Saturday, May 26, 2007
Midwifery has never been illegal in Australia but it is very much under the thumb of the medical establishment. Midwives in Australia have traditionally practiced more as Obstetric Nurses (Mum uses the terms “midwife” and “obstetric nurse” interchangeably describing herself as both, something that would make modern midwives cringe) and Obstetricians set the policies and protocols. Hospitals are staffed by midwives (in the US they use Labour and Delivery Nurses) and 2/3s of Aussie babies are caught by midwives, but the majority of midwives practice under a medical model.
I have been involved in the starting up of Midwifery led units and it has been very very interesting. We have started one in Wollongong but it is very much under the control of our Consultant. He still sets the criteria for women to be "on the program". In fact you need a consultation with him in order to get on to the program! This is ridiculous as it is within a midwife’s scope of practice to care for women autonomously throughout pregnancy and childbirth, referring to an Obstetrician if anything deviates from normal. Obstetricians are specialists in complications of pregnancy and birth and the evidence shows that when healthy pregnant women are under the care of physicians the outcomes are inferior to a matched group being cared for by midwives. It is this medicalisation of normal pregnancy that costs a fortune, does not improve outcomes, and leads to a lot of unnecessary intervention (Australia is approaching a 40% caesarean section rate!) with the sequelae that goes along with it.
Back to our local consultant…interestingly, one of the requirements to take part in the Midwifery Group Practice (or MGP) is three ultrasounds during pregnancy, (btw, evidence shows routine ultrasound in pregnancy does not improve outcomes). If you decline to have these you are kicked off the program. The clincher? He owns the local ultrasound clinic! Ka ching!
Our local MGP was supposed to be a 6 month pilot in Wollongong then move out to Shellharbour (where I live) and operate at Shellharbour Hospital with no Obstetrician on site (complications requiring Obstetric care would require transfer to Wollongong). That was 4 years ago. The outcomes of the program are of course superior to the outcomes of the obstetric led care in hospital (midwifery care is always superior to obstetric care :) ) but whenever there is talk of the program going to Shellharbour we have headlines in the paper: "BABIES WILL DIE SAY LOCAL DOCTORS". I kid you not. The doctors have repeatedly stopped the program moving to Shellharbour and it operates in Wollongong still.
The AMA continually uses scaremongering tactics, and the “Babies will die” comments are usual whenever a new midwifery led unit opens. In fact one Queensland obstetrician, former Queensland president of the AMA, made headlines when he referred to the Brisbane Birth Centre as “The Killing Fields”. The Brisbane Birth Centre has superior outcomes to the general labour ward care. This particular OB runs a private practice that is 100% caesarean section.
Interestingly, this man (his name is David Molloy) appeared on 60 Minutes in a Caesarean Section promotion piece describing the procedure as “the choice of the emancipated woman” and also as the safest way to give birth. He overstated the risks of vaginal birth and understated the risk of Caesarean Section. When asked about the 150% increase in emergency hysterectomy rates in Victoria (emergency hysterectomy is a risk of Caesarean Section) he replied that it is not an issue when Australian women are currently having an average of 1.7 children (I do wonder how he would feel about losing a sexual organ whether or not he wants more children). Current research indicates a 3 x maternal and neonatal mortality rate from CS. He did not mention this. He also stated that vaginal birth causes sexual dysfunction, incontinence, etc. He did NOT mention that the latest research shows that CS is NOT protective in pelvic floor dysfunction.
We had a case in Queensland where a woman, who had experienced 2 CS, wished to birth her next child vaginally. The hospital she planned to birth at pressured her for a CS stating that they were only willing to allow her to attempt a vaginal birth under very strict criteria such as continuous monitoring, being confined to bed, etc. They scheduled a CS for her but, feeling bullied, she informed them she would not turn up and made plans to birth in another hospital. The original hospital called DOCS on her(like your CPS) and they went to her home when she was in early labour (this is in direct contravention of the legislation which states that DOCS may intervene if an unborn baby is in harm’s way but SPECIFICALLY excludes the mother’s birth choices). She was able to fend them off and ended up birthing vaginally in the second hospital. Mother and baby were well.
David Molloy, then the Queensland president of the AMA (Australian Medical Association), was very vocal about this incident criticizing the woman for “risking her child’s life”. He stated that the woman had a 5-19% chance of her uterus rupturing resulting in the death of her baby. The actually risk of uterine rupture in a vaginal birth after caesarean is 0.4% with about 1 in ten of those cases considered “catastrophic rupture” resulting in the death of the baby. How can an AMA president get away with making such blatantly false and misleading statements to the press? No idea. I know a couple of people who wrote to the AMA about that specific statement and the AMA replied with “the doctor knows best” (I am paraphrasing of course!).
So you mention the AMA.… that is a small part of my experience with the AMA here in Australia. On a more positive note, I have seen the new president of the Royal Australian New Zealand College of Obstetricians and Gynaecologists in interview a couple of times recently and she is great. She was being interviewed about our soaring CS rates and she provided a very balanced and informative view on the risks and benefits of both. It is refreshing to see after hearing OBs like David Molloy advertise the procedure as safer and easier than vaginal birth (absolutely not true).
And that brings us to homebirth. When I was pregnant with Lucy I was reading a very mainstream pregnancy book and there was one paragraph in it about homebirth. It stated that for well women, home could be the safest place to birth your baby. I was outraged as EVERYONE knows that homebirth is foolish and risky and I intended to write the author a letter telling her how dangerous it was to publish such false and misleading information. So I looked up her references and was astounded at what I found. In study and after study homebirth has been shown to be as safe, or safer than hospital birth. Not only are the mortality rates similar, but in study after study the babies were in better condition at birth, mothers were in better condition, mothers experienced less PPD, higher breastfeeding rates, etc.
However, the exception is the Pang study. This study looked at out of hospital births in Washington state and, unbelievably, does not distinguish between planned and unplanned homebirths! The researchers looked at all births that occurred outside of the hospital but had no way of knowing which were planned homebirths with a midwife in attendance and which were BBAs (born before arrival - babies born on the way to hospital), unplanned homebirths, homebirths without a trained professional in attendance, whether the woman had had prenatal care, etc. Unsurprisingly, the Pang study shows that babies born out of hospital have a whopping three times the neonatal mortality rate as those born in hospital.
And this is the study that physicians always quote and that ACOG (the American College of Obstetricians and Gynecologists) has on their website. Of all the studies in existence on planned homebirth (I’ll send you a list of abstracts if you are interested) the Pang study is the single one that shows better outcomes in a hospital setting. And in spite of its flaws it is the one that is repeatedly quoted by physician groups.
Through out public health system midwives can only provide care under the supervision of a general practitioner or specialist obstetrician. This puts midwives on the same footing as nurses with NO midwifery qualifications and Aboriginal health workers! When a bill was proposed allowing midwives to bill the public health system for their independent services the physician associations kicked up a huge stink. It is ironic as midwives can be supervised by general practitioners with no obstetric qualifications or experience but cannot practice autonomously under our public health system.
Friday, May 25, 2007
1) Smoking doesn't cause cancer, because I smoke and I don't have cancer!
You've got an argument? Fine. Bring it on. This isn't an argument, it's a fucking rationalization. You've smoked a pack a day since you were thirteen, and you're in perfect health? That doesn't mean that there's no link, it means that you were fucking *lucky*. It's like saying "I got shot and didn't die, therefore bullets don't kill people." What the hell kind of science is that? You can't map a trend from a sample of *one*.
2) Global warming is a hoax, because it's a cold day outside!
...and let's also add the left-wing "How can people say global warming is a hoax? It's such a hot day outside!" Yes, I've heard both.
Now, look. I'm a global warming skeptic. There's an argument to be had here. This is not it. Climatology means mapping trends over periods of thousands of years; you've gone ahead and made an assertion based on a study of *twenty seconds*. In one location. All argument like this does is serve to make the rest of us look stupid.
(Insert snarky "You don't need any help for that! Ha-ha!" here.)
Thursday, May 24, 2007
(Just don't mention that you're a *right-wing* American satirist. That tends to clear the party out rather quickly.)
One of the books I brought with me was Stephen Mitchell's "The Gospel According to Jesus", one of those projects akin to the Jefferson Bible that attempts to take the Synoptic Gospels and form a single coherent text out of them, excising passages that are contradictory, historically unsupportable, or that the editor didn't like. This seems like a perfectly acceptable process to me, since I suspect that this is how the Gospels were largely compiled in the first place.
Those who argue for the historical validity of the Gospels frequently say that they *couldn't* have been fabricated, because there were still some people who were alive during the ministry of Jesus when they were composed. I actually found this a reasonably compelling argument -- five years ago. I have since lived through two terms of the Bush administration, where they will say one thing, a year will pass, and they will then assert the complete opposite -- and everyone will nod their heads and say "Yes, that's correct."
We'll eat up any bullshit with a spoon if it's said to us confidently by someone in a position of authority. That's true of politics *or* religion.
Tuesday, May 22, 2007
So shortly before I left the US, my car was broken into and a CD wallet stolen. This wallet contained 72 CDs, which I’d just spent some time sorting; I’d been collecting them since I was twelve; and I estimate their total value to be somewhere in the neighborhood of $1000.
I have two responses to this.
It’s been said that the reason why we regard life, liberty, and property as sacred is because they represent temporal states: to steal your property is to steal your past, to steal your liberty is to steal your present, and to steal your life is to steal your future. If my current emotional response is any indication, this is a remarkably accurate characterization.
What really stings isn’t the financial loss, although that’s significant; it isn’t the loss of resources, although most of the music from my shows has been drawn from this library; it’s the loss of *history*. There’s music in there that I’ve picked up on my travels to other countries; music burned for me by friends and girlfriends; music that got me through some hard times, and some harder ones; music that played in the background as I composed scenes for plays. I’m a materialistic guy, and I get too attached to *things*: but those things carry part of my past with them, and their loss can’t help feeling like a violation of that. *That’s* the ultimate reason that theft is evil, and property is important: because you’re not just stealing an object, but its history, as well.
Which may well be my trying to rationalize how fucking pissed off I am right now.
And yet — maybe as a product of just how chaotic my life has been for the past couple of weeks — when I realized it was gone, there was actually a moment of — serenity? I mean, I’d spent a lot of time sorting them, not alphabetically but in chronological order of the composition of the earliest song on each CD. I — ah — get wrapped up in certain, uh, rituals and patterns, and that turned out to be a big job. And suddenly — whoosh — it was gone. I’d been liberated of it.
I mean, there’s a big part of me that’s disgusted with myself for even owning that much stuff, y’know? And not just the stuff — the *history*, that I’m carrying around that much stuff *mentally*. I’m the kind of guy that keeps boxes of every letter, note, object I received from every terrible relationship I’ve been in, because I *can’t get rid of it*. I have pictures of most of my ex-girlfriends in my wallet, because I don’t know how to throw them away. And, yeah, the bulk of my response to the theft is anger.
But there’s a small, very small part of brain that wants to thank the thief for liberating me of my possessions. Does that make me crazy?
“Ryokan lived in a small hut at the foot of a mountain. One evening a thief broke in, only to find that there was nothing in the hut worth stealing.
When Ryokan returned, he found the thief and said, ‘You’ve probably come a long way, and you shouldn’t return empty-handed. Please take my clothes as a gift.’
Shamefaced, the thief took the clothes and left.
Ryokan sat down naked and looked up at the sky. ‘Poor fellow,’ he said, ‘I wish I could give him this beautiful moon.’"
-Paul Reps, Zen Flesh, Zen Bones
Ah, the joys of airline travel! I suspect I can look forward to being randomly selected for any number of searches over the next forty-eight hours.
Number of signs have posted that we’re currently on an “orange alert.” I guess my main beef with the color-coded alert system — and, I suspect, the real source of much of the ridicule that’s been heaped upon it — is the fact that you can’t really *do* anything — you don’t go to shelter or cancel your flights or stay home from work. It ultimately ends up feeling like the government jumping out form behind the bushes and shouting “Someone’s trying to kill you! Booga booga booga!” then running away.
Y’know, as much as the romance of airplane travel has worn off for me over the years — am I crazy for actually liking airports? I never get lost, and I actually don’t mind getting stuck in them. They’re almost like self-sustaining mini-civilizations, and I find in them much of what I love about city life in microcosm: they’re crowded, expensive, everyone’s in a hurry to get somewhere, and you’re constantly weighting your likelihood of being shot.
I have a habit of running my hand along the rails of the moving walkways, and it always comes up coated in filth, the source of which is not to be contemplated. The one exception to this rule? Japan, where they apparently hire someone to wipe them down multiple times a day. I am adding this to my long list of Reasons Japan is Fucked the Hell Up.
It seems to me that among the greatest casualties of tightened airport security must be chick flicks. How are romantic comedies to end now, when the jilted lover, running to prevent the object of his desire from flying out of his life forever, is gunned down by a bevy of trigger-happy air marshalls?
Come to think of it, I’m hard-pressed to think of many such movies that wouldn’t be dramatically improved by this treatment, so perhaps it’s all to the good.
Saturday, May 19, 2007
A lot of the “Support our troops” rhetoric has been re-emerging lately, seemingly not unlike Prometheus’ liver in its ability to regenerate itself, and it’s continuing to do a very good job of the thing it was designed to do, which is shutting me up.
There’s a number of reasons why it leaves me scratching my head, slack-jawed and unable to respond, not least because it’s always seemed to be such an obvious straw man argument to me: nobody *doesn’t* support the troops. Nobody’s cheering at the idea of American soldiers getting shot at. People bring up the military men returning from Vietnam who were spit on: but I find it extremely difficult to credit that that’s going to happen now. The cultural climate’s changed, not least because of people yelling about supporting our troops.
Taking the argument at face value, I just plain don’t get it, and I’m the first to admit it: I don’t see how claiming that the invasion of Iraq was a horrifically bad administrative decision, a bureaucratic fuck-up for Blobby’s Big Book of Bureaucratic Fuck-Ups, is somehow an expression of contempt for the guys on the ground.
Probing a little deeper, I think it has to do with a differing concept of love: that for them, love of country must be composed of a kind of blind adulation, an unwavering support for everything it does. Let’s add this to the list of the things I fail to get. I mean, I love my family, but I can acknowledge that they’ve done some pretty fucked-up things. If I found out that, say, my nephew had murdered somebody, I would do everything I could to help: speaking in his defense, getting him a good lawyer, trying to get his sentence reduced, et cetera. I get the impression that the “Support-our-troops” camp would be helping him hide the body.
But we can get a little deeper than that, can’t we? Ultimately, the reason I have such a hard time responding to the slogan is because there’s a grain of truth to it: I *don’t* support our troops. I support the American people; in a broader sense, I support the human race, the species into which I was born, of which the military branch of the United States government comprises a very small percentage. As long as that percentage is doing work that I feel is beneficial to the rest of the species — including my favorite component of it, me — then, yeah, I’ll support it. When I feel that it’s doing work that’s actively harmful? I’d be nuts to.
None of which, none, is passing any kind of judgment upon the individuals inhabiting that percentage. I don’t have any issues, good or bad, with the individuals. It’s collectives I don’t trust: and that’s the case whether they’re parties, corporations, governments — or militaries. As James Madison put it, “A standing army is one of the greatest mischief that can possibly happen.” (His syntax, not mine.)
One of the better concepts drilled into me growing up was “Love the sinner, hate the sin” — and if we can sidestep for the moment how terribly loaded those particular word choices are, all it’s really saying is that people can do shit you don’t approve of without you passing judgment on them.
In my last political satire, Libertarian Rage, I made a conscious decision early on not to mention any politicians by name — because I wasn’t interested in ridiculing *people*, I was interested in ridiculing *ideologies*. I may object to just about every decision Bush has made since he was appointed to his office by the Supreme Court (including, y’know, that one) — and I will call him on every bullshit decision he makes — but I am singularly ill-equipped to pass any judgment on him as a person, as a human being, because I *don’t fucking know him*. I honestly can’t tell if he’s a bumbling puppet or brilliant con-man or a dangerously wide-eyed idealist. And even if I could, I don’t know what his private thoughts are in the dead of night, nor do I have any desire to. Not my job.
Christ’s injunction to “Love thy enemies” is one that gets thrown around pretty glibly, but its implications are terrifying: it means, well, loving your enemies. It means loving Osama bin Ladin and Saddam Hussein; it means loving both your military and political opponents; it means finding a way to love George W. Bush. Not letting them get away with shit. But not passing judgment on the contents of their hearts, either.
Vengeance is easier. Rage is easier. Hell, a lot of the time it’s useful, too — witness this site. But left unchecked, it leads to things like blood feuds, crusades — and wars. Compassion, mercy, forgiveness — they’re hard. They’re *fucking* hard. But if we entered this raging inferno in a state of grief and anger, we’re not gonna crawl our way out for as long as we’re clinging to the things that brought us here…
…e quindi uscimmo a riveder le stelle.