Time to Nurse the Baby

Breast feeding is the most natural thing in the world. Or so they will tell you when you are blissfully pregnant with your first.  For many of us, it’s not quite as easy as all that.  The last thing we need is public scorn for trying to feed our babies in places other than darkened nurseries.  I have no patience for people who are so scandalized by the possibility of an errant nipple that they insist we feed our children in bathroom stalls.  Get a grip, people. When I was nursing, I couldn’t find a nursing bra I liked, and I developed an entire uniform around a “sleep bra” and men’s undershirts with slits cut in them under huge camp shirts.  I still flashed people, I’m sure.  Because that’s what happens when your baby decides he’s done for the moment and spits out your boob in public.

And yes, I was asked to feed my children in the bathroom.  I am so sorry my breasts inconvenienced you.  By the time I was confident enough to actually leave my home with a nursing infant, I had already overcome the hurdle of bleeding nipples.  “If it hurts, you’re doing it wrong,” advised my la leche counselor.  “This is the only way he knows how to do it,” I replied.  Bleeding nipples are almost as painful as childbirth, and while it only lasts for a few days, it’s enough to make some women give up, and I don’t blame them.  I was educated and determined and I had the support of my family.  I still didn’t manage to nurse either of my children for the full year recommended by pediatricians.

In my state, only 10% of babies are still being breast fed at 12 months.   This is despite the many known benefits of breastfeeding including a decrease in obesity, diabetes, ear infections, allergies, and asthma. Higher IQ scores in children who were breastfed have also been reported as well as a 30% decrease in SIDS deaths.  The cost of formula (as much as $2000 for a year’s worth) is prohibitive and damn inconvenient.  As far as I’m concerned, the number one benefit to nursing your baby is you can do it while you are asleep.

We as a society need to commit to breastfeeding as the healthiest start to a baby’s future.  Pamphlets and free breast pads are not enough.  New moms need our support. Education is certainly a factor.  Some cultures, even in the United States, still see an ick factor to nursing that can only be overcome by patience and exposure.  It would help if women were seen nursing in public on a regular basis.

But let’s be realistic.  Lots of women stop nursing for a variety of reasons.  Lack of adequate milk production is one.   Pediatricians and lactation consultants will tell you this is a rare phenomenon. But a lot of women run into it, especially faced with THE PUMP.  Some women are pumping pros and do both breasts at once in their cars while they are driving while learning French. For the rest of us, we nurse our babies, put them down for a nap, pump so we can leave the house alone, manage to produce 1/2 ounce of milk, cry for 45 minutes, and eventually go buy formula.  But for working mothers who want to nurse, the pump is not a luxury item reserved for date night.  It’s a necessity.

The only reason I was able to breastfeed my children for seven months was because I was not working.  Women do not need better breast pumps.  We need time to nurse our babies.  If we are serious about the health of women and children, we must address the fact that we are one of the only countries in the world with no mandatory paid maternity leave.  Even the Family Medical Leave Act, which is guaranteed unpaid leave, only lasts for 12 weeks.  This is barely enough time to form an initial bond with a new baby.

In a depressed economy, taking time off for a new baby is a luxury few can afford.  A 2012 Department of Labor survey showed that nearly 25% of women took less than 2 weeks off after the birth of a baby, and about half of those took less than a week.   It is no wonder that women with longer maternity leave also report higher rates of breastfeeding.   A generous maternity leave is also associated with reduced rates of depression in women, even years after returning to the workforce.

Some economists contend that maternity leave also benefits businesses as it prevents high turnover rates and training costs.  Some companies are starting to realize this, and maternity leave is offered as part of a competitive benefits package.  For most women, however, this remains out of reach.

If we as a culture believe in the health and well-being of women and children, if we believe that the health of our infants should not be dictated by Nestle, if we believe in work life balance, we cannot accept current American leave policies.  And for those of you afraid of accidentally seeing a nipple while a baby is eating her dinner, go put a blanket over your head.

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Chasing Fire or One Evening in the Odyssey of Parenthood

Kid number two and I went fire chasing last night.  We’d had an early dinner at our favorite burger joint, so it was not even 6:00 when we came out of the restaurant to see pillars of black smoke in the sky.

“Maybe we should follow the smoke,” I say although my mind was already half immersed in a honeysuckle bubble bath and an early pajama time.

“Maybe we should,” he says. “Like a mother/son adventure.”  Who am I to stymie a mother/son adventure?  So we follow the smoke.  It was farther away than I had realized, and it took some driving around to locate the industrial building in the middle of town that was burning.  Not to be dissuaded by road blocks, we cut through a gas station and parked unobtrusively across the street.

“Just say we’re press, if anyone asks,” I tell him.

It was a large metal building that I was later told was used for making ATV parts.  I’m not sure what was in there that was burning, but something was shooting flames high up into the air.  While there were multiple emergency vehicles on site, one lonely firefighter stood atop a ladder and directed a spray of water into the heart of the fire.   Everyone else was supervising.

“That actually looks pretty dangerous,” I say.  “That poor guy up there covered in black smoke.  How can he breathe?”

“I’m sure he has an oxygen tank, Momma,” said my child, trying not very hard to keep the scorn from his voice.

“He’s been up there forever.” I say.  “So much water, and the fire is still going.  You’d think there’d be water flowing down the street by now.”

This time he sighed audibly.  “The water evaporates, you know.  Because there is a fire in there. ”

“Right,” I say.  Fourteen years of fascination of things that burn have obviously prepared him for this conversation. It seems to be a boy thing.  But that would be sexist.

“It might be a woman,” I say. “There is no reason to assume that all firefighters are men.”

“Do you think women firefighters get a lot of dates?”

“Hmm.  I don’t know. Maybe some men are intimidated.  Would you be intimidated by a woman firefighter?”

“No. That’d be badass.”

“I fear your predilection for watching anime featuring young Japanese girls with weapons of mass destruction may have warped your view of women.”

“Maybe I just need a badass woman.”

“Yes,” I said.  “I think you do.”

 

In Memory of the Challenger

Today marks the 30th anniversary of the Space Shuttle Challenger disaster.  It was 1986 when the Challenger was launched, carrying the “First Teacher in Space,” Christa McAuliffe.  She never made it.  Seventy-three seconds after launch from Kennedy Space Center in Cape Canaveral something went wrong.  While many people remember an explosion, and some news sources even added explosion sounds to the news footage, what actually happened was the solid rocket booster caught fire and detached, leaving the shuttle to crash land in the ocean.  It was this impact that killed the seven crew members although whether or not they were conscious at this time remains unknown.

As a Florida kid, I’d seen a bunch of shuttle launches.  Up close is great, but the 150 mile trip to Cape Canaveral often left us disappointed as launch delays were common.  We could often see shuttle launches from our backyards or school playgrounds. It was something we took for granted like orange trees and alligators.  So I wasn’t watching the shuttle launch on TV or out the window at the time of the disaster. I was sitting in Spanish class trying to grasp the subjunctive tense.

Some kid whose name was Brian, I think, was skipping class and gazing at the sky through a haze of weed when the shuttle broke apart.  He burst into the classroom in a panic.  “It exploded!” he said, excitedly.  “It’s falling in the ocean!” The teacher didn’t believe him at first, but he managed to convince her, and we all went outside.

It was cold out and clear. I strained to see if there were bodies falling from the sky.  There were none, of course. By the time I saw the wreckage in the sky, the astronauts were sinking in the Atlantic Ocean.  It all seemed so macabre, though, as if we witnessed death up close even though we were so far away.  It was messy, gory, graphic if only in our minds.  I have a hard time remembering how I felt past the gut reaction of horror. I still can’t bring myself to post a picture of the debris. Please enjoy this picture of Christa McAuliffe.

Those of my generation are likely to have strong memories of the disaster, especially for those of us who witnessed it in real time in person or on TV.  One study shows that in children, memories of the event were recalled years later in much the same way as personal traumas full of colorful, specific, and mostly accurate details.

Nothing else got done at school that day, or for the rest of the week.  Our teachers turned into counselors.  We were encouraged to share our thoughts, our grief.

The greatest tragedy of the shuttle disaster is of course that it could have been prevented.  It was later discovered that the O-rings that held the rockets together were made brittle by the cold temperatures, and some engineers knew it and even tried to halt the launch. Space travel is of course inherently dangerous, but it appalling to learn that risk factors could have been mitigated and were not.

Since then, there have been changes at NASA.  The shuttle program was grounded for several years while an independent investigation was conducted, and changes were made.  I can only believe that the astronauts who sacrificed their lives contributed to the future safety and prosperity of the Space Program.

Please share with me your memories of that date as I pay tribute to the crew of the Challenger.

Christa McAuliffe

Francis R. “Dick” Scobee

Michal J. Smith

Judith A. Resnik

Ronald E. McNair

Ellison S. Onizuka

Gregory B. Jarvis

 

 

 

Autism and the Anti-Vaxx Cult

The anti-vaccine movement very seldom comes to the clinics where I work.  We serve mostly Medicaid and uninsured patients, and parents here know that a kid coming down with chicken pox would mean a parent missing up to two weeks of work.  Skipping the Varicella vaccine could be a financial disaster.  In addition, our state laws requiring vaccination to attend school or daycare are the strictest in the country which is why in a state that seems to be last in so many health care measures, we have a 99.7% vaccination rate for kindergartners.

Skipping vaccines is a luxury.  Discussions of possible complications and disruption of herd immunity may not persuade people to vaccinate their children, but if they know that a round of whooping cough means they may not be able to pay rent, a trip to the pediatrician or health department makes economic sense.

It is no accident that the anti-vaxx movement comes out of more affluent communities. Not everyone has time to join in the “crunchy mom” movement characterized by cloth diapers and suspicion of foreign chemicals, the government, and the medical establishment.

Where does this movement come from? These fears are not without merit, after all.  The ingredient list in a vaccine is full of hard to pronounce foreign sounding compounds, and if history teaches us anything, we are right to be suspicious of unknown side effects.  Thalidimide, for example, never got through the United States FDA, but it was used widely during pregnancy by European women who then gave birth to children with serious limb deformities.

On-line and neighborhood communities have sprung up for “crunchy moms” who reinforced each other’s fears and convictions.  Those who express doubt or change their minds about vaccines are ostracized, which is one of the criteria for being a cult.

While I do feel some suspicion of the establishment is justified, the evidence for the safety and efficacy of vaccines is overwhelming.  I would argue that vaccination is the most well-researched, well-practiced, and well-tracked medical breakthrough of our time.   The evidence is in.  But apparently it isn’t reaching everyone. Refusal to vaccinate your child is cultish behavior.  And it’s hard to leave a cult that tells you vaccination may cause your child to be autistic.

Fear of autism is a main characteristic of the anti-vaxx movement.  Now debunked research pointed to preservatives in the MMR vaccine as the culprit.  But was this really so hard to believe? Diagnoses of autism are on the rise with as many as 1 out of 150 children now being diagnosed by age 8.   Surely this is caused by something, right?  When first categorized, cold uninvolved mothering was blamed for autism in children, as if just not loving your child enough caused the neurological disorder.  As this explanation fell out of favor, parents struggled to find alternate reasons for the prevalence of autism.

A brief look at the history of Autism as a diagnosable disorder, however, points to a much simpler explanation than the preservative thirmosol or other suspected culprits including GMOs, plastics, and chemtrails. I think this is an important piece of the puzzle that is often ignored.  Autism Spectrum Disorder has only been in the DSMIII since 1980, and it has been revised multiple times since then. The majority of children today classified as being “on the spectrum” would never have met the criteria in the 1980 DSM. And prior to that, most children with severe forms of autism were simply thought to be schizophrenic.

Whether or not this knowledge would be convincing to anti-vaxx parents is questionable.  In fact, studies show that presenting parents with scientific evidence about vaccination does little to nothing to change their views on the risk factors their children face.  What does seem to change their minds is actual outbreaks.  This is horrifying because an unknown number of children, even vaccinated children, may contract measles before this phenomenon passes into obscurity.

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Will a Mosquito Change the Abortion Debate Forever?

Part of my day job is keeping track of outbreaks of infectious diseases, and I have to tell you I am losing sleep over the emergence of the Zika virus.  Zika is a mild illness related to Dengue Fever which is caused by the bite on an infected mosquito.  80% of people who contract the disease are asymptomatic, and those that do have symptoms recover quickly.  Cases reported in the United States were thought to have been contracted in South America, and it is not expected to become a serious problem here.

In Brazil, however, Zika is thought to be causing serious birth defects.  Women who contract Zika during the first trimester of pregnancy are thought to have an increased risk of giving birth to baby with microencephaly, characterized by a smaller than normal head, moderate to severe brain damage, and even death.  Nearly 4000 cases of this condition have been reported in Brazil since October in a country that saw only 150 cases in all of 2014.

Management of this crisis must take multiple forms.  Vaccine research is already underway and increased mosquito control programs are also in the works. Meanwhile, Brazil (along with Colombia) has advised that women simply do not get pregnant.

In this heavily Catholic country, access to birth control has increased a great deal over the last decade.  Just this past May, the government announced that oral contraceptives would be available at reduced cost without a prescription in both private and government run pharmacies.

How available these pills are to the poorest of Brazil’s women who are more likely to be exposed to the elements including infected mosquitos is unclear.  What we do know is that some Brazilian women will become pregnant over the next few years, and some of them will have been infected with Zika.

Abortion in Brazil is legal only in the case of rape or to save the life of the mother or if the fetus has a rare birth defect called anencephaly.  Like microcephaly, anencephaly affects brain growth, but is considered incompatible with life.  Even with these exceptions, information about legal abortions is hard to come by, and finding a provider is even more difficult. Only about 3000 legal abortions are performed annually.

Nonetheless, abortion is actually more common in Brazil than in the United States with more than 1 million performed per year.  That’s a lot of illegal abortions.  Despite the growing black market for safer pharmaceutical abortificants, back alley abortions remain dangerous.  It is estimated that a Brazilian woman dies from an illegal abortion every 4 days.

Whether or not you believe that abortion in the case of severe birth defect is a moral choice, rest assured, it’s already happening.  We can expect the maternal death rate from abortions to go up from here.  The question is just how bad will it be? Letting women bleed to death who feel unable to care for a severely handicapped child is not a solution.

If the Brazilian government is serious about preventing a generation of brain damaged children and an increase in illegal abortions, cheap pills are not good enough. Long term forms of birth control such as implants and injections must be offered to all women, especially those with little access to even basic medical care.

As these children continue to be born and need care, taxing the current medical and social services systems, will attitudes towards abortion change? In the United States, many medical personnel who were on the fence about abortion in the 1970’s became more sympathetic after witnessing birth defects in children born to mothers who had contacted  Rubella, which like Zika caused severe and often fatal birth defects.  Abortion suddenly became a compassionate choice.

It will take several years to fully realize the effects of Zika on the women of Brazil, their children, and the choices they must face.  I have no idea what I would do if I found myself pregnant under the threat of Zika.  I only know I would want to have choices.  The women of Brazil as well as the other 20 affected countries deserve choices too.

 

In Defense of the Throwers of Tantrums and the Parents who Love them

When I was in my early twenties, I did a lot of tutoring. A lot of my clients were Korean wives of visiting professors. One afternoon, I showed up for a session with a client. I’m not sure if she had forgotten I was coming or what, but when I got there, she let me in with a sigh. She was in stained sweat pants and a ripped t-shirt. I walked into her kitchen where her one-year old son sat on the floor. Naked. With an entire cake. He was happily licking the frosting off the wall. Tsk. I thought. The way Koreans coddle their children.
Of course, this was before I had two boys of my own. I can tell you now that what ever series of unfortunate events led to this particular scenario, it is a universal human experience of parenthood, not some cultural anomaly. When you have children, you do things you would never think you would do. Like letting your baby suck on sugar packets at a restaurant so you can eat, driving in circles in the parking lot of your apartment trying to get the kid to sleep, or sticking the binky in your mouth to clean it off once it hits the floor.
I was about 10 months pregnant when I went into Babies R Us for some last minute items. I don’t know if all Babies R Us stores are like this, but the one I went to had the loudest toilets on the face of the earth. Any time anyone flushed, there was a pressure change that made your ears pop. My toddler was fully aware of this and was absolutely not going to go into the Babies R Us bathroom. You’d think I would be able to make him, but you’d be wrong. I made it to the door, and he put his hands and feet on the door jam and screamed. I was about to just pee on the floor and hope people thought my water had broken when a complete stranger came up to me and offered to hold my child so that I could relieve myself in the pit of despair.
“Oh God, yes.” I said. “Take him.”
Despite my greatest hope, I mean fear. She gave him back after I was done. He was still screaming.
This is why it makes me cringe when I see strangers criticize the parenting skills of moms and dads just trying to get by. Let me just tell you, you can do absolutely everything exactly right, and your child may still have a complete meltdown in the middle of Walmart. And you’re probably not doing everything exactly right. If we still lived in large family groups, people would know this. But they set out into their single or coupled childless lives with this idyllic image of what they think parenthood should look like. Apparently, some people are blessed with especially well behaved children, or so I’ve heard. They are probably boring dull children.  This is why I am still grateful to that kind stranger. I wish I could send her my son’s handsome Senior Picture and a copy of his ACT and tell her he’d turned out ok after all.
Baby number two was slightly less prone to tantrums, which is why I actually left home with him on purpose. I took him on long walks in his umbrella stroller. We were a mile and half from home when he suddenly determined that Sunday outings were unholy torture. There was to be no more pushing in the stroller. To ensure this, he put his huge baby feet behind the front wheels and made banshee noises. For about an hour. Finally, a grandmotherly lady came out of her home to see what the ruckus was. She spoke to me soothingly with tales of her own children and let me use her phone so I could call for a Dad pick up. Thank you, Mrs. Henson. He’s doing much better now. He still has big feet. Just like your son in Idaho, he wears a 14 now.
Both my kids were diagnosed with autism spectrum disorder, actually  Asperger’s Syndrome, and perhaps I had more difficult toddlerhoods than many moms. But whether a child is a little bit different or not, he has bad days just like you do. And nobody gives him a margarita after work.
By all means, if you see a child being abused by an adult, notify the authorities. But if you see a kid at the grocery having a complete breakdown because of the way plums smell, he is probably overtired and over stimulated, and so are his parents. Some days, there is a battle of wills, and some days the parents lose. That doesn’t make them bad parents. It makes them human. A kind smile of understanding instead of a dirty look could really make a Mom or Dad’s day.

To Forgive is Divine

Although I am not a Christian, I think I do understand the idea of God’s forgiveness. We are all children in the eyes of God, and we are imperfect and make mistakes.  If we learn from these mistakes, in other words, repent, our relationship with God remains intact.  I think this can transfer to the secular realm as well.

When I was in kindergarten in the mid 1970’s, our school had a handicapped class.  I think that’s what it was called, the handicapped class.  I was aware that it was there.  I’m sure I didn’t give a lot of thought to the pros and cons of mainstreaming those with physical differences.  Maybe I felt a little curiosity, maybe a little compassion.  I must have been told they all went to class together where they could get extra help, where they could be with other kids like them, so they didn’t have to feel isolated or different.

One day I was with 20 other kindergartners standing in line in a hallway while our teacher ducked into the office.  The handicapped class made its way down the hall coming from the opposite direction.  They were noisy and slow as braces clanked, walkers scuffed, wheels squeaked.  I don’t know how it started.  Maybe it was just one kid who had never seen anything like it before, one kid who thought the parade of painful gaits was funny, one kid who laughed.  And then they were all laughing, every single kid in my class was laughing.  It was so loud. And it seemed to last for hours as they went by so slowly. I wanted to cover my ears because it was so loud.  I didn’t think it was funny.  I didn’t know why they were laughing.  But obviously, I was supposed to laugh, wasn’t I?  I didn’t quite know how.  It came out like a throaty bark, a strangled dog trying to get air.  But I gave it my best shot.  I laughed as loudly as I could to drown out all the other laughs so I wouldn’t have to hear them.

Our teacher came out then, and she was furious.  I wish I remembered what she had said to us, if the teaching moment to end all teaching moments was fully realized.  But I didn’t hear a word she said because I was crying.  It was the first time I remember feeling really bad about myself.  I’d done something awful, and I had known better.   It was the first time I had done something truly unforgivable.

But was it unforgivable?  Do you think less of me?  I was five.  And I immediately repented.  In the eyes of God, I would be forgiven. And I hope you forgive me too.  But I wonder about that class full of children who struggled just to make it down the hall.  How many of them, now in their 40’s, remember that day?  How many of them forgive us?

And that’s the thing.  We are not God.  We are slighted and hurt and gravely wounded by those around us.  We are scarred both by accidental slights and malicious intent.  And we inflict pain on others and still walk around thinking we are decent human beings.  Is that why we say we forgive?  So that we can expect others to forgive us?

Once, many years ago, I was picking up my kid from preschool.  Somewhere between the two car seats and the diaper bag and the sleep deprivation, I managed to hit the minivan next to me with the car door.  I rolled down the window and looked for damage.  I saw a microscopic ding, nothing anyone would ever notice.  Crisis #412 of the day averted.  I was still getting everyone buckled when a hugely pregnant woman came barreling towards me.

I AM VERY DISAPPOINTED THAT YOU DID THAT, she snarled quietly.  All I could think was that this woman was not only hormonal, but also clearly had chronic rage problems for which she must have received a great deal of therapy where they taught her to say I AM VERY DISAPPOINTED in the scary quiet voice  instead of cursing people out in the middle of parking lots full of toddlers.  I stammered, red faced, embarrassed.  I started to pull out my insurance card and my checkbook, but she would have none of it.  She slammed her car door in my face and spent the rest of the school year avoiding me.  She wanted me to know I was not forgiven.

I didn’t exactly lose sleep over this.  But I am a little concerned for this woman’s children who probably pissed her off regularly.  Maybe that’s another reason we forgive, to let go of anger. Being angry at someone indefinitely is taxing.  It’s stressful.  And as far as vengeance goes, it’s not particularly fulfilling.  Holding a grudge, according to Buddha, is like drinking poison and expecting the other person to die.  So having this vehicle of forgiveness is a handy out to have.   It’s an acknowledgement that every hit you take is in the end about how you handle it.

I thought about this a lot when the relatives of church shooting victims in South Carolina came forward to publicly forgive the killer for his act of unspeakable violence.  There were those who criticized them for doing so, but if it brought them peace, who should dare take that away from them?  I could only imagine how I would feel if it were me.  I think anger might be the only thing that held me together.  Maybe it would consume me.  Maybe I would be unable to forgive. And that would just be a tragedy on top of a tragedy.