Monthly Archives: March 2009

Good news

I guess this is what my research methods professor meant when he was talking about regression toward the mean. There is so much back-asswardness left over, health and science wise, from the last administration that it seems like Obama is really churning out a lot of liberal policies when, in actuality, his policies are just righting some wrongs and supporting evidence and better outcomes.

Here is a good example: A federal court ruled the FDA was wrong when it dragged its feet over approving OTC (over the counter) availability of Emergency Contraception (EC). It will now be available to 17 year olds (good!). This was something that was recommended by the FDA’s own panel of doctors advised that it be available OTC for all ages way back in 2003. We are getting there. Slowly.

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Another reply-turned-post, breastfeeding style

I have added yet another blog to my reader. I liked this post at Hugo Schwyzer’s blog. He discussed the Rosin breastfeeding article and mommy wars in general. The comments had some mommy wars type arguments in them, so I figured I would reply:

*****

Great post.

I write about the subjects of mommy wars and breastfeeding a lot. In fact, I have a Mommy Wars Bingo Card since so many of the same kinds of comments come up over and over again.

I wrote about Rosin’s article, too. The problem with her (and some of the comments on here, and many of the discussions about breastfeeding vs. formula) treatment of the discussion of breastfeeding is the assumption that breastfeeding is the intervention and formula feeding is the norm, and the greater problem of not treating this as a health decision (with obvious social and feminist and classist issues, but primarily a health decision).

Breastfeeding is and should be the normal and recommended feeding of all newborns. If an intervention is sought (formula feeding), there should be ample health indications for doing so. Just like any other health treatment, other issues do come into play (such as compliance – if the mother can’t comply due to work obligations or unwillingness) then that is of course an issue. If the infant is losing weight despite lactation consulting, that is a health issue. However, those must be weighed against the absolutely undeniable health benefits of breastfeeding.

Interventions due to complications (such as formula feeding, induction of labor, cesarean section) should not become the “normal” treatment options for women and newborns who do not warrant interventions. The evidence does not support improved health outcomes with such interventions, it actually shows more harm than benefit.

I am all for discussing the social, economic, and other considerations that come into play with delivery, access and compliance when it comes to these and other health decisions, but let’s keep the ideal treatment options in perspective when we have these discussions.

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Read this post

Shakesville has a wonderful, tragic post up by a birth mother (aka first mother or biomom) who gave up her child for adoption. I have long argued that adoption is not an easy answer to abortion (or infertility, for that matter.) It infuriates me when people talk about the so-called post abortion syndrome, yet don’t acknowledge that people who relinquish their born children experience a great sense of loss. I am surprised so many people say they have never even heard this perspective, but, on the other hand, birth mothers are so silenced by the “adoption is a wonderful gift” lobby I guess I shouldn’t be surprised. Don’t get me wrong, there are some adoptive parents who have wonderful relationships with their adopted children. However, the pain of relinquishing a child should not be overlooked.

I am going to reproduce the whole post here, since it is so fantastic.

*****

Hey, Shakers, Liss has graciously allowed me to yell in her forum. Many thanks, Liss. I have no other outlet for what I’m about to say. I want to tell you first: at least one of you knows me in person. What I’m about to say is something you do not know about me. If it’s not you, then one of your friends might be like me.

I’m the birth mother of an adopted child, vehemently pro-choice, non-Christian, very unsuited to motherhood, and after over a decade, have got some things to tell the world about adoption. It’s been stewing since I heard about the recent rash of pre-abortion ultrasound legislation. While I am touched that so many men in such various states are so deeply worried about women possibly being all sad from having an abortion, I wish to point out to these compassionately bleeding hearts that the alternatives are not exactly without their own emotional consequences.

Keep in mind, this is from over a decade ago, and maybe things have changed – but I did four quick searches and found one site that says it’s for birthmothers, and it turns out, it’s to show them how easy it is to find a good family for your baby. It’s a placement site; they don’t care about anything but babies. I didn’t find a single one for birthmothers who have already given up their kids. I’m sure they’re out there. Somewhere. No need to go google for a half hour just to find me one site, okay. If you do, you’ve proved my point.

I have given a baby up for adoption, and I have had an abortion, and while anecdotes are not evidence, I can assert that abortions may or may not cause depression – it certainly did not in me, apart from briefly mourning the path not taken – but adoption? That is an entirely different matter. I don’t doubt that there are women who were fine after adoption, and there is emphatically nothing wrong with that or with them; but I want to point out that if we’re going to have a seemingly neverending discussion about the sorrow and remorse caused by abortion, then it is about goddamn time that we hear from birth mothers too.

Believe me when I say that of the two choices, it was adoption that nearly destroyed me – and it never ends. The only comparison I have is the death of a loved one. The pain retreats, maybe fades, but it comes right back if I poke at it. Writing this has taken me nearly two weeks. Normally, I can write this amount in about thirty minutes, with bathroom breaks. I started to type, and stopped only to reread, then go wail into my pillow. There is no such thing as “over” with this.

Birth mothers are a demographic seldom heard from, and then generally only in the context of how soon they want to “replace” their lost child. This is a huge WTF to me. I went into a self-destructive tailspin for over a decade, and never once thought that maybe a new doll would do the trick. Yet every support group, every online forum, every possible resource I found, all zeroed in on this one-size-fits-all panacea. I didn’t want a new baby. I never wanted any babies in the first place. I also didn’t want an abortion, and I don’t see how any of my reasons for any of this are anyone’s business, either. It was my choice to make, and that is that.

What I didn’t realize at the time – because not one person in my whole life had ever seen fit to mention the possibility, including the pre-adoption counselors – was that I’d spend so long hovering on the edge of suicide, desperately trying to find some way to deal with an all-consuming pain I had no idea even existed. I had never needed help so badly, and I doubt I ever will again. I’ve known a lot of birth mothers, and I consider myself lucky; I’m less broken than many of them, somehow. Maybe it’s because I never did get any kind of therapy. I couldn’t find any that didn’t make me feel inhuman.

I don’t know what the post-adoption counseling is like now, but in my day, it was through the adoption agencies or religion. In my case, the adoption agency was Catholic, lots and lots of Catholicism, so no help there; I was also extremely upset that they provided psychiatric, drug-assisted help, but not mention that it was possible you’d have need for it until after it was too late. This is the kind of thing you really need to know before you make the decision, if only to brace yourself. No, until the baby was gone, it was all paperwork and offering to put me into a nice Catholic household where I could go to church with the family, watch wholesome programs on TV. I’m not Catholic. I’m not even Christian. The idea of church revolted me, as much as it would revolt others to have to follow a religious or non-religious lifestyle that they don’t share. Also it was mentioned that I’d have to go along with all the Catholicism, because if I didn’t, my host family could have me removed. To where? That question was never answered. Also, I don’t watch TV, not that anyone asked.

So I handled it myself, which wasn’t easy, but at least, I could pee in the middle of the night without someone I barely knew hovering outside the door. I’m not sure what mattered more, privacy or freedom, but they were both necessary.

Then the baby came, and soon I realized that it had fucked me up considerably to give it away. When I did, I went looking for help. The adoption agency I went through was so Catholic that my fillings hurt. So, I looked around. I kept looking for ten years. I never found counseling or therapy or any kind of help whatsoever that wasn’t about self-hatred.

Post-adoption counseling turned out to be focused on getting yourself together enough to make yourself a new Christian baby so you could be a good Christian wife and mother. I kept getting the same thing. What if you don’t want to have a New Baby ™, or can’t? Or you’re not religious? And why the fuck are actual babies so disposable that you’re expected to get over it after a suitable period of mourning (i.e., till you get a good Christian husband) in the case of adoption? It’s odd how this does not apply in the case of aborting a blastocyst, when you’re expected to wall yourself into a tomb away from decent society and gnaw on the bitter bones of your own despicable evil. Bad woman. BAD.

Where did this all-too-common idea that the only normal reaction is “longing for replacement motherhood” come from? I think that it at least partially comes from the roles women are assigned in society. Sometimes it seems like the only acceptable choice we have is when to become a mother, not if. I had my tubes tied without having any more babies, and all of a sudden everyone viewed me as an alien life form. Maybe, just maybe, if we had less “make BABIES!1!” pressure in this world, we’d have fewer stories such as Susan Smith and Andrea Yates. There’s nothing wrong with wanting to have kids. There’s a hell of a lot wrong with making people feel like monsters if they don’t.

I’d also like to point out that every time I mention the adoption in public (including the Net), one of these things invariably happens:

1: metaphorical pat on the head: “you did the right thing”, which helped at first, but rapidly came to sound amazingly condescending. Nobody asked me if I was doing okay or anything like that, ever, even though I quite spectacularly wasn’t.

2: “what kind of a woman gives up her BABIES?!” – this is always said by exactly the kind of people I don’t want to be having a conversation with in the first place.

3: “don’t worry, you can have another one” – would people say this to a parent whose child had just died? That’s what giving one up feels like.

4: a lecture on the evils of abortion, which seems grotesquely out of place in this context, and inevitably makes me turn extremely vicious in real life. I can pretty much guarantee that talking about the downside of being a birth mother on the Net will bring out at least one, regardless of where on the Net it’s posted. I can also safely assume that any such commenter will not have read this far, but just in case, I want that commenter to know one thing: your deep concern for pregnancy (in a thread about adoption) sounds more like the self-righteous squawking of someone so deeply disturbed over their own lack of bone-deep ethics that they’re compelled to spend their days lecturing the rest of us. Address your own issues. I suggest volunteer work, but I don’t recommend any kind of personal contact; you lack empathy. Many cities, even small ones, have beautification programs involving cleanup and planting trees, which might do for a start. You will be enriching the lives of others, improving your own health, you can proudly point out “your” trees, and you’ll feel self-righteous with damn good reason for a change.

Back to my topic, which was:

Adoption fucked up my head far worse than abortion. I’ve googled over the years about the psychological aftereffects of giving up a baby, and what little I found is astonishing. Depression and suicide rates ridiculously high, comparable to PTSD – and beyond a shadow of a doubt, there is no way you can cook any post-abortion trauma study to come anywhere near post-adoption trauma levels. Strange how peer-reviewed studies on this are damn near non-existent; strange how nobody mentions any of this when it’s not just your mind on the line, but also that of your kid or kids (more on that later). Strange how this is never on the radar when these stupid obstructionist anti-abortion rules are proposed by retrofuckwits.

They’re always blatting on about how concerned they are for us, apparently because women aren’t capable of making decisions without the gently guiding hand of all-knowing patriarchy, lest we irreparably damage our emotions and drown in a whirlpool of remorseful tears. They care ever so deeply about the long-term psychological effects of not having at least 10 months to consider whether or not to terminate a pregnancy, but no mention is ever made about women who actually do give up the baby. Seems to me that anyone who actually does so is lauded far and wide for Doing the Right Thing, but is simultaneously despised for being an unnatural uterus-bearing mechanism which has horribly malfunctioned. Where the fuck did that narrative come from, and why does everyone buy into it at some level?

Nobody ever seems to address this stuff.

Nor do the pro-lifers (or the media, or anyone outside of pro-choice circles) ever address the stats on adopted kids having lifelong issues with having been given away. I freely admit that I don’t know what adoptees go through, so I’m going to let others do the talking on that topic (I really hope you do; I only know my side, and I fret and worry and freak out about my child). Again, though, you never see pro-lifers worrying about anything besides forcing a birth. I never see pro-lifers doing anything constructive about adoptees of any age.

Emotional fallout only matters to them as a political talking point, in a conversation that includes space only for what is convenient to their preexisting narratives. There’s no space to talk about, for example, how, to give a baby up for adoption, you’ve got to get the father’s signature on the papers, or else face legal hell (now, or later). I was raped, by a so-called friend; I had to go through legal hell to get a signature anyway. It was pretty damn adversarial.

Men are generally left out of the conversation altogether, and when men talk about losing a child, it is most frequently on various men’s rights forums getting worked up about having their kids taken away in divorce, as if that’s comparable. I am looking forward to a man wisely explaining to me how this is not at all the same thing as what he’s been through, because his is worse, because it’s his money, for 18 years, and he didn’t want the kid in the first place, and she was a bitch anyway, and men have no rights and it is so unfair. And when MRAs aren’t busily whining about losing their children in a custody battle, they’re whining about how they should have some say in whether a woman is allowed to get an abortion, even when they don’t want the child and want it put up for adoption. I can’t even imagine the psychological ramifications of being forced into adoption, when it’s indescribably hard after a decision made of one’s free will.

To wind this down: one size fits all doesn’t apply to adoption, any more than it does to abortion. If there’s going to be discussion about mental issues arising from abortion, then there had damn well better start being just as much – if not more – discussion about mental issues arising from adoption. I cannot say that I’d be surprised to find out that any concern on the part of pro-lifers about birth mothers ended the second she signed the papers; I will scream “Hypocrisy!” as loud as I can if they try to pass off their latest brainfarts as such. You’ve seen this already: they also argue about the sanctity of a fetus’ life, but I see no legislation addressing the quality of life of adoptees.

None of which matters to the kind of people who picket clinics. Not me, not the kid, nothing. All they care about is whether or not they win.

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A premature reply-turned-post, breastfeeding style

I haven’t read the original article, “The Case Against Breastfeeding” in the Atlantic. I am not sure if my stress levels can handle it. I am started with a link to it on Alas, a blog. I am planning on thoroughly enjoying a critique of the Rosin article and her manipulation and misquoting of statistics on the U.S. Food Policy blog. From what I have read (I would have to look this stat up again) there are hundreds of studies a year published that confirm the advantages of breastfeeding. It is easy to hand pick a few with the weakest results and say the evidence is “thin”.

But, that didn’t stop me from posting a reply on the post I did read on Alas, a blog:

One of the main problems I have with a lot of the discussion about breastfeeding is that it is a health care decision. It is not a lifestyle decision or a social decision. Of course, as in any other health decision, there are many cultural and social aspects involved. But, whether one is a stay at home mom or works is not in the Healthy People 2010 goals. Increasing breastfeeding rates is, for a good reason.

There are absolute, irrefutable health benefits to breastfeeding for the mother and infant(s) (congrats on the twins!) that are not on the same level as “talking about the advantages of breastfeeding makes me, a formula feeding mom, feel guilty”. (See Mommy Wars Bingo). Breastfeeding is and should be the way that one is supposed to feed infants, barring any health issues that are contraindications. Just like a vaginal delivery is the healthiest way to deliver a baby, barring any health reasons that are contraindications. Of course there are complications and exceptions, but that is true for every health decision, from aspirin to knee replacement surgery.

It is of course relevant to discuss the greater social aspects of breastfeeding, but it seems like the conversation is always dominated by this topic, and whenever it is brought up as a health discussion, people want to negate that aspect of the discussion by saying the social aspects are more important.

******

I found an even better reply! This is from the US Food Policy post:

Hanna Rosin did not quote from the wide body of literature on the risks of formula feeding. Breastfeeding is the normal state of feeding an infant. It confers no benefits — it is the norm. The risks and costs of alternatives are what need to be assessed.

First, she uses sleight of speech to disparage a wide body of doctors who contributed to the American Academy of Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk. She provides no evidence whatsoever to support her statement about these doctors have an agenda. Conflict of interest in the medical arena usually involve payments of large sums of money from those who have commercial interests to those who are making statements. No one pays doctors to make positive statements about breastfeeding.

Second, if you look at the American Academy of Pediatrics statements, she avoids the conditions for which there is solid evidence that there is an increased risk from formula use including bacterial meningitis, bacteremia, diarrhea, late onset sepsis in preterm infants, necrotising enterocolitis, urinary tract infections, and postneonatal mortality. Solid — meaning lots of credible studies. Since I started an MHS at Hopkins in 1983 through completing a doctorate in Nutritional Sciences at Cornell in 1993, I literally read THOUSANDS of credible studies — and there are tens of thousands out there. I have stacks of meta-analyses under my desk and I reach very different conclusions

What she tackles in her article one condition among the many conditions of the “suggestive” research that is very hard to prove. This is the realm of SIDS, asthma, diabetes I and II, overweight and obesity, hypercholesterolemia, Hogkins, lymphoma and leukemia. These conditions are multicausal. It is very easy to design a study poorly and not see results and very hard to design a good study to find the causal links because the many of the effects are modified by other effects.

But even if all of this suggestive research turns out to not be so suggestive, what about the solid research? And she did not even site the risks to women when they don’t breastfeed.

Now, why is it that someone like Hanna Rosin with no science background at all can call into question what is a huge body of research by mentioning one little sideline of the many studies that show an increased risk of disease from use of formula? Does she have better qualifications than MDs that have no conflicts of interest that wrote the policy statement?

As for the economic analysis of a breastfeeding, the World Bank tried such an approach many years ago with their Disability Adjusted Life Years. I worked on the protein energy malnutrition section. This approach was deeply flawed in that there was no way to include the fact that some interventions provide multiple benefits. Those interventions that addressed a single disease showed up better than those that addressed many diseases and had multiple benefits because the economic models were inadequate to deal with multiple benefits.

In terms of the costs of breastfeeding, what we are really talking about is the costs of caregiving. Babies need contact and interaction. Breastfeeding is but one way to provide this while at the same time providing food. What unfortunately has happened during the years when women were discouraged from breastfeeding is that we adopted feeding modes that are unhealthy for infants. I would love to work with exclusively formula feeding mothers to assist them to do what I do with mothers that have had breastfeeding problems — that is “mimic normal infant feeding” and “mimize risk”. The culture has adopted unrealistic expectations for the frequency and length of infant feeding as well as the amount of interaction that is really needed. In the past, women were in communities where sharing of childrearing with close kin members was far more common. Woman also did their productive activities in close proximity to their children so the displacement to feed their infants while working was not as much of a problem. Now women are expected to do it all on their own and conduct their income generating activities in a separate environment from their infants. The segregation of mothers from their infants does come at a cost.

Finally, the real clincher that everyone forgets about is that we had a healthier alternative in the past. Wet nursing was acceptable and available. Your sister could feed your infant to give you a break and no one would bat an eyelash at the practice. Now, in our super sterile environment where we confuse an infant’s normal food with yucky body fluids — such an idea is usually met with shock and horror.

Yet, human donor milk has been shown in many studies to be less risky than formula.

As for her assumption that only formula feeders are given a hard time, I beg to differ. If you took a sample of 1000 women, I am dead certain that 100% of that sample would say that their infant feeding choice has been criticized, regardless of what choice they made. If you took a sample of 1000 women on any parenting issue, you would find the same results. BUT, there is a false equivalency in this statement. If you looked at the degree of negativity in the “criticism” you would find that the most negative, disgusting comments are reserved for women who nurse in public. There is a huge degree of Lactaphobia in the culture due to the sexualization of the breast. You would never get away with saying that African Americans, homosexuals, the elderly, Jews, Muslims or any other group would have to eat in the bathroom. Yet, routinely, women are told that the only place their infants can eat normally is in the bathroom.

Hanna Rosin doesn’t have the credibility to debunk the vast body of literature that I have read with her brief skimming of a few choice articles. She merely follows formulaic rules for justifying a billion dollar industry that took away choice from women for several generations and wants to perpetuate myths the risks of their product.

A better analogy than smoking is diabetes. Would you give insulin to someone without diabetes? No. Would you tell someone with diabetes that they are just as healthy as someone without it? No. Would you hesitate to give insulin to someone with type I diabetes? No. Would you tell them it was poison. No. Would you try to get someone with type II diabetes to eat better and excercise? Yes. If they still needed insulin, would you give it to them? Yes. Would you still work to help them overcome barriers to diet and exercise? Yes. Would you call health care practitioners that spoke frankly about diabetes “fanatics” or “nazis”? No.

Most of the discussion of infant feeding is highly irrational and overly emotional.

In the meantime, I will continue to assist women with pragmatic solutions to mimic normal and minimize risks of feeding their infants tailored to their own specific situations.

Susan E. Burger, MHS, PhD, IBCLC, RLC

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My conscience clause comment

My comment to the Department of Health regarding the proposed rescission of the Bush era conscience rule. For information on making your own comment, please visit Rachel at Women’s Health News.

This comment is in regards to the rescission proposal.
I am a medical student, a future ob/gyn, a mother, and a concerned citizen. I think there was no current need for the new conscience clause ruling. The former HHS secretary, Mike Leavitt, purposefully mischaracterized the state of licensing for ob/gyns in order to forward a political ideology. The American Board of Obstetrics and Gynecology publicly demanded that the HHS show even one case of discrimination against a practitioner who exercised his or her right to refuse to participate in an abortion, and Secretary Leavitt was unable to produce even a single example.

The Obama administration states that it is committed to changing the unfortunate recent history of overlooking science and truth in order to advance political ideology in health policy. In fact, most of these decisions have been based on opinions that only represent a minority ideological belief of the citizenry. The rescission of this ruling is imperative to reestablish faith in our national health policy.

The current conscience legislation is already too overreaching. I am concerned that requiring health care entities to pre-certify that they do not discriminate in hiring, specific to conscience refusal, will hamper the ability of certain organizations to fulfill their mission statements. For example, in my high risk area, South Florida, the Department of Health has family planning clinics established and funded for the sole purpose of providing birth control to the underserved. With the climate encouraged by this recent legislation, it is entirely plausible that these facilities would be forced to hire employees that are opposed to birth control.

In fact, some sections of the rule do not refer to abortion at all, and could be construed to apply to any practice that a potential employee finds unethical. Birth control is not abortion according to medical definitions of pregnancy and the methods of action of birth control, but many extremists see forms of birth control as abortion, and the law caters to such a worldview. How long until observant Christian Scientists are applying for jobs at surgery centers with the intent of obstructing surgical procedures? It seems like this rule is likely to increase costly lawsuits. It also seems like health care entities will be almost forced to hire employees that will expressly NOT fulfill their job duties in order to avoid such lawsuits. Where is the pressing need to increase such lawsuits? In actuality, there is a pressing need for more abortion providers and more contraception access, not less. There is a pressing need to reduce health costs, not increase them. There is a need to increase common ground, not accentuate difference and encourage uncooperation when there is already more than adequate provisions protecting conscientious objection in health care.

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Reply turned post, bloggers unite! style

Thanks to a tip from Feministing, I found this column on Mother Jones about the Future of Abortion Providers. I agree with the idea that we need more feminist activists and more abortion providers. I don’t agree that calling feminist bloggers sluts is the way to do it.

Here is the reply:

Blogging and activism are not mutually exclusive. In fact, I blog, I joined Facebook because my medical school class had a group on there, and I am a member of Medical Students for Choice. I am one of those future abortion providers you want so badly. I am also a young (well, not so young, but still…) feminist.

I think the problem with convincing people to become abortion providers is a lack of dialogue on the subject, which makes it easier for medical students (and the rest of the public with whom they interact) to dehumanize women who get abortions. Women most certainly do not talk about it in person, if you haven’t noticed. Do you know the most effective way I get involved in changing the dialogue about abortion? Through blogging and on message boards. I can talk to one medical student at a time, one person at a time face to face. I get hundreds of hits a day on my blog right now.

I agree with your cause. I don’t agree with your methods. Slut-shaming young feminists is not going to create future abortion providers. What are you doing to support MY future as an abortion provider? I am lucky to have my in laws pay for my younger son’s day care, and my mother pays my car bills, and we still struggle for me to stay in medical school. And this is with me taking out the maximum in loans. I will be graduating with about $300,000 in debt. This is not even considering the money I will have to pay in malpractice in ob/gyn on top of my loan payments.

And where is the money come to pay for abortion services? Are YOU fighting for reimbursement of abortion and contraception by insurance and Medicaid? Do you know how I stay informed and fight for issues such as that? On (gasp!) blogs!

Please, find a better way to help me out.

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Vagina Monologues

One of my classmates at mendical school is an amazing amateur photographer. He put up photos of the Vagina Monologues on Flickr. I am the narrator, so I am the pudgy brunette who is sitting on the stool with the music stand in front of her in a lot of the pictures.

Enjoy!

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