Tag Archives: pregnancy

Sunday spam: muesli bars and gummy snakes

Muesli bars and gummy snakes are what I ate at about 7am before my recent 9am childbirth… thus thematically appropriate for this small collection of links, some of which I’ve had sitting around for a while.

Using WOC in the Natural Childbirth Debate: A How-To Guide.

If you are a progressive in the Natural Childbirth Movement (or any other, for that matter), use Africa City women to promote the idea that “natural is better.” Talk about women who toil in the fields, squat down to give birth and return to picking rice. Or peanuts. Or anything else that can be picked. After all, the women of Africa City are resilient! Strong. So strong that they do not even require support from the other women of Africa City. Or medication. Or comfort. This example–of giving birth in the field–illustrates how over-reliant “we” have become on useless technology. Of course, you don’t expect “us” to be quite that strong. We are not beasts of burden, after all…

If you oppose the Natural Childbirth Movement (or any other, for that matter), use Africa City women to remind “us” of how bad “we” used to have it, before all of our live-saving medical advances. If women die in childbirth in Africa City, it is only because they lack the Modern Technology we should be grateful that every last one of “us” has unfettered access to. Use infant mortality statistics from the most war-torn countries to argue why a healthy woman from Portland shouldn’t give birth in her bathtub with a midwife who carries oxygen and a cell phone. Redact all mentions of Africa City women who are not hopelessly impoverished. Ignore those who are systematically abused with Modern Technology, sacrificed as Guinea pigs on its altar. All bad outcomes in Africa City are due to the lack of Medical Technology, never unrelated to it, and certainly never caused by it.

Early Labour and Mixed Messages

The emphasis on hospital as a place of safety whilst also encouraging women to stay away results in some very contradictory messages and ideas (please note these statements do not represent my own views)[…] We are the experts in your labour progress, our clinical assessments can predict your future labour progress… we will send you home if you are found to be in early labour… if you then birth your baby in the car park it is not our fault as birth is unpredictable[…] This is a safe place to labour…. but you can only access this safety when you reach a particular point in your labour… preferably close to the end of your labour i.e. you should do most of it on your own away from safety.

Warning for discussion of pregnancy loss. The Peculiar Case of Miscarriage in Pop Culture

Miscarriage is a tricky cultural thing, pop culture or not. It’s a deeply forbidden subject, much like many other things deemed ‘mysteries of womanhood,’ like menstruation, like pregnancy itself. People don’t talk about miscarriages and that discouragement means that many people aren’t aware of how common they are, let alone how devastating they can be. When people lose a child, they can reach out to their community for help and they are given space and time for healing. When they lose a fetus, they’re expected to keep it to themselves.

Sadly, sometimes pro-choice people can be the most vehement about this, concerned about blurring the lines between fetus and child, and saying that claiming a fetus is morally or ethically equivalent to a fully-developed, extrauterine human being could be dangerous. This makes the mistake of applying broad strokes to the issue, though. Legally, of course, a fetus should not be equivalent to a child. Personally, however, losing a wanted pregnancy is an intensely emotional experience and it can feel on some level to the parents like losing a child, with the added burden of not being allowed to acknowledge it, talk about it, or ask for help.

Sunday Spam: bagels, lox and smoked salmon

In belated honour of my breakfast in New York, Sunday July 8.

Baby Loss and the Pain Olympics

Warning for baby loss discussion.

I really have to question why seeing someone else processing their emotions is her pet peeve.

Do I believe a miscarriage and neonatal death is the same thing — of course not. If they were the same thing, they would share the same term. But just because I see them as apples and oranges doesn’t mean that I don’t also see them as fruit. They are both loss.

The deadly scandal in the building trade

Readers would not guess from the “national conversation” that the construction industry is sitting on a story as grave in its implications as the phone-hacking affair – graver I will argue. You are unlikely to have heard mention of it for a simple and disreputable reason: the victims are working-class men rather than celebrities… The construction companies could not be clearer that men who try to enforce minimum safety standards are their enemies. The files included formal letters notifying a company that a worker was the official safety rep on a site as evidence against him.

On Technical Entitlement

By most measures, I should have technical entitlement in spades… [and yet] I am very intimidated by the technically entitled.

You know the type. The one who was soldering when she was 6. The one who raises his hand to answer every question–and occasionally try to correct the professor. The one who scoffs at anyone who had a score below the median on that data structures exam (“idiots!”). The one who introduces himself by sharing his StackOverflow score.

Puzzling outcomes in A/B testing

A fun upcoming KDD 2012 paper out of Microsoft, “Trustworthy Online Controlled Experiments: Five Puzzling Outcomes Explained” (PDF), has a lot of great insights into A/B testing and real issues you hit with A/B testing. It’s a light and easy read, definitely worthwhile.

Selected excerpts:

We present … puzzling outcomes of controlled experiments that we analyzed deeply to understand and explain … [requiring] months to properly analyze and get to the often surprising root cause … It [was] not uncommon to see experiments that impact annual revenue by millions of dollars … Reversing a single incorrect decision based on the results of an experiment can fund a whole team of analysts.

When Bing had a bug in an experiment, which resulted in very poor results being shown to users, two key organizational metrics improved significantly: distinct queries per user went up over 10%, and revenue per user went up over 30%! …. Degrading algorithmic results shown on a search engine result page gives users an obviously worse search experience but causes users to click more on ads, whose relative relevance increases, which increases short-term revenue … [This shows] it’s critical to understand that long-term goals do not always align with short-term metrics.

Angels & Demons

One of the various Longform collections, and like many of them, a crime piece:

On June 4, 1989, the bodies of Jo, Michelle and Christe were found floating in Tampa Bay. This is the story of the murders, their aftermath, and the handful of people who kept faith amid the unthinkable.

On Leaving Academia

As almost everybody knows at this point, I have resigned my position at the University of New Mexico. Effective this July, I am working for Google, in their Cambridge (MA) offices.

Countless people, from my friends to my (former) dean have asked “Why? Why give up an excellent [some say 'cushy'] tenured faculty position for the grind of corporate life?”

Honestly, the reasons are myriad and complex, and some of them are purely personal. But I wanted to lay out some of them that speak to larger trends at UNM, in New Mexico, in academia, and in the US in general. I haven’t made this move lightly, and I think it’s an important cautionary note to make: the factors that have made academia less appealing to me recently will also impact other professors.

Ethics, Culture, & Policy: Commercial surrogacy in India: A $2 billion industry

Since its legalization in 2002, commercial surrogacy in India has grown into a multimillion-dollar industry, drawing couples from around the world. IVF procedures in the unregulated Indian clinics generally cost a fraction of what they would in Europe or the U.S., with surrogacy as little as one-tenth the price. Mainstream press reports in English-language publications occasionally devote a line or two to the ethical implications of using poor women as surrogates, but with few exceptions, these women’s voices have not been heard.

Sociologist Amrita Pande of the University of Cape Town set out to speak directly with the “workers” to see how they are affected by such “work.”

Should you give birth privately?

A few people have been researching their options over the last few years about giving birth in Australia, and have asked me what I think about having private health insurance or giving birth in a private hospital.

Background: maybe you shouldn’t ask me! I’m not a health professional, I’m a mother of one, and he was born in a public hospital, in which I was a public patient.

And now, crucial fact about private hospital cover: it pays much of your hospital stay fees and some of your doctor’s in-hospital fees. It does not pay for private consultations with a doctor in an outpatient/private room setting.

You know what obstetricians charge a lot for? The “pregnancy management” fee, to cover your outpatient care in pregnancy. If I recall correctly, the Medicare rebate for this is on the order of $400 to $500. In Sydney, private obstetricians may charge upwards of $4000 for this fee. Who covers the difference? You do. (OK, full disclosure, the Medicare Safety Net may help too, I don’t know the details except that MSN actually cut benefits specifically for obstetricians a few years ago because they’d all upped their fees to incorporate the MSN rebate. So, mostly you do!) Also, anaesthetists in the private hospitals usually end up with a decent gap fee, if you have an epidural or Caesearean.

So, private system birthing is expensive regardless of insurance.

Finally, tests like ultrasounds are usually Medicare plus out-of-pocket too.

Now, birth choices in Australia.

Homebirth. There are some very small number of hospitals in Australia that will allow their midwife staff to attend some homebirths. It’s very easy to get disqualified from such a program. I would be on several grounds (some more legit than the one I’m about to give you), including the simple fact that my son’s birthweight was over 4.0kg.

You might also birth with a privately practicing midwife, or, in theory, with a private midwife collaborating with an obstetrician as backup (there are very few such arrangements so far). Most, although not all, private midwives will also only work with pretty low-risk women (singleton pregnancies, head-down, no high blood pressure or diabetes, that sort of thing, about 80% of pregnancies get a low-risk classification IIRC).

Is private insurance useful? Some private health funds provide some limited cover for this, I believe, on the order of $1k to $2k of the midwife’s fee, which is around $5k last time I looked. In the collaboration setup Medicare contributes too, I think?

Birth centre These are midwife-only maternity units attached to public hospitals. (Sometimes at some physical distance, eg Ryde Hospital only has a birth centre, with transfers to Royal North Shore several suburbs away.) You need to be assessed as low risk and if that assessment changes (and this isn’t uncommon, eg, your baby is breech or you get diabetes or pre-eclampsia) you get summarily transferred to the doctors and your whole care team often is suddenly switched out from under you. (Also they usually don’t do epidurals, I think? So the transfer rate for pain relief is not insubstantial I believe.)

Is private insurance useful? No, this is publicly funded.

Public hospital, midwife’s clinic If you go to a public hospital, and are assessed as low risk, almost all of your pregnancy management will be by midwives. Often they “caseload” now, meaning you see the same one each time. Again, if you become high risk, swish, off to the doctors.

Is private insurance useful? No, this is publicly funded.

Public hospital, doctor’s clinic. If you aren’t low risk, this is you. (This was me.) Chronic health problems or pregnancy complications (like pre-eclampsia) put you here. For your appointments, or at least most of them, you see an OB registrar or staff specialist. On high rotation, often, that is, you won’t usually see the same one many times. If you have a vaginal birth it may still be midwife-only, or largely midwife managed.

Is private insurance useful? No, this is publicly funded.

Public hospital, private doctor’s patient. In this case, you choose your doctor, see them mostly in their own clinic, birth in a public hospital (with you or your private insurer paying for the facilities) with the doctor of your choice attending. This is subject to gap fees for the doctor.

Is private insurance useful? Yes, pays for your accommodation and some of the OB’s and anaethestist’s (if needed) gap.

Public hospital, private midwife’s patient. This depends on a midwife/obstetrician collaborative practice. As I said, rare, but there’s at least one that allows a public hospital birth (private admission) with the midwife of your choice: Melissa Maiman in Sydney.

Is private insurance useful? Yes, pays for your accommodation. Not sure what happens if an OB and/or anaethestist are needed.

Private hospital, private doctor’s patient. There’s no midwife-managed option. If you’re birthing in a private hospital, you need a doctor of your choice attending. Again, pre-birth consultations in their own clinic, and subject to gap fees.

It’s definitely worth noting that while your private doctor will be an obstretrician and can manage higher risk pregnancies, for really serious stuff like prematurity earlier than a certain point, pregnancies with more than 2 babies on board (I think) and similar, they will actually refer you into the public system!

Is private insurance useful? Yes, pays for your accommodation and some of the OB’s and anaethestist’s (if needed) gap.

Public hospital, high risk clinic. I don’t know much about this, I’m told it’s the next level up in risk, and it well might be my next pregnancy. Joy. This is where you end up with OBs with a high risk interest, maternal-fetal medicine specialists (OBs with a formal subspecialty in very high risk pregnancies), renal physicians, endocrinologists, etc. This often involves referral to a tertiary hospital. (Sometimes specialists can consult without you being in one of these, like, an endocrinologist might monitor diabetes or thyroid hormones with you in the regular doctor’s clinic or seeing a private OB.) Birth choices guides don’t talk about this option very much, because you don’t really have a choice at this point (except birthing unattended or with a very risk-tolerant private midwife).

Is private insurance useful? I’m not sure, to be honest. It probably depends on the risk profile of your actual birth, I guess? If your birth is able to be attended by a regular private OB, maybe they let you do this? But you can do this publicly too.

Further reading on birthing choices

My Birth has a lot of information on birth procedures and the outcomes of different birthing providers, from a low intervention advocacy standpoint. One thing of note which gets picked up a lot by low intervention advocates is that despite the private birthing system referring all their hardest cases back to public, and despite the public patient profile being poorer with less good preventative health care and so on, private hospitals have much higher intervention rates.

Conclusion

It really depends on where you want to birth and with who attending. If the idea of the same doctor doing your pregnancy management and attending your birth appeals, that’s tending towards private birthing and thus private health insurance. But it has high out of pocket costs on top of the insurance premiums. (Note also that private health insurance policies are expensive if you include obstetric coverage, and will always have a 12 month waiting period for it, so you must obtain it before pregnancy.)

I was reasonably happy as a doctor’s clinic patient for my first birth. If I was low-risk I’d probably likewise go public, ideally with a birth centre or caseload midwife pregnancy+birth.

Sunday Spam: apple and cinnamon risotto

Apple and cinnamon risotto is one of Matthew Evans’s recipes in The Weekend Cook. I have some quibbles with that book, mostly that if anyone tries to romance me with the things listed under “romantic weekend” their expectations will be dashed, but this sounded ambitiously tasty.

In other news, I’m enjoying the Instaright Firefox add-on, which adds an address bar button and a right-click menu item for sending a link to Instapaper. Still liking Instapaper just fine except that it will only ever send 20 articles to one’s Kindle, and one day I managed to queue up close to 40 articles.

It would be kind of cool if Instapaper let me put out Sunday Spam as an instapaper. (I believe the ability to instapaper things to other people is an often requested feature.)

The Two-Minus-One Pregnancy

Linked in several places, this is an article about selective reductions (ie, aborting one fetus in a multiple pregnancy) from twins to singleton pregnancies. I’m not really sure why I was so interested in this—I’ve read several articles on reductions over the years and they’re all pretty similar—but I was. Perhaps it’s just that I definitely share the public fascination with twins described in the article.

Jenny is an asshole, and so, of course, am I

Infertility blogger Julie of A Little Pregnant shares her thoughts on Two-Minus-One: again nothing ground-breaking, but I enjoy Julie’s blog so have a link.

Jailhouse phone calls reveal why domestic violence victims recant

Phone calls between alleged perpetrators of domestic violence and their victims (which were known by the parties involved to be being recorded) show that the typical strategy for getting the victim to recant is getting their sympathy for one’s terrible situation facing trial and jail (rather than, at least in these cases, of threats of more violence).

Are software patents the “scaffolding of the tech industry”?

Counter-arguments to pro-software-patent positions, largely stressing that these particular pro-patent positions are concerned with the ability of the first inventor to profit from their invention, rather than with encouraging innovation in general.

Top 10 Things Breastfeeding Advocates Should Stop Saying

From earlier this year, includes “formula is poison” and “Moms who use formula don’t love/value their babies as much as moms who breastfeed”. I know people who have been hurt badly by statements this strong, in one case seriously considering giving up all plans for future children because of a failed (and mourned) breastfeeding relationship with her first child.

HPV: The STD of a New Generation

I’m pleased to have found Amanda Hess’s current online home again. Here she is on the interesting status of HPV: the STI that so very many people have, with attendant interesting interpretations by everyone from vaccine manufacturers to social conservatives.

What if Publishers are right about eBook prices?

Arguing that there’s a strong case that ebook prices will go to $0, and that this would not be a public good. Interesting, undoubtedly highly arguable. (Does not answer the question about why digital music prices haven’t and thereby make the required distinction between the two arguments.)

You Do Something with Your Hair?: Gender and Presentation in Stillwater

Gender presentation in Saint’s Row 2 is pretty unrestricted, and the game has gone out of its way to avoid using pronouns to refer to your character.

Crashing the Tea Party

David E. Campbell, an associate professor of political science at Notre Dame, and Robert D. Putnam, a professor of public policy at Harvard, argue that their research shows that the Tea Party brand is getting toxic in the US, together with some data showing how closely Tea Party affiliation/identification corresponds with Republican Party membership and belief in a less strong church-state separation. Perhaps not a very exciting article for people who follow US politics more closely than I do.

11 Percent

11 percent of housing in the US is unoccupied, s.e. smith writes. In addition to the good of housing people, wouldn’t fixing this housing up stimulate demand in construction?

2010

I dented:

I had a baby. There. That’s my year in review post! (I’m enjoying everyone else’s.)

A year ago I was already been monitored several times a week in case rising blood pressure resulted in a sick fetus. That started on Boxing Day. A year ago I was keeping a secret pregnancy blog, and in January I created a new tag “over-fucking-due”. (OK, yes, technically “post dates” but since induction came up for me from 38 weeks onwards over-fucking-due was the appropriate sentiment.) Here’s some thoughts from that:

January 6: Hornsby’s hospitalisation time for mothers who had a vaginal birth and don’t have post-birth complications is 48 hours. If I’m induced Monday and Janus is born that day, then this time next week I will likely be home with him. This time next week.

January 9: My mental model of being overdue (I am not, but in a few days will be) was that women mostly hate it because it’s like being nearly due but not fair. For me though, things have actually changed for the worse over the last couple of days.

January 9: I have decided that Monday or early Tuesday morning would be optimal baby-having time, because the hospital is airconditioned and I would like to lounge around in a private room for the Tuesday heatwave. Let’s make it happen, Janus. Thank goodness I don’t live in Adelaide.

January 10: Meanwhile, waiting for labour: exactly as boring for me as it has been for every other pregnant woman in the history of the universe. I’m convinced the whole having sex with your acupuncturist while mainlining habeneros and raspberry leaf tea and constantly going for long walks thing is just to stop the revolution. The revolution that would inevitably happen if post-dates women were left to their own devices.

January 11: I trundled off for an ultrasound this morning. I don’t know the exact results. She said the placenta looked ‘mature’, undoubtedly that’s not an entirely positive thing. The amniotic fluid looked fine. The computer estimated his weight at 4kg almost exactly. I have no idea how the blood flow measured up, it took her forever to do it because he was playing with the cord. The exact prognosis will have to wait on the doctors tomorrow.

Apparently he has hair.

Oh good times, especially as he wasn’t born until a week and a half after all that. The only fun bit was talking about all of the silly self-induction advice. There’s a stand-up routine in there somewhere. (Also January 11′s heatwave was nothing on that of January 24, which reached 43℃… and! yes! I was in hospital!)

However, on reflection, I think I was wrong. In fact, the thing, the single thing, about 2010 was becoming a mother. The specificity of being Vincent’s mother isn’t confined to this year. And for all that another child would be a strange mystery and unexplored territory, I would be doing it as a mother already. I’ve been in places like that now, just not necessarily in the same company.

In 2010, I became a mother.