, canning and
cooking. Except I'm not wearing a bra.
Don't hate.

I'm sure we've all seen those blog posts about how 'overachieving' moms try too hard, make the rest of us look bad, give us a false expectation of reality, etc. I wish I could find the original article I read - full of positive affirmations that we're all doing a good job, we're all good moms, blah blah blah.

Well, of course. Why does it matter if someone is addicted to Pinterest and loves to craft and make exquisite Christmas cookies and you don't? Since when is this a sign that you're a "bad mom?"

As I canned what seemed like my 500th jar of applesauce this morning, I thought about that article - and how it's often perceived that anyone who so much as turns on an oven is thought of as a "overachiever." I sometimes wonder what people think when I post pictures of all the canned goods, birthday cakes and Barbie clothes I like to make. I wonder what the other moms think when our kids line up at Halloween, and my child is wearing a hand-made costume that took weeks to make while the kid next to her is wearing something they bought on clearance the day before yesterday.

I am not going to let that stop me, though, because you know what - it's my passion! It's what I love doing. And if those other moms don't, so what. I'm sure they have passions and interests that I don't have; things they know how to do that I wouldn't have a clue about. Why are we turning this into another mommy war? Why are you letting someone else make you feel inadequate? And why is this even perceived as an inadequacy in the first place?

One of my favorite DIY bloggers is Ana White - a wife and mother who knew nothing about power tools and building stuff and then decided to learn. Now she is building her mother a freaking house! Can you imagine? I bet she's doing it all to make the rest of us look really bad ....

I can't wait to make this and show the entire world
how awesome I am. *sarcasm*
Photo credit: lynneslovables.com

So far this summer I've canned, tried a buttload of new recipes, and picked fruit with my kids (cue the happy music and images reminiscent of a J Crew catalog), have plans to make more Barbie clothes for a craft show and am constructing a replica of a toy fashion shop and modeling runway to showcase my stuff. Because I'm nuts. And because I freaking love it and think it's fun. Not to make you feel like a bad person, so get over yourself already. (said in the most polite way possible)

I like to write, do family genealogy, bake and cook, photography, make beaded jewelry, make Barbie furniture, antiquing and yard saling and probably a bunch of other crap I can't even remember. While I'm not very good at decorating cakes, I still enjoy doing it. And when I've posted pictures before (of the ones that actually looked presentable), I've heard comments like, "You're such a good mom." Why?! Because I baked a freaking birthday cake?! Our culture has become so used to just opening a box and dumping it out and voila, you have a meal. And while I certainly make my share of Stove Top stuffing, it makes those of us who actually like to slave over a hot stove doing this stuff feel like freaks, like we're only doing it to show people up.

Before modern packaging, people canned and preserved food because that's all that was available. Things like store-bought sugar were a luxury. Handmade clothes were the standard because nearly everyone knew how to sew, and mass-produced clothing was a sign of status and wealth.

Pardon me while I post my pictures on FaceBook - because I want to share in a way that was shared with me, and sparked an awesome idea. That is why I sometimes wish I could live in Pinterest. So many great ideas, and who cares if you don't do them all? Who is ever going to know but you?

It can be so gratifying to take something from raw material to finished product (finish a project? What??) - whether it be sewing, hunting, carpentry, cooking or whatever. Instead it's almost like they're saying, "How dare you know how to do all that stuff, then have the audacity to share your ideas! Shame on you!"

I think our ancestors - you know, the ones who lived on farms and knew how to build and do things for themselves because there was no other way - would be laughing at us because many of these skills are a lost art. Gone are the days of little girls sitting quietly, cross-stitching a sampler (I wonder if that's a discipline skill in and of itself). I am amazed when I read the book Farmer Boy by Laura Ingalls Wilder: an account of her future husband Almanzo's family, an entire chapter is devoted to what the kids do all on their own while the parents are away for a few days. They use up all the sugar to bake goodies and make their own ice cream, and when a problem arises that could get them in some serious hot water, older sister comes to the rescue by meticulously patching up the wallpaper and scrubbing the entire room. Wow. A kid knows how to do that, all on her own?

An awesome photo collage wall that
I've been wanting to do for at least
five years now. I *will* do this. Someday.

I'm fortunate to have the time to dabble in a variety of things because I'm a stay-at-home mom, but I think I'd be doing this even if I had a "real" job. Sometimes, it comes down to priorities and making time for your hobbies - which can be a great stress-reliever! And sometimes I wonder if women, more so than men, create these inner and outer battles with themselves and each other - dwelling on what other people do and gauging their own abilities based on their perception of someone else. My husband is crazy busy with work but makes time to go hunting - because it's therapeutic, it's a passion, and a craft, so to speak. Are other men jealous of my husband because he hunts and can field dress a deer? I doubt it. So if someone is putting smiley faces on their kids' sandwiches and enjoys it, so be it. If you feel like a "bad mom" simply because of this, please don't. Sometimes I think the only one making you feel inadequate is you.

And if you'll excuse me, it's time to put my handmade-from-scratch calzone (no premade dough here!) in the oven. (My kids are eating cereal instead.)

If you're interested in seeing my (inadequate) craft blog, click here. Not updated very often, but I try. LOL

"Dr." Amy to speak at September ACOG conference

noreply@blogger.com (The Deranged Housewife) — Fri, 26 Jul 2013 16:08:00 +0000

I just heard it through the grapevine that the formidable "Dr. Amy" of homebirth hater fame is on the docket to speak at an ACOG conference in September. And not surprisingly, one of her topics is "Everything an obstetrician needs to know about homebirth."

Of course, I don't know personally, but I'm going to take a wild guess that she's never attended a homebirth before. Yet she is probably considered the "expert" source on them, most likely because she squawks the loudest. Never mind what actually comes out of her mouth.

Here are her "credentials," according to the ACOG PDF handout:

Um, no, not exactly. Although I realize that the title "Dr." is often a courtesy after a physician has left practice or retired, this is incredibly misleading. My father-in-law is a retired physician that most people address as "doctor," but he certainly doesn't go around representing himself as a licensed, practicing physician. I would hope those in attendance actually know better when listening to her blather on for an hour about how much she hates homebirth and the women who choose them.

A Google search of her name produced the obvious results referring to her blog and "advocacy." She shows up on a number of websites like Healthgrades, listing a physical address to what would seem an office, but no reviews from actual patients. And when you search her name on the Massachusetts Board of Registration in Medicine database, you come up with this:

She spends countless hours trolling the internetz for every story ever published about homebirth and basically makes all natural birth advocates everywhere out to be liars. Yet she continues to represent herself as a licensed physician who is still practicing medicine. Hypocrisy much?

Since ACOG is trying to set guidelines that offer women the best care while treating them with dignity and respect, I'm not really sure how she fits into their lineup.

According to ACOG's website, they acknowledge that

"Most women have normal conception, fetal growth, labor and birth and require minimal-to-no intervention in the process. Women and their families have different views about childbearing based on their knowledge, experiences, belief systems, culture, and social and family backgrounds." (Really? They really believe that?! Who knew.)

It goes on to explain their idea of what "patient-centered care" means:

""Patient-centered" means that health care providers, and the system they practice within, accept that the values, culture, choices, and preferences of a woman and her family are relevant within the context of promoting optimal health outcomes."

They also acknowledge that part of that patient-centered care includes having not only a skilled attendant (which can come in other forms besides an OBGYN), but also "supportive resources."

Based on their description, I don't think Dr. Amy fits into their scheme of things at all. Either that, or they're just very out of touch with the way a majority of births are carried out these days. Phrases like "support" and "education" are all relative, when you consider that many patients often get all their information from their physician and trust no one else in the process.

On the surface, healthcare initiatives and much of the jargon ACOG churns out sound great - but when you actually ask women about their experiences, it seems that there is a major disconnect. ACOG itself argues that they feel the hospital is the safest setting for giving birth, but admits that it "respects the right of a woman to make a medically informed decision about delivery." It's clear that Dr. Amy does not. I am really curious to hear how this one is going to play out.

From The SOb's website: What a caring, compassionate and professional
way to promote your "advocacy." Would you want someone this vulgar and
derisive in charge of your care?

More reading:
The C in ACOG Stands for Castrated

Your baby, the (normal) "problem sleeper"

noreply@blogger.com (The Deranged Housewife) — Sun, 21 Jul 2013 01:05:00 +0000

There's so much parenting advice out there, some of it really good, and some of it pretty awful. Sometimes it's hard to know what to do, especially if you're a first-time parent, and many times people can make you feel really guilty and pretty horrible for listening to your gut instinct when it comes to raising children.

If there's one thing I learned after having three kids, is that they're all different. As much as the mechanics of babies are the same (yeah, they eat, poop, sleep, repeat) they're not: their personalities begin to emerge early on, and as they grow and learn, you have to tailor your parenting to fit their needs and differences. But I came to the conclusion based on the advice of others, and in observing others and what's considered social norms, that sometimes we think it's the other way around.

Getting your baby on a sleep schedule, whatever that is, is probably a perfect example. People will ask you if your child is a "good baby," which must mean "Are they sleeping through the night yet?" when they're 3-4 months old. I remember with my oldest, as a newborn he would be awake at all hours before I finally thought, What am I doing?! This child should be in bed. But lucky me - I was spoiled by what I'll call the "Perfect Sleeper."

He slept through the night probably around four months, which I'd say is great (when compared to my other two). If he cried or fussed at night, it usually meant one thing: he'd filled his pants and needed a diaper change.

I can't imagine if I had taken this advice - from the cringeworthy What to Expect website - you know, the book everyone loves to hate. It reads like something out of a Dr. Spock time warp:

"Your baby's bad sleep habits are being rewarded. If your child cries at night to be fed and you feed him, or if he cries because he wants to be held, and you pick him up, then he learns a tricky lesson: Cry and I'll get what I want. But by six months, rest assured he needs neither a nighttime snack nor a cuddle; he's just getting away with that because he can..." (emphasis mine) Healthy full-term babies are capable of fasting for up to 12 hours at night by six months of age..."

Unless, of course, your child is like mine and has just taken a giant dump when he's "supposed" to be sleeping. I mean, really. Every child is different! This is basically assuming that there surely must be something wrong either with your crappy parenting or your child - who can sleep for long stretches but simply doesn't want to. Stop cuddling your child at 2 a.m.! He doesn't need it!

What?!

I don't think there's a parent on Earth who would say, "I really regret spending more time with my kids." Love them, hold them, feed them, rock them - they're only little once.

All kinds of things can mess with their sleep schedule: illness, hunger, emotional needs, or meeting milestones (that always kept my kids up - they were practicing their new skills!). If your child is going through a growth spurt, heck yeah they're going to want to eat in the middle of the night. It may not happen to every kid, but it doesn't mean there's something wrong with yours if it does - it's totally normal!

Fast forward to children #2 and #3 - who probably slept through the night at around 18 months. I very briefly tried the "cry it out" method with my middle, who was having none of it, and just wanted the breast, for crying out loud. It was so much easier to just give it to her, spend the five minutes to nurse, and then both of us would go back to bed. End of story. Is she waking up every three hours to eat now that she's six? No. My youngest was probably the same way, I can't even remember. But somewhere in there I realized something crucial: if I don't change my perspective, especially on nighttime feedings, this is going to get old. Quickly. And I can't afford for that to happen because we've got a lonnnng way to go.

I noticed, especially with my youngest, all he wanted was five more minutes. Just a little longer on mommy's lap, at the breast, and he was okay. The more I tried to rush things because I had something else to do, the more he just wanted that time with me. It was like a way of forcing me to slow down, relax, and listen to him and his needs, instead of demanding that he conform to my schedule.

I'm not going to say it was a bucket of laughs the entire time, but once I started seeing it as less of a nuisance and more of an opportunity to just love my children, it totally changed how I felt about dragging my butt out of bed in the middle of the night to deal with that "problem sleeper." My youngest, who is 4, still occasionally gets up to come to me in the middle of the night, even if it's just to cuddle and fall asleep in my arms, and will gladly go back to his own bed to kick, thrash and roll around as much as he damn well pleases.

And by the way, all of them were breastfed exclusively for six months (my daughter a little longer), and were nursed long-term. All treated much the same in terms of feeding and bedtime routine, all with different results. I know some parents struggle for long periods either getting their children to go to bed, to stay in bed, to sleep alone, etc. - they're all different. No one method is going to work with each and every one of them, and sometimes it will take great feats to get them to just lie. still. for. five. minutes. It will seem, as it did for me for many many many nights up with one baby or another, to be an eternity, and before you know it - poof, it's gone. That's what you should expect.

For much better advice, click here. :)

Mom kicked out of pool for breastfeeding

noreply@blogger.com (The Deranged Housewife) — Fri, 19 Jul 2013 13:43:00 +0000

A mom in Great Britain has staged a nurse-in because she was asked to leave the pool area while nursing recently. The lifeguard asked her to stop because it violated the 'no food and drink' rule. But the thing is, she was physically in the pool when she was asked to stop.

Normally I'm all for breastfeeding your baby wherever, whenever the baby needs to be fed. But I must admit, I find the idea of breastfeeding while in the pool kind of gross - but it has nothing to do with modesty, covering up, exposing the breast or any of that.

Despite being treated with chemicals,
swimming pools are still pretty
disgusting when it comes to germs and
bacteria. Studies have shown that kids
and adults alike are known to treat it as
a public bathroom.
Photo: analab01/Stock.xchng

I think one person actually unfriended me on FaceBook over posting this article, perhaps misunderstanding my concern and interpreting it that I don't support public breastfeeding. Actually, it's quite the opposite. But I can understand how the pool would be concerned with her nursing there, and they actually stated that she was free to nurse anywhere around the pool area, just not in the water.

Some mentioned the risks of milk leaking (probably unlikely) and the baby throwing up. In my case, this would've been a reality with my second, who regularly threw up copious amounts and then proceeded to want to nurse all over again. I probably would not have wanted to nurse in the pool, but had I decided to, most likely we would have contaminated the entire area. The cost to treat a pool that's been contaminated is likely quite high because it's a very involved process, involves closing portions of the pool and results in a loss of revenue because no one can swim.

Despite all the chemicals used, pools apparently are still pretty disgusting. The woman was sitting in the jetted whirlpool area (I'm assuming the baby pool) where probably nearly all of the four-and-under set forego interrupting their play and just simply urinate wherever they are. If you've ever used those "swim diapers," they're pretty much worthless at containing anything. And it's estimated that even 1 in 5 adults pee in the pool. Disgusting!

Not to mention the grossness that's floating: residue from personal care products and sun lotions, body oils, dead skin cells. Yuck. It almost makes you never want to go swimming again, breastfeeding or not.

It's been estimated that many people don't shower before entering the pool (who knew?) and therefore all kinds of interesting things like e. coli hang out in the filters and everywhere else. Bacterias that can ear infections and skin rashes were found in a majority of public pools, and "pools used primarily by children tested positive 73 percent of the time." Apparently public municipal pools are the worst offenders.

It's not like your breasts are sterile, but perhaps reducing one more point of contact while nursing is wise, rather than staging a protest to fight for your right to breastfeed in what is quite literally a public bathroom.

Review: VBAC Facts Class with Jennifer Kamel

noreply@blogger.com (The Deranged Housewife) — Tue, 09 Jul 2013 17:16:00 +0000

Image: VBACFacts.com

This weekend I had the pleasure of attending Jen Kamel's VBAC class "The Truth About VBAC: History, Politics and Stats" in Buffalo, NY. She is amazing - traveling the lecture circuit to present loads of information to both laypeople and birth workers alike.

I've already had a VBAC and I'm "just" a birth advocate, but I highly recommend the class if you can either attend in person or check out the webinar version. Why spend money on a class when I'm not even a birth professional? For philosophical reasons, this was as inspiring as it was educational.

What an opportunity it was to network with local doulas, midwives, advocates and birth professionals! I met new friends, heard and shared stories and exchanged information that not only could I use but pass on to others as well. The presentation was heavy on graphs and charts (Jen's favorite LOL) which is a good thing - putting it all into perspective is important. Without that perspective and information, women are potentially making a life-changing decision with less data and fewer facts, perpetuating the idea that "VBAC is dangerous!" and that it's selfish, foolish or risky to even consider it.

Some important take-away messages that I left that night with:
• Studies are important, as long as you're looking at the big picture. For instance, rupture rates are key, sure; but if the study you're reading doesn't tell you the number of women who had labor induced or augmented, then it's not going to give you all the facts. That is very important information to have - because it can increase the overall risk of rupture. Without it, it can definitely skew your impression of whether it's safe or not. Is your doctor quoting these same studies, that might present data the way he wants it to? Perhaps.

• Ultimately it all comes down to the level of risk that you are willing to accept. One is perceived as inherently safer, or more dangerous, than the other. Why is this? Because one is performed much more frequently than the other, to the point where risks and disadvantages are glossed over and minimized. I've always thought that it's just a shuffling game: you're trading one set of risks for another. You put off the more immediate risks of a VBAC and trade them for the more long-term, cumulative risks of repeat cesarean. If you're not looking at the long-term picture, you may not have all the best information at the time.

Why does a rare but well-publicized uterine rupture (which is not always catastrophic) send up more warning flags than surgical complications after four cesareans? Why are we more afraid of the risk of rupture - which may not even be realized - than we are about cesarean complications, that are becoming increasingly more common as more women have more cesareans?

Jen's presentation may be just the thing to give a VBAC mom the edge when it comes to studies and statistics - and it's downright sad that you even have to walk into a doctor's office defensively posturing yourself with a ream of studies to back up your birth plan. Don't expect your doctor to know all the facts and figures - or to even come close. Jen's information is nothing that you can't already find on your own, it's just painstakingly put together from the same medical journals and articles your doctor has access to - conveniently all in one place. The benefit to you is that the legwork has already been done - which is a big plus when it comes to the virtual sea of data that can be very overwhelming. Kudos to Jen for her hard work and determination!

For a list of upcoming classes and webinars, visit www.vbacfacts.com.

Why do women choose "risky" births?

noreply@blogger.com (The Deranged Housewife) — Sat, 11 May 2013 16:12:00 +0000

Whenever a tragic birth outcome makes the headlines, especially if it's perceived as "risky," I know women ask themselves, "How can a woman do this? What on earth was she thinking?" It's hard not to, but much of the time, I can totally understand why.

The death of any baby is tragic, and I guess hindsight is 20/20 when you pronounce the death "unavoidable." In the case of this Australian woman, who was attempting a VBAC at home after two cesareans, she was summarily lambasted for not following the advice of her doctor and "internet advisers" were blamed for giving her false information on what she should do. One woman said, "I blame the 'variation of normal' crowd." (The woman's baby was breech.)

Contrast that to this story, of an American woman who died of complications following her sixth cesarean section. No is blaming her for her risky decision to have so many cesareans, as I'm sure she took her doctor's advice - and I highly doubt he/she was pleading with this mother to "please have a VBAC! It's safer!"

What's the difference, really?

Why is accepting one death - that could have also been avoidable - okay, but not the other? Imagine if the Australian woman had decided on that third cesarean, perhaps going on to have more children and more cesareans, and ending up like the woman who died? Are we saying that's just an acceptable risk that you take and "so what?"

I see it as merely shifting the risk. The more you discourage VBAC in women who've only had one prior cesarean, especially in those who desire larger families, the more you end up hearing stories like this. It seems like our medical community, and society at large, is perfectly willing to believe in dangerous paradoxes - namely, that VBAC is dangerous and cesarean section is "perfectly safe." Many commenters were disgusted that she went against the advice of her doctor and attempted a VBAC, which was unfortunate; but for many women who do take that advice, you better believe their doctor can churn out just as much misinformation as that sandal-wearing hippie natural birth advocate you so despise. How is being the opposite side of the same coin any better?

Add the fact that very few hospitals receive an official "Mother-Baby Friendly" designation (not that that matters, I guess) or can seem to be supportive without treating mom like brainless chattel and it should be easy to see why women choose an alternative birth. How many times have you heard that it's damned-near impossible to have a normal, let alone natural (gasp!) birth in a hospital setting? I'm not saying it can't be done, just that it's usually difficult and you have to really work the system (which has quite a learning curve, let me tell you).

For those who frequently bitch about how reckless or crazy women are after disastrous home births, what are they doing to make hospital births more hospitable? Oh wait - they're usually the ones that tell you to just "let go of your anger and get over the 'birth experience' - just deal with it." I'm guessing they've never once cracked open a book that details some of the absolutely barbaric birth practices that "modern" obstetrics have put women through* over the generations, and for what? To be treated like a human guinea pig? Or the formidable, unmentionable "physicians" who like to demonize all women for even thinking about a home birth, much less having one - are they making stunning strides and initiatives to support women in a comfortable, accommodating hospital atmosphere? Or just complaining about it and publishing the names and addresses of those women who've lost children in home births?

I'm not sure how I managed it, but I had a VBAC in 2006 and sort of fell into an OB's practice that would actually "let me" do it. I don't think I had any clue how difficult it is for some women to have one. If I hear someone say "just find a supportive OB and hospital with lots of experiences in VBAC" one more time I'm going to scream. Because it's definitely not that easy.

From the ICAN website.

If you look at this list, many are rural hospitals or in smaller towns. And many are hospitals in large cities. I'd like to know how you are just going to up and "find a supportive hospital" when they don't seem to exist. If you live in the boonies, your options for supportive hospitals and OBs or midwives is probably pretty limited, and I'm willing to bet the cesarean and induction rates at those hospitals that serve rural women are through the roof. ACOG Guidelines be damned; they aren't offering up an attorney, birth doula or physician to see you through your VBAC - which means the "guidelines" they issue do little to help the patient if a doctor can just pick and choose which guidelines to follow.

(*And for the record, I'm not intimating for one second that before modern obstetrics, women didn't suffer or go through torturous experiences in order to birth children, sometimes with disastrous results. But I think our glorification of modern medicine might be, at times, misguided and perhaps glosses over its sordid history and past failings.)

More reading:
The "C" in ACOG stands for "castrated"
Tori Spelling and cesarean complications: why we need to hear about it

Newsflash: Pitocin could harm your baby

noreply@blogger.com (The Deranged Housewife) — Fri, 10 May 2013 15:22:00 +0000

For some of us, the idea that Pitocin is not exactly a walk in the park is nothing new. So when this official proclamation came from ACOG, a lot of people were like, "Well, duh."

Apparently this is "the first study of its kind to present data on the adverse effects of Pitocin use on newborns." Considering how deeply entrenched its use has been since its inception as the drug we know today, I find that incredibly shocking.

Unfortunately it seems like either those who swear up and down that it's the Devil's poison end up getting it, or those who are warned "don't induce!" often find out the hard way that in many cases, yes, it does suck as badly as everyone said it would. (Although obviously this is not the case for everyone.)

Back when my niece was expecting her first child, she said she was not planning on inducing but asked for advice about it. I tried to offer my opinion without sounding preachy, and a many of her friends said that in their experience, it was terrible and to avoid it if she could. I don't know what happened, but the next thing I knew, she was getting induced, had a hellish labor, and now apparently doesn't want any more children. *sigh*

What I've noticed is when people are asking about Pit, there are usually tons of people who relay their experiences - some okay, some great, some perfectly horrific and the stuff of nightmares. I'm not one to try and scare women by propagating horror stories, and whenever I speak of this stuff I try to be as balanced as possible. But I can't help but notice that usually, all the dissenters are ignored, their advice chucked to the curb and the mom is induced, sometimes with not so happy results. Sadly, it seems like those who filter out what they don't want to hear seem to have the worst time of it.

Either that, or one of two things happen: a dozen people say, "Well, I had it in labor and did just fine," as if they refuse to believe there is actually a problem. Or, they list the numerous reasons why they needed it in a defensive tone, which is kind of sad. Again, for some women, it's what they need and can really benefit them. But for everyone? I don't believe it.

I think some women get defensive because their hackles immediately go up and they miss the part where, again, it says that for some women, it can be a life-saving, very important drug to have on hand. I also wonder if they are in denial that their doctor could ever give them something that might be unsafe, completely trusting them with their own wellbeing as well as their unborn baby. I'm not necessarily saying that they aren't acting in your best interests, but rather questioning why this needs to be standard fare in so many hospitals today. One source suggested that approximately 81% of women receive Pitocin either to augment or induce labor. 81 percent?!

And because it's become so commonplace, it's perceived as unequivocally safe, a perfectly normal and acceptable routine of labor. If you question it, I highly doubt your doctor or nurse is going to calmly say, "Oh, you don't want it? Okay, that's fine." Administration protocols seem to vary by hospital and doctor, and while some appear to follow perfectly reasonable guidelines (especially the idea that if this isn't working, let's send mom home), others are outrageous - as expressed by nurses who work with these people, not just "natural birth hippie chicks."

From a popular internet forum for nurses. Click to enlarge.

Some things to consider:
• Sometimes inductions and Pitocin use are completely necessary and the best thing for both mom and baby. If at all possible, perhaps suggest a gentle induction that can get things started in a minimally invasive way. Remember that in first-time moms, inductions can increase the risks of cesarean, although sometimes this is unavoidable. (Pre-eclampsia is a good example.)

• Sometimes it is not necessarily the best course of action but is given anyway. Know that you have rights. Some women do say that while they refused it during their labors, they had it given to them anyway; perhaps hiring a doula or having a birth advocate present with you may help. Some reasons for its use are dubious at best, and can cause more harm than benefit. (For an example, click here.)

• Get all the facts prior to an induction and ask lots of questions. If your doctor starts talking about an induction early on as a matter of course, this could raise some major red flags.

• Throughout its history, it has affected different women differently. This can depend on a number of factors, including how aggressively it's administered. While it can have many benefits, it is not without risk to both mother and baby.

More reading:
Pitocin side effects
Five ways Pitocin is different than oxytocin