January 19, 2008

Childbirth--Feminist Choice Issue

If you are thinking of getting pregnant, trying to get pregnant, or already pregnant, buy or borrow two excellent new books--Pushed by Jennifer Block and Born in the USA by Mardsen Wagner. Read them before your next OB appointment; they might substantially reduce your likelihood of having a C-section. As a long-time childbirth activist, I am appalled that so many American women face returning to work six weeks after major surgery.

Marsen Wagner is formerly the director of Women’s and Children’s Health at the World Health Organization (WHO). A whistleblower, he offers a scathing attack on obstetrical standards of care, suggesting they are abusive at worst, and based on nonscience that mainly serves doctors’ interests at best. Jennifer Block was an editor at Ms. magazine and a writer and editor of Our Bodies, Ourselves. Her book, extremely readable, covers much of the same ground Wagner’s does. Read the excellent, lengthy review in the Women's Review of Books:
Here are two central facts about American birth: first, the US spends more per capita than any other developed nation on maternity care. Second, the World Health Organization ranks the US thirtieth out of 33 developed countries in preventing maternal mortality, and 32nd in preventing neonatal mortality. Our country is not doing well by mothers and babies.
Both these books describe, in splendid detail, the myriad interventions of “active management”—the practices perpetrated upon even a healthy woman planning the most unremarkable of births. Although these practices may help in critical situations, they are more likely to cause harm than good in a normal birth. For example, active management includes the induction of labor in as many as forty percent of all American births, even though this leads to longer and more painful labors and “ups a woman’s chance of a [cesarean] section by two to three times,” according to Block. ...Active management also includes speeding up a woman’s labor with the use of Pitocin in perhaps a majority of American hospital births today. According to Block, “a recent American College of Obstetricians and Gynecologists (ACOG )survey found that in 43 percent of malpractice suits involving neurologically impaired babies, Pitocin was to blame.” And it includes routine electronic fetal monitoring, used in 93 percent of hospital births even though studies show that its only effect is to increase the c-section rate.

The quintessential intervention is the cesarean section, which is how nearly thirty percent of American women delivered their babies last year. WHO says that when a population has a c-section rate of higher than fifteen percent, the risks to the mother and baby outweigh the benefits—and a WHO study found that “the main cause of maternal deaths in industrialized countries is complications from anesthesia and cesarean section,” Block reports. She cites another study published last year, of 100,000 births, which found that “the rate of ‘severe maternal morbidity and mortality’—infection requiring rehospitalization, hemorrhage, blood transfusion, hysterectomy, admission to intensive care, and death—rose in proportion to the rate of cesarean section.” As for the baby, other research has found that “preterm birth and infant death rose significantly when cesarean rates exceeded between 10 and 20 percent,” and that “low-risk babies born by cesarean were nearly three times more likely to die within the first month of life than those born vaginally.” Nonetheless, ACOG not only rejects the fifteen percent target, but even continues to support the idea of elective c-section.

What are your alternatives to an interventionist and/or C section birth?

As evidence is increasingly showing, the people who best enable normal births are midwives. Obstetricians, after all, are surgeons, and many never witness a natural, normal birth in their training. Midwives, in contrast, are women who know that one of the best answers to pain is sitting in a warm tub, who know how to manually palpate a woman’s belly to find the baby’s weight and position, and who know how to help a woman handle labor in ways that facilitate birth.But midwifery in the US is up against some powerful forces—mainly, again, obstetricians and American College of Obstetrics and Gynecology. Doctors throughout American history have worked to discredit midwives—labeling them dirty, uneducated, and unskilled—and to drive them out of business. Today certified nurse-midwives who practice in hospitals report having their hands tied by doctors and hospital protocol.

Is it possible for change to come from women themselves?

Block ends with a challenge to today’s organized feminists to bring birthing under the umbrella of “choice,” quoting childbirth educator Erica Lyon, who says, “I think this is the last leap for the feminist movement. This is the last issue for women in terms of actual ownership of our bodies. It will take a revolution."

These books deal only peripherally with one of the most problematic issues: what do you do when women freely choose, or think they freely choose, medical procedures that increase their risk and that of their children? If women believe their obstetricians are their best advocates, how do you convince them to think skeptically? Until women take birth into their own hands, until they realize that doctors are not necessarily women’s advocates, until they seek out the evidence, which is in these books but not in doctor’s offices, about the normalcy of birth and the dangers of interventions, they are going to continue to believe that birth is a crisis about which only one person – the obstetrician – knows best.

We fought this battle in the 1970s and early 1980s and thought we were winning. I had four children between 1973 to 1982; two were hospital births, two were home births. I employed one obstetrician, one family practioner, and two nurse-midwives. I was given pitocin against my will for my only OB-assisted birth; I received no other medications.

January 12, 2008

Has Feminism Won Its Battles?

Unlike most feminists with my intellect and education, I decided to stay home with my four children full-time for 15 years and part-time until the youngest went to college. I involved myself in nonsexist childrearing, childbirth education, breastfeeding counseling, parent education, toddler playgroups, babysitting cooperatives, cooperative nursery schools, school libraries, a campaign to save the local public library, the nuclear freeze movement, mental illness support and advocacy, parent advocacy for playground upkeep and a preschool playroom, a high school group for interracial understanding--the list is endless.

When I made the mistake of attending library school and social work school, I naively assumed my qualifications would be obvious and no one would dare to treat me like a beginner. I was given the responsibility of an experienced worker and the salary, benefits, and respect of a beginner.

I recall one infuriating incident during my first social work placement; my childless supervisor earnestly instructed me how to interview a client with her two year old present. I had frequently run La Leche Meetings with 20 moms and 30 babies and toddlers. Women social workers who had taken very short maternity leaves and worked full-time during their children's childhood too often acted like all my knowledge had been attained by cheating. I got more respect from male professors. The situation has worsened; women are terrified of taking only a few years off from work. And yet the men who fought World War II left their jobs for several years and did not suffer economic consequences. The government even paid for their college and grad school education.

When my mom went back to college in 1963 and work in 1968, after having raised 6 children, she was accorded more respect and her experience was more honored than mine was 20 years later Full-time childrearing is frequently belittled as beneath the time and attention of intelligent, well-educated parents, who presumably should have exploited immigrant women of color to love and understand their children while they pursued their more important jobs. Remember, things have not changed for the valiant, loving women of color who raise our children and care for our parents. I am often appalled how little highly successful two-career couples pay their nanny; many fail to provide the caregiver with any benefits, least of all health care.

I agree that most women with college degrees, graduate, or professional degrees have made enormous strides in most major professions and in the workplace generally. Even nurses and teachers have made significant progress because they unionized. Public librarians and social workers usually make less than any other professionals with graduate degrees because they are mostly women and they are not unionized.

It is only when women have children or have to care for aging parents that they fully realize that women have mostly gained the right to follow the traditional male life style, emphasizing work over relationships, caregiving, community activism.. As women chose to have children at an older and older age, the realization is late in coming. At that point their lives tend too become too frenzied and exhausting to leave any time for feminism and political reform.

January 11, 2008

Women's Issues Are Family Issues

The recurring reference to women's issues in the media needs to be clarified. Most of these are better described as family and caregiver issues. However, vitally important women's issues exist. These include the availability of abortions and the morning after pill, the scandalous C-section rate, and the obscene harassment of nursing mothers. Too many companies expect breastfeeding mothers to pump in filthy toilets for 20 minutes and refuse to provide a comfortable room for them to pump and adequate short-time storage for breastmilk.This is a health issue as well since the American Academy of Pediatris recommends breastfeeding for at least a year. Working mothers of infants are heroic, incredibly dedicated to making sure their babies only get breastmilk and not formula. Encouraging, supporting, and facilitating breastfeeding is an integral part of wellness and prevention.

The best way to reduce the C-section rate is to to use nurse- midwives for normal births, but obstetricians fiercely resist giving nurse-midwives hospital privileges. At this point in New York City, the first question after how big is the baby is did you have a C-Section? It appalls me that the most educated professional women in history are allowing that to happen to them. When I was pregnant with my first child 35 years ago, baby books advised not considering a doctor with a C-section rate higher than 5 percent. Obviously the human race would have died out long ago if a 30 to 40 percent C-secton ate was the norm. I crusaded for natural childbirth and had my two youngest daughters at home with a nurse midwife.

Virtually all nannies and human health aides are women. In New York and Long Island they are almost always women of color. They can't afford to own cars. They have to struggle to work on public transportation that doesn't necessarily get them where they need to be; some take three different subways and buses. Agencies fail to even provide a mapquest to the client's home. Some caregivers have left their own children in the Islands with relatives, so the moms can make enough money to rescue her own kids from abject poverty. How shamelessly they are exploited is certainly a vitally important women's issue. Caregivers who are illegal immigrants can be virtually slaves, too afraid to complain or quit because they will be deported. Home health agencies charge the clients more than twice the amount they pay the women who actually doing the caring. They have absolutely no job security. Most have no health benefits, no disability benefits, are not eligible for unemployment. How we treat these loving, warm, compassionate, kind women is a national disgrace.

But almost all other "women's issues" are parent issues, caregiver issues. We seem to have made no progress on parents' sharing equally in child care and elder care responsibilities. The oldest daughter (if there is one) is usually her parents' caregiver, no matter how many siblings are in the family. Caring for aging parents disrupts women's work schedules even more than caring for young children.

The mommy wars drive me round the twist. In the 70s the feminist agenda was that society and the economy would change fundamentally so that moms and dads could share equally in child care. Now everyone seems to work longer than a 35- or 40- hour week; grandparents are either employed or too far away; day care centers are not staffed by professional teachers with a career path, so the turnover is constant. How dedicated can anyone afford to be at $8 to $10 an hour, often with no benefits? Excellent day care, where teachers are educated, accredited, and paid like grade school teachers, is very expensive, and the state would have to offer considerable support.

Men almost never work in day care or nursery schools; the sexual abuse day care hysteria ended that. People don't want to hire boys as babysitters or men as nannies. That is revoltingly sexist. Misogyny is hatred of women; sexism applies to both sexes. Women seem to have made more progress than men in bursting through gender stereotypes. So guys, you might be entitled to call your mate a "female chauvinist pig," though you might spend the night on the couch. Men rarely seem to complain about the sexism inflicted on them since such criticism would be seen as girly.

When I was struggling to practice nonsexist childrearing in the 1970s and early 1980s, I noticed that parents of boys have a much more difficult time. Strangers abuse mothers on the street if the boy's hair is too long, his colors are considered girly, he is carrying a baby doll, he is crying. They are frequently accused of making their sons gay. I have five brothers and four daughters; my mother raised my brothers to share the housekeeping and the childcare. I love to take care of my 8-month-old grandson three days a week. He greatly resembles his adventurous, world-traveling mother, who has lived in places like Niger, Kosovo, and Rwanda. I eagerly await defending this enchanting bundle of rambunctiousness from sexist constrictions of his creativity and determination. Together we could run a childproofing business. When I put him down on any floor, he immediately crawls toward the most dangerous object in the room. even though there might be dozens of more suitable things for him to play with.

When I lamented the lack of male participation in the blog, Unfogged, I got this discouraging reply:
"It's a bit of a chicken and egg problem; as long as childcare (and kindred professions) is seen as feminized, it will be a pretty small minority of men who will consider this kind of work, and therefore the proportion of perverts in that sample is going to be way above average. Anecdotally I would say that the same is true, for slightly different reasons, of scout masters, camp counselors, and wrestling coaches. In a sense, it's not irrational when people look askance at a man interested in taking care of children; there is an inclination to ask oneself whether there is some nefarious ulterior motive at work. A result of sexism? Of course. But the motives of the individual are not necessarily sexist".

My answer: My brother has been an elementary teacher in Portland Maine for about 20 years. He laments that male teachers would be terrified to touch or hug a 5 year old who had hurt himself or herself, although a female teacher would be glad to do so. It is outrageous to say the perverts are more likely to care for young children. I doubt that perverts are more likely to choose to work for peanuts. What possible proof can you give? How can men tolerate such assertions? What message does it convey to young children if they have no male teachers. Boys learn that only girls are caregivers. People speculate the boys have more trouble adjusting to the feminized environment of school.

Things were different in the 1970s, at least in New York City. Nursery schools and kindergartens tried very hard to recruit male teachers. When my daughter went to a Montessori nursery school down by the world trade center, she had a wonderful male teacher. Fathers spent lots of time taking care of young children and to the best of my knowledge their willies don't fall off. Whoops, I am married to an Englishman. Taking care of young children is incredibly exciting and fascinating. They are the best learners and the most creative free spirits you will ever encounter.

Every industrial Western nation has more family centered government policies than we do. American families no longer believe that government could make it more possible to be good parents, good caregivers of the elderly, and good workers. I hope the first woman president can implement significant change.

January 8, 2008

Isn't Fighting Sexism a Progressive Value?

Melissa McEwan has an excellent article on Shakesville, pointing out that Edwards and Obama should be commenting on the sexism directed at Hillary Clinton.

Read the whole article. Here is part of it:

Isn't it? One wouldn't think so, given the way Hillary Clinton's peers are allowing her to be subjected to all manner of indignity on the basis of her sex, with nary a peep in her defense. John Edwards' response to reports of Hillary's emotional moment—which, once the national press was done with it, had turned into a full-blown emotional meltdown—was disgraceful. Obama merely declined to comment in this case, but he hasn't gotten to New Hampshire with clean hands, having recently reduced Hillary Clinton's experience as first lady to attending tea parties; then, responding to being called out by the Clinton campaign on the obvious sexism of that jab, he denied he was referring to her gender (really?—he'd describe a man's experience as having "tea" with people?) and resorted to a thinly-veiled update on the old "hysteria" chestnut: "Those folks must really be on edge."

Yes, that must be it. Or, perhaps, they were rightfully angry about the oblique use of sexism as a political weapon from their own side of the aisle.

Further down:

Obama and Edwards ostensibly believe that men and women are equal; the people who share that belief should expect them to endeavor to defend that principle at every turn, not just when it is politically expedient. See, the thing is, it's been politically expedient to throw women's rights under the bus before, and some of us would like the assurance that we're casting a vote for someone who regards women's equality as an unyielding and constant principle—not a bargaining chip nor just another plank in a platform that can be discarded as necessary. If these blokes refuse to mount a vociferous opposition against sexism on the campaign trail, just because it helps them, that doesn’t bode well for the women they seek to represent as their president.

January 6, 2008

Divergent Thinkers

Some parents have asked me why I feel so passionately about preschool psychiatric diagnoses when my own daughters didn't have such serious problems. I will let you in on a secret. Bright, creative children can have a terrible time adjusting to traditional American grade schools. Bright bored children don't finish worksheets, don't pay attention, daydream, forget assignments, leave books and homework home, ignore the teacher, read ahead of the class and miss their place if called upon, miss many days of school. My local school insisted on testing a kindergarten boy for development disability; his IQ was genius level. When my writer, pictured above, was in first grade, her teacher refused to assign her to the advanced reading group until she was more "cooperative and compliant."

Rose never became compliant. In kindergarten she refused to do assignments because "writers use their own words." In high school she refused to do art projects because "artists paint what they need to, not what the teacher assigns." Now I would be told to have her tested because her "emotional maturity" lagged behind her intelligence. My two high school valedictorians were not given any awards from grade school. They only truly liked school when they got to Yale.

Your bright preschooler might face as many challenges as your friend's autistic or ADHD son. More schools have special ed services than have gifted services. Again and again, I questioned whether home schooling might be easier than my daily struggle with their school. Younger parents might not anticipate the extent to which they need to be advocates for their kids in American's test-obsessed schools. Getting high test scores is more important than being a gifted musician or artist. Kids who don't adjust to the norm are stimatized. The most creative, divergent thinkers our society desperately needs can be slapped with a psychiatric label and have their giftedness drugged out of them.