Pregnancy: Policies, Policing, and Protection

Debbie says:

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In November, it seems lots of people in my feeds were writing about or linking to articles about pregnancy. Let’s start with the unalloyed good news, from Remy Tumin, writing at TakePart:

… many new moms in developing countries … suffer from postpartum hemorrhage, the leading cause of maternal mortality. Now the LifeWrap is making great strides in reversing the mortality rate in these countries.

Made of neoprene and Velcro, the wet-suit-like garment is cut into segments. The LifeWrap acts as a first-aid device to stabilize women like Aisha who don’t have access to resources to stop the bleeding immediately. The low technology keeps women alive while they travel to a hospital for surgery or wait for treatment.

To date, LifeWraps have been used on more than 10,000 women in 33 countries. According to the American Congress of Obstetricians and Gynecologists, a woman dies every four minutes from postpartum hemorrhage.

According to Tumin, the LifeWrap was developed by Suellen Miller, a nurse-midwife and a professor at the University of California San Francisco. Miller based the design on a garment developed by a female U.S. astronaut; earlier more complicated versions were used on soldiers in Vietnam.

In a recent study in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology it was recommended that the garment be made available by governments and included in all health care centers as a management protocol for postpartum hemorrhage. LifeWrap is on internationally approved lists from the World Health Organization, International Organization of Obstetrics and Gynecologists, and the United Nations Commission on Life-Saving Commodities…

Miller and her team train clinicians around the world on how to use the garment and give presentations to departments of health and professional associations.

One of the most heartening trends in the world today is the continuing development of low-tech medical, communications, and other solutions that serve the poorest people on the globe, including this one.

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The next piece of pregnancy news is also good, despite the qualifiers at the beginning of the article. Miriam Zoila Pérez at Our Bodies, Ourselves, writes about a movement to change the common U.S. policy requiring women to fast during labor.

The logic behind requiring women in labor to fast is thus: If the labor changed course, and a c-section was needed, a patient who had eaten recently was at risk of aspirating her own vomit if given general anesthesia.

It is a policy predicated on a lot of if/then scenarios, and applied incredibly widely (to pretty much everyone giving birth in a hospital setting) despite a relatively low risk and changes in practice. Most c-section anesthesia is provided in a similar fashion to an epidural (through a spinal block) and not through a mask over the nose and mouth, where the potential aspiration risk came in.

According to the article, in the eight years between 2005 and 2013 there was only one recorded U.S. case of aspiration related to labor, and the article doesn’t say whether or not the patient died. It certainly seems that the risk is vanishingly small.

Midwives and home birth advocates have been encouraging light meals during labor for years; “labor” is well-named, and doing heavy work while fasting is (in most circumstances) an unnecessary burden. The medical establishment in the U.S. is wending its slow, ponderous way toward making these changes, while miidwives have been encouraging their clients to eat light meals for years (and centuries).

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Supermodel Christine Teigen posted an Instagram photo of her bowl of Fruity Pebbles cereal combined with Captain Crunch cereal. I can’t say I’d eat it, but I’m not a supermodel, I’m not newly pregnant, and I’m not Christine Teigen. Many commenters appreciated it, but some took her to task, and a Twitter-battle ensued. Tracy Moore at Jezebel has the story, and also misses the point.

Moore says:

There is apparently no sweet spot that immunizes any pregnant woman from this scrutiny, even when you are a health-conscious supermodel-type person who likely won’t gain much weight in the first place. It’s nearly impossible that she would not know exactly what is “good” and “bad” for the baby (as much as anyone can), given she has extraordinary access to resources that will ensure a perfect specimen to carry on the legacy of her extremely symmetrical genes.

Moore goes on to discuss uncertainties about fetal health, her own pregnancy story, and generally concludes

there was and always will be a complex negotiation going on between mother and child during gestation for resources, nutrition, and literal space in the body.

She suggests trust (that women are doing the best they can) and compassion for their struggle. Compassion is good and trust is valuable, but neither of them apply here. Teigen’s baby is not public property, and neither is her body. Whether or not she is doing her best, whether or not she knows what’s good, whether or not she even cares is her business. It’s arguably the baby’s father’s business (if there’s an involved father), and possibly the grandparents. You can make a case for it being the obstetrician’s business. You can stretch it to her close friends and family having an interest. But you and I, strangers on the Internet, journalists at Jezebel, bloggers at Body Impolitic, we don’t get to say one damned thing to Teigen about her choices, even if she posts them on the Internet. We get to back off and let her live her life, experience her pregnancy, have her baby, and eat whatever she wants to eat (and show us photographs of it if she feels like it). And we get to appreciate LifeWrap, and better options for women in labor.

Incomprehensibly Irresponsible: Brain Drugs and Babies

Laurie and Debbie say:

In 2008, we wrote “The Medicalization of Human Variety,” about how concerned we (and much of the medical establishment) were about the increase in prescribing Ritalin and other psychoactive drugs to schoolchildren.  We are shocked and saddened to find out how much worse things have gotten in the last seven years.

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Alan Schwarz, writing in the New York Times, details much nastier drugs than Ritalin, such as the antipsychotic risperidone (Risperdal) given to babies and toddlers. Schwarz reports “almost 20,000” such prescriptions were written in 2014,  a 50% jump from 2013. Prozac prescriptions for children that young are rising almost as fast.

We can’t even count the number of ways that this is horrible.

Brain science is itself in its infancy. Virtually all of the psychoactive medications prescribed today work by guesswork and hypothesis. We might know that a drug raises serotonin levels or reduces cortisol, but no one really understands why or how those chemical changes affect mood, behavior, resilience, et cetera. And no one understands what else these chemicals might be doing to the brain.

Whatever we do know about brains we know about adult brains. Children’s brains are incredibly plastic, growing at phenomenal speeds, and very little studied. In the case of Ritalin, it took medical scientists decades to understand that it affects children exactly the opposite way it affects adults. With newer drugs like Risperdal and even Prozac, the effects are unpredictable and could certainly be the opposite of what the prescribing doctor intends. Since we can’t ethically, morally, or as human beings experiment on living children to find out what works, this study has to proceed extraordinarily slowly and carefully.

… Dr. [Mary Margaret] Gleason, [a pediatrician and child psychiatrist at Tulane University] said that children with ages measured in months had brains whose neurological inner workings were developing too rapidly, and in still unknown ways, to risk using medications that can profoundly influence that growth. She said the medications had never been subject to formal clinical trials in infants and toddlers largely because of those dangers.

“There are not studies,” Dr. Gleason said, “and I’m not pushing for them.”

Perhaps most important, while some percentage of the children receiving these drugs have some kind of medical need that the drug at least might address, many of them are just behaving like children their age.  Schwarz uses the phrase “tempering chronically disruptive behavior,” which is easy-to-read code for “This kid is hard to manage.”

“There are behavioral ways of working with the problems rather than medication,” said Dr. [Ed] Tronick, [a professor of developmental and brain sciences at the University of Massachusetts Boston], who runs a program that teaches health care providers to assist families with troubled children. “What is generating such fear and anger and withdrawal in the child? What is frustrating or causing stress in the parent? These are the things that have to be explored. But that takes time and money.”

He also said something we said back in that 2008 post:

There’s this very narrow range of what people think the prototype child should look like. Deviations from that lead them to seek out interventions like these.

These kinds of “interventions,” these drug-based “solutions” to behavior that can almost certainly be addressed with patience, creativity, love, and (when appropriate) therapy, can destroy a child’s life, destroy a family’s life, and damage everyone who cares about that child and family.

It’s bad enough that these drugs are officially available to children in the 8-10 range depending on the drug. It’s bad enough (though completely not surprising) that the pharmaceutical companies getting rich off the drugs have stories of “positive effects among suffering young people” they can tell to line their pockets. Some of those stories are probably true, but you can bet your last dollar that they are cherry-picked from a set of mostly miserable-to-neutral stories. What’s worse is that too many people don’t care about our society’s children enough to protect them from harmful chemical intervention; we just want them to shut up, behave right, and not bother anybody.

Children are a global treasure; they’re the hope we have. They have a right to grow up whole and complete and uninvaded.