The Nature of Science

As alluded to in my last post, I do a fair bit of lurking at a site called Science Based Medicine. It's not generally the posts I'm terribly interested in, it's the comments that inevitably follow and the debates that go on that pique my interest. I really enjoy learning how other people think and make judgements.

One thing that comes up over and over again on that site is this theme: those who choose to question/delay/selectively vax, those who choose alternative medicine, and (now) those who choose to natural birth or homebirth are uneducated and making decisions not based in science. As you can probably infer, I take a bit of issue with this broad generalization. As I see it, science, in and of itself, does not dictate which choices should and should not be made. Science is a tool, a process, for gathering information in order to inform the decision that is to be made. Science is amoral - real life, and the application of science, is not amoral, and as such, when making a decision (especially about medicine and intervention), the realities of life and the individual values of those involved, as well as the science, play a part in the eventual decision that is made. For instance, say someone has a terminal condition, and science has shown that there is a treatment that will prolong life by several months, but this treatment also has the side effect of causing significant pain - is it anti-science for an individual to choose not to have the treatment? Is it to be inferred that if the person chooses to decline the treatment, he or she is uneducated?

As someone who is not religious in any way, shape, form, or manner, the amount of smugness that I have observed on websites like Science Based Medicine bothers me, as it seems to come from as much dogmatic fervor as might be observed in a fundamentalist religion: those who do what we do are good, everyone else is silly/stupid/damned. Science is not about being close-minded or entertaining only one theory - it is about exploring the possibilities and gathering as much information as possible.

Making a decision that is not in the mainstream of medicine is not necessarily a rejection of science. And to suggest that different people cannot look at the science and still come to different conclusions about how to treat in medicine betrays the ignorance of the one making that assertion, not the one making the differing decision.

A Good Smiting

I'll admit it. I experience schadenfreude from time to time. Now is one of those times.

Extremely vocal (and generally incredibly illogical) anti-homebirth advocate Dr. Amy Tuteur has found a new pulpit from which to preach her ad hominem attacks and general mouth-foaming about those poor, uneducated, foolhardy, and misguided women who eschew all that modern medicine has to offer and choose to have unmedicated or even *gasp* homebirths. The woman who generally employs a post-and-run approach to birth issues in a variety of online forms (or a delete-all-those-who-point-out-the-lack-of-science/evidence-behind-my-thinking on her own blog) has found a new home at Science Based Medicine.

*snerk, snort*

While Dr. Amy started off with a post that had the regulars at SBM nodding their head in agreement, it has only taken three posts for the the zealotry and lack-of-research that is Dr. Amy to have presented itself. In her post today, Dr. Amy begins by trying to convince the SBM readership that "natural childbirth was invented by a man to convince middle and upper class women that childbirth pain is in their minds, thereby encouraging them to have more children."

Um, yeah. Because for thousands upon thousands of years prior to the 20th century, women were having epidurals and c-sections. This whole unmedicated vaginal birth thing is *such* a newfangled thing.

Dr. Amy goes on to make a number of historical mistakes in her post and tries to paint the entire natural birth movement as possessing the same mindset of a particular male doctor from the early-to-mid 20th century. Ordinarily, this type of illogical writing would have me quite upset and quite possibly spending hours researching, commenting, and debating.

But Dr. Amy made a huge mistake. She posted her unresearched tripe on a board full of well-researched, scientifically minded readers. And while I do not agree with a good bit of the posts (or commenters) on the site, I do have to say this: there are all well-educated and can spot a logical fallacy (for the most part) from miles away.

And they are giving Dr. Amy a bit of a schooling.

Excuse me while I make a bowl of popcorn and sit back to enjoy the schadenfreude.

On Health Care

It's taken me several days to formulate my feelings about the health care bill that the House passed. Actually, it's taken me several days to find the words to express my anger and disgust about the Stupak-Pitts amendment that was added on at the last minute to the health care bill. And I still don't know whether my words will do my feelings any justice.

I'm angry. I'm angry at the Democrats - who I have supported with both money and efforts - for throwing women's reproductive rights under the proverbial bus in order to pass a flawed health care bill with a pitifully weak public option. I'm angry that in a country that supposedly has separation of church and state, Catholic bishops had so much power over the bill via the Stupak-Pitts amendment. I'm angry that the Democratic leadership is so weak that they allowed this "compromise" to occur in the first place.

I'm just angry.

In case you can't tell, I'm pro-choice. I've said it in a blog post before and I'll say it again: no one likes abortion. No one thinks it's great. But in the reality of our world, it is a necessary procedure. While the Stupak-Pitts amendment does not overturn Roe v Wade, it imposes such an effective economic barrier to access that for many low and middle income women, Roe v Wade might as well have been overturned. Abortions will still be available for those women who can afford it out of pocket, but for those women who can't afford the $300-$900 for a first trimester abortion, sorry...basically, we're telling these women: you can't afford an abortion, so you now have to pay for even more expensive maternity care and, more than likely, the raising of a child. You didn't conceive this child on your own, but if the father opts to not be responsible and pay child support, our courts aren't going to do much to help. We're not going to help you with maternity leave - chances are you will have to be back at work within 6 weeks. And on behalf of those who believe that the woman should be shown no sympathy or empathy because she made the decision to have sex in the first place, we're saying you're so irresponsible in the first place that we're going to force you to be responsible for raising another human.

Having known quite a few women who have had abortions for different reasons, it makes me angry that a bunch of people in Washington felt as though paying for a medical procedure that is utilized by 1/3 of all American woman was verboten, but the same people think it is ok to pay for Viagra. I'm angry that my rights and my access to healthcare are being determined by the leaders of a religion that I do not belong to.

I'm angry that the leaders I honestly believed in are showing themselves to be no more than mere politicians.

That's most coherant I can be about the subject at this point.

All Hallows Skanks?

I love Halloween. Really - it's probably my favorite holiday. My husband and I love decorating the front lawn with a combination of homemade and store-bought horrors, fill the evening with low-lying fog, and create an eerie atmosphere that does a good job of scary the neighborhood children.

I was the one who was frightened, however, when I opened up the latest Party City circular. Not by how scary the costumes were, but by how skanky they were.

Seriously. It seems like all of the female costumes were low-cut, mini-skirted, or sheer. Even the teen costumes left little to the imagination. There is something to be said for being confident in your sexuality and your body, but that doesn't mean you should parade it out there like a cow at the State Fair! I know Halloween is about fantasy and playing a character, but aren't you supposed to leave the sexual role-playing for the bedroom - you know, where the costumes that look like underwear should stay as well?

Cripes! They found me!

By "they" I mean the formula companies. Since I did not have a baby registry with this pregnancy and did not birth at a hospital, I thought for sure that the formula companies would not know about my potential source of income for them, er, my bouncing baby boy. But wouldn't you know what showed up in the mail two days ago?

A formula sample kit from Enfamil.

And then today, a glossy "magazine" from Enfamil titled "Nourishing Dreams."

On the inside cover is an ad (well, the whole thing is an ad, but permit me to indulge the sham that the glossy is somehow a legitimate publication) touting Enfamil Premium as a way "you can do more to give him a solid foundation." Hey, Enfamil? You know what I am doing to give my son a solid foundation? I'm breastfeeding him.

On the first page, there is a short paragraph about the challenges of motherhood: "There are round-the-clock feedings, dozens of diaper changes, and a scarcity of sleep...we thought you could still use a little help." Dude, Enfamil is going to clean the house and make dinner for me?!?! No? They're just going to push formula? Oh, drat.

Several pages later is an "article" titled "Your Fuss-Free Guide to Supplementing." Some excerpts: "Why do so many moms supplement?" Ooh, ooh, I know!! I know!! Is it because formula companies have done a bang up job making breastfeeding seem unnecessary and supporting outdated ideas about breastfeeding? Not to mention, the fact that formula companies in the United States shower expecting and new moms with free formula and coupons during the first few critical weeks of breastfeeding in an effort to thwart breastfeeding success? "Supplementing gives you certain freedoms." Oh, drats, I guess I was wrong. "You can hand off feeding to Dad or Grandma, or go back to work without the hassle of pumping." Yeah, but then comes the hassle of trying to keep your milk supply up when baby is filling up on formula and doesn't want to nurse as much because the formula digests far more slowly than breastmilk. Of course, when your supply begins to drop because baby isn't nursing as often, rest assured, you can always buy him some more formula.

Next up: "A 60-Second Introduction to Formula." One benefit of formula feeding: "This way, Dad can get in on the act, too!" Because, you know, Dad couldn't get in on the act by changing diapers or playing with the baby at other times. One of the pieces of advice given here is "if adding a bottle here and there makes you a calmer, happier mom, that will benefit your baby too." You know what else generally makes for a calmer, happier mom? Valium. Maybe all new mothers should be prescribed Valium, as, hey, if it makes mom calmer and happier, it might benefit baby too!

Yeah.

So, how exactly did I get on the list to receive this wonderful publication and the generous samples of formula? Best I can figure, my information was sold to Enfamil when I went shopping at Motherhood Maternity for --- (wait for it) --- nursing bras.

There has to be some irony in that.

Brainwash, rinse, repeat?

I've tried not to write anything about the whole Obama-speech-to-American-schoolchildren thing. Really, I've tried to hold my tongue. Maybe it's the sleep deprivation, maybe it's my sheer amazement at the things I'm hearing and reading from parents who think Obama is out to brainwash their children, or probably a combination of the two, but I just can't keep quiet any longer.

Get real, people.

First of all, the man is a freaking politician, not a hypnotist. What exactly do you think he is going to do or say in 15-minute speech that will cause an entire generation of children to rise up and create a new socialist world order? I mean, honestly? I've seen video of mothers breaking down in tears over the thought of their precious offspring being forever warped by watching a 15-minute speech about education and the need to stay in school. I don't get it. I mean, if their kids are anything like them, they'll probably be sticking their fingers in their ears and screaming "I can't hear you" anyways, right?

Second, to those who don't want their kids seeing the speech without their parents being present: what kind of children are you raising? You do realize that in order to be a successful adult, you're supposed to have the ability to think for yourself, and this ability is not magically conferred upon you the second you turn 18 - you have to practice and hone this skill way ahead of time. Parents who feel the need to vet everything and anything their children come in contact with seem to be setting their kids up to live inside a plastic bubble, because heaven forbid the kids should hear or see something that differs from what mommy and daddy believe or think. What will happen to these kids when they go out into the big old world and have to deal with people who have different thoughts, attitudes, beliefs, and backgrounds from their own? Is mom or dad going to be there day in and day out to protect them from ideas that might challenge their own? Are these parents screening each and every schoolmate and friend to make sure everyone believes the same things, has the same political leanings, and worships at the same locale? Because if you think a 15-minute speech by the President can cause little Susie to turn to the dark side, whoa, what about a 30-minute lunch with friends who aren't the same religion?

But you know what really gets me? The same parents who are upset right now about Obama "indoctrinating" their children tend to be the same parents who want prayer in public school and Creationism in the science books. These are the same parents who don't understand why people of other faiths - or those who have no faith - might take issue with that. If a 15-minute speech can lead to the downfall of everything Mom and Dad have tried to teach their children, what effect do you think having to listen to day after day, year after year, of Christian prayer might have on non-Christian children? Why is it ok to attempt to "indoctrinate" these other children? Or is indoctrination only ok when it's your beliefs that are being pushed?

Breastfeeding - A Good Way to Get Fired?

It has been a win some/lose some week for breastfeeding moms who work.

The California Fair Employment and Housing Commission ruled (CFEHC) that a woman cannot be fired for breastfeeding during break time. Marina Chavez, a cashier at Acosta Tacos in Los Angeles, was fired from her job when her manager discovered she had been using her breaks to breastfeed her premature baby. When manager Jaime Acosta discovered that Chavez's boyfriend had been bringing the 4-week-old baby to the restaurant so Chavez could nurse the child in the car, Acosta told her she could not come back to work until she stopped nursing her baby. When she stated that she could not wait that long to return to work because the family needed the money, Acosta fired her. The CFEHC ruled that breastfeeding on one's own time (as the break is considered to be) is protected under California law. Acosta Tacos was ordered to pay Chavez $41k and pay a fine to the state of $5k.

At least one state got it right. Unfortunately, it would seem that another state got it wrong.

The Ohio Supreme Court ruled that the Totes/Isotoner Corporation was lawful in firing LaNisa Allen from her job for taking unauthorized breaks in order to pump milk. According to Ms. Allen, she was told she could pump during her lunch break, more than 5 hours after last nursing her then 4-month old son. When she waited the 5 hours, she found that her breasts would hurt and she would leak milk. After noticing that other workers took unauthorized breaks to use the restroom and have a cigarette, she began taking a break at 10am in order to pump. When her supervisors discovered this, they fired her for taking unauthorized breaks. Ms. Allen filed suit, claiming she had been discriminated against. The Ohio Supreme Court disagreed.

Really, how is this anything but discrimination? Many lactating woman cannot just "hold it" for 5+ hours without suffering from pain and engorgement, at the very least. Not allowing an engorged woman to empty her breasts can lead to blocked ducts and mastitis, a serious breast infection. Would the Ohio court have ruled it was ok for the Totes/Isotoner corporation to fire someone with diabetes if they took "unauthorized breaks" to check their blood sugar and take insulin? Or how about if they fired someone with bladder issues who had to use the restroom more often than once every 5 hours? As it is, according to Ms. Allen, co-workers took unauthorized breaks to smoke and use the bathroom - why was she singled out and what was lawful about that?

To make things even worse, Totes/Isotoner touts their Comfort for a Cure Campaign to raise money for the breast cancer research. Yep, the very same body part that produces breastmilk. By the way, did you know that breastfeeding has been found to reduce the risk of developing breast cancer? So it would seem that Totes/Isotoner only cares about finding a cure, but not supporting the prevention of breast cancer.

Yeah. You can send those emails to customeraffairs@totes.com.

Protecting the United States

Having been subjected to the abject cheesiness and mind-blowing silliness of Indian mainstream cinema while growing up, there is a part of me that understands why Homeland Security might see Bollywood as a threat. But, come on, did they really have to detain Bollywood icon and superstar Shah Rukh Khan at Newark airport for "secondary questioning" for two hours? I mean, was he threatening to start a non-sequitur, perfectly choreographed and lip-synced dance sequence or something?

According to Khan, his only possible crime was having the last name "Khan." I guess having the name Khan might be construed as sign of a possible threat, you know, if you were Captain Kirk or something. But guys, this is Shah Rukh Khan! All Homeland Security had to do was google the man's name to know who he is and what he looks like. Hell, they could have just gone out and asked some of the cab drivers waiting outside the airport to ID the man!

I'm not saying that an actor - any actor - is above the law or rules and regulations. However, it is a little scary when the Department of Homeland Security's information gathering is so poor that they can't correctly identify the biggest actor in India - especially in less than two hours.

Epic fail guys.

Back on the Grid

Like a lot of women who opt for a homebirth, I did not choose to let my mainstream ob/gyn provider know that I was leaving that practice for the rest of the pregnancy and the birth, instead opting to "go off the grid" quietly by not scheduling another appointment. My last prenatal appointment with the practice was at 18 weeks. As such, I expected to get some questions when I showed back up at the practice last week with a two-week old baby and case of mastitis. However, I must say, I was a little surprised at some of the questions I got.

The nurse in the office was a little surprised to learn that we had delivered our son at home without assistance. But what seemed to really surprise her was the fact that the homebirth midwife sewed up the 2nd degree tear that I had; her facial expression and tone of voice suggested that she wasn't aware that direct-entry midwives knew how to do such things. The doctor who examined me also had some questions, such as whether I had received any prenatal care from the midwives (um, yes - I received excellent prenatal care from the midwife, as a matter of fact) and whether I was receiving any postpartum care from the midwife (again, yes).

What was interesting, to me at least, was that prior to leaving the practice and opting for a homebirth, the subject of having a homebirth came up during one of my visits, and the care provider railed against the idea, calling it "dangerous." And yet, from the questions I was being asked following my successful homebirth, it was obvious that at least two providers in the practice had little understanding of what homebirth actually entailed or what the training of the homebirth midwife might have involved. It makes you wonder - how can you argue against something if you honestly know nothing about it?

A Homebirth Story

I've talked about planning a homebirth in previous posts, so I thought it was only fair to share the story of how the homebirth went. The following is my homebirth story:

D was born at 7:20am on Saturday, July 18, 2009. He weighed 8lbs, 9oz and measured a healthy 21.25in in length. D managed to make his entrance into the world in approximately 39 minutes from the first contraction. The story probably begins the day before, on Friday. Scott, my husband, IM’ed me from work to ask, hypothetically, what we would do if the midwife and her assistants were unable to make to our house in time for our planned homebirth. Given that our first son was born in under 2.5 hours, it wasn’t an outlandish thought, but I still thought it was silly. In spite of that, I responded that we would let my body do what it needed to do, but I would need him to “support my perineum.” Scott asked what that involved, and in trying to describe it to him, I decided to find an article or two that explained emergency childbirth and send the links to him. In spite of his busy day at work, Scott did, in fact, take the time to read the first article I sent him. This was a good thing, as it turned out. He also said that should he have to deliver the baby, his fee would be a Mesa Boogie amplifier and Paul Reed Smith guitar.

I woke up around 6:41am to use the toilet and as I was getting out of bed, I felt a contraction. As with my first labor, I found that an assisted squat was the most comfortable position to ride out contractions, so I spent the first contraction sitting on the toilet. After it was over, I went back to bed and woke Scott up, telling him that I thought I was in labor. I laid on my side as Scott rubbed my back and timed the next two contractions: 4 minutes apart, 30 seconds to 1 minute in duration, and painful. Definitely time to get up. Scott got dressed and went downstairs to call the midwife. I decided to take advantage of the “early” labor and get into the shirt I planned to birth in. After riding out another contraction, I put in my contacts and brushed my teeth. In retrospect, I should have realized how much faster the labor was proceeding, as I had to stop several times while brushing my teeth in order to stretch and breathe through contractions. There seemed to be very little break between the contractions. I went back to the toilet in the master bath to ride out another set of contractions and Scott came back upstairs. I suggested that he lay down the shower curtains and vinyl tablecloths on the floor in the guest room, where we had planned on having the birth, as well as put the waterproof sheet on the bed in there. At that time, I noticed I was starting to bleed, a sure sign of transition. Scott suggested I go into the guest room, but I said I would rather go into the other upstairs bathroom (across the hall from the guest room) because I would be more comfortable using the toilet to squat on. At this point, there was no break between the contractions. I walked to the other bathroom, groaning and breathing deeply the whole way. When I was in labor with older son, I had screamed during contractions until the midwife, at the hospital, suggested groaning deeply; the change in vocalization actually helped a great degree, and I remembered this when I was in labor with D. I labored in the hall bathroom for probably around 5 minutes as Scott and my mother got the guest room ready. At that point, I felt the urge to use the toilet; only thing was, when I pushed, I distinctly felt the sensation of a head descending. At first, I thought I was mistaken. Then I felt the urge again and started pushing and realized, no, in fact, that was a head descending. I told Scott the baby was coming. He came into the bathroom and asked me what I meant. I stood up, half bent over on the toilet, using the seat to support myself, and reached down and felt between my legs – and felt the top of D's head, still in the placenta. “I can feel his head,” I said. Scott began to panic a little and told me to move to the bedroom, and I told him no, I was not moving. I felt the urge to push again and felt my water break. Scott insisted, again, that we move to the bedroom, and I told him, no. “Catch the body,” I told him as I pushed a fourth time and caught the head. Scott, somewhat awkwardly, managed to pick my leg up above the toilet seat and get his hands beneath me to catch the body. I vaguely recall him saying “Oh my god” several times. I backed up a little and we maneuvered D out of the toilet so that I could hold him to my body to warm him up; little D looked quite stunned, but began to cry almost immediately. My mom looked down at her watch and noted it was 7:20. Scott directed my mother to get some towels from the guest room, and D proceeded to pee on me. As the towels were brought to us, I started to feel the urge to push out the placenta. Not wanting to have to dig it out of the toilet, I told Scott to take D so I could catch the placenta. He took D and I delivered the placenta. It was bit surreal: I was sitting/squatting over the toilet, holding my placenta with both hands, as I watched my husband warm our newborn son up in a blue bath towel. After a few minutes, I realized I should try breastfeeding and order to keep myself from hemorrhaging, and asked my mom to get the plastic bin to put the placenta in. She did, and I sat down on the toilet and attempted to nurse D, but found it difficult given the position. Scott asked my mom to help me to the bed, while he used a bulb syringe to clean out D’s mouth and nose. I felt woozy as my mom helped me to the bed and felt grateful to lie down; the midwife estimated, afterwards, that I had lost double the normal amount of blood giving birth, so it was no surprise that I was feeling light-headed. As Scott was bringing D to me, I heard his big brother singing to himself in his bedroom – he had slept through the entire thing. I attempted to nurse D while lying on my side on the bed, but found it quite difficult considering he was still attached to the placenta, which was lying in the plastic bin on the bed. Scott called the midwife, who was on her way, to let her know that he just delivered a baby and we were anxiously waiting for them. About 20 minutes after D was born, Bethany, the midwife assistant/apprentice who lived closest to us, arrived. She clamped D's cord and had Scott cut it. Then Meliea, another assistant/apprentice arrived. They got D cleaned up, weighed him, and helped me to nurse him as we waited for Amy, the midwife to arrive. Once Amy arrived, they examined D. My mom went and got my older son ready, and he got to meet his new baby brother; he was less than impressed and wanted to go downstairs and watch cartoons. My mom and older son went downstairs, Scott following shortly after with D, as Amy, Bethany, and Meliea tended to me, cleaned up the bathroom, and documented all the details. Once I was all taken care of, Scott brought little D back and I spent some time falling in love with my new baby boy.

It was not the ideal delivery, but it did go rather smoothly. It was an amazing, surreal experience, and I so glad we knew what to do and planned for a homebirth – better than the likely alternative of giving birth in the car on the side of the road! Only problem is, now, in addition to the midwife’s fee, I also have Scott’s fee for catching D!

The Man in the Mirror

I've never been a huge Michael Jackson fan. Sure, I've enjoyed his music, but I never bought one of his albums, never went to a concert of his. And yet, like so many, I was stunned and shocked by his untimely passing at the age of 50.

As a child of the 80s, his music was a part of the soundtrack of my childhood. I remember watching MTV at my friends' houses and marveling at his music videos. I'm sure I recorded a song or two of his off the radio for my mix tape collection. I danced around in my room to his songs. And, like every one else, I was increasingly disturbed by his transformation from a handsome young black man to an ethnically ambiguous caricature of a human figure. The lightened skin, the continued plastic surgery - it was all so bizarre. And as a child and then as a teenager, it made no sense. As an adult, however, it became clear that what we, the public, were seeing on the outside was a representation of the pain and disfigurement on the inside. Stories emerged from interviews with Michael himself, as well as family members and those who knew him, about physical and emotional abuse at the hands of his father, Joe. His immense talent - the very key to his fame and fortune - seemed to be the trigger for his father's driving him like slave to rehearse and perform. Rather than statements of love and approval, young Michael heard insults about his nose and the darkness of his skin. His talent, which brought him the love and admiration of a worldwide audience, only caused his father to push him more, to isolate him more, to abuse him more. And no one stood up to protect Michael. Is it any surprise that he became a man who could not survive as an adult? Is it any surprise that he became a man who could not see the beauty in himself and instead subjected himself to countless cosmetic procedures in order to achieve "perfection?" That little boy who had seemed to have everything, in truth, didn't even have the basic thing most children have: the love, acceptance, and protection of a parent.

That is the tragedy of Michael Jackson's life. His greatest gift was the reason for his downfall. And what is so tragic is that every day, we see that others are not heeding the moral of Michael Jackson's story, that there are still parents who treat their children not as a special gift to protect and nurture, but as a meal ticket to exploit and sell. There are still parents who see their children as a means to an end, and not a joy to cherish for its own rewards.

My favorite Michael Jackson song is "Man in the Mirror." In it, he talks about the need for change to start with each person looking at himself or herself and making a commitment "to make that change" starting with that "man in the mirror." It is so sad that when Michael Jackson looked at the man in the mirror, he saw the distorted image painted for him by his father, and not the one the rest of the world saw. Rest in peace, Michael. I sincerely wish you had found that peace while here on Earth.

Bad Medicine

Oh this ticks me off! The American Medical Association has come out against healthcare reform, primarily because of opposition to a public health care plan. One of the major reasons for that opposition is the contention that "the corresponding surge in public plan participation would likely lead to an explosion in costs that would need to be absorbed by taxpayers."

Right. Because our current system, in which there are 40 million Americans without health insurance, leading to a focus on emergency medicine rather than preventative medicine, is really cost effective.

Or is it that the AMA is worried about the effect of having someone who calls for evidence-based medicine holding the purse strings for medicine? What would happen to billing for the "machines that go ping" if the guys writing the check said they wouldn't pay for them because they do not improve outcome?

Whose health is the AMA more concerned with: the health of the average American, or the health of their members' bank accounts?

RIP Dr. Tiller

It has been several days since the Wichita doctor, George Tiller, was murdered while in his church. And I am still sad over his death. I have debated whether I wanted to blog about him and about abortion, about whether I wanted to enter the fray. And I have come to the decision that one of the best ways to honor Dr. Tiller's memory is to be open about the reasons women went to see him.

Back in February, my husband and I, accompanied by our toddler, went to the ob/gyn's office for what I expected would be our last visit before I transferred care to my homebirth midwife. I was approximately 18.5 weeks pregnant and was going to have the now-routine anatomy scan done. Technically, the scan is done to make sure the fetus is growing correctly, that the pregnancy is proceeding normally. But I would say most women see it as the chance to find out whether they are having a boy or a girl. My husband and I were hoping to learn that we would be having a little girl, though we would also be happy to find out we were having a healthy little boy as well.

The ultrasound technician was cheerful and made jokes with us as she began the scan. She remembered my son from our previous two ultrasounds and was joking with him as she went through the scanning process. My husband and I waited anxiously to find out whether we were having a boy or girl, and the technician quickly told us we were, in fact, having another boy. Lying on the table, I gave my husband a wry grin - another boy. We were in for another exhausting couple of years.

As the scan continued, I noticed that the technician became quiet. She stopped talking to my husband and I. She stopped joking with my son. I remember looking at my husband quizzically several times and noting from his expression that he, too, had noticed the change in her demeanor. After over half an hour, the ultrasound technician told us that a nurse would be in to take us to another room to speak with the doctor, and the technician left without looking at us. Both my husband and I knew something was not right. As we sat in the next room, waiting for the doctor to talk to us, I could hear the technician in the hallway, speaking with the doctor. I heard her say to the doctor, "I've never seen a cyst that big before." I was becoming extremely worried.

The doctor came in soon after and told us what the scan had found: the fetus had what appeared to be two large cysts, known as choroid plexus cysts, on his brain. He also had what appeared to be an enlarged stomach. Individually, these would not be cause for alarm, but since our baby had both, there was concern that the fetus might have a chromosomal abnormality. We would need to see a high-risk obstetrician with a more powerful ultrasound machine in order to determine whether there were more soft signs of abnormality and, based on that, we would need to decide whether to have further testing, such as an amniocentesis. I asked what chromosomal abnormality the fetus might have; the doctor said that choroid plexus cysts tend to be seen in fetuses with Trisomy 18, a condition that is generally not compatible with life. The doctor said that she would call the women's center downtown and make an appointment for us; since we were the last appointment on a Friday afternoon, we would have to wait until Monday to find out when our appointment would be.

I know I held it together until we left the doctor's office. I was sent to the lab to have some blood drawn, and the phlebotomist asked about the pregnancy and whether I knew what I was having. I remember thinking, "I don't know that I'm really having a baby" but actually telling her, in a daze, that it was a boy. Once we left the building and got in the car, I broke down crying. My husband and I sat there, with our son in his carseat, holding each other as I cried. I remember thinking this couldn't be happening. This couldn't be possible.

As soon as we got home, I looked up Trisomy 18. What I read was not heartening. If our baby had Trisomy 18, the chances of him making it to term were slim; 95% die in utero. Those babies with Trisomy 18 who do survive to delivery die within days, if not hours. The median lifespan for Trisomy 18 babies who make it to term is 5 to 15 days. I was heartbroken. Instead of sending out a happy email to friends telling them we were expecting another boy, my husband and I were facing the prospect of losing our child. It was at this point that we began to seriously talk about what we would do if the tests showed the worst case scenario was reality. We talked about abortion.

I spent the weekend reading more about Trisomy 18 and about abortion, between bouts of crying. My husband and I found that neither of us wanted to talk about the baby, it was just too painful to consider what might be, but we both wanted to comfort each other. But both my husband and I were honest with each other: if our baby turned out to have Trisomy 18, we would not carry to term. It was that weekend that I learned about Dr. Tiller and his practice in Kansas. I read the stories his patients had posted on different websites. I read about his compassion for women, for couples, having been dealt a cruel hand by Mother Nature and having to make a difficult decision. Above all, I spent the weekend hoping that I and my husband would not have to make that decision, that everything would be ok, that it was just a false alarm.

For nearly 4 days, I and my husband wrestled with the what-ifs, wrestled with the possibility that we would have to make the difficult decision to end the pregnancy. It was with great relief that I laid in a different ultrasound room on the following Tuesday and learned that the baby showed no other signs of Trisomy 18 or, for that matter, any other chromosomal abnormality. A follow-up ultrasound four weeks later showed the two cysts on the brain had disappeared and the stomach, while still somewhat large, was normal in size. It was going to be ok. The high-risk obstetrician discussed with us the very low likelihood of there being a chromosomal abnormality, given the level-II ultrasound results and the results of my bloodwork; based on that information, we opted not to have an amniocentesis. It was going to be ok.

I am grateful that we did not have to make the decision to terminate the pregnancy - to abort the fetus. But I know that there are other women, other couples, who do not receive happy news at their follow-up appointments, who do not get the sense of relief when their testing results come back. And it is for them that I also mourn. For while the service Dr. Tiller provided, late-term abortion, is not one that all people would like to have exist, it is one that needs to exist. And the health of women in the United States, the options of couples and families facing the realities of a pregnancy gone horribly, horribly wrong, is threatened by the loss of Dr. Tiller.

Rest in Peace Dr. Tiller.

Why Its Better to Keep Your Mouth Shut

I'm no fan of Megan Fox, the actress (and I use the term loosely) from "Transformers." But sometimes, people say something so stupid, you just have to stop and go "Whaat?"

Case in point.

In the latest Esquire magazine, Fox apparently makes a jab at fellow actress, Scarlett Johansson, stating: "I don't want to have to be like a Scarlett Johansson – who I have nothing against. But I don't want to have to go on talk shows and pull out every single SAT word I've ever learned, to prove, like, 'Take me seriously, I am intelligent, I can speak.' I don't want to have to do that. I resent having to prove that I'm not a retard."

Um, hun? By even using the term "retard," I think you've removed all doubt about your intelligence...

Vaccine-Nation

Jim Carrey, the Hollywood actor, has become an outspoken proponent of safer vaccinations. He recently published an opinion piece on The Huffington Post calling for more research into the effects of vaccination, more specifically the current vaccine schedule and the components in vaccines.

Judging by the comments, Carrey's suggestions strike some as close to blasphemy.

I myself never questioned vaccination until I became pregnant with my first child. As a child of the 80s, I had the MMR and DPT vaccines. Before trips to India, as a child and as an adult, I got the recommended travel vaccines. I was aware of the vaccine controversy because of the fact that I worked with autistic and autistic-spectrum children in my clinical training to become a psychologist. But it wasn't until I was 7 months pregnant and really looking at the latest vaccination schedule that I begin to feel something wasn't right.

The facts are simple: American children are getting more and more vaccinations as time goes on. Day-old infants, before they even leave the hospital, are usually given the Hepatitis B vaccine. Hepatitis B, by the way, is a bloodborne virus that is usually transmitted through IV drug use or unprotected sex. I asked several doctors why an infant would need to be vaccinated for an illness that is contracted through behavior that they would not be engaging in; after all, the Hepatitis B vaccine is only good for 10 years, and I seriously doubt that the vast majority of elementary school kids, even in this day in age, are engaging in sex while using IV drugs. None of the doctors could give me an answer. I saw that the Chicken Pox vaccine was required; I have a clear memory of having chicken pox at the age of 5 - certainly not the happiest memory, but I, like every other kid in my kindergarten class, made it through unscathed, save for a few scars from a scratched pustule. And now, states are seeking to add on more and more vaccinations. New Jersey has been considering adding the yearly flu vaccine to its mandatory schedule. Texas was, for a while, mandating Gardasil, which protects against certain certain strains of the sexually transmitted human papilloma virus, for school attendance. Where does it end? When is it enough?

It's not just about autism, though. To make this issue solely about whether or not vaccines cause or do not cause autism is to miss the bigger question: Is it safe to give so many vaccines? Are the risks of so many vaccines outweighed by the benefits? We know that allergic reactions to vaccine components do occur. We know that children, such as Hannah Poling, are, in fact, injured by vaccines. The risks/benefits of not vaccinating a health worker for Hepatitis B who comes in contact with blood is considerably different than for a day-old infant. To suggest there is a one-size-fits-all invasive intervention when it comes to vaccination - when I have yet to see a one-size-fits-all invasive intervention in any other part of medicine - almost seems obscene. To ignore the likelihood of individual reactions and the need to modify vaccination based upon the individual's own and familial medical history and vaccination needs is absurd. I use my own family as an example: There are four generations in my family (that we know of) who have autoimmune disorders. My paternal grandmother and my father both have rheumatoid arthritis. I have Graves Disease. My brother's daughter, at the ripe old age of 2, was diagnosed with Juvenile Rheumatoid Arthritis. The evidence is quite clear that the immune systems in my family are atypical. So why would I want to have my son -who received half of his genetic makeup from me - be vaccinated with a large number of vaccines at one time? Why would I want to vaccinate him for illnesses that he has little danger of catching at this time, such as Hepatitis B? The history is clear - overaggressive immune systems run in the family; why would I want to provoke an aggressive immune response in my little boy?

I believe vaccination, like all valid medical treatments, can be positive and lifesaving. But just as we don't arbitrarily send all depressed patients for electroshock treatment because of the risk/benefits involved, I don't believe we need to mandate that all of our children be vaccinated against every disease. There are risks to putting anything into the human body - from medications to foods - just as there can be benefits. The challenge is determine where the happy medium is, and as of yet, neither the government nor the pharmaceutical companies appear to want to consider doing the research to find that point. The risks of mandating so many vaccinations needs to be studied in depth and by researchers without ties to the vaccine manufacturers. A lot of little lives could depend on it.

Forget Slumdog - Just Plain "Dog"

Sadly, another disturbing incident involving one of the child actors who performed in "Slumdog Millionaire." Rubina Ali, the little girl who played the child version of the female lead, was reportedly offered for sale by her father for 200,000 British Pounds. Comment boards are aflame with people hoping someone, anyone, comes in and rescues Ali from her family; angry comments being made against the director and producers of the movie for not providing more for the child actors; comments about the need for the Indian government to step in; comments about the evil things poverty does to people; and, of course, the run-of-the-mill comments about why are people in such poverty not controlling themselves "more responsibly" and have such large families that they can't support.

Whew!

While it would be great if a benefactor did come in and adopt Ali and save her from her situation, the sad fact is that in India, alone, there are more than 11 million children living in the exact same conditions that she is. 11 million in one country, living in squalor. Approximately 50% of Indians live in poverty; 40% of these individuals are children. One benefactor coming in and saving Ali will not change the conditions for these other children, many of whom are, assuredly, facing being sold into prostitution and slavery as well. It would be great if there was as much outrage and outcries on behalf of these children as there is for Ali.

With regards to the Indian government stepping in and helping these children, that is unlikely to happen without consistent pressure from the outside world and media. The Indian government is known for being corrupt and suffering from it's own inertia. It will likely step in and investigate the Ali situation because of all the worldwide attention being paid to the situation, but as soon as the cameras go away and the lights dim, Ali, just like the millions of other children, will be left to fend for herself.

As far as the producers of "Slumdog Millionaire," honestly, while it would be great if they stepped in and did something, I do not find them to be responsible for this situation. Yes, Ali got paid approximately $4000 to perform in a film that has grossed millions worldwide. Yes, the producers and other workers on the film have undoubtedly made huge sums of money in comparison. But, as with all unknown actors, Ali was paid a prearranged sum for her work. Most actors do not get profit-sharing of the film, regardless of their life situations; in that manner, this case should be no different. As it is, after the fact, the producers did set up educational trust funds for the "Slumdog" child actors and have arranged for their families to move out of the slums. Blaming the filmmakers for this situation is the wrong action, in my opinion.

Personally, I believe that the blame lies squarely on the shoulders of Ali's father, Rafiq. While the poverty that the Alis live in probably plays a factor, the father's apparent greed and desire for more money for himself appears to be the strongest contributing factor. And unfortunatley, in this regard, he is no different than the numbers of parents here in the United States who exploit their own children for wealth and fame (see: Dina Lohan, Lynne Spears). Even if the filmmakers had given Ali $100,000 or even $1 million for her work, I do not believe it would have been enough for her father - he would still be seeking to make more money off of his child. And unfortunately, as with the complexities surrounding poverty in general, the question of how to deal with parents like this is not an easy one - or one that has a convenient Hollywood ending.

A Rose by Any Other Name

I guess I shouldn't be too surprised, considering I lived in Texas for 8 years...

State representative Betty Brown is causing a wee bit of an uproar after suggesting that Asian Americans should adopt American names in order to make things easier for poll workers at precincts. Apparently, the fact that nowhere in the Constitution is it indicated that ease of pronunciation is a prerequisite for voting rights eluded Ms. Brown.

A gem from Rep. Brown:
"Can't you see that this is something that would make it a lot easier for you and the people who are poll workers if you could adopt a name just for identification purposes that's easier for Americans to deal with?"

The ignorance is almost frightening.

Sexting: A crime or kids being kids?

There has been a lot of discussion about sexting, the act of sending nude pictures over cell phones, in the news lately. A prosecutor in Pennsylvannia threatened to charge 3 teenage girls with sexual abuse of a minor for taking pictures of themselves wearing bras and sending the pictures to friends from their camera phones. That's right: the prosecutor was basically stating that the girls had sexually abused themselves. He justified his actions by stating that their pictures were child pornography. If convicted, the girls could serve time in prison and be forced to register as sex offenders.

Huh?

Look, I don't think anyone would argue that sexting is a really, really stupid thing to do. Really stupid. Monumentally stupid. But is it really a crime to simply be guilty of being a stupid teenager? Last time I checked, it was not illegal for a person to take pictures of him or herself, naked or not.

Now, what you might ask, would I consider a crime? Receiving said pictures and then sending them on to other people without permission, like what Phillip Alpert did. In a temper, Alpert, who was 18 at the time, forwarded nude pics of his 16-year-old girlfriend, which she had sent to him, on to family and friends. However, I don't think that such an action should be a felony, which was what Alpert was convicted of, and I certainly don't believe that it is an act that requires registering as a sex offender. I think that it should be a misdemeanor, perhaps along the lines of harassment. This might discourage teens and adults from not only forwarding such pictures on, but just might discourage some of them from taking such pictures. Because heaven knows, you can tell a teenager not to do something until you are blue in the face, but in the end, it's their decision and they have to deal with the consequences. Let's just make sure the consequences fit the crime...or lack thereof.

A Question of Rights

I am currently 26 weeks pregnant with my second child, a little boy, whom my husband and I plan to usher into the world at home, rather than in a hospital. The decision to homebirth is, to say the least, a controversial one in the medical community. There are certainly those doctors who would argue that I am endangering my fetus by choosing to birth with a midwife in attendance, outside of the hospital setting. But as a competent adult and citizen of the United States, that should be a decision that I have the right to make and carry out. It is my body, after all.

Unfortunately, the ability of pregnant women to make such medical and bodily decisions for themselves is coming under attack, and in the most insidious ways.

On April 4, the North Dakota State Senate voted to defeat legislation that would have defined as a human being "any organism with the genome of homo sapiens," whether inside or outside the womb; in addition, the legislation would have conferred equal protection under the law to these organisms, from the moment of fertilization.

The scary part is that the North Dakota House had already passed this bill.

While on the surface, this may look like yet another battle in the abortion debate, the fact of the matter is that bills like this not only undermine the ability of a woman to make decisions about abortion, they undermine the rights of women to make medical decisions, period. By defining life as starting at conception and conferring equal rights on fertilized eggs, suddenly, every miscarriage can be considered a possible homicide, every woman who drinks alcohol or uses drugs when there is a possibility that she might be pregnant is guilty of child abuse, and every pregnant woman who does not agree with the advice of her doctor could be forced, against her will, to undergo medical intervention because of the "rights" of the unborn.

Think I'm overreacting? In 1986, Ayesha Madyun was court-ordered to have a c-section after her water broke two days earlier and she had not given birth; doctors argued there was a 50-75% chance that the fetus was in danger of infection if Ms. Madyun refused intervention. The baby was born healthy with no sign of infection. In 1987, Angela Carder, a woman who was extremely sick with cancer, was forced by a hospital and a judge's order to undergo a cesarean section to deliver her daughter at 26 weeks of gestation. The neonate lived two hours; Mrs. Carder died two days later, and the c-section was listed as one of the causes of her death. In 1996, Laura Pemberton, a woman who was denied the VBAC she wanted, was arrested by a sheriff while in labor and forcible brought to a hospital to have a c-section; Ms. Pemberton later went on to have 4 more children vaginally, without incident, though she labored in hiding. In 2003, Amber Marlowe, a woman in Pennsylvannia, was told by doctors that she had to have a c-section because the fetus was estimated to be 13lbs, which, in their opinion, was too large to birth vaginally. While the doctors and hospital were successfully getting a court order to force the c-section, Mrs. Marlowe and her husband went to a different hospital, where she successfully delivered the 11lb, 9oz girl vaginally without medication.

This is just the tip of the iceberg.

No court can compel a person to have medical intervention, such as a transplant or blood donation, for the benefit of another already living person. Yet, these cases show that when it comes to pregnant women, their rights to make medical decisions for themselves are not absolute. If attempts to define personhood at conception succeed, how many women will be forced to undergo interventions and treatments that they do not want? How many women will avoid getting adequate prenatal and personal medical care in order to avoid the chance of being forced into unwanted treatment? Where will it end?

The Case Against "The Case Against Breastfeeding"

Yet another volley in the mommy wars…this time, the formula feeders strike back. *sigh* An opinion piece, “The Case Against Breastfeeding,” published in The Atlantic written by Hanna Roisin is the latest salvo. What is presented at the outset as a take down of the scientific studies that support the benefits of breastfeeding over formula feeding instead comes across as an angry diatribe from a woman who is trying to balance three kids, a marriage, and a career, and views the pressure to breastfeed as the one of the keys to her unhappiness. It seems to more about one woman’s insecurity in the choices she is making or would like to make and emotions she feels about those choices. Ms. Roisin, as it becomes clear, is not one of the mothers who enjoyed the breastfeeding experience. But rather than a) accepting that all of mothering is not enjoyable or b) choosing to formula feed instead, Ms. Roisin instead writes a factually and scientifically questionable article that seems intent on trying to reassure herself that if she were to switch to formula feeding, it would be ok.

Let me be upfront: I breastfed my older son until 22 months of age and I certainly plan to breastfeed my second son, who is due this summer. For me, breastfeeding wasn’t easy – my son was severely tongue-tied, which meant round-the-clock nursing until he was diagnosed and his tongue clipped at the age of 6 weeks. At that point, I did have to supplement him with formula for several weeks while I worked on rebuilding my milk supply – a process that meant nursing, followed by bottle-feeding, followed by pumping at every single feeding. It was exhausting and I could really understand why another mom in different circumstances would choose not to do it; I certainly would not have held it against another mother who chose to formula feed instead. We suffered through bouts of thrush, blocked ducts, and engorgement. When I went back to work, I lugged my detested pump with me and dutifully spent my breaks pumping. No, it was not all sunshine and roses. But I did it because on my personal hierarchy of parenting priorities, breastfeeding was high on the list. I put a lot of effort into making the breastfeeding relationship work, so please excuse me if I get just the tiniest bit irritated when Ms. Roisin comes along and likens breastfeeding to “the vacuum that was keeping me and my 21st-century sisters down.”

Ms. Roisin, breastfeeding did not keep me down. On the contrary, being able to work through the challenges of breastfeeding and being successful with it, sticking with it in spite of the looks I would get in public, and making it close to my goal of breastfeeding for 2 years was empowering for me. I’m not a perfect parent – I don’t do organic, I don’t cloth diaper, the tv is not forbidden in our house, and there are quite a few evenings when dinner is an overprocessed frozen pizza. I admit it freely: I actively make less than the ideal or best choice on more than the rare occasion – but I also own those choices and I don’t need to denigrate the choices of others in order to feel like a good parent. I’m not going to rail against the pro-fresh food lobby or try to poke holes in research that supports the premise that eating fresh and whole foods is healthier than eating frozen pizza. What would be the point? I might feel better about choosing the pizza, but it wouldn’t change the fact that the fresh and whole foods are healthier than the frozen pizza. I pick my battles based on what my values and priorities are. It’s part of being an adult and part of being a good parent. And I certainly don’t need the validation of someone like Ms. Roisin to feel good about that. Why she needs the validation of myself and the other "breast-feeding fascists" is beyond me.

Hiding Under the Couch

"Hiding Under the Couch" otherwise known as my reaction to Bobby Jindal's rebuttal to President Obama's State of the Union speech.

First, I must say, in all superficiality, damn, Jindal was wearing a lot of makeup!! The man's skin looked pretty flawless, which, well, really isn't the case.

Second, make him stop! The voice, the voice! That accent! Where in the hell did he get that accent from? That accent is not Baton Rouge! That accent is like a really bad voiceover from a 1950s educational film. And it grates! As if there aren't enough horrible stereotypes about Louisiana to begin with, now we have to add that voice to it?

Third, you know, to be honest, I can appreciate Jindal relaying that anecdote about his immigrant father talking about the plenty that America holds and the inspiration it brings. Maybe I can appreciate it because I remember repeating the same type of anecdote during speech competition in HIGH SCHOOL. Egads! As we Indians don't have to deal with enough as it is - now we have to live this one down!

Fourth, maybe I missed something, but how was the Bush administration's response to Katrina a positive show of Republican leadership?

Fifth, make it stop! Make it stop! I feel like I am being lectured by Farmer Folksy McFolks-a-alot. For the love of all that's holy, make it stop!

I'm going back to hide under the couch now...

The Long Arm of the Law

There are some days when nothing lawmakers do (or try to do) surprises you. Then there are days like this. In Virginia, state senator Mark Obenshain has introduced Senate Bill 926, a bill that is not only an insult to each and every female in the Commonwealth, but also, if passed, an insane intrusion into the right of privacy that every individual has. In a nutshell, the bill seeks to mandate that within 24 hours of a miscarriage, law enforcement officials must be informed of the incident, if medical professionals were not present at the miscarriage. In addition, the remains must be saved until law enforcement professionals give their permission for the disposal.

What?!?

First of all, 20 to 25% of all pregnancies end in miscarriage. And I would venture a guess that a large number of those miscarriages do not conveniently occur with medical professionals in attendance. That would be a large number of incidents that would need to be reported to and investigated by law enforcement. Given the budget shortfalls occurring across the nation in light of the recession, is that really an effective use of investigative resources?

Second, the majority of miscarriages occur before the end of the 1st trimester. Any remains of the fetus can be hard to discern at that point. Are women really supposed to hang on to every bloody toliet paper strip and maxi pad? Are they not allowed to flush the toliet? No showers during the loss, because blood and tissue could go down the drain? I mean, honestly? I hate to say it, but only a man -who could never have personally experienced a miscarriage - could write such an inane bill.

Third, many miscarriages are the loss of a very much wanted and hoped for baby. For the mothers (and yes, the fathers as well) who experience them, there is very real grief over something that is still poorly understood by medical science. There are few answers for the woman who is - or has - suffered a miscarriage, and as a result, women will often times blame themselves for real or imagined mistakes that they made during the pregnancy. To have to deal with law enforcement personnel at that time, rather than spending that time and energy dealing with the emotional and physical aftermath of the pregnancy loss, is an unconscionable mandate.

The bill is an affront to the rights of every woman - not just those of childbearing age. Should this bill become law, it would set a dangerous precedent as to when and how government can intervene in the private medical matters of women. I mean, what's next? A government inquest every time a woman gets her period?

Give me a break.

Someone needs to go back to Journalism 101...

Someone at 20/20, that is. On January 2, 2009, 20/20 ran an episode themed "Extreme Parenting." As part of this package of segments, they ran one about homebirth. Sort of. Captioned as a story about homebirth, the segment interchangeably describes homebirthing with a trained nurse-midwife in attendance with homebirthing without medical personnel in attendance, a practice often called unassisted birth. By conflating the two, 20/20 not only does a disservice to the general viewing audience and those who choose to homebirth, it also calls into question the intelligence of its story editors and journalists.

The segment opens somewhat dramatically with a shot of a log cabin surrounded by mountains. Journalist Elizabeth Vargas voices over this image, inviting the audience to think about what it must have been like to give birth on the American frontier 200 years ago. "There's not a hospital or a pain-relieving drug or an ob/gyn in sight." Heavens to Betsy!! What shall we do? In order to showcase what Betsy might have done, the segment then shows snippets of classic Western movies (or perhaps they confused these fictional movies with actual historical documents - one can only guess). Vargas states that in spite of the "primitive" and "dangerous" methods, by today's standards, women seemed to do okay. However, she states, there is a small segment of modern American mothers-to-be who are "choosing to give birth without medical assistance." As Vargas says this, we see images of women holding newborns right after giving birth - images that are likely familiar to anyone who has seen the documentary "The Business of Being Born." You know, that documentary that followed medically-trained midwives as they helped women give birth, not just some layperson off the street who don't know nothing about birthing no babies. Next, we are introduced to Laura Shanley, a Colorado woman who is one of the most outspoken proponents of unassisted birth. We move directly from a quote by Shanley to a snippet from The Business of Being Born showing Ricki Lake's homebirth with her 2nd child. A homebirth that was attended by a midwife. Confused yet? This back and forth between unassisted birth and midwife-attended homebirth continues throughout the poorly-written segment. To blur the line even more, the last part of the segment is Shanley talking about unassisted birth. Wow. Way to not muddy the waters, ABC.

I really wonder if after viewing the final version of the segment, Ricki Lake got pissed off and decided to do an expose of the geniuses at 20/20, because if I was her, I would be right pissed off. Really, the only thing lacking from the terrible segment was an interview with the notorious homebirth opponent, Amy Tuteur. Eh, maybe someone at 20/20 was thinking that day...