Death: an Issue in Perinatal Care

The most recent study on c-sections confirms that Cesarean Deliveries for low-risk pregnant women increases babies’ death risk .

. . . Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death . . .

In other words, when comparing otherwise "low-risk" deliveries (singleton, full-term, no medical risks or complications), a baby delivered by c-section has a 2.85x chance of dying in the first month. The study analyzed 11,897 deaths out of 5.7 million deliveries. That's thousands of babies who died with no discernable risk indicator other than their surgical delivery. The study doesn't ask the real question -- why are healthy mothers having surgery instead of giving birth to healthy babies? It's common knowledge that c-section rates are skyrocketing, even though this is driving up public health care costs. The American College of Obstetrics and Gynecology virtually forces repeat c-sections even though their policy doesn't save lives of mothers or babies. It's so rampant that the latest issue of "Birth: Issues in Perinatal Care" published a roundtable on the subject of Why Do Women Go Along with This Stuff?

Why?

How long before the "standard of care" for childbirth -- the legal duty we use to judge whether a doctor made a mistake -- reflects the scientific evidence? Are 3,000 dead infants enough to get someone's attention? Because that's what I see when I do the math. As long as experts tell malpractice juries that a c-section is a safe and surefire way to save a baby's life, insurance companies will be covering their own butts with their "when in doubt, cut it out" policies.

As long as our culture accepts surgical delivery as normal and healthy, we're going to keep having this "issue" with birth -- if a doubled infant death rate can be called an "issue."

UPDATE: More numbers came out today. . . this from the journal Obstetrics and Gynecology: C-section moms have a triple death rate .

Watch! It

In the spirit of posting more pithy and current observations, I'll comment on today's breaking news: CBS has been busted for using Photoshopped pictures of Katie Couric that make her look thinner than she is. I'm not sure why this is a big deal. The before and after pics (always fun) just look like a good tailor paid attention to her jacket seam. And in case you didn't catch the original of the doctored photograph, it was published in "the September issue of Watch! which is distributed at CBS stations and on American Airlines flights." In other words, who cares?

The CBS President has expressed "surprise and disappointment," but it's not clear why. Without sounding cynical about a stain on the journalistic integrity of Watch!, this probably has more to do with the actual leak of before and after photographs on the internet. Or maybe the real news is that Couric is less skinny than I thought she would be, for someone who's made news for being a cute young person taking on a job traditionally held by older, serious men. Are the media trying to warn all of us of our impending disappointment, in case we tune in to the evening news expecting to see more light between Couric's arm and ribcage?

Me, I prefer to think that any corporate "disappointment" is a reaction to the implicit invalidation of Couric's body -- and for the message sent to women everywhere that, no matter how successful we are in the world of men, we still must be "fixed" until we are an appropriate size and shape.

But, nope. It's not because they photoshopped her -- just that they went too far, and got caught. Photographs of models and celebrities are constantly modified to look more "perfect." Last year, Aisha Tyler (actor, writer and official beautiful skinny woman) wrote an essay in Glamour with her own before-and-after photos, including retouching instructions (such as "fix stray hairs," "make legs thinner," and a few ominous notations about lightening her skin). This is apparently old news (searching for an archived article, I only find that everyone's already blogged about it); But check out this great before/after of Britney Spears.

Yes yes, women constantly get the message that we aren't thin and perfect enough. The propogation of fake photos is a lie so pervasive, it's easy to forget it's all around us. The other day I found myself feeling inferior to a woman in an animated TV commercial. She had such luxurious hair. Another successful moment of seduction -- since I can't afford an actual Photoshop amputation, I can be lured into purchasing shampoos, cosmetics and pills that promise to rid me of my undesirable physicality. It's not just "blemishes" like pimples and scars that make me feel imperfect -- but the very pores, hairs skin and fat that make us human. The joke is, there is no perfection -- Just an industry that says "give us your money" without caring if we give up our selves. The tragedy is, our bodies aren't just another accessory. They are our living us -- our skeletons, our thighs, our freckles and our cellulite. Objectification and commodification of (usually women's) bodies and appearance aren't just amusing and annoying. These are are the fruit -- or maybe the roots -- of our culture of death.

It's a joke and a lie. And we believe it, again and again. It's such old news. Maybe when more of us become as wealthy and powerful as Couric, there will be more surprise and disappointment about it. And we can respond, as she did, that we prefer ourselves as we are.

Links:
Nerds Demand Katie Couric Be Fatter

And today's New York Post Front Page

Unconditional Love

So why punish children?

I guess this is where I really want to go with the themes of grace, retribution and rehabilitation. Why do we punish children? I'm talking the young ones, under the age of 7 or 8 (although I have thoughts on the older ones, too).

We tend to take for granted the idea that rewards and punishments are a necessary way -- if not the only way -- to train children in appropriate behavior. We're supposed to find deterrents to discourage undesirable behavior: penalties that add a little something unpleasant in order to "make them learn" or "make them think next time." The idea is that, upon their next opportunity for misbehavior, they'll consider the possibility of the penalty, fear it, and choose to avoid it by pursuing a course of appropriate behavior. Rewards, the mirror image of punishments, provide incentives for desirable behavior -- so the child is to choose a course of action (staying quiet, sitting down, stop hitting) in an effort to receive an (often unrelated) benefit.

Spelling it all out sounds pedantic. But behavioral conditioning in its current form is hardly innate to our biological and spiritual makeup -- in fact, it's a fairly recent cultural tradition.

A "utilitarian" value system -- seeking the greater social good through punishment of undesirable activity -- originates in (among other things) 18th Century economic theory. For instance, the theories of Jeremy Bentham (the economic legal theorist) on "strategic behavior": a potential criminal weighs the possible punishment against the benefit of his crime. I might decide, say, it's worth it to go 10 mph over the speed limit, because I want to get where I'm going more than I care about a 1% chance at a $100 speeding ticket. And really you don't have to analyze Bentham to understand the "Pavlovian" method of reward and punishment. This is so ingrained in our culture that few parents question whether it's a viable (much less moral and ethical) approach to raising their children. But it's critical to question whether reward and punishment "work" in families -- what goals do they accomplishment? And at what cost?

People are relational. We crave society, family, approval, validation and attention from each other. We can call these relationships "rewards" -- and surely we have all behaved strategically in the interest of pursuing a relationship -- but in doing so, we sell ourselves short. When we approach our relationships with the goal of conditioning other people's behavior, we shut our eyes to the possibility of unconditional love.

Love can be examined by science (and social science). Maslow's Heirarchy tells us that, with our biological and safety needs met, love and belonging come next; without them, we cannot proceed to growth and self-actualization. Study after study shows that infants thrive not just on food, sleep and warmth but on their attachment, both physical and emotional, to people who love them. And for most of us, love is even bigger than that -- it’s our defining value, our foundational premise, our directive and our goal.

But behavioral conditioning gives a message of conditional love. When our children are Pavlovian objects, to be trained by well-timed rewards and punishments that coincide with their behaviors, we react strategically in hopes of manipulating them. The most obvious examples are threats of pain (the American spanking, a part of many "traditional" upbringings which most of us would say we survived just fine) -- even temporary pain, that does not mark or injure, operates by causing enough fear of significant pain that a child molds his behavior appropriately. But that's not the only way we tell our child that he's safed and loved only if and when his behavior pleases us. Punitive isolation (the traditional "time out") tells a child, "you will be accepted as part of our family again when you behave appropriately -- or finish paying your penalty." And our very attention and affection for our children -- the comforting hug, the kind word of praise, the cozy snuggle -- can be defined as "rewards" that we must strategically dole out or withhold in order to react appropriately to their behavior.

The problem is, reward and punishment don't work all that well. So many parents, after reading every advice book and following every formula, become frustrated when no amount of consistent and stern punishment will get them the behavior they want from their children. And when our attitudes are locked into a model of behavioral conditioning, we often just give up and stop trying to hold our children to any standards at all. And what do kids really sit through punishments reflecting on the moral lesson -- or do they think more along the lines of "No fair! I hate you!" How many of us have rewarded a child only to pursue a spiraling game of "how much will you pay me to do what you want?" Or felt bored and dishonest when praising a child's banal (yet appropriate) behavior? Our hearts are crying out for a relationship -- for honest and unconditional love. But we fear that by loving unconditionally, we might ruin our children for life.

The good news is, none of this is necessary. Children can be disciplined in appropriate behavior without reward and without punishment. We can set boundaries and uphold standards without pain, fear or withholding affection and care. When our instincts move us to comfort a crying child, we can follow the wisdom of every cell in our biological makeup -- the legacy of generations of mothers and fathers -- and raise a healthy family by following those instincts. Parenting is easier (and much more fun) than all the books on reward and punishment would have you believe.

At our house, hugs and kisses are free.

For reference:
Arms of Love Family Fellowship
Effective Practical Parenting: Communicating Love
History of Punishment

Peace through Peace

Along the lines of culpability, grief, justice and peace: Two impressions of recent, tragic local car accidents:

First, a quote from the family of Joselito Barber, the police officer killed last week by a driver doing over 80 mph on a city street under the influence of cocaine. When commenting on the exceptional sentence expected to be sought against the driver for her "outrageous recklessness," Barber's family members are quoted as saying, "We have faith in the legal process and will do what we can to assist in the criminal proceedings as they unfold. We want our focus to remain on celebrating Lito's life and on preserving his memory. No legal or criminal proceeding is going to return him to us, or reduce our pain."

Second, the response of Heidi Coffee, who lost her husband Gavin this week when he swerved to avoid falling metal shelving that had fallen from a pickup truck on I-5. Recent law, passed in response to similar unsecured-load accidents, criminalizes this kind of negligence. It remains to be seen whether this driver will be prosecuted under the new law. But Heidi Coffee has moved toward personal reconciliation by inviting the driver to her husband's memorial service. "Gavin had this great saying, 'Holding a grudge is like taking poison and waiting for someone to die.'"

Grief can rage. Anger is an awful but expected part of an awful but expected human process. At some point, though, when rage turns into blame, resentment and hostility, we're not just feeling a raw emotion -- we are choosing a course of action. It's useful to remember that, in our grief, we don't have to take on the burden of judging and punishing those who wrong us. That's what our legal system is for.

Of course it remains to be seen (as always) whether the system works. Criminal punishments serve a few different purposes. Punishments should deter -- presumably, the threat of being caught and prosecuted will make us all extra cautious when securing our loads. We have an incentive to be careful. Our criminal penalties give voice to our society's "standard of care" -- we have a duty to each other to be sober when we drive. We owe each other an extra bungee cord in the back of the pickup. Unfortunately and ironically, the punishment is meted out once its deterrent effect has failed. It's too late for those lives to be saved; for the system to work, I guess the idea is that we prosecute these individuals to make an example out of them, and deter others.

Punishments also serve as retribution. Penalties make someone suffer for the suffering they caused. This idea is so old, and so embedded in our cultural consciousness, it's hard to think critically about. We're left wondering whether someone "deserves" to be punished without remebering what this really means. These drivers won't be punished simply because of the choices they made: they are no more culpable than thousands of other drivers that do the same thing, month after month -- but with enough luck or whatever other links in the chain of cause and effect that no one was killed. The crimes in question are combination of their choice (failing to meet what our legislators and prosecutors have defined as a duty to society), and the consequence. What is a fitting punishment? And why?

As a tripartate democracy, the idea is that we can learn and change as we go. Perhaps we'll learn that our driving while intoxicated laws aren't "strong" enough. Or that the unsecured load law really doesn't help anyone, and makes us all end up feeling lousy instead of vindicated. Thankfully, we've also learned from the Barber and Coffee families that forgiveness and dignity -- peace -- can be ours, even in the face of brutal grief -- and that our legal system doesn't have to be perfect in order for us to find peace and move on.

Postscript: Punisment through incarceration also can serve to protect society by taking the criminal out of circulation for a specific period of time. This makes practical sense in the case of Officer Barber's death -- where the driver has a history and propensity for similar behavior, and may be for those reasons a "menace" (although I don't know that the vehicular homicide statute is designed for this). Less so in the case of Gavin Coffee's death, where the driver, one might imagine, has a very, very slim chance of ever posing a similar freeway risk again.

I Forgive His Crimes of Fashion

I came across this Picture of the Bin Laden Family in Comcast's August 2006 Channel Guide Magazine. The magazine (my main TV Guide) features the photo as part of a blurb about two upcoming Osama Bin Laden documentaries. The actual text doesn't appear online (perhaps wisely), but the picture does -- a striking group of fashionable-looking young Saudis, circa 1971.

I like how it captures that self-conscious / self-satisfied moment in adolescence. They look like the Brady Bunch (or a few Brady Bunches), right down to the wide ties. And there is young Osama Bin Laden. Which would probably be "haunting" except he has a huge dorky grin on his face, and is hardly recognizable. The picture (and, I hope, the upcoming documentaries), serves to remind us that goofy, earnest teenagers can become fanatical world-domination-caliber terrorists. He obviously wasn't born a bearded old monster.

I don't think much about OBL. How can I? (I was going to plead "I'm a busy working mother," but realized that Christine Amanpour, who led the investigative report behind the CNN documentary, has a young son just a few years older than mine). At times I find myself wishing he were dead, which feels at once uncomfortable and futile. It's discouraging: I have been terrorized and my government's attempts at retribution haven't worked (because I don't feel any better). Bin Laden is a legitimate threat, if there ever was one, but his death would not sate us (and might not make us safer). He's dangerous because they idolize him, but more dangerous because we demonize him. As an enemy, he is as seductive as he is elusive: we have come to believe that our nation must defend itself, if not from the threat of a single man, than at least from a single ideology. Can it be this simple? Or are we only distracting ourselves from economic, cultural and military realities that are too complex (or too inconvenient) to untangle?

I'm wary, and it's going to take a good documentary to get me to stomach some Bin Laden narrative. I don't know if he's a psychopath, or simply evil. He must have once been a typical man with typical failings (Greed? Ego? Lack of empathy? Ideological arrogance?) and I guess we're supposed to learn about what on earth kind of cultural and political context torqued and amplified him until he reached the current status of monstrosity/idolatry that is truly analagous (little is) to Hitler.

I can't imagine any satisfying ending to Bin Laden's story. In 2003, when we saw the awful wire photos of dead Uday and Qusay Hussein -- grotesque in both their humanity and their monstrosity -- I learned about nothing but pathos. It resonated of Flannery O'Connor's A Good Man is Hard To Find, but I'm still not sure why. I guess it's the brutal questions of cruelty and redemption: Whether we can recognize them, whether we care, and whether it's all still too ugly too face, either way. Bin Laden's story only promises more pathos. Is he the Misfit? And if so, what do we learn when we face death looking him in the eye?

Maybe I'll watch the documentaries and learn something. For now, my fascination is with the blurb Comcast ran in its TV Guide article (sorry I'm having trouble uploading it). They said, "The hideous '70s duds worn by then-16-year-old Osama bin Laden (second from right) in this 1971 photo would be the least of his crimes." I can't tell if this is a joke, because it is not really funny. Because his clothes are not even that bad; he's just wearing a green shirt and flared jeans. The guy with the short orange tie, hip belt, and the Austin Powers hair, maybe his clothes are "hideous." But exaggerated accusations of Osama Bin Laden's FASHION crimes don't really get us anywhere. The caption is so bad its funny, but not in the way it's supposed to be.

It is just a step away from some awful pun like "Fashion Victims of September 11th." Really.

(And I'm not beyond being amused about these things IF something's funny. Bert is Evil is funny)

In the Footsteps of Osama Bin Laden, August 23 on CNN
The Final Report: Osama's Escape, August 29. on National Geographic Channel

Pacem via disputare

"Peace through argument" just kind of came to me as a kind of subtitle, and I didn't think much about it until I tried to explain it. I guess it means a couple of things:

First, personal peace of mind -- serenity, quiet and calm -- through the refinement and articulation of our own convictions. "Argument," not because we're always right. Not because we've got to force everyone else to agree with us. But because it speaks to our own confidence in the face of disagreement. And the process of learning through disagreement. Good argument is free of hostility. But through good argument, we assert our convictions without taking on the fear or hostility of those who disagree with us.

Second, social peace -- Cessation of armed conflict. Peaceful communities that are safe and thriving. The peace of families within our homes. But this also through the dynamic interchange of ideas, the convictions of individuals and communities. It happens when we challenge ourselves to organize our thoughts, stop assuming we're right, move beyond seeing only two sides to every issue and become unafraid to engage difficult topics (and difficult people). The peace of social justice happens through vigorous and often uncomfortable process.

Peace is a blessing freely given us, and it is also a gift we can freely give each other. It is a personal and social aspiration and a fruit of considered discourse. And I like the contrast of Peace/Argument. It's like a reminder that peace is not passive and permissive. And that the goal of argument is not aggression and self-vindication.

"Smiling is very important. If we are not able to smile, then the world will not have peace. It is not by going out for a demonstration against nuclear missiles that we can bring about peace. It is with our capacity of smiling, breathing, and being peace that we can make peace." Thich Nhat Hanh.

"The fruit of the spirit is love, joy and peace." Galatians 5:22

Moonsnail (No, not Sovin)

So, you have to name the blog before you can set it up, which I guess is fair. This is consistent with the English 284 (Short Story Writing) rule that you can't turn in anything called "Untitled," no matter how earnest and dramatic a font you come up with. Decide what its about, and come out and say it. Also, don't write about your dreams. And no robots.

For a blog title, I wanted a phrase that would succinctly encompass the topics of law, rhetoric, celebrity-think, culture, parenting, childbirth, Anita Shreve novels, Marian theology (open to learning here, no thoughts formulated yet) and all these swirling thoughts that might somehow make it here. I considered the Jane Austen quote, "You should have distinguished." But that’s so accusatory. And evokes an unnecessary feeling of poignant regret.

Please note that, if you look online for inspiration, about.com has a blog name generator. I don't know if it's any good because I quit after it suggested "Heart Community" and "White Times." No, not White Times. Maybe I should have kept going, so I could find more things to blog about. In search of other blognameters I found http://www.wordconstructor.com/ which will let you type in a word and use that as inspiration to invent an entirely new word. I typed in “Robin” and it suggested "Sovin," which it rates as "47%." Which I don't get because three out of the five letters are the same, which would make it an even 60%. No, not Sovin.

So, I turned to the idea of a physical or natural image -- something with energy that expands and grows, nonlinear, and not quite predictable, but that eventually organizes into something more than itself. I came upon the word WHORL which seemed perfect:

WHORL: A form that coils or spirals; a curl or swirl: spread the icing in peaks and whorls; An arrangement of three or more leaves or petals radiating from a single node; A single turn or volution of a spiral shell. One of the circular ridges or convolutions of a fingerprint. An ornamental device, as in stonework or weaving, consisting of stylized vine leaves and tendrils. A small flywheel that regulates the speed of a spinning wheel.

I like all those things. Frosting! But I set up the Whorl Blog and realized that “whorl” looks a whole lot like “whore.” Which probably lends itself to all sorts of interesting linguistic and cultural exploration, but I’m not about to name myself that, am I. So I started thinking about the whorling spiral shell, which led me to google around on that idea, which led to Lunatia, the Latin genus for a moon snail.

Moon snails are cool. They are chalky blue on the outside and glossy shades of lavender on the inside. A live moon snail is a huge, gooey mass of mollusk that is four times bigger than its shell. It has a muscle that it uses to drill through the hard shells of clams and oysters. It lays its eggs in these big leathery swaths of sand that are so perfectly circular they look like they were fabricated on a wheel. I remember seeing these egg collars when I was little and having the image that all moonsnails were female -- motherly. But I don't know, maybe there are two sexes or maybe they are hermaphrodites? But then the maternal symbolism things carried itself out this morning, when I looked for moonsnail pictures online and had kept finding ones that looked just like a single, huge breast.

Moon snails are mathematically perfect spirals hiding burrowed into the wet suction of the intertidal sand. They are elegant, messy, delicate, strong, succulent, carnivorous, and life-giving. I think that's a good start.

Robin's Introduction

So, for all the time I spend writing, I've been resisting a blog. It seems like I spend most of my energy emailing boring things about myself, mostly to my family. Or complaining online about things like "why my job is annoying." Or getting into arguments along the lines of "here’s why I’m right, and you need to listen to me." I spend a lot of time worrying that people are being too reactionary and not listening and learning as well as they could. And reflecting on all the baggage we have that makes us defensive and clogs our critical thinking.

But I thought I couldn’t do my own website, because 1. It would be boring (My mom is patient enough to read things like "I dreamed I was brushing my teeth". Or maybe now that I think about it, she doesn't actually read them) and 2. If all my writing just complains about people in my life to other people in my life, who is left to read my blog? What is left to write about?

Then yesterday I had two actual Ideas in the course of an hour, and it occurred to me that there might be a better way to express myself than cramming it into an email about my Greek Monte Cristo Sandwich recipe. Or like a better place to put things down so I don't lose them. So I'm aiming to assemble some thoughts and format and intentionality.

And maybe this will raise my standards for myself. I’m hoping to make this a little quiet place for me to sort out the noise and figure out what I’m thinking. Or maybe it will be a noisy place where I can find my voice and be loud.

Lunatia Heros

The Northern Moonsnail.


This photo courtesy of Washington State University Extension Island County Beachwatchers. I hope to take my own photo soon.