"Dr." Amy to speak at September ACOG conference

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 

Woman sues clinic for failed abortion

Photo credit: andreyutzu/stock.xchng

I wasn't really sure I wanted to write about this - it's always a touchy subject, and I don't think we have enough time to go into detail on my feelings about abortion. But hey, what the heck.

I first read about this woman - a mom of a preschooler who attempted to have an abortion, which was unsuccessful - and ended happily (she's happy about it, just for the record) with the birth of a healthy, live infant. Thankfully, they posted a link (that most people either missed or didn't bother to read) that is a little more detailed than theirs.

The woman has a double uterus with two cervices (that's plural for cervix) - otherwise known as uterus didelphys. Apparently it's rather rare and goes undiagnosed unless the woman has problems, such as miscarriages and preterm births. From what I understand, uterine defects - especially this one - can cause repeated miscarriages, pre-term births and intrauterine growth restriction, depending on the severity of the defect. I myself have a bicornuate uterus, which is a heart-shaped variation that at the very least is why two of my children were not able to turn into the vertex position before birth.

According to the article, during the woman's first pregnancy the embryo implanted in the right uterus, producing a healthy, preterm infant delivered by cesarean. Unfortunately, the second pregnancy implanted in the left portion, and doctors felt that it could jeopardize the life of the mother if she remained pregnant.

I don't necessarily fault her for following the advice of her doctor. Nothing in this article made her sound cruel, heartless, or any of the other vile comments that some people made. She followed the advice of her physician, something many pregnant women do every day. Is the doctor always right? Depending on who you ask, that might be subject to debate.

I've read some literature from at least one OB who said that oftentimes women are given a grave diagnosis and decide to abort based on that opinion alone. Some, he reported, sought him for a second opinion and were surprised that it might not be as terribly serious as they once thought (and some definitely seek second and even third opinions only to be told the same devastating news). Really, though, when you think about it: childbirth advocates and many others often realize that many obstetricians are taught that pregnancy is an illness, a pathology. What else can you expect?

If indeed her doctor's advice was premature, or he was unnecessarily trying to scare her, this again can point the finger at doctors who are quick to suggest abortion for anomalies that are not as life-threatening as once thought. If anything, his suggestion that her uterus would be "too weak" may have been misguided or bad advice, but it all depends on the degree of deformity. If her doctor's advice really wasn't that sound, then he failed her. How many times have you heard someone say, "Just trust your doctor!" How about when he's telling you "You're stupid for attempting a VBAC, it's so dangerous,""I can't believe you're planning a home birth - are you trying to kill your baby?"

How can we fault her for just taking her doctor's advice, something every pregnant woman is encouraged to do?

So to get to the details: this woman sought an abortion from a clinic and they supposedly announced her free and clear after the procedure, only for her to find out she was still pregnant. I'm sorry, but I don't see how they can even begin to deny her claim: if you go in for an abortion and something is allegedly done to you, if you remain pregnant it's clear that they didn't do their job, correct? How can they deny no wrongdoing or negligence?

This woman then spent the rest of her pregnancy wondering what would happen: would her baby be born prematurely? Would her water break at 18 weeks and the baby die anyway, compounded by the failed efforts of the abortion clinic? I can't imagine her fear - then wondering, once the baby was born, if there would be lasting complications. And lastly, wondering, if they didn't perform an abortion, what the hell *did* they do to me?! 

The point remains: they were negligent. They screwed up. Whatever the case, they said they were doing something - for a fee - and they didn't do it. What if something terrible had happened? If she had had an ectopic pregnancy and they handled it this way, there's probably little doubt that she'd be dead by now. If they didn't get sued or at least called out by her, who else are they going to mess up with?

Maternity leave rates around the world

It may come as a shock to some, and not to others, that the US is one - if not the only - nation that does not offer mandatory paid maternity leave to new mothers.

It makes the US sound pretty darned bad to be stacked up against third-world nations who seemingly offer better for their women. Maybe, maybe not. Even working a dead-end job you hate is arguably better than no prospects at all. Some of the countries on this list made me wonder: What is it like giving birth in, say, the Democratic Republic of the Congo? What's it like living and working there?

My husband visited there last year and he could probably tell you better than I: if you are lucky to have a job, you will get, according to statistics, 14 weeks of partially paid maternity leave. Among the Congolese, however, about one in 13 women dies during childbirth, ranking them 17th in the world for maternal deaths. My husband was awestruck by the dichotomy of living conditions there: in the villages, at least one man took in many children (almost a dozen) who were either his own or orphaned, doling out food to the family and himself often not eating for days at a time. On the flight in from Brussels, only the wealthiest of Congolese could even begin to afford a plane ticket, and you would be sitting amongst only the upper crust of businessmen and women, not average citizens. In the city of Kinshasa, he noted the absolute dismal filth, and the children who would crush rocks and pebbles into sand to sell for a little extra money. He even got a tour of the local hospital (where Hillary Clinton once visited), which has a large wall around it to keep out the 'dregs.'

Yes, the same country that requires a woman's employer to grant her maternity leave and a part of her wages is also the same government that employs soldiers who help themselves to your possessions and house, because the military is grossly underpaid and pissed off that they can't feed their own families. They are also the same government that sanctions rape of their women, sometimes upwards of 100 victims at a time. In many aspects of life there, much of the female Congolese population are treated like shit. So who cares if they get paid maternity leave? (It's a wonder, really...)

One would wonder, then, especially among these poorest nations, what percentage of those women really get maternity leave? Likely precious few.

More reading:
Congo-Kinshasa: Where giving birth is deadly
In US, maternity leave benefits are still dismal
Women for Women International

WTH?! Wednesdays: Pinkwashing Hall of Fame

Now that we're seeing pink ribbons literally adorning everything, I've become acutely aware of them when I'm out shopping and doing things. They're everywhere. They're multiplying, it seems, and can be found on the strangest of items.

This Pinterest board is worth sharing, as it highlights the absurdities and questionable practices surrounding the breast cancer awareness campaigns. One thing is quite clear: whether they donate to research or not, it's an industry - a marketing ploy that gets you to feel better about spending money. I wonder, what do cancer victims and survivors think of that? That someone is basically making money off of their disease? Has anyone ever asked them or are they just "bitching?"

This election cycle we're constantly hearing about the "war on women." I argue that there are many of them being waged, some silently, some not so much, and this is just one of them. Because it won't take long before someone criticizes your "poor attitude" in questioning the ethics of raising money for cancer awareness, or where the money really goes. If you dare question it, you're unfriended, blocked, criticized, told to "get a life" because you want to show what real awareness looks like: maybe a recovering mastectomy patient, not someone decked out in pink and white and prettied up for the cameras. It seems to be the one real truth no one wants to see.

One thing that really makes me shake my head are the campaigns to raise awareness that are from products that can actually raise your risk of cancer. Some of the companies responsible for donating millions (hey, good for them!) are also simultaneously marketing products that are putting their very user at risk for the disease. Go figure. Here's a short list:

Nestle has donated probably gagillions of money (Ok, I don't have a source for that LOL) towards breast cancer awareness and research, yet is only "phasing out" the cancer-causing plasticizer BPA from their water bottles. While I don't necessarily fault them for that, I do fault them for their long-standing heavy marketing of infant formula to mothers who are either in vulnerable populations or just being part and parcel of convincing otherwise capable women that breastmilk is inferior. You can slap the words "breast is best, but...." on your container a hundred times, but it doesn't help. Guilty of sending in official-looking "milk nurses" into poor African nations, Nestle effectively 'hooked' mothers on the stuff and had them believing their own milk was inferior. Not only would their breastmilk then dry up, but they'd be forced to buy more of the product they had no money to buy, and reconstitute it with contaminated water, leading to sickness and even death of the baby.

While only recently has the link been made to breastfeeding and cancer prevention, the health benefits to both mother and baby have been well-established. The presence they and their counterparts had (and continue to have) in influencing cultural trends and thus destroying any chance of a successful breastfeeding relationship could very well have lead to increasing cancer rates among women for decades.

Exposure to cleaning products is one plausible link to breast cancer, according to some studies. When you think about it, females are generally more likely to be in more direct contact with these products, and for longer periods of time (no offense to guys who clean). It's reasonable to suggest that products can also be leached into the bloodstream and can affect the offspring of their users as well. Have you ever looked on a bottle of cleaning solution? The ingredients are usually not listed - either because there wouldn't be enough room on the label, or they're too scary to think about.

Many of the products that contain known carcinogens are manufactured by companies that donate heavily to breast cancer awareness and research. One marketing ploy I find kind of annoying is how many of these products are geared towards women - even though yes, men do clean, and men do get breast cancer. A pink mop or Swiffer? Pink dishwashing gloves? Gee, thanks a lot.

The cleaning aisle at Walmart was awash (no pun intended) with a sea of pink ribbons, mops, dusters and other garbage. As far as I could tell, when I looked closely for the "We donate money to the cause" disclaimer, there was nothing on the label - or on Swiffer's website - that indicated any money went towards breast cancer anything of any kind. Not surprising.

The chemical industry also produces plasticizers that have known feminizing agents in them, that have been in use for decades. Plastic wraps, containers that are re-heated again and again and leach into your food, as well as agents in shampoos, makeup, personal care products, children's toys  and baby bottles are also points of controversy, and many of these byproducts would be found in the bloodstream of just about anyone - including unborn children.

Photo credit: USAToday, 10/5/2010

The alcohol industry has also been quick to jump on the bandwagon, but not without notice. Many are questioning that one, since studies have shown that alcohol consumption can be a risk factor in the disease. The image above angered some cancer survivors, and I can see why. Another article from CNN with the headline "Buy a bottle, save a breast" irked others who felt - and I agree - that we're focusing more on the breast than the person attached to it.

The sex industry seems to be the most recent player in the "awareness" game. Although I can't prove it anymore, this image was taken last year from the "Save the Boobies" breast cancer "awareness" fan page on Facebook, but when I went back to look for it, it had been taken down. This is their idea of a "breast exam."

The porn industry has graciously? donated a penny per view of their breast-related content towards breast cancer awareness, but I argue that really the only thing we're aware of is breasts. Not the illness itself, the risk factors or prevention techniques, not the reality of it at all, but simply breasts. It's another way to use controversial, if not completely offensive images, slogans and questionable marketing ploys to get people to support a feel-good cause. It goes much further to damage any real awareness, though, because we are so used to seeing images like this one in public - yet one very good way to lower your risk is to breastfeed, which no one wants to see you do. With the combination efforts of the infant formula industry and overt sexualization of the breast, an important preventative measure has now been nearly quashed.

Using cutesy slogans like "boobies," "tits," "hooters" and other sexualized euphemisms is equally offensive, in my opinion, because it not only sounds degrading and juvenile, but tends to make light of a very serious, often debilitating, disfiguring and deadly disease that can devastate entire families. I know we can't all be serious all the time, but I think because we often see too much of this kind of "advocacy" we don't take it seriously enough.

The food industry is equally guilty of just slapping a ribbon on things and calling it "good." I can't even begin to detail the chemicals and other crap we're ingesting every day, meal after meal for years, that likely contributes to breast cancer (if not a whole host of other cancers). Some additives actually have estrogen-like qualities and therefore could contribute directly to estrogen-fed cancers. Of course some foods have naturally-occuring estrogen-like properties (soy, for instance).

It's impossible to pinpoint so we use terms like "could" and "probably," because there are so many factors it might be impossible to tell for sure. But just in reading the list of ingredients, you know it can't be all that good, can it?

Ultimately there is so much we don't know, at least for now. I don't want to come off as a complete wacko conspiracy theorist, but even these obvious links should be enough to make you wonder where we get our information from, and make us question the motives of people and companies who want us to think we're helping for a good cause. Questions we should ask ourselves before we "think pink" include:
1. Does this product contribute to cancer in some way?
2. Does this product or slogan objectify the breast and women in general?
3. Is my money even going to the cause?
4. How much money is this group actually donating to research? To raising "true" awareness?
5. Does this campaign, slogan or product do more to hurt cancer victims and survivors than actually help them?

More reading:
Buying pink may not mean what you think - YouTube
Seven controversial pink products for breast cancer awareness

Book Giveaway! The Immortal Life of Henrietta Lacks

What an amazing, heartfelt book. The book details the life of Henrietta Lacks and how she became the unwitting progenitor for landmark advances in medicine - and yet never saw a penny for any of it. Among the book's timely topics are HPV and cervical cancer as well as the raging debate over informed consent - especially for the indigent.

Read more about the book here: Amazon.com review

If you'd like to be eligible to win a copy, post a message in the comments section with your name and contact information - please make sure you either leave an email address for me to contact you, or enable your profile to receive email so I can reach you if your name is picked. This is very important - because even if you leave a comment, if I can't contact you then you won't be eligible. Comments must be received by noon Monday, March 6, 2012. 

Good luck!

Facebook censorship reaches a new level of absurdity

If you're a natural birth and/or pro-breastfeeding advocate, you've likely heard about Facebook's ridiculous stance on breastfeeding photos - and how they frequently leave up images that show half-naked women doing anything but breastfeeding. But lately their ironic censorship has reached a new level of battshittery.

Photo credit: Seana Berglund

This photo, showing a woman's placenta, was removed. According to a leaked document, these are guidelines on content Facebook finds objectionable: "Depicting the mutilation of people or animals, or decapitated, dismembered, charred, or burning humans...Photos and digital images showing internal organs, bone, muscle, tendons, etc. Deep flesh wounds are ok to show; excessive blood is ok to show.... Crushed heads, limbs, etc. are ok as long as no insides are showing. ... Note: No exception for news or awareness related content."

I can appreciate that when it comes to certain issues, Facebook has a conundrum on their hands: intent can mean a lot when it comes to what you're posting. And obviously the placenta is an internal organ, but there is nothing threatening about a life-giving organ such as this. Unfortunately, it seems like when it comes to this policy, Facebook has it bassackwards: "crushed heads" are okay - I can't think of a context where that's necessary except in gory accident photos or some kind of horror film exposition - but the placenta is not. What?

And how can images of internal organs, bones and tendons be a good thing? If they're used for educational purposes, in which they're done all the time. So in their minds, a medical textbook - or educational photo such as the one above - is wrong. Not even news photos - taken by someone who obviously thinks the reader can gain some insight from seeing it - is appropriate, according to them.
But, in an ironic twist, the photo from a pro-life group showing "what an abortionist does" was removed - presumably because yes, it shows a mutilated, dismembered .... wait a minute. Human? Can we call it that? Since some argue that up until a certain point the fetus isn't a human being, or a "person," what should we call it? If, in fact, it's not a human being, then it should be allowed to show under the "excessive blood and crushed head" rule, maybe? Insides are showing, yes - but again, if it's not technically considered a human, then what?

Whew. I think we're stepping into dangerous territory here.

Which brings us to the next image. This one was removed as objectionable content, presumably flagged by users, and then reinstated - with an apology - from Facebook.

This content, posted by Dutch physician Rebecca Gomperts, clearly shows how a woman can abort her fetus by taking misoprostol, or Cytotec.

Several things bother me about this, and I feel that Facebook is ridiculously libelous in reinstating, and apologizing for removing, this content.

Whether she's a physician or not, Gomperts has no business offering this information in the form of a profile photo - presented like a prescription - to a woman she's never even seen before. She has no idea the age, health condition or anything, really, about the audience she's reaching, and whether Cytotec is really appropriate for them or not. Drug allergies? Sorry, no clue. Whether you're really nine weeks along or not? Nope. Not sure of that either. And her suggestion to see a doctor only if complications arise is essentially asking another physician to finish what she started - for good or bad.

Both in the profile photo and on her website, she advocates lying to medical staff - something that could interfere with your care, depending on the situation. And I'm not sure that doctors are all that stupid that they won't figure something out. If you're not telling them the truth, how can they adequately care for you?

Not only that, but it's laughably insane that she makes presumably desperate and troubled women think that they can just walk into any pharmacy around the world and demand this product. Depending on who's reading it, the dispensing laws could vary greatly. One could probably get it over the internet without a prescription, which is illegal, and possibly dangerous - in that you can't really guarantee what product you're taking, or who it came from, by ordering in online. And ironically, her website warns against doing that because of the risk of receiving a fake product. God only knows what could happen then: either it won't work and you'll still be pregnant, or it could do some serious damage to your health. I hear another giant can of worms opening somewhere...

After taking the pills, you are supposed to take a pregnancy test within three weeks (at which your fetus presumably would be a maximum of 12 weeks old, which could dramatically change the course of treatment if you were still pregnant). What do you do if the test is still positive? Call Dr. Gomperts?

Oh yeah, about that. Up until a few years ago she'd probably be in the middle of the North Atlantic on a ship, offering medical abortions to women from various countries who seek her care. I'm not even going to go there - except to wonder what kind of follow up care these women received to make sure everything really went as planned. Does she care? Would she just hand you over to someone else? Or would she wait around to make sure it's all the way it should be? If you regret your decision, which some women actually do, will she offer post-abortion counseling? Probably not, as she'd likely be halfway across the Atlantic by then.

For "practical" reasons, she stated that she didn't perform surgical abortions on the ship, presumably because she didn't have the resources. Her reasoning was because it would require about 20 minutes per woman, and for legal reasons they didn't want to be out in international waters that long. (Not, I guess, because they really wanted to make sure you were okay after the procedure.)

I'm not arguing that if a woman really wants to do this, she'll do it anyway. What I do find extremely alarming is the detached, remote attitude of this doctor - and how it presumably insinuates that this woman will be alone, on her own, in her decision, with possibly no support. If something goes wrong, who is to blame? Gomperts? Facebook, because of the bad outcome? How are they going to handle the potential liability? Misoprostol does have a failure rate and some women will need further procedures in that event. Even though it's a small percentage, it's a very real risk. And it's also never been FDA-approved as a standalone abortifacient.

It's important to note that just as it can happen in a laboring woman, a uterine rupture, although rare, can happen when inducing abortion with misoprostol. At the very least, this can cause excess bleeding, and possibly impact future pregnancies, should you decide to want additional children. And some factors, according to one reference, site the rising cesarean rate as a factor, ironically:

"Uterine rupture with the use of misoprostol has been reported more frequently in multiparous women and in women with uterine scars. It is more often observed at term than in the second trimester [3]. The rate of caesarean births has been on the rise, it has lead to and increasing numbers of women with a uterine scar seeking TOP [3–7]."

(Interestingly they mention the risk of rupture at term, something few OBs are willing to do when it comes to inductions of labor.)

The subject of the case report was a 27-year-old mother of two with no prior uterine scar who sought a termination (referred to as TOP) at 10 weeks, based on her last menstrual period. (Ultrasound revealed she was really 16w5d instead.) After having an incomplete abortion with the use of misoprostol, she went back for a follow-up procedure, where it was found that she had sustained a uterine rupture and 50 ml of blood was noted in the abdomen and the woman was prepped immediately for surgery.

Now, as rare as that can be, can you imagine going through that as a scared, lonely teenager - by yourself? Based on information you found on the internet?

Surprisingly, as far as I can tell in the black hole of Facebook rules and regulations, there is no rule against dispensing medical advice on their site. Which means I could presumably tell people how to use any type of drug to do anything, whether it's legal or not, and whether it's truly "safe" or not. I'm obviously not a physician, but why should that stop me, according to their rules? And haven't we all, at one time or another, seen, heard or witnessed a physician giving very bad advice? Just because they have a medical degree does not make them perfect. It doesn't even mean they always, absolutely know what they're doing.

After Gomperts' ship was sunk, so to speak, she decided to offer pills online through her website. A physician would ask the patient, someone living in a country where abortion was illegal, about two dozen questions over the internet to check for contraindications and the pills were shipped out in a plain envelope.

The issue of prescribing without even seeing the patient is still a problem. If you're a woman living in a country where you can be prosecuted for having an abortion, what happens if you take these pills and something goes wrong? Will you avoid the doctor because of the fear of getting in trouble? Will Gomperts' organization face prosecution because they prescribed you - even after answering those 20 questions - a medication without seeing you? What if the person is lying, out of desperation to just get it done and over with?

The bottom line in Gomperts' profile photo is that it's irresponsible. It glosses over the need for crucial follow up care and doesn't stress the reasons why you should seek it, especially if the misoprostol was ineffective. And it doesn't adequately address the risks associated with it, or the potential failure rate (which is between 10-15 percent). How is this adequate informed consent?

Again, if you want to do this, you're going to do it anyway - I'm not denying that. But to ignore the possible complications of doing something like this is irresponsible, and I bet if it were any other medical predicament besides this, we'd be up in arms. 

You've lost that lovin' feeling

If you've ever opened a spam email, seen an infomercial or traveled down the vitamin aisle at the pharmacy, you have probably seen the (often ridiculous) products marketed to men to the improve their sex drive. The commercials for Levitra and similar products are vomit-inducing for sure, and kind of make me laugh - what about all those women with low sex drive? Who are these women that men are trying to please by rushing out to order libido enhancers?

The claims they make are laughable - and I can't believe reputable pharmacies are actually selling this crap. But what I want to know is, where are the female enhancement pills? Why does no one seem to care about that?

According to one 2008 study, upwards of 40 percent of women report having a low sex drive. While the Levitra ads are geared towards people reaching retirement age, studies indicate young women have this problem, too. Many think that use of antidepressants and birth control can be to blame - Paxil, for one, is a known killer of the sex drive. Apparently, many of the women in the study also reported being depressed - and noticed a further decrease in libido when using antidepressants.

Guess what? Depression and low sex drive can also be signs of a thyroid disorder! Of course, the article doesn't mention the word "thyroid" as a cause anywhere. Many popular medical sites often do not include low sex drive as a symptom; in fact, one site suggested it was only a problem in men.

Women are often embarrassed to talk about sexual problems with their doctors, and many times it's blamed on lifestyle: busy, working full time, raising children, "you're tired!" Nah, I don't think so. While it can certainly contribute to that, it often doesn't get to the root of the problem. And if your care provider doesn't know it's a symptom, they're more likely to brush you off.

Awhile back I blogged about a friend who's doctor insisted she "stop drinking too much soda pop" in response to her noticeable weight gain, even though she doesn't drink pop, she said. As far as her excruciatingly low sex drive, her doctor's advice was to "fake it." How horrifying.

So, we market millions of dollars worth of junk medicine to men in an attempt to restore their "function," but women get relegated to the back burner - perhaps even ignored and brushed off - when it comes to their sexual problems. 'Just blame it on kids!'

Ladies, just another reason to get your thyroid tested. And men, skip the worthless enhancement pills and get yours checked, too!

More reading:
Low Sex Drive and Thyroid Disease
Sex Drive 101 for Thyroid Patients
Low sex drive in women

The pregnant woman as public property

Marathon runner Amber Miller gave birth within hours of
finishing the Chicago Marathon. The way people criticize
her, you'd think she gave birth along the way and kept
running with the baby still attached or something.
Photo credit: Griska Niewiadomski.

I was all set to finish my series of posts on vaccines when this story grabbed my attention: marathon runner Amber Miller gave birth to her second child within hours of finishing the Chicago Marathon. Pardon my ADD postings, but reading about this amazing lady was just awesome! Until I got to the comments section, that is.

Of course - whenever there's a story in the news about a pregnant woman doing something, there are sure to be a plethora of stupid ass comments to follow. Remember when a pregnant lady walked into a bar?... almost sounds like a bad joke. Unfortunately, it wasn't: back in January, a story hit the news about a woman who was eight months pregnant walking into a bar with friends. She had flown into town for her baby shower, and her friends convinced her to go out for a few hours with them.

But her effort at late-night fun lasted a whopping 15 minutes. No sooner than Lee had arrived, a bouncer at the the Coach House Restaurant told her she had to leave; no pregnant women allowed.

Too bad she wasn't drinking anything stronger than water. She was seen at the bar with a friend who was doing shots. Perhaps she was keeping track for her, who knows. Whatever the case, even though law enforcement said there is "no reason" she should have been asked to leave the bar, the bouncer escorted her out.

I'm sure the bar is concerned about rowdy patrons and bar fights like you see in the movies. However, one can easily surmise that they would do the same thing they did to this woman: ask the offending patrons to leave the restaurant. And no where in the article does it mention anything about a scuffle, flying beer mugs or overturned tables. Really, though - if that kind of thing were going on while this woman was inside, don't you think she'd do what most reasonable pregnant women would? She'd leave the area. It's not like she's going to body slam someone and join in.

The woman did not partake of any alcoholic beverages, and it can be assumed that just like everywhere else, there is no public smoking in restaurants in the state of Illinois, where this took place. And even if she had a glass of wine - which is, according to some, okay for a pregnant woman - who are they to decide for her whether she is using good judgment or not? Since when does that give strangers the right to police our actions once it's obvious we are pregnant? What are you going to do - give every woman of childbearing age a pregnancy test before she enters the bar area, just in case?

Just like in Amber Miller's case, there is a familiar pattern here: treating the pregnant woman like public property, as if she is incapable of making decisions for herself and her unborn child.

It seems like once you are visibly pregnant, people feel the need to comment endlessly on your condition, touch your belly, and step in and make decisions on your behalf. I'm not sure what it is about pregnancy that makes perfect strangers feel the need to treat us like helpless idiots who have no brains, feelings or an original thought of our own.

Several years ago (before the days of officially no smoking inside public buildings) I worked in a pharmacy with a pregnant woman. Our boss would sit behind a partition during his breaks and smoke. Somehow I don't remember the smoke being that bad, but at least one customer felt the need to comment curtly on how she didn't think pregnant women should smoke. While now I think our boss should have had the courtesy to go outside and do it, Tara didn't seem to mind and just gave that customer a sweet "Go screw yourself" smile and moved on. (Tara also worked her last shift before maternity leave all while having contractions, and when her shift ended she calmly proclaimed, "Okay, I'm going to the hospital now to have the baby. See you in a few weeks." Wow, that's my kind of woman. I think she had the baby less than an hour after getting there, with no epidural.)

Amber was, according to several articles, in excellent physical condition - she'd have to be, in order to run a marathon only ten months after her first child was born. People called her stupid and selfish, and some suggested that her baby should be taken away by child protective services! Many questioned the authority of her doctor for even giving her permission to run it in the first place.  Of course, if she had done it without his permission, they would have raked her over the coals just the same. Amber walked and ran the race, so I'm sure she realized her obvious limitations and didn't try to push herself. It's not like she was in a dead sprint the entire time. Some use foul language and call her names - you'd think she was doing crystal meth on the sidelines or something.

The pervasive myths about pregnancy continue, as usual: that a woman is in a "delicate condition" and must be treated like a piece of glass about to shatter. I'd love to talk to Amber and see how her labor went - she apparently gave birth little more than two hours after getting to the hospital (before stopping on her way to get a sandwich, though). I don't know what her philosophy on birth is, but I'd say she did everything right: kept herself in great physical shape, remained upright and moving and ate while in labor - all of which can help speed up labor and make delivery easier. The comments that demonize her are based in the ignorance that a laboring woman needs to be shackled to the bed with continuous monitoring, tubes and wires - not have the audacity to keep moving, and even (gasp!) eat a sandwich. When the only thing you know about pregnancy and birth comes from "A Baby Story" it's not a wonder the comments she received were so inane.

Amber, I want to tell you that you did everything right and congratulations on your baby and your marathon! I can't wait to read about then next one. :)

More reading:
Photo finish: Woman gives birth after running (and walking) marathon - chicagotribune.com
Woman gives birth after running Chicago Marathon - CBS News
Woman gives birth after running Chicago Marathon - Chicago Sun-Times

Gardasil and the systematic destruction of Michele Bachmann

As the election season draws closer, there is a lot of media attention on Minnesota Republican Michele Bachmann - namely a systematic destruction of her career a la Sarah Palin - because of Bachmann's views on the controversial HPV vaccine, Gardasil.

Many were not happy when Texas governor Rick Perry voted to push through legislation that would make it mandatory for the vaccine to be administered to Texas school kids. Some, including Bachmann, criticized him for being 'sold out' by the vaccine's manufacturer for the tidy sum of $5,000. Perhaps, but I'm not so sure. I think he was just drinking the Kool-Aid prepared for him by Merck - the same crap doctors, nurses, and just about everyone else feeds to us when it comes to making informed decisions for our kids.

The other day I decided to flip on the TV and watch a little Fox News, only to see a group discussing Bachmann and her 'radical' views on Gardasil on Greg Gutfeld's segment. One contributor said she couldn't understand what the big deal was and called the vaccine a "wonder drug for women," and made a reference to schools requiring vaccines anyway - so what's the big deal about this one?

During a news break just a few hours before, the news anchor made Bachmann sound like a complete moron for daring to question "science." Everyone is trying to make her look as pathetic and idiotic as they did Sarah Palin, nitpicking and ridiculing at every turn.

She's the candidate everyone loves to hate - and no one wants to admit that they agree with. Dr. Manny Alverez, a Fox News contributor, stated his piece on their website that he has to 'side with Governor Perry' on this one, but doesn't agree that it should be mandated by the government. He also goes on to say that it isn't 100 percent effective at preventing or treating all strains, and thinks Perry made the wrong move by endorsing it. Well then, it doesn't sound like you are siding with Perry at all, does it? Did I read that correctly?

He latches on to her claim that a parent told her it caused her child's mental retardation after she received the vaccine. True or not, he isn't making any mention whatsoever of the potential side effects of this or any other vaccine, a completely legitimate argument not to vaccinate. Bachmann never said she personally made the claim, only related the story of someone else that did - and Merck immediately, unsurprisingly, went on the defensive.

Basically what I have noticed is that they are completely ignoring the issues surrounding Gardasil - whether they're political, philosophical, medical or spiritual - and ganging up on her to destroy her credibility and her reputation. No one mentions anything about side effects or potential complications, or that it ideally should be administered to children as young as nine years old.

Apparently Perry's legislation did include an opt out* for parents, but that also seems to be publicized little. Some argue that bureaucratic red tape could make it difficult or virtually impossible to refuse, combined with pressure from districts to go ahead with it. The word 'mandate' implies that parents don't have a choice when really they do, but I bet Merck and others involved want you to think you don't - sort of the "if you can't beat 'em, you might as well join 'em" approach.

What everyone except Bachmann seems to be missing is the idea that yes, this threatens personal liberty - that of the child in question and that child's parents. The state, to some extent, does intervene in our lives, in the sense that we would be arrested if we were doing our children bodily harm. Unfortunately to some, not vaccinating your child constitutes as 'bodily harm.' Where do you draw the line?

As a result, the State of California is giving children as young as 12 years old the power of informed consent to be given Gardasil, without their parents' knowledge. Groups that support the legislation include the ACLU, ACOG, and Planned Parenthood, and opposition is considered "largely faith-based." (I find it laughable that the ACLU, of all organizations, is basically saying only the rights of certain people - in this case, not the parents - count.)  I find this probably the most alarming, least-talked about aspect.

As parents, we know how hard it often is to refuse vaccinations at the doctors' office that we might philosophically disagree with, and are frequently pressured by pediatricians, healthcare workers, school nurses, friends and family to vaccinate for everything, without question. How then, do you expect a 12-year-old to adequately make that decision? And why are they essentially ignoring the rights of the parents? What happens if a well-informed child tries to refuse? And if children are fed scare tactics to get the shot, but know their parents don't approve, isn't this essentially a situation of the school district (and the state) pitting the child against her parents?

Apparently this legislation is part of an already existing bill that enables children as young as 12 to seek treatment and testing for STD's without parental permission. (Click here) The thinking is that those kids who are too afraid to talk to their parents will get the treatment they need. Unfortunately, I think that is only feeding the problem.

The core issue at the heart of the state-forced Gardasil vaccine is that parents are not often adequately talking to their kids about sex. Period. Kids know little information about what constitutes sexual contact, and parents admit to not having appropriate conversations with their children about it. The state, in an effort to curb STD and pregnancy rates in teens, has no doubt decided to do the parents' jobs for them - figuring that if they don't, we will.

The problem is, many parents do educate their  children about the reality of sexual relationships and the dangers of STDs. In many circles this vaccine, and our overall sheeple mentality on vaccines in general, is that it will fully protect our children 100 percent of the time. Even though some suggest educated teens do wait longer to have sex, there is still the idea that "teens are teens" and will do this sort of thing, so why not provide a safety blanket of sorts. Others think that safety blanket is not enough, and it might fool teenagers into thinking they have a green light to engage in even riskier behavior.

In order for the vaccine to work, it's suggested that patients receive three doses, and some are speculating that often the girl doesn't get the remaining two vaccines. You're considered more at-risk for HPV if you've had multiple sex partners, or been with someone who has. Additionally, the younger a girl is when she starts having sex can also increase her risk. The irony in this is that culturally, we seem to condone teen sex or even embrace and tolerate it in an effort to remove the stigma. Combined with the fact that many parents do not adequately inform their teens about the potentially life-threatening repercussions of sexual relationships, this is like setting a trap for our children and then pushing them into it. Even so, is that really up to the state to decide?

In the meantime, legislators had to disclose that Merck personally paid them to push legislation through. And at $360 for a trio of doses, that's a lot of money the drug manufacturer stands to gain.

The Gardasil problem joins a number of other ones surrounding our medical community. What once started out as an altruistic approach for the common good, now the boundaries are blurred as more and more people want to take initiatives to force that "common good" on others. Forced or coerced vaccinations are just the tip of the iceberg; it's not unheard of for women to be forced into cesareans by court order, or for cancer patients who refuse treatment to be ordered to do so. A UK woman with severe hospital phobia and "learning difficulties" has been the subject of just such a debate, and was ordered into surgery to save her from potentially fatal cancer. What does it take to deem a patient unfit to make their own medical decisions? Probably not a whole lot.

Because Bachmann is essentially questioning the motives of the medical community and others' blind trust in it, I think it will be hard for her to wade through the mire of opponents. I'll also be waiting to see if Merck personally decides to take action to shut her up already regarding her claims on Gardasil, or if the media will essentially take care of that problem for them.

I'm seeing an interesting turn of events, though - perhaps what will amount to parents on both sides of the political and faith-based spectrum siding with Bachmann because she is such an outspoken opponent of this policy.

More reading:
Judge criticizes council for trying to force contraception on woman - The UK Telegraph
One More Girl - Truth About Gardasil documentary
Bachmann's Vaccine Theory pulls GOP to Jenny McCarthy Territory 

*The Association of American Physicians and Surgeons, Inc. issued this statement on Perry's approach to state-mandated Gardasil, as copied and pasted from the blog, "A Time for Choosing:"

“Opting-Out” of HPV Vaccine WILL NOT WORK for Many in Texas

Governor Perry is misleading legislators and families in Texas by claiming that they will be able to “opt-out” of having their 6th grade daughter vaccinated with the vaccine for the sexually transmitted virus HPV. For many families currently, the exemption isn’t worth the piece of paper it is printed on. Besides the simple fact that parents should not have to get permission from the state to make informed consent medical decisions for their own children, here are four reasons why “opting-out” of state mandated vaccines doesn’t work for many families in Texas:

“Opt-out” or Conscientious Exemption to Vaccination Process is a Bureaucratic Nightmare

To get the exemption form, parents must first submit a written form to State Health Department in Austin which forces the disclosure of the child’s full name, birthdate, and mailing address. The Health Department takes those written requests and creates yet another form on which they print the child’s same personal information that the parent had to send to health department, and the Health Department sometimes takes weeks to mail out these forms inevitably disrupting the child’s school attendance. The Health Department only sends the forms by U.S. mail, and once the parent receives the forms, they must be notarized within 90 days of submitting them and then repeatedly resubmitted every 2 years even though there is no expiration set in statute.

[1] Because the Health Department further eroded parental rights by publishing more rules getting rid of provisional enrollment for exemptions, (families used to have 30 days at the beginning of school to get their paperwork in), now schools participate in aggressive misleading education campaigns touting “no shots – no school” while not informing families of the exemption or the instructions how to obtain it.

Private Schools Deny Admission

The Texas attorney general issued an opinion in April of 2006, ga0420, that states that private schools do not have to accept the conscience exemption to vaccination in Texas Law[2], and many private schools do not. For example, the Dallas Diocese for Catholic Schools policy number 5024 states, “Schools will comply with immunization requirements established by the Texas Catholic Conference Education Department. Conscientious objections/waivers are not accepted in schools of the Diocese.” [3] Every new vaccine mandate causes more children with valid legal exemptions to be denied their private school education.

Doctors Refuse Medical Care

Even though you may be able to get a piece of paper from the state health department affirming your right to refuse state mandated vaccines for your child, just try and find a doctor who will honor it! According to a recent study published in the Archives of Pediatrics and Adolescent Medicine, 39% of pediatricians surveyed said they would throw kids out of practices who are not vaccinated. [4] PROVE has documented this rampant problem of doctors dismissing families utilizing a vaccine exemption in Texas to the legislature in previous sessions. Please review our report entitled “The Erosion of Public Trust & Informed Consent through Immunization Harassment, Discrimination and Coercion” prepared for the House Public Health Committee in 2005. [5]

Insurance Rates Rise and Accessibility Affected

Responsible parents who have secured health care coverage for their children will be forced to pay higher insurance rates whether they want the HPV vaccine or not. Even if you “opt-out” of the HPV vaccine mandate for Gardasil by Merck by securing a conscientious exemption waiver, there is no way for Texas parents to “opt-out” of the corresponding rise in their insurance premiums. § 1367.053. (a)

(2) of the Insurance Code REQUIRES that any vaccine required be law must be covered by insurance. [6] This first-dollar coverage requirement results in corresponding direct hiking of insurance premiums to meet costs, and for a vaccine as expensive as this one, an HPV vaccine mandate risks putting premiums for basic health care coverage out of reach financially for even more Texas families. Additionally, we have received complaints from families where insurance companies are harassing parents with letters and discriminating on coverage based on whether or not the child has had all their state mandated vaccines.

Has the woman's right to choose gone too far?

When it comes to abortion, I often find myself with one leg straddling each side of the fence: while it's never a choice I hope to have to make, I think it's a deeply personal issue that's between a woman, her doctor, the baby's father, and God. Unfortunately, because of our "right to choose," have we often eliminated everyone but ourselves in that equation? Is it really just about us, and no one else?

Like many women, I don't know if I could make that decision even if it meant dire straits for me. Most mothers would willingly sacrifice their lives for their children, but anymore we are being told that's only okay some of the time. If you want the baby, that's okay; if you don't want to keep the baby, then forget everything and put yourself first. If there is a fetal anomaly, they tell us, it's murky but usually perfectly acceptable to abort based on test results that indicate something might be wrong. Many terminations for fetal anomalies take place because of a problem that is incompatible with life, and I guess I can understand that.

But the "right to choose" starts crossing gray areas when you abort for disabilities that can be corrected: club foot, for instance (a birth defect both myself, my father and my son were all born with). Cleft palate is completely correctible but might leave some obvious scars, but hasn't stopped some people from aborting anyway. Where do you draw the line? At some point, are we engaging in more social engineering to create 'the perfect child?'

That said, I'm not really here to debate abortion in and of itself, just some of those areas where we're unsure - like in this case: mothers who "reduce" the number of fetuses they're carrying for social reasons.

But here's the kicker: Jenny, the mother, is older (which predisposes her to multiples) and she was undergoing fertility treatments - another almost surefire way to guarantee you'll be taking home more than one bundle of joy from the hospital.

Ever since I read that article, I just can't seem to wrap my head around that idea. If you're ill and birth control failed, I can understand that. I've known at least one friend - an evangelical Christian - who terminated an essentially non-viable tubal pregnancy because it could have killed her. But this - just because you only wanted one child and think you can't handle any more than that? I don't get it.

Jenny didn't want to look at the ultrasound screen during the "procedure," because this is "no blob of cells," this is an already formed fetus at around 12 weeks old, with finger- and toenails forming. A tactic often used by the pro-life movement, it puts a face on the child you're carrying, and often resulted in women changing their minds about going through with it. After all, if you don't look at the screen, you can't see movement, the baby sucking its thumb or hiccuping.

A fascinating debate unfolded in the comments section of this article, and many people - even some who claimed to be pro-choice - were left shaking their heads in disgust. It also caused many pro-choice advocates to rethink their stance on the right to choose, and how that right has essentially turned into something much, much different than originally planned. I applaud their ability to perhaps reexamine their stance and question the moral and ethical lines that this issue has crossed.

As the sole bearer of a pregnancy, it seems we have taken that power to extremes and used it in ways that give us unimaginable power over another human being - and not just the potential life that we're carrying. While the pro-choice culture seems to do everything in their power to demonize "sperm donors" as uncaring and uninterested (which many of them are, admittedly), I've heard from many heartsick dads who desperately want the woman - the mother of their child - to reconsider before having an abortion. They want to raise the child, even terminating the mother's rights if that's what she wants, so they can be the dad they feel responsible for being. But they're basically told "it's the mother's right to choose, buddy" and that he has no recourse whatsoever in seeing his offspring into this world. Because it's her womb, he's basically shit out of luck.

On the flip side, there are those women who unintentionally get pregnant and want to keep the baby, but the father does not. Perhaps both of them thought they were protected by birth control, and were using it correctly but something obviously failed. Should he be forced into being a father, even after taking reasonable measures to protect himself? If neither party expected the birth control to fail, even after using it responsibly, then what? I have no real answer for that one. But I bet the court system does: it's called child support.

When a father wants to walk away, we hear "he needs to man up and take responsibility for his baby." But just by virtue of the fact that she has all the right "parts," the same does not apply to her. 

Jenny is just one of many who virtually strong-armed her doctor into performing the procedure, and still "resents" that a doctor refused her. How can she ethically force someone else's hand to be part and parcel to her idea of a "perfect" family? Is it fair, or ethical? Do these people even care?

As far as Jenny is concerned, I see a common line of bizarre reasoning pop up when she voices her concerns: how will I have enough love for all my children? I don't want to neglect my older children and be a "second rate" parent, whatever that means. How will I be able to provide for those children? Those fears are not uncommon, even among mothers of singletons. And yet, once that child (or children) is born, you suddenly forget all about that and focus on your child. And no doubt, you just do it. I know my kids would probably be thrilled at the idea of having two babies in the house, but it seems few think of consulting the remaining siblings in the family. What if they say, "Sure mom, that's great. We'll do whatever we can to support you?"

Some of the comments came from parents of twins, one mother flatly stating, "I wouldn't wish twins on anyone." That makes it sound like a death sentence; as if anyone who conceives twins is doomed to failure and can't possibly take on the task. Culturally we've come to see children as an inconvenience, and something about these women suggests that they want to control the conception, the pregnancy and the birth, right down to the letter. Perhaps these are the mystery women we keep hearing about that want to schedule their inductions and planned cesareans around their work schedule? I'm sure they exist, somewhere.

Yet, women living in the 21st century have more access than ever to toys, television, video games, high-tech cribs and all kinds of stuff to keep kids busy. Strollers, Moby wraps and Baby Einstein were completely unheard of in our grandmother's generation. I once told my dad, "I don't know how your mother did it with seven children and no stroller or playpen." He just laughed - because that was what you did - you just did it. Because they were your children and you loved them. I think we have this idea that every woman everywhere was tied down to the bed during ovulation every month so that she would immediately become pregnant with 14 children during the course of her lifetime. While there are women in my distant lineage who fit that description - probably a baby every 18 months or so - they weren't all that common. I think we take that information and apply it to our own lives, in a modern sense, and think "Dear God, how insane is that? How could you possibly handle all those children?" Since we can't travel back in time to ask Great Grandma Mabel herself, we probably won't really know the answer to that question.

The one major problem I have with Jenny's situation is that she never gave it a chance. You can assume, based on how high energy your toddler is (come on, what toddler isn't high energy?!) that you couldn't do it. I would venture a guess that yes, it's pretty tiring and emotionally draining at first to raise twins, just like it often is with singletons. In retrospect, some singletons are probably even more "work" than twins would be - but you can never know for sure. When I think of the people I know who, before modern ultrasound, didn't even know they were having twins until mom suddenly got the urge to push one more time - I think, "Ha - you think you've got it bad?!" At first, it's a shock, but then you step back, reexamine your priorities and pull your head out of your ass and say, "Okay, I can do this." Especially since I basically predisposed myself to this "problem" to begin with.

I question her motives for terminating based on what her life is like now, before having another baby - because our typical American culture is so beyond spoiled that real, true poverty is virtually unheard of for us. Perhaps for some they are truly scrimping and saving as much as they can; for others it means they'd have to get rid of a third car and send their kids to public school instead of private, and well, that's just unacceptable. I know at least one couple who are struggling through adoption, and I speculate it's because they do not want to risk having their own biological child due to his hereditary heart defect. Are their fears grounded? Probably. But instead they have chosen not to create that life in the first place, rather than take a chance and then renege like Jenny seems to have.

There are some who believe if an abortion is sought, it should strictly be used for dire circumstances. There are also those who believe, as one commenter did, that a woman should have a right to choose at any time during her pregnancy. As we saw in the recent murder case of Dr. Tiller, he often aborted babies very late in pregnancy, often near term, which probably makes even some of the most hard-core activists squirm. As it should - because, we can argue, that at that stage in the game a baby can survive, even with some theoretically minor complications, but still have a quality of life. If they were all medical terminations, you'd think whatever was so life-threatening would have claimed the mother's life before 40 weeks gestation. To me, Jenny's situation is more like a designer pregnancy - where parents and doctors can basically socially engineer the "perfect child." One OB in the article says she would definitely terminate if an anomaly were found; and reducing a pregnancy is just engineering that family size to better suit your supposed wants and needs. How is it really any different than say, sex selection in India or China - which is still based on cultural beliefs and expectations, just different ones, perhaps.

It's easy to say, as Jenny did, "don't judge" - which sounds, anymore, like code speak for "Don't judge me, because I don't want to be held accountable for my actions," however morally repugnant they might be. We certainly "judged" women like Susan Smith, Andrea Yates and Casey Anthony for their part in the deaths of their children - who, one can argue, at least had the opportunity to live a life, no matter how short. Like one commenter said, "What's the difference if you give birth to twins and then stab one of them?" A few weeks, maybe months. The behaviors we observe on ultrasound at 12 weeks aren't much different than those seen in a newborn, except that they can live and breathe outside the womb.

When you have even pro-choice advocates questioning their stance, it becomes clear that the "freedom to choose" has become completely manipulated and abused, to the point where it has morphed into something totally different than what it originally set out to be. And now, as a result you see almost a callous lack of appreciation for human life - which you can't deny at 12 weeks gestation. I've seen much of that same coldness in many teens facing pregnancy today.

It seems like Jenny's biggest problem is that she sees life as a guarantee, when it really isn't: there is nothing saying that she wouldn't miscarry the remaining baby, experience a still birth at 38 weeks, or her husband wouldn't drop dead of a heart attack the day after she came home from the hospital. Some in the article talk at length about all the risks of having a twin pregnancy, yet in the same breath we tell women, "Pregnancy is not an illness!" And I'm sure many of the supposed risks and fears Jenny and others were gripped by would, like they often are with everyone else, never be fully realized. Like the last couple mentioned in the article, who were both expecting twins at the same time, they reduced and then later miscarried anyway. They have to ask themselves, was it all worth it? Are we really exercising our right to choose, or playing God?

The "Truth" about Pelvic Organ Prolapse

I'm not a Dr. Oz fan, but couldn't help noticing that he was talking about something not many women like to discuss: pelvic organ prolapse. I also was intrigued not only because of my birth nerdiness, but because I share some of these complaints and wondered: does anybody else?

Supposedly the "last taboo topic" in gynecology (nah, I think that'd be having a homebirth) I was curious, because I too was hesitant to talk about it. With strangers, sure; but friends - I wasn't really anxious to share that info with people I went to high school with (which is why I don't advertise my blog around casual acquaintances - I really don't want them knowing the intimate state of my vagina.)

Anyway, Dr. Oz revealed just how common pelvic prolapse - when your reproductive organs come out through the vagina - really is. The crowd was hushed as women in many age groups looked like they were hanging on to the edge of their seats. We all cruise through the female incontinence aisles at the grocery store (on our way to somewhere else, right?) and know those problems exist, and that they're actually pretty common. (There's even an entire company devoted to sending you your incontinence products, in discreet packaging directly to your house, so as to avoid being spotted at the grocery store.)

The primary risk factors are childbirth (especially after having several children), weight, and age. The problem is, Dr. Oz - and pretty much everyone else outside the birth advocacy circle - don't tell you that how you give birth can impact your risk factors.

If there's one thing I'd like to change about my vaginal birth, it's directed pushing. As one article on Dr. Oz's website said, "You take a genetic predisposition, a 9 pound baby, and three hours of pushing" and it's not a wonder we have these problems.

Back up a minute.

Three hours of pushing - even the one hour and ten minutes I pushed - is probably more common than it should be in hospitals. From my experience, I know I had absolutely no desire to push. Laboring down was not an option, and I wish I knew better to just wait for my body to do it on its own. Even if you were knocked unconscious, your body would still involuntarily contract and push that baby out on its own, but who has time for that anymore? It's rush rush rush to get the baby out (even in the absence of problems) and move on to someone else.

Consider what happens when you're constipated and trying to have a bowel movement. Pushing and straining - much like during childbirth - are probably going to do little more than produce a wicked case of hemmorhoids and even rectal bleeding. But if you wait until you have the urge (which is involuntary, much like pushing out a baby) it's a lot easier with a lot less work. So even though I personally detest the phrase 'it's like taking the biggest crap of your life' to describe childbirth, in some ways it can be compared, yes.

In the process of laboring down, the body can actually stop the labor process altogether, sort of as a last-ditch effort to conserve energy for the big event. And like a bowel movement, most women describe the urge to push as uncontrollable and something they just had to do. Unfortunately, I have never experienced that feeling, the feeling of knowing my body is doing something on its own volition because that's what it's supposed to do - not push a baby out at lightning speed just because somebody told me to.

In reading about the subject, some physicians simply blame childbirth in and of itself for prolapse, while others say traumatic childbirth is a cause. I'm not sure women realize there is any other kind, which is sad. Things like cord traction - literally pulling on the cord to get the placenta to detach from the uterine wall - is another risk factor. Forceps deliveries, episiotomies (again, largely unnecessary but done anyway) and prolonged, directed pushing are other causes, and yet all are considered standard procedure in many labor and delivery wards. In other words, we've experienced this crap for so long that we don't even know it's the cause - and that it's not really as normal as we think it is. We're normalizing the abnormal.

Many times, in an effort to avoid postpartum hemmorhaging after birth, they use cord traction to avoid a "retained placenta" - and cause even more bleeding as a result.

"Retained placenta" is another term I have a problem with. While the standard seems to be around 30 minutes after birth, it seems that, like everything else, it's different for everyone. While I'm obviously not an expert, I'd guess that in the absence of bleeding - and with the presence of breastfeeding right away - leaving it more than half an hour is probably okay. When I did some quick searching on it, I found several who said an hour, two hours - even 30 hours - and she lived to tell the tale. *gasp!*

More often than not it seems doctors are too quick to expect the placenta to come out and rush it with cord traction, which is often quite painful and dangerous if too much force is applied. I've also talked with people who agree their doctor was way too eager to detach the placenta and literally yanked on it - which can cause the very complications you're supposed to be preventing.

One study has shown that injections of oxytocin into the umbilical cord vein does not decrease the need for manual placenta removal; however, you're back to that murky definition of 'retained placenta' again. According to the article, retained placenta is more likely to happen to women in "wealthier nations." Not surprisingly, the study found that among women in the UK, Uganda and Pakistan, the women in the UK were more likely to have a retained placenta:

The researchers also found that the need for manual removal was higher in the United Kingdom (69 percent) than in Pakistan (62 percent) or Uganda (47 percent).

Many are quick to point out how dangerous it is to give birth in third-world nations like Pakistan and Uganda. While there is no doubt some truth to that, giving birth with overloads of obstetrical interventions - like in the UK - is probably just as bad. (Side note: not surprisingly, Uganda is the only nation of the three that doesn't have a relatively low rate of breastfeeding, which is often a good way to encourage the placenta to detach by itself. Incidentally, the CDC has determined that most US hospitals are severely lacking in their breastfeeding support, which could be further contributing to this problem. Add to that the frequent, often prolonged separation of mother and baby immediately following birth and it could add to further reliance on active management of the third stage of labor.)

Ironically, many in the UK scratch their hands and wonder why women in the UK are experiencing this problem, despite having access to all the best care and resources. Dr. Andrew D. Weeks of the University of Liverpool thinks prolonged cord traction might be an issue. Ya think?

Some sites list things like "unusually large babies" as a cause - perhaps it's more the interventions perceived as necessary in delivering that "large" child (and the idea that everyone has a different definition of what a large baby really is) that are key here. It's not uncommon for someone to have a very actively managed labor with a larger baby that results in significant trauma to the pelvic floor. Conversely, we hear of many women successfully delivering bigger babies with little if any tearing - which can depend on the birth setting. (Home birth? Natural hospital birth?) and the attendant (midwife vs. doctor? Someone who is more pro-natural birth?)

Sadly, doctors like Dr. Oz and urologist Jennifer Berman might hand out less-than-helpful advice because they've never actually seen a normal birth in progress. They often see the end result of years worth of obstetrical manipulation and intervention and chalk it up to just plain old childbirth itself, perhaps recommending an elective cesarean to avoid all that damage (even though studies have shown it doesn't). Yes, some women will be prone to this - for a number of factors besides childbearing - despite having an intervention-free birth. Some women get it and they've never even given birth. But until you can compare what often is and what could be, you have no real idea that the process is totally tampered with.

In doing some reading, I came across a very sad post by a nurse who experienced a pretty difficult birth, no doubt precipitated by the fact that she was induced at 37 weeks. The baby sounds like it just wasn't ready, but doctors attempted every means possible to get that child to come out, resulting in some nasty-sounding results. She wondered if she had a case against them because of everything she went through.

Some of the answers she got were quite shocking. Daring to call the normal 'abnormal,' she got berated, told she was a liar, and that what she went through didn't happen as she said it did. She was told that "controlled cord traction" was basically no big deal and an "acceptable practice." Maybe so, but it shouldn't be, especially in the absence of other complications. In the end, another forum user piped up and said "You think you had it bad??" as it to get into a virtual pissing contest about who could tell the most Horrible Birth Story Ever. I felt sad for the woman, not only because these women attacked her for questioning the status quo, but because they echoed what our legal system tells us: that unless you have something permanently wrong with either you or the baby, that you should just shut up and get over it.

After seeing some of the audience members on Dr. Oz's show, you realize that women have basically been giving birth violently for decades, perhaps even more than a century. I didn't see any hippie mamas standing up in the audience saying, "Well, I had a natural home birth and mother-led pushing in any position I wanted to, so I don't have that problem." She'd probably be stoned to death if she did. That, and the number of what we could call near-failed inductions - those where a vaginal birth happens but I'm not sure I'd call it successful, exactly - probably means more women are continuing to suffer.

While Dr. Oz's segment was titled "Suffering in Silence: The Shame of Pelvic Prolapse," I really think the people who should be feeling shame are those who insist on continuing these practices even though it's not in the best interests of their patients.

More reading:
Diagnosis and management of retained placenta after vaginal birth - Dr. Andrew Weeks talks about the risks and complications of retained placenta, but admits:

There is no consensus worldwide as to the length of the third stage after which a placenta should be termed "retained" and intervention initiated.

Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial - This study suggests the use of CCT is beneficial and says that a continuous infusion of oxytocin were given to each patient after delivery of the placenta. I'm curious, though, what percentage of mothers breastfed immediately after birth, and how long were their placentas retained before someone decided to manually remove it?

Controlled Cord Traction During Third Stage of Labor - This study seems to contradict what the previous one said, in that

"Controlled cord traction (CCT) is actively promoted in combination with prophylactic uterotonics for the prevention of PPH. While the administration of uterotonics has been proven effective, there is no evidence of CCT being beneficial or safe. 

The purpose of the study was to determine: 

1. In women having term, single vaginal deliveries in hospital settings, in whom the third stage is managed with prophylactic oxytocin, does CCT produce a clinically significant reduction in the incidence of postpartum blood lose? (sic)
2. In these women, does CCT produce a clinically significant increase in the incidence of severe complications, including uterine inversion or the need for subsequent surgical evacuation of retained placental tissues and membranes (curettage or manual removal)?

Injections Aren't Solution for Retained Placenta: Study - ABC News
Management of the Third Stage of Labor - Medscape

The third stage of labor refers to the period following the completed delivery of the newborn until the completed delivery of the placenta. Relatively little thought or teaching seems to be devoted to the third stage of labor compared with that given to the first and second stages. A leading North American obstetrics text devotes only 4 of more than 1500 pages to the third stage of labor but significantly more to the complications that may arise immediately following delivery.^[1] One respected author states: "This indeed is the unforgiving stage of labor, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster."

While that may be true to some extent, why do our bodies have these built-in mechanisms to aid this natural, physiologic process?
Postpartum Hemorrhage - Wikipedia 

A Cochrane database study^[5] suggests that active management (use of uterotonic drugs, cord clamping and controlled cord traction) of the third stage of labour reduces severe maternal bleeding and anemia compared to expectant management. However, the review also found that active management reduced the baby’s birthweight and increased the mother's blood pressure, afterpains, nausea, vomiting, and use of drugs for pain relief. The number of women returning to hospital with bleeding also increased. Another Cochrane database study^[6], focusing specifically on the timing of the administration of the uterotonic drug oxytocin as part of the active management of the third stage of labour, suggested that administering the drug before the expulsion of the placenta did not have any significant influence on the incidence of postpartum hemorrhage when compared to administering the drug after the expulsion of the placenta.

 Eight Ways to Avoid Pitocin in Labor and Why You Should - Birth Sense blog