Monday, September 17, 2007

Boobies, bogeymen and babies: the unabashedly crunchy post

Recently, I went out to dinner with some friends. One, slightly known to me, was pregnant and expecting her first child. Others were swapping birth stories, and I had my mouth full, so I just listened. Oh, but you should ask her about her second birth, one said, pointing to me. I swallowed hastily, as another said, laughing, 'Yeah, but you should also know that she's really, really crunchy granola.'

Yes, I have a strong opinion about childbirth, and especially about c-sections and VBACs. I think there are too many of the first and too little of the second, and I'm a suspicious soul generally when it comes to medical consumerism. I know a few doctors, some professionally and some personally (the wife of one of my bleaders, for one), whom I'd trust absolutely if they performed a section. But the vast majority of ob/gyns? The statistics do not speak well of the profession as a group, I'm afraid. And I'm not so sure they speak well of the consumers, either.

So. I read this post at doulicia, and immediately sent a happy, excited email to the Grandmere, a person of wisdom and concern in regards to these matters. Wonders of natural childbirth in New Jersey? Rates of c-sections far below the national average? And in, I repeat, New Jersey??? The state has never struck me as a particular bastion of medical heretics. The Grandmere was as puzzled as I, as doulicia herself, and made some enquiries.

Here is a response from a trustworthy source working in the area (trustworthy by my standards, so caveat bleader). Please note that when she talks about her clinic patients, she's talking about those at her workplace, which is not Muhlenberg:

Muhlenberg is a small hospital with NO NICU or pediatric department. Babies are taken care of by pediatric hospitalists, as there are no attendings. Clientele is poor, black or Hispanic. I'm sure all high risk patients are shipped out to St. Peter's in New Brunswick. Any middle class family in this catchment area probably delivers at JFK in nearby Edison or goes to Somerset or Overlook.

More likely they have fewer C-sections because they do not have 24-hour anesthesia coverage and are not so worried about poor women and illegal immigrants suing for poor outcome. The high national C-section rate, I believe, is the result of MD fears of lawsuits if the baby is born with a hangnail, much less CP or infection or...

Our middle class/upper-middle class/wealthy mothers WANT C-sections. Labor is yucky and it HURTS! They surely want to breastfeed, but also expect to sleep through the night. (We do LOTS of education before and after birth on the importance of exclusive breastfeeding, for mom and baby, but...)

Our best breastfeeding moms are the clinic patients, almost all Hispanic. (Our black patients are usually middle class). They keep them in their beds with them, and breastfeed, breastfeed, breastfeed.


It makes me inexpressibly sad that WHO recommended standards for medical care are available to 1. the over-educated and crunchy (like me), who advocate furiously and can afford a doula and - this bit is crucial - are self-absorbed enough to trust ourselves over the wisdom of the medical standard, and
2. the lower class, who have no choices. This is frankly wrong.

This analyst offers a lot to consider, and I'm afraid I agree with most of it. I think too many people have sections because of poor labor support, I think they have poor labor support because they don't realize that they probably need more than a hospital (and a husband/partner) can give. And as a culture, we're afraid of pain. We don't like it, we refuse to accept it, and we turn those who can tolerate some into martyrs and heroes.

Should we accept pain when there is a choice? Well, I suspect it depends on the baggage for that choice. Should we accept that this hospital produces such amazing stats under these circumstances? Again, consider the baggage. American medicine just hasn't hit its stride where laboring mothers are concerned, and apparently the pendulum still swings too far one way or another, spending much too little time in the middle.

I'd like to try an experiment: let's pick a hospital with good medical backup - a good NICU, round the clock anasthesia, enough ORs, sensible doctors, etc. Offer a neutral prep class to mothers, one that talks about healthy and good pain, and tells you how to work with it, as well as giving you the options. (I remember my hospital tour with #2 - the nurse described the typical patient as flat on her back, plus epidural and catheter. If that's what you present as normal, then you get the stats to match it.) Then, equip each laboring mum with a doula - a good one, a sensible, noncrystal-waving one, and get the medical trappings of birth to a bare minimum. Check the laboring woman at the start and late in the game, unless she's presenting with complications. Reduce the pressure on her, increase the support, and see what happens.

I bet that we'd get many fewer sections, and many happy mums - and fewer happy lawyers holding hefty paychecks.
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Let's take the granola all the way to the cereal bowl, shall we? To cap off this post, here's this:

In response to my link about nursing in public, Mother in Israel pointed me to her own blog, and this http://mominisrael.blogspot.com/2007/09/nursing-in-negev-or-nursing-in-toilet.html post. It makes me tired and grumpy - what's the problem with a woman nursing among women? During my mother's shiva time, I nursed the Toddles in front of all sorts of people, but I watched the Grandmere's cues carefully. Sensitivity and respect - it was a strategy that worked just fine.

You grouchy types should just hush up - you're drowning out all of the quiet live and let live types, you are overriding all of the quiet, sympathetic smiles, the nostalgic glances. Your irritation and strident criticism is just too loud for a nursing mum, already anxious about tzniut [modesty] and kavod ha'makom [respect for the place] to hear the community's support when she nurses her child at services.

Yes, some communities have a nursing room - and some even locate it just off the women's section of the communal prayer room. (I have private, irritated thoughts for communities who relegate me to hot little rooms a floor or two away from the davening [prayer].) And others don't want to see a nursing mum, let alone her baby. But others, like my shul, debate whether it's okay to ask a woman to toss a shawl over her shoulder while nursing her baby in the women's section during davening. And they'll assign another, sympathetic nursing mum like me to do it.

The problem with the folks who hiss at small children who wriggle, or at mothers who nurse (even in the nursing room, as M.i.I's post shows), is that they resonate more loudly in the psyche than the folks who don't hiss. And for someone new to the community, the hissers can cut off newbie's chance to actually learn about the community, to see whether the shul is a hot small room (A), an adjacent (B) or a stay home (C) nursing community.

So I put it to you: two days of Rosh Hashana, with the extended service of the High Holy Days. Followed immediately by shabbat, and the shabbat davening. That's a whole lot of shul. And, if you are a nursing mum, it's a whole lot of staying home (if you have community C), or feeling anxious (A) or mostly accepted (B). Or frankly included.

Hmm. High Holy Days, when we examine our conduct towards others - even more so than our conduct towards the Big Guy Upstairs. Hmm. Yup, now would definitely be the right time to hiss at a poor mum, juggling her baby and her siddur [prayerbook]. Oh, yes - tactically sound, folks. Tactically sound.

As a considered, mature response, I have decided that the hissers among us should be dubbed 'boobies,' for boobies they are and boobies they object to. Silly boobies. Sit down and focus on your prayers, and not on a mother attending to her child.

2 comments:

Dana said...

Sadly, the article cited on doulicia's blog is completely and totally inaccurate. NJ's c-section rate is 37.0% (although reported to the CDC as 36.3% but that's another story!). I have emailed the reporter and editors of the NJ Courier News and so far, they aren't interested in correcting the information. True NJ rates for c-section and vbacs in all NJ hospitals are right here: www.nj.com/news/bythenumbers/

mama o' the matrices said...

Dana,

it is sad, isn't it? Whether from the perspective of the things doctors do or the things that we medical consumers accept, it's just plain sad.

Thanks for the link! Intriguing that NJ has two sets of stats for VBACs and C-sections. Or perhaps I shouldn't be surprised - as the Man likes to say, it's all in how you crunch the data...