A Bit of History That Gives Me Chills

Yesterday one of my favorite bloggers, The Unnecesarean, posted an excerpt from a history text about birth in the early 20th century. The excerpt presents the practice of putting women under "twilight sleep" for labor and delivery as a way to convince WASP women to have more babies because "modern" birth practices render it painless-- or at least without the memory of pain. I had never heard of this racist/classist perspective of twilight sleep before. But it got me thinking, especially since I recently read that the tv show Mad Men featured a character giving birth within the haze of twilight sleep.

I can't remember the first time I heard about women being "put under" to have their babies- it was probably as a child or teen. Until a few years ago, I guess I thought it was a benign but clumsy attempt to spare women the pain of birth. No big deal. But then I happened to see "The Business of Being Born, " a documentary by Ricki Lake that covers a little bit of the history of birth in the US. The historical aspect was eye-opening, to say the least. When you start to think about the fact that this is the way many of our parents came into the world (and maybe even some of us, considering twilight sleep was prevalent well into the 60s and even the 70s in some hospitals), it can be downright scary.

Beginning in the 1900s, a combination of scopolamine and morphine was administered to all women entering the hospital for birth. Women had no recollection of the birth, and certainly no recollection of any pain. Feminists heralded this as a fantastic medical breakthrough, and demanded its widespread availability for birthing women. As word spread of this wonderful new pain-free way to give birth, women across the country chose to deliver in hospitals offering twilight sleep. In fact, there are reports of women being put under for delivery whether they wanted it or not, even against their own explicit refusal. But since women had no recollection what actually happened during their births, and husbands at that time were not part of the birth process, it was years before the true horror of twilight sleep was exposed.

Since the women were not fully sedated, and not fully relieved of the pain of labor, they had to be placed in restraints in their hospital beds so as not to thrash themselves onto the floor. When husbands started questioning the marks on their wives' wrists and ankles left behind by the leather restraints, the practice of restraining was not abandoned. Instead new restraints made of lambswool were designed so as not to leave any marks. Women were left, tied down, to writhe through their labors until the doctor arrived with forceps to extract the baby. (See photo at top.)

When the effects of the medicine wore off, women were presented with a freshly bathed, blanketed bundle of baby. Some women complained of feeling detached from their babies, like they weren't even sure it was their own child. The drugs also crossed the placenta and often sedated the baby, resulting in breathing problems. Over time the method was eventually abandoned, as a result of the negative side effects and the second wave of feminism. As women reclaimed control of their reproductive lives, including access to birth control pills, they also began increasingly demanding unmedicated births and fathers' involvement in births. The development of epidural anesthesia also played a role in the demise of twilight sleep.

Maybe it's my own personal bias against hospitals, but the thought of literally being dropped at the door of the maternity ward by my husband and literally having no recollection of anything else until being handed a baby two days later utterly horrifies me. I don't think the method would have taken off if husbands had been allowed in- I cannot imagine any man permitting such barbaric practices to be visited upon his wife. But they didn't know, so they couldn't help.

There was (and I think there still is) a certain mystique around birth: We don't know exactly how labor starts, and can't predict when it will happen. Regardless of a mother's weight gain or belly size, we don't know the size of the baby until it's born-- even ultrasound measurement can be off by a pound or more in either direction. This mystique allowed generations past, and still allows many people today, to maintain a certain degree of ignorance about birth. It's very easy to assume that the doctor has all the knowledge, the hospital has all the equipment, so all the expectant parents need to do is show up when it's time. I think that is a dangerous attitude. The same people who wouldn't hesitate to seek a second opinion from a doctor who said they need a heart transplant... the same people who would consult with three different orthopedic surgeons about a knee replacement... don't think twice about their choice of care provider, birth place, or pain management options. I could write a whole other post on the topic of informed birth choices... But suffice to say for now, If you don't know your options, you don't have any.

Vitamin D Confusion

Until recently, I'd never given vitamin D much thought. I mean, rickets? Isn't that a disease that pirates and other seafarers got, along with scurvy and beriberi? It seems like every time I turn on the news lately, vitamin D deficiency is linked with other health conditions, such as cardiovascular disease, prostate cancer, diabetes, depression, even H1N1 influenza. The problem isn't limited to adults, either. New research has indicated that children are vitamin D deficient as well.

It's possible we've taken the "safe sun" message too much to heart. We've become so accustomed to slathering on sunscreen every time we step outside that we're blocking our bodies' natural vitamin D production from the UV light of the sun. Ironic that by trying to prevent one disease, skin cancer, we've potentially put ourselves in the path of other diseases.

The NIH recommends 400 IU of vitamin D supplementation for adults, assuming an individual is not synthesizing any vitamin D from sunlight. But is that enough? Recent evidence makes the case for higher amounts, up to 5000 IU per day. There is also a case for modest sun exposure, 5-10 minutes of full sun (without sunscreen) on the arms/legs/face, 2-3 times per week. But the amount each individual needs varies based on age, race, time of year, and latitude. So how to know if you're getting enough?

I was surprised to learn recently that a simple blood test can tell you if you're getting enough vitamin D. (And with my annual physical coming up in a couple of weeks, I'm definitely asking for my D to be tested as part of my labs.) If you'd like to ask for it too, it's the 25-hydroxyvitamin D test, also known as the 25(OH)D test. Note: This is different from the 1,25-dihydroxyvitamin D test [1,25(OH)2 D], which will not give an accurate portrayal of vitamin D status. According to the Vitamin D Council, a healthy level is 50-80 ng/ml, which should be maintained year-round.

Another bit of information of note: Athletes may need more vitamin D than the general population. This is an area of research that needs more study, but initial recommendations are on the upper end of the intake range. One writer chronicled her experience with D deficiency and its effects on her athletic performance. If your performance has been lagging for no apparent reason, it might be time to check your D level.

I think this is as good a reason as any for me to pack it in and move to the Caribbean. "Sunshine Vitamin" anyone?

Exercise and Breastfeeding

A new study from the University of North Carolina-Greensboro concludes that breastfeeding mothers who exercise lose less bone density and less lean body mass than non-exercising women. Although the study is small and the topic warrants further exploration, the results are promising. Bone loss is normal during pregnancy and lactation, as the baby depletes some of the mother's calcium stores for skeletal development. Bone density generally rebounds, at least partially, after a woman ceases breastfeeding. But concern over osteoporosis could lead some women to decide (or be convinced) to wean prematurely.

The UNC study demonstrates that moderate exercise, in addition to its many other benefits, can mitigate the effects of breastfeeding on a mother's bone density. It is important to note that the women in the study did not have a gym membership or attend group exercise classes- they performed a combination aerobic/strength-training routine 3 times a week in their own homes. In other words, the benefits of exercise are not out of reach to women unable to join a health club. For women who worry that exercise will affect their milk supply, there is no research that supports this myth. Furthermore, the additional caloric expenditure associated with both exercise and lactation (along with healthy eating habits) may help mothers shed their pregnancy pounds more easily.

Are Motherhood and Feminism Incompatible?

I have never considered myself a feminist. I'm not "anti-feminist." I support many of the aims of feminism, such as gender equality in the workplace and advocacy for victims of discrimination, violence, and sexism. But I just haven't felt like I fully identified with the socio-political group of "feminists."

What comes to mind when you think of the feminist movement? Maybe it's women like Gloria Steinem and Betty Friedan. Maybe it's politics, like the Equal Rights Amendment and Roe v. Wade. Perhaps it's social issues, such as sexual harassment, domestic violence, or rape. Or maybe it's just Girl!!! Power!!! I'd say all of those are pretty valid answers.

But when you think of feminism, do you think of moms? Probably not. Do you know why? Because the feminist movement doesn't think about moms either.

In the United States, something like 80% of women will have at least one child. That's more than the number of women who obtain bachelor's degrees (26%) and more than the number of women participating in the workforce (60%). But where is the feminist activism on behalf of mothers?

I started with perhaps the most well-known feminist group, the National Organization for Women (NOW). The "Top Priority" issues that NOW works with are listed on the front page of their site: Abortion and Reproductive Rights, Economic Justice, Ending Sex Discrimination, Lesbian Rights, Promoting Diversity and Ending Racism, and Stopping Violence Against Women. Worthy causes, all. When I clicked on "Many more" at the bottom of the list, I found, way down on the list of "Other Important Issues" a link to the Mothers [sic] and Caregivers [sic] Economic Rights page. The issue as NOW sees it is paid parental leave. Their action plan on this issue consists of.... a petition. Oh, and encouragement for women to contact their Senators. Wow, great plan. Things weren't any more promising on the Abortion and Reproductive Rights page. Apparently, the only reproductive rights that NOW supports are the ones that assist women who DON'T want to be mothers. The agenda is abortion, emergency contraception, and birth control access for all women. These are important issues, but do nothing for the women who choose to carry a pregnancy to term.

I next decided to head over to NARAL Pro Choice America. This was another bust, as their platform of issues encompasses only abortion rights, birth control access, sex education, and "Women of Color." Nothing about being pro-choice for women's childbearing options as opposed to pregnancy prevention and termination options.

Surely the ACLU must be working on behalf of mother's rights, right? Wrong. While they have a Women's Rights Project (started by Ruth Bader Ginsburg), the project only focuses on four areas: Employment, Violence Against Women, Criminal Justice, and Education. Again, all important issues, but nothing that directly advances the position of mothers.

I wandered over to the Obama Administration site, Change.org. There is a Women's Rights page, but it looks like news stories, blog entries, and job postings. Nothing resembling any kind of national movement of any type.

This is getting discouraging.

Isn't anyone fighting for better maternity leave policies? For breastfeeding women who are returning to work and need time and a place to pump breastmilk? For women who want to be attended by a homebirth midwife (still illegal in 10 states)? For women who want options other than a court-ordered cesarean section?

Well, how about the National Advocates for Pregnant Women (NAPW)? Now we're getting somewhere! The NAPW includes the following in its mission:

• By focusing on the rights of pregnant women, including those who are continuing their pregnancies to term, we hope to broaden and strengthen the women’s rights and progressive movements in America today... While it is generally recognized that people have a right to bodily integrity and the right to procreate, women face an array of restrictions on their reproductive decision-making, from restriction on access to abortion services, to restrictions on alternative birthing practices to a wide variety of health and welfare polices that devalue and undermine motherhood for some women, including low income and women of color. Although it is generally accepted that adults can decide what medical treatment they will or will not have - once a woman becomes pregnant others may be able to make that decision for her.

Now that's what I'm talking about. While the NAPW doesn't address issues beyond pregnancy (such as maternity leave and breastfeeding rights), it's still a great agenda. However, they do not specifically bill themselves specifically as a "feminist" or "women's rights" organization. They consider themselves a reproductive and human rights organization.

The National Partnership of Women and Families works toward family-friendly employment policies, such as flexibility in the workplace and paid sick leave. In fact, the National Partnership helped draft the Family Medical Leave Act legislation. Their agenda is great for working mothers, though I would like to see them go even further by adding support for breastfeeding/pumping moms. And in the reproductive health arena, they only scratch the surface, by supporting general ideas of affordability, quality, evidence-based and patient-centered care. It would be good to see

The other problem: Have you ever heard of the National Partnership and/or NAPW? Most people probably have not. They don't have the prominence of (and the political weight that goes along with) larger organizations like NOW and the ACLU. Women (and men too!) need to know about the NAPW and the National Partnership in order to give the organization a broader base of support and more political sway.

To be fair, there is a patchwork of different groups that support specific mothers' rights issues. For example, The MAMA Campaign and The Big Push for Midwives support choices for birthing mothers and pro-midwifery laws. First Right works to end breastfeeding discrimination. Over the past few decades the feminist agenda has not adequately included the rights of mothers. As it stands now, there isn't one umbrella organization to encompass ALL of the personal, political, social, and economic issues mothers face. Maybe some would say it's not necessary, that the other groups, small and large, that have a piece of the "mommy agenda" will be able to get the job done. I wonder, though, if it's an idea whose time has come.

Health Care: Why It Will Still Suck After They "Fix" It

I admit I am getting annoyed. I tried to be patient with this process, but as the days and the weeks and the months tick by, it becomes more and more clear that 300 million Americans are about to get a giant Congressional rectal exam.

I'm not one to join the Teabaggers (and really, with a name like that, how can you take yourself seriously?), and I'm certainly not one to take my AR-15 to an angry town hall meeting. But I think I have read enough on the subject of the health care reform fiasco to realize that we're not going to get the change we've been promised. What we will get is a piece of crap legislation that protects the interests of Big Insurance and Big Pharma and does nothing to improve access to and the quality of our healthcare.

We know that what we have now isn't working. The oft-quoted figure is 47 million Americans are uninsured, and the truth is that millions more are underinsured. In this country, we provide more "care" at greater expense and at worse outcomes than any other industrialized nation. The insurance industry and Medicare have a whole lot of influence how physicians practice. Insurers and Medicare set reimbursement rates for procedures. Basic care has a low reimbursement rate. But the more tests and procedures a doctor orders, the higher the reimbursement. As a result, they often provide more, often unnecessary care. I don't blame doctors for trying to make a living. They go through years of study and rigorous training to practice medicine. But we've created a system that incentivizes quantity over quality.

In the endless, exceedingly tedious debate about healthcare, a few major items have been discussed.

1) A single-payer system. Often compared to Canada and the UK, opponents argue that it will "ration" healthcare. And send your grandparents to the death panel. Certainly those systems have their drawbacks. It is true that some people have long waits for treatment, though my understanding is that those are "nonemergency" cases. If you're having a heart attack, it's not like they send you to wait in line. I also just want to point out that WE ALREADY RATION HEALTHCARE IN THE U.S.. Every time an insurance company denies a claim or refuses to cover a test, treatment, or procedure, they are RATIONING. And if they deny someone a treatment that could or would be lifesaving, well, that sounds an awful lot like a death panel to me. A uniquely American single-payer system (with salaried doctors and coverage for everyone) could be made workable if anyone cared to try. But try getting that past the insurance companies who have bought off Congress. This option is completely off the table at the moment, maybe forevermore.

2) "Universal mandates." Everyone has to be covered, no ifs, ands, or buts. Employers must offer coverage to employees. Those who are unemployed or otherwise don't have coverage through an employer are required to buy into insurance cooperatives (see #3) and/or a government-run plan (see #4). Sure, sounds great in theory. But small businesses will be hard-pressed to provide insurance to their employees, even if there are cooperatives to buy into. And large businesses could choose to cut costs by scaling back their plans- and if employees opt-out, so be it, they'll save even more money. So there is no reason for companies to provide anything but a bare-bones plan with minimal coverage. Employees can choose the lousy plan their employer offers, or pay more to the government plan or a cooperative. Which means we'd be in no better position than we are now. Furthermore, without underwriting reform (see #5) to ensure that no one can be denied insurance or be required to pay astronomical premiums due to pre-existing conditions, requiring everyone to be covered could put a lot of strain on a lot of family budgets.

3) Insurance cooperatives. This is an idea with some potential, but also with some pitfalls. The basic idea is that doctors, hospitals, and businesses band together to offer services to members. The model would likely be Group Health of Seattle, which covers about half a million members. The benefit is that co-ops are non-profit and member-run, with the goal of keeping costs low. In theory, such co-ops would compete directly with private insurers and force insurers to lower their own prices. However, co-ops have a less than stellar history, and there is no guarantee that they would be successful in significantly reducing premium costs to members. (Just for kicks, I went to Group Health's site and got quotes based on my own family of 5... They don't have a plan that matches our current health insurance. The co-pays are higher, they all have some kind of deductible, and all have at least 10% coinsurance. The closest plan to ours is $888 a month, which is more than what we currently pay out of our pocket, but my husband's employer picks up part of the tab. My guess is that the total cost is fairly similar, but Group Health's plan covers less.)

4) Government-run plan, aka "the public option." Sort of a third alternative to Medicare and Medicaid. The government obviously has the negotiating power to keep costs low. But would it just be Medicrap? Hard to say. The insurance lobby has been crying like a bunch of little girls whose kitten died about this one. They complain that they couldn't compete with the government keeping prices low. Well, they could start by not paying gazillion-dollar salaries and bonuses to their company officers. There are questions to be answered about any public option, such as who would be eligible and what kind of financial assistance would be provided to those at lower income levels. But what once was a mainstay of Obama's call for reform has been all but ditched.

5) Medical underwriting reform. At present, insurance companies can refuse coverage to, or cancel coverage for, anyone with a "pre-existing condition" or a condition that becomes too expensive to treat. Depending on the insurance company, a pre-existing condition can be almost anything, from seasonal allergies to cancer, from a being beaten by one's spouse to a prior c-section.* And watch out if you get sick: Your insurance company may drop you like a hot potato. This denial of coverage definitely needs to change. In 2007, nearly 2/3 of all bankruptcies were due to medical bills- in 80% of those cases, the folks who filed had health insurance. (Himmelstein, D, E., et al, “Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, May 2009.)

6) Tort reform. Supposedly our legal climate forces doctors to practice defensive medicine. I say supposedly because it appears that doctors are acting more as a result of the fear of lawsuits than actual litigation. A new report in Business Week asserts that malpractice suits do not add appreciably to the costs of health care. According to the New York Times, frivolous lawsuits and huge jury awards are not burdening the system. Those who favor tort reform point to Texas as a successful model. While it's true that malpractice lawsuits, malpractice judgments, and liability insurance costs have all been lowered in Texas since the reforms were implemented (all good things), Texas still has some of the highest healthcare costs in the nation.

Will any meaningful change actually be made in this reform process? I somehow doubt it. The smoke and mirrors thrown at us so far fail to impress me. I don't pretend to have the answers myself, but I can clearly see that the House and the Senate have done nothing but kill trees with their 1000+ page bill. I am disappointed that Obama has taken a weak and waffling standpoint on the whole issue. He has backpedaled on the public option. And he didn't give any real direction to Congress- a group of folks who have probably the best health care plan in the country and therefore could care less about anything but the campaign contributions they get from Big Insurance and Big Pharma. The bottom line is that as long as healthcare has a profit motive, we will never see any meaningful improvement in costs or in quality. Since there doesn't seem to be any likelihood of making insurance companies non-profit entities, I'm betting that real reform is nothing but an illusion.


*The c-section issue is a double-whammy, because those women who can't get insurance due to a prior c-section also face hospital and physician policies "prohibiting" VBAC . Which means that many of those women will not only essentially be forced to undergo major surgery, but they'll also have to foot the entire bill, to the tune of $15,000 or more.

NYTimes Article: Froot Loops Are Health Food

Link to article

You may soon be seeing the new "Smart Choices" labels on products at your grocery store. Several manufacturers- such as Kellogg's, Kraft, and PepsiCo- have banded together to label certain products as "better for you" options. They formed a committee, including the dean of Tufts University school of nutrition and representatives of each the cooperating corporations, in order to decide which foods would meet their criteria to receive the Smart Choices green checkmark logo.

Now here's the problem. Can we honestly think that giant processed-food manufacturing companies are going to put consumers' best interests ahead of their own financial interests? I'm going to go with, "Uh, no."

So what foods have made the list? You can do a search online for products by brand or by category. It's rather amusing to look at the contradictions. All-Bran and Corn Pops are both Smart Choices? Or as the article points out, both regular AND "light" mayonnaise are Smart Choices too? So, according to the Smart Choices program, it seems there is no substantial nutritional difference between those products. Also included as a Smart Choice: Fruit Roll-Ups. Never mind that in a 14g serving, 7g is pure sugar. A Smart Choice can be made of 50% sugar? Seriously, did a group of 7 year olds put this list together?

By artificially enhancing a food with little to no nutritional value, manufacturers can slap a Smart Choice label on a product. (Coming soon to a store near you: Bacon! Now with added calcium!) And by doing this, they can still claim they are following federal nutrition guidelines. This is a complete scam on the American public and an insult to our intelligence. There's hope though: The FDA has written a letter to the Smart Choices program to put the committee on notice that they'll be facing regulatory scrutiny. Let's hope they're willing to put some muscle behind the criticism. No, it's not easy to altogether avoid processed foods. But as consumers we can learn to read nutrition labels and make better choices without some silly checkmark contrivance.

Medicated Moms

Today I read this article about a mother who decided antidepressants were the answer to her parenting stress. Her anecdote about the kids bickering in the backseat of the car is a story all too familiar- Been there, done that, got the t-shirt.

But... Since when is getting angry and yelling at your kids a condition requiring medication?

I absolutely believe that there are legitimate uses for antidepressant and antianxiety medications. There are people who wouldn't be able to get out of bed in the morning without them. But by all indications, use of these medicines has greatly increased. Some would say they are overprescribed- even the author acknowledges it:

"My doctor said he prescribes mood-enhancing medications about 10 times a week... My friend called her doctor to make an appointment and talk about going on Paxil. The nurse said she would just call the script into the pharmacy. No appointment necessary."

No appointment necessary? Are you kidding me? I had to make 3 calls to my doctor, begging her to call in a prescription for antibiotic eyedrops for pinkeye without seeing me first. Why are there doctors handing out powerful psychotropic medications like they are candy?

Here is my biggest problem with the author:

"Maybe moms like me should do more yoga, cut back our responsibilities, see a therapist, exercise more, put duct tape over our mouths every day after 5 p.m. Maybe we should do anything to avoid relying on drugs to become calmer, happier people."

She outright acknowledges that there may have been other (non-pharmacological) ways to handle her stress and anxiety, but did she bother to try them? No, she didn't. It's easier just to pop a pill. Antidepressants have well-documented side effects. As far as I know, yoga and therapy do not.

I reiterate the fact that there are many people for whom antidepressants are nothing short of a godsend. Yet I have to wonder if we, as a society, have come to view any negative emotion as a sign of a mood disorder. Or maybe it's that we think we can use a pill to cure just about anything. Or maybe [conspiratorial whisper] the pharmaceutical companies' marketing tactics have convinced us we are broken and need to be fixed.