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Monday, May 24, 2010

'Commandments' article misses its mark

Poor Heather W. She probably never dreamed that her article, "The 10 Commandments of Dining with Little Kids ," would stir up so much controversy. (Complete with 'gentle reminders for non-parents alike,' whatever that means.)

I've had assignments like this one; I wrote a piece several years ago about family-friendly restaurants in our area and how to make it a more enjoyable dining experience. I don't know if Heather has kids, but I at least wrote from personal experience. And it didn't include "leave the kids at home." (And if I remember correctly, all of the restaurants I featured were "upscale," so that doesn't necessarily mean they aren't child-friendly; just the people dining there will be.)

Even though she made a disclaimer in the beginning that she's not "anti-kid," to most of us she sounds exactly that: someone who has no children, and expects everyone to fit her neat, crumb-free little idea of what the world should be like. People who are thoroughly grossed out by screaming, snot-nosed faces, poopy diapers and Cheerios picked up off the floor ("Five second rule!").

Throughout Heather's list of "do's and don'ts," she basically makes it sound like parents and their young broods should just stay home - be relegated to the virtual safety of their own house, where no one can see, hear or look at your undisciplined, hungry little brats. That way no one but you has to hear their screaming, endure their impatience at slow service or smell unpleasant odors. Big strollers blocking the way are annoying and loud toys are a total nuisance!

I don't know if Heather is aware of this, but sometimes those high chairs at restaurants can be really nasty. As in, my child is stuck to the seat, they're so gross. Not to mention my baby is a big boy - I joke that he wears lead-lined pajamas - and won't sit still very well on my lap. In the high chair, he's sitting up high with us, in perfect line to rip the tablecloth off, play with and drop silverware all over the floor, and spill things. Should I just leave him at home then? (Oh yeah, and at 14 months, he likes to scream. Not because he's upset, but because he likes to hear the sound of his own voice, which is something I think a lot of adults suffer from, coincidentally.)

As far as screaming, misbehaving kids, I've learned not to jump to conclusions too quickly. I think many moms of autistic children and others with difficulties want the world to know that it's just not possible, sometimes, to keep their children quiet. At some point you have to live your life, and if that means going out in public with a child who is likely to blow up at a moment's notice, so be it. A few weeks ago I was out grocery shopping with my two youngest. I had the baby in the cart and had dropped off my daughter at the play area already. We passed a grandmother-ish type pushing a young boy in a shopping cart who, by my best guess, looked too old to be having the fit he was throwing in public, and an older guy stopped me and said something in passing about how the woman should smack the kid. I said to him, "You don't know what's going on with that boy," and left it at that. He just looked at me and tried to laugh it off by saying, "But yours is behaving so well!" I said, "You haven't seen my older two."

And while we're banning strollers from crowded restaurants, shouldn't we just tell people, "Sorry, I know you're in a wheelchair, but it does take up a lot of room!" No, I didn't think so. But what Heather doesn't realize is that this world is really meant for people who can walk under their own power, no strings attached. Meaning, no one in a big, bulky wheelchair or with a double stroller, or kids on each hip. Try fitting into narrow doorways, up and down stairs and between narrow aisles at the malls without dragging a display of men's dress shirts with you. It's not easy.

And God forbid if your baby gets hungry! You are not to breastfeed at the table!

This is the comment that got most people riled up, understandably. Heather suggests checking out the bathroom - because many of these fancy, four-star restaurants we all want to attend on a regular basis have really nice restrooms! I can attest, as someone who often uses those public restrooms for their intended purposes, there are places I wouldn't even want to take a crap in, let alone feed a baby. But if Heather wants to pick up her plate of filet mignon and join one of us in the stall, feel free!

As a parent of three who uses a stroller and still breastfeeds, I have a few commandments for Heather and her crowd:

  1. Relax. The world does not revolve around you. Put yourself in our shoes for one-half second and perhaps you'll understand that babies only poop the minute you're in an inconvenient place, and kids will be angels until you dine out in public. 
  2. Breastfeeding in public is not a crime in any state. So stop making women feel like criminals for feeding their children. I suggest you look the other way if you suspect someone is nursing their hungry, screaming child in some place other than a bathroom, because your eyeballs might just fall out of your head if you don't. 
  3. Have patience. Don't think that parents actually enjoy hearing their kids screaming, acting up or doing other embarrassing things in public. Parents are entitled to enjoy themselves too, and sometimes that involves having their children with them. Babysitter called off 20 minutes before you were supposed to leave? Yep. You have reservations and are meeting friends? Yep. You're going anyway because you're entitled to enjoy yourself too? Yep. And remember, you were a child too, once upon a time. In an era before DVDs, fancy strollers and other gadgets to keep a kid busy. What did your mother ever do with you?
  4. Don't assume anything. Especially that the child who is throwing a tantrum in public can control himself, or that his behavior is even really predictable. Sometimes it's a battle for parents to just step out for an hour in public, and they shouldn't be made to feel that they can't include their children in that time. 
  5. If you want quiet adult time, perhaps you should stay home. That way you can make dinner in the privacy of your own kitchen, trying out fancy new recipes together. (How sexy!) Then you can do whatever you want - flash as much cleavage as you want, talk as loudly as you want or say any off color comment you can think of, all without fear of offending others (especially people with little kids). You can behave suggestively with each other and fawn all over each other, all without fear of stares or offending someone who just doesn't have the guts to tell you to knock it off. And you won't have to see anyone nursing their baby in public! Because we all know that's not what boobs are for, right? 

I know Heather's suggestions are for "upscale" dining establishments, whatever that means. Maybe Heather also doesn't realize that no one really has time for all that fancy stuff once they have kids. I think a lot of people are missing the word 'upscale' and expecting this kind of militant behavior of parents and their kids in all places, even those touted as 'family friendly.' Her suggestions on breastfeeding almost make it sound like nursing in public is only for those low-class places that most parents go to with their kids, not "four-star restaurants."

In the end, I think Heather, like most people, just needs to get over herself and order take-out already. Then everyone is happy.

Tuesday, May 18, 2010

Are you in an abusive relationship - with your OB?

I am convinced that some women are in abusive relationships and don't even know it. They would never tolerate emotional or psychological abuse from their husbands or boyfriends, yet they put up with it for nine months from one of the people who is supposed to support and protect them the most: their obstetrician.

After reading some of the abysmal comments from My OB Said What?!?, it's painfully obvious that many (not all) obstetricians and labor and delivery nurses are psychologically and emotionally abusive towards patients. Perhaps it's subtle; maybe it's not. But it's still there. I refer to this website continually because I feel it's a cross-section of reality - comments coming from real doctors, from real women and their real experiences. Some span the decades; most are recent. It's a telltale sign that the maternity system continues to be broken, and has been for a very long time.

We can easily 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?
Humiliation comes in many forms, including medical staff assuming you don't know who your baby's father is (even though he's present in the room), a home-birth turned transfer when they assume you've had 'no prenatal care' (even though you bring extensive medical records), or being treated like a child  who has no ability to assess the situation or speak for herself.

Telling you things like "You'll never be able to birth any baby vaginally!," "Don't you think your husband would rather you had a cesarean? " or "Are you from Africa? " serves to do nothing except undermine your self-esteem and make you think your body is defective. Many women are told this even though they've already birthed vaginally, something I find particularly mind-boggling.

• 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."

• Do you sometimes feel trapped in the relationship?
This often happens when you know your doctor is a jerk, but you feel helpless, especially as you approach the end of your pregnancy. Often, doctors will threaten to drop you from their care, which is illegal, but still we feel obligated or threatened into continuing with something that we obviously don't want. Little do women know that they can find care late in a pregnancy, but often it is very difficult and stressful.

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.

• 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, it's often called) and coercion to get you to comply with his wishes. There are probably too many examples to cite or we'd be here all day if listed them. Some that  I've heard recently are "You can't have a due date without one," from an L&D nurse when a patient didn't have an ultrasound done. Another prime example is homebirth, where doctors, nurses and just about everyone else are under the impression that you can't birth without a doctor present. And if you do seek their care, they often sadistically withhold it from you as a means of inflicting punishment, or inflict pain intentionally - like stitching up cuts or tears without anesthetic after a natural birth. (This happened to me, and it didn't help that I saw the needle, either. I expressed pain and discomfort, which was pretty much ignored.)

• The OB puts forth a closed system of logic, and allows no real input or criticism. "In other words, what he says goes." Again, I could spend all day with this one, from the super-exaggerated "exploding uterus" claims that VBAC is too dangerous , to the VBAC candidate who goes through an entire pregnancy and then shows up in labor, only to find a replacement doctor who dashes all her hopes without so much as a word. Typically, in my experience, I ran into this behavior when I dared to ask questions at appointments, and got answers that made no damned sense but ended with "Trust me!" or something equally inane. Either way, they are using manipulation and outright lies to get you to comply, which are also signs of abuse. (Although a little extreme, check out the link to find out how your OB might actually display psychopathic traits . Scary but somewhat true!)

• 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, needless risk. (Unnecessary inductions and unnceseareans are a prime example.) Jennifer Block brings this up in Pushed: A doctor that's pushing for a cesarean because the patient's fluid levels were low, and afterwards cheerfully announces when Block asks, "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?

• And as part of the last criteria, he projects the blame for his (relationship) difficulties onto his patient (partner). "If only you had agreed to an epidural sooner , we would have been done by now!" Another classic: "A natural birth can take all day, and I just don't have time to do that." 

The abuse can go beyond the emotional and psychological into the physical. From denying emotional distress  or physical pain , to purposefully inflicting pain as a way to almost punish the patient for her wishes - like intentionally not numbing the perineum while making repairs, or forceful but unnecessary removal of the placenta .

Often emotional and psychological abuse in a spousal relationship culminates in a physical altercation, such as rape. It's extremely important to note that rape does not always have a sexual connotation, but can mean several things:

  1. To seize, take, or carry off by force
  2. 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". 

This type of rape can happen in obstetrics: it's often called "birth rape." Having a c-section against your will - which can and does happen, contrary to those uninformed people who think it doesn't - is almost like the culmination of many of these key points into one event: the forced birth of your child. Your doctor has used scare tactics and fear to get you to comply, often when the actual risk level is so minute as to be almost non-existent; and/or used physical means to force you into a suboptimal birthing position - does this sound like rape to you? - (one mom on the My OB Said What?!? forum says she was strong-armed by two nurses and had her limbs held down in the lithotomy position). He may have withheld information from you on his c-section rates, or perhaps created in you a sense of protection that he personally would prevent such a terrible thing from happening and there was no need to educate yourself any further about your choices. Perhaps you're attempting a VBAC, and he was supportive of you at first, but isn't any longer. 

It's important to remember that, to some people, that's exactly what it feels like to have a vaginal exam that you don't consent to (and nor do you have to, either). Or an episiotomy they don't want (or need) - Tina Cassidy mentions this in her book "Birth", where the mother refused the procedure and told the doctor not to do it, but he'd already begun. Those people who tell the patient to shut up and get it over with ("just have the section already!") are enablers to the abuse. People who criticize women who use the term 'birth rape' 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 as a means of justifying it. 

Some people attribute it to a lack of compassion or understanding for their patients, almost like their common sense filters have been turned off, causing them to say stupid, heartless things without even thinking. Maybe, but I'm not totally convinced. How come there's no "My cardiologist/neurologist/gastroenterologist said what?!?" website? My family and I see a number of specialists for different things, and I've never been treated even remotely like this by any of them. 

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. Having information about providers and your choices before you get pregnant - because it can often be a long battle that draws out over the entire duration of a pregnancy - is probably tantamount, even though it sounds extreme. Being active in your birthing community by maintaining relationships with birth-friendly people, whether they're friends, midwives, doulas or whomever, can help you establish contacts that can prove very helpful in having a good birth experience. 

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

Thursday, May 13, 2010

Before there was Dr. Biter ...

The big buzz in the birthing community is the latest controversy over Dr. Robert Biter losing his hospital privileges in San Diego, California. But before him, there were others.

Back in 2005, Dr. Colleen Murphy of Anchorage, Alaska came under fire for her low c-section rates, which resulted, ultimately, in a three-year suspension of her medical license. Hospital privileges were also suspended at an Anchorage hospital, and a second hospital - Providence Alaska Medical Center - also revoked her privileges as well, although they reinstated her - and her license - several months later, along with an apology.

Apparently doctors at Alaska Regional Hospital felt she was putting 'patients at risk' by "allowing" women to experience a trial of labor after one or more cesareans. The license suspension was based on ten births attended in 2004, five of which, they claimed, she "failed to meet the minimum standard of care."

I'm curious what the 'minimum standard of care' is. A Pitocin drip for every patient, regardless of need? Premature rupture of membranes for no reason? And it seems that Dr. Murphy was only operating on ACOG Guidelines, that suggest a TOL for most VBAC patients is safer than a repeat cesarean. Obviously those "guidelines" are not followed very much, and were completely ignored in this case.

In the same year, Wilmington, NC OB Helen Sandland packed her bags and left New Haven Regional Medical Center after hospital administrators told her to "do more c-sections."

Dr. Sandland wrote in her resignation letter to the hospital: "I leave NHRMC with my morals and backbone absolutely uncorrupted." Thank God!

Still think your doctor always does what's in your best interests?

Both of these doctors are still practicing. Dr. Biter probably will, too, even if it means that patients will have to drive hours to get to him or make other crazy arrangements in order to have their babies delivered by him. All of them have patients with nothing but good things to say about their quality of care, yet the hospital doesn't care about that. In all its findings, I wonder if the committee in charge of suspending Dr. Murphy's license ever asked her patients what they thought about their care. If they ever looked at the outcomes of her patients - and their babies - not only in the short term, but in the long term as well. I find it scary that hospitals will basically admit that making money is their bottom line, even if it means doing something totally unnecessary to patients. It's alarming that all the way across the board - outside of the field of obstetrics, even - that "more is better" when it comes to patient care. No one seems to realize or want to admit that they're being used. You already feel like a cow when you're nine months pregnant; now you're being treated like one - a cash cow - by your doctor and the hospital.

Thank goodness there are still a few doctors left who see their patients as people - not just objects or slabs of meat to be dissected up for profit.

Sunday, May 9, 2010

Bring back Dr. Wonderful

At a rally outside Scripps Encinitas Hospital in San Diego, CA. 
Posted by a fan on the FaceBook group "I Love Dr. Biter! "

If you want a natural birth, you might find it's getting harder and harder to come by. Your friends will probably laugh at you, call you brave or crazy, and your doctor might sneer and mock you for your decision. It seems like few doctors will support you in your quest to have a healthy, normal birth - and this guy - Dr. Robert Biter - is one of them!

His patients call him 'Dr. Wonderful.' If he's so wonderful, then why has he lost his privileges at Scripps Encinitas Hospital in southern California?

Because he isn't doing enough c-sections. And because he's supporting mothers, giving them and their bodies a chance when few others will.

That's what I heard this morning when I logged onto FaceBook. I'd never even heard of this guy until this morning, and after I read this, my blood boiled for most of the day. I thought, You have got to be kidding me. But hey - look at the figures: a vaginal birth with no Pitocin, no epidural, and no interventions is probably cheap. Too cheap. Especially compared to a c-section.

I can see why his patients call him "Dr. Wonderful." In the photos posted over at The Navelgazing Midwife he looks like the baby's father, right in there with mom holding her hand or wiping her brow. Dressed in regular street clothes, not much identifies him as the doctor except the pair of sterile gloves. Dude, that rocks. There is nothing more psychologically and emotionally strengthening than a care provider who is right there with you, fighting the good fight to bring this baby into the world: not leaning over you, saying "You're not progressing fast enough - you're lousy at pushing!" and other nonsensical crap.

When women want a natural, normal birth, they head to Dr. Wonderful's office - in droves, apparently. He gets nothing but glowing reviews from patients when you Google his name:
"Dr. Biter is a fantastic doctor for delivering your baby! While most will show up at the last second to pull your child out while they're crowning - he will be there through the entire pushing process ..."
 "If you have a birth plan, this man will honor it..." (from a dad)
"Many of my friends have also delivered with him and each of us have had great birth experiences with him."
"I wanted an all-natural birth experience and he was totally on board. He really helped relax me and had that baby out in 30 minutes." (first-time mom)
There are lots more. Apparently if there are any negative reviews, it's because of the horrendous wait time. Of course it's bad - he's probably one of the most sought-after guys in the area. If I could birth with this guy, I'd probably camp out in his office for a week, if need be!

Scripps Encitas Maternity Center boasts of "high-tech equipment, medical care and comfort to offer you the world-class care that Scripps is known for." Apparently they haven't learned that high-tech isn't even necessary sometimes, and isn't always better. If they're so concerned about your care, then why are they trying to take away the one person who could help facilitate a happier, healthier birth experience? Now that's world-class care. But that doesn't make them any money. Sure, their patients are over the moon with their experiences and they and their babies do better for it, but the hospital's bankroll doesn't reflect that. In fact, what it says to the outside world is, "We are willing to force someone to put you and your baby at increased uncessary risk in order to fund our facility." That is definitely low class, not world-class.

Saturday, May 8, 2010

The Richest Moms in the World

Just in time for Mother's Day, Forbes Magazine has put out their 'Richest Moms in the World' list . I thought, "Oh, this ought to be interesting." I pictured the stories of hardworking moms who built fortunes from the ground up, raising a family at the same time, blah blah blah. Overcoming adversity and all that good stuff.

Not quite. When I opened the link, I saw the starched, made-up faces of women in their 70s and 80s, some younger ones mixed in, who, as predicted, inherited their fortunes from dead grandfathers, fathers and husbands. The only adversity some of these ladies likely saw was which nanny to choose for their children, and who would watch the kids while they holidayed in the South of France again this year? Bleh.

I wasn't surprised to read that only 70 women have billion-dollar fortunes in the entire world, compared to the "555 self-made billionaires who are fathers." And, says the article, of the 70, "just eight of these built their own."

I'm not sure what to think about that: as if so few women are capable of building a business that is very successful? Or that society puts pressure on women to thrive and succeed in business, while at the same time expecting them to be full-time, nurturing, perfect moms to boot? Or that a true measure of wealth, to most moms, has nothing to do with money, which perhaps explains why there are so few?

I'm a serious Little House on the Prairie addict, and one of my favorite episodes is "The Richest Man in Walnut Grove." Obviously the Ingalls family has little money and makes do with what they have. But to Charles, his riches come from having a loving family, and that's more important to him than any amount of money. I think most of us moms agree.

I don't know how much stock to put in the article, because really, all it shows to me is that these women knew how to pick 'em. I'm sure they have advisers to help them manage the fortunes they've acquired, so for some - maybe with the exception of Fidelity Investments' Abigail Johnson - it has little to do with having a head for business.

I know the economy is bad, etc. etc. etc. I know that living on one income is rough, because we've done it since even before we had kids. I know that for many families there is no choice but to have both parents working just to make ends meet. But I also know people who are a slave to their lifestyles: two (or three) cars, a summer house, swimming pool, and all the trimmings. Everyone in the family has a cell phone, satellite tv, more clothes than they could possibly wear, and toys out the ying-yang, yet "we don't have any money!" I guess the basic necessities are different from one family to another, but making real sacrifices to make ends meet (like ditching the premium cable package and choosing another cell phone plan) might save you some money each month. (Actually, we got rid of cable and switched to TracFone and are probably saving like $100 or more each month now.)

But I also know families of working mothers who choose a career for reasons that are inexplicable to me. One mom is concerned about tenure at her teaching position and sends her daughter to daycare, even during times she is off from school. Another mom works at a high-paying job even though her son has a terminal illness that will eventually claim his life before he's old enough to get married and have a family of his own. We get told every day by little old ladies hunched over from age that "these times go by fast, enjoy them!" and somehow, I don't know if we believe them. We nod and smile and think, "What a crazy old bat!" And yet, when things slow down and I have a moment to catch my breath, I think about that time and wonder where it went, even as a stay-at-home-mom who has had them all day, every day.

I can't help but think of the old adage, 'Money can't buy happiness.' One of the women on the list has one daughter, and they aren't even on speaking terms (related to her giving away millions of her vast fortune to someone other than her kid.) For others, it's never enough, and they always wish they had more.

For me, and probably most of us, having our children by our side, whenever we can, makes us way richer than these ladies.

Sunday, May 2, 2010

'No epidural for me: I'm brave'

I love Flair on FaceBook. But this one I didn't love - the "epidurals are for sissies" button. A literal "vag badge," perhaps?

That's kind of like the stupid comment I heard on a Baby Center board about VBACs: "No VBAC for me - I love my baby!" What the heck?

I know the person who made this Flair means well, but unfortunately comments like this only serve to further polarize the birthing community. We know that every woman is different, and thus every pregnancy is different. So is our individual level of pain tolerance. What is relatively painless for one woman might be excruciating to another. Add another set of circumstances in there, like fear, psychological issues like prior sexual molestation or abuse, medical issues like vaginismus, and the level of pain for one woman is completely different than the next.

I'm all for natural birth, and feel that out of my three births, the ones with spinal anesthesia produced infants who were slower to take to the breast and generally sleepier. But considering the risks of having an epidural, not to mention the unpleasant side effects that can sometimes happen, sometimes I wonder if the women getting the epidural are the brave ones. It's a good thing you can't see what's going on behind your back.

I'm sure if I looked hard enough, I'd find the "NCBers braid their toe hair and eat granola" Flair or something similar. Private thoughts aside, sometimes I think we need to just smile and nod, keeping our mouths shut. I would hate to have this flair posted to my wall and hurt the feelings of my friends, maybe one of whom had a horribly long, posterior labor that was quite painful. I had back labor for the first hour or so of my VBAC labor before my baby turned; I don't know how I would have coped had it lasted the entire time.

And some women who know the risks and go into it with an open mind end up getting the epi, whether because they were pressured or because the pain was just much more than they expected. I'm sure the one mom I know who suffered major internal damage as a result of her rather botched vaginal delivery was thinking that. I suppose, unless we don't have a horror story to tell, it's hard for us to remember that neither side is a complete walk in the park, and just about anything can happen.

I just like to say, "Maybe you won't need one; just wait and see what happens."

Saturday, May 1, 2010

Join me on FaceBook! (Another shameless plug)

Yes! I'm on FaceBook! Isn't it scary?

If you're a fan, I invite you to join The Deranged Housewife's Fan Page . Together, we will join forces to infiltrate the birth community! Or at least that's what I envision, anyway.

Feel free to "friend" me if you like as well! Whoopee! Ironically when I added my first "friend" the captcha word was "effacing." Is that a good sign or what?