Lead Paint -- Delicious But Deadly!

Nicholas Kristof has a depressing column today about women dying in childbirth, and Bush administration cuts to our (already feeble) funding of efforts to combat the problem. This is the kind of thing that makes me reflect on how much I loooove modern medicine. I have a good friend who is a doula, and another friend who gave birth at home to a 9+ pound baby. When I hear them talk about how childbirth is a natural process that doesn't need to be overmedicalized, I always think, yeah, OK, you know what's natural? Dying in childbirth, that's what. I would never, ever want to give birth at home, though I think people should be allowed to if they want, and if some responsible doctor deems it's safe. Give me some of that sweet hospital loving! I want teams of white-suited neo-natal specialists standing by in the NICU, just in case. And pain relief! I had planned to try natural childbirth with my first baby (I told my doctor that I didn't know how badly it would hurt, so I couldn't really say in advance). After 20 hours of contractions and little dilation, I got the epidural, partly because it looked like I was heading for a C-section anyway. Holy Moly! Those things rule! From searing agony to enjoying a cup of tea and listening to Nightmares on Wax chill me out with some fine trip-hop, in about 10 minutes. (Once I relaxed in my new, pain-free environment, everything sped up massively, and Zoë was born within the hour.) Different doctors use different drugs, but here in Singapore it seems they inject Demerol right into your spinal column. Fuck the bullshit. I was reminded of my mom's advice (she was a hippie natural childbirth pioneer and had both me and my brother that way). She said the childbirth educators were going to lie like crazy about the level of pain, and talk about "pressure", and not to believe a word of it. No, she said, that hideous agony stuff you read about in great works of literature is all true. (Cue Medea on the preferred battle/childbirth ratio.)

This isn't to say I don't support lots of changes to former medical practice that allow women more control over their deliveries, such as refusing unnecessary or painful procedures, bringing in family and labor coaches, breastfeeding in the delivery room, rooming in, and so on. That's all to the good. I'm just saying that for me, personally, the idea that there will be a machine monitoring my baby's heartbeat all the time is not alienating and over-medicalized, but awesome. I think that if we could travel back in time and poll mothers throughout the ages, my view would be dramatically in the ascendant.

You know what else is great? Vaccination against childhood diseases. Sign me up. I'm giving my baby extra shots (well, not really). Living in Asia will cause you to reassess your risk priorities. They actually have polio in India, for example. And every day on the street, I'm sure I walk by at least a few people who just got off the plane from India. Or rural Cambodia. If I could only contrive to get us all vaccinated against malaria and dengue fever I'd be all over it (there are no vaccines, unfortunately for millions of victims). Singaporeans regularly fog for mosquitoes with I know not what noxious substance, and I love it! I just close the windows. (Neither dengue fever nor malaria is endemic to Singapore, but there are a small number of cases each year. No, thanks.)

I feel very strongly that the people involved in hyping the thimerosal/autism link have blood on their hands. Babies have been born deaf, and with profound retardation because their mothers were exposed to rubella by some unvaccinated older child. Children have died from preventable diseases because parents were frightened by misleading and paranoid information, much of it promulgated by (cue scary music) evil trial lawyers. No one should get whooping cough anymore, ever. I have a great deal of sympathy for the parents of autistic children, but the evidence supporting a link between the MMR vaccine and autism was always really weak. And once the data came out of Denmark showing that the removal of mercury from all vaccines had not been followed by any lowering of rates in autism in the relevant age cohort, it was incumbent on everyone to say, oh, there turned out to be no link after all. And that's even before the recent Lancet retraction.

Sometimes the government isn't lying to you. Like about eating mercury, say. It's really bad to ingest mercury. Waddling Thunder, guest-blogging over at Crescat Sententia, scoffs at the FDA's recent advisory on tuna intake for pregnant (or soon-to-be-pregnant) women, nursing mothers, and small children. Easy for him to say, because as a 2nd year Harvard Law student, his brain is fully formed and relatively impervious to assaults from low doses of mercury (so long as he doesn't become a do-it-yourself hatter or something). If anything, the FDA is probably pussy-footing around on this issue under pressure from Chicken of the Sea, because the truth is that mercury ingested in this way is really, really bad for developing fetuses and young children, and is present in maternal cord blood at double the mother's own blood levels. Libertarian types sometimes go a little funny on issues like this, so let me make it clear. Just because it's the government talking doesn't mean we shouldn't listen, if they happen to be right. Like, don't eat lead paint chips, either.

Mr. Thunder complains that the FDA thinks a lot of silly stuff about unpasteurized cheese, and he's half right.

A prime example is this astonishing fact sheet about dairy safety. Not only does the FDA reiterate its frankly hysterical regulatory ban on unpasteurized cheese and milk ("Unpasteurized milk and dairy products may contain harmful pathogens and are not safe to eat, drink, or use in making foods"), but it also somehow decides that even pasteurized soft cheeses are unsuitable for consumption by "pregnant women and their fetuses, the elderly, and people with weakened immune systems".

Now, the reason they say this is not because they are evil and crazy, but because even pasteurized soft cheeses, as well as deli meats, can be contaminated with listeria, which is no big deal for normal people, but does cause miscarriages and stillbirths in pregnant women. I think contamination is caused by sloppy food handling/manufacturing; maybe the FDA should be kicking some butt in some cheese factory somewhere. It seems pretty darn rare, but if all you have to do to rule out some chance of miscarriage is to stay away from the Camembert for nine months, then why not? I hasten to add that I think, as long as the risks are publicized and small, we should be able to import, domestically manufacture and consume all the uncooked, fermented pork products and stinky unpasteurized cheeses we want. Plus, I eat raw cake batter and cookie dough all the time (and therefore raw eggs), so it's not like I'm little Miss Food Safety Nazi. I'm just asking for some accurate risk assessment, is all.

Comments

[back40]

"Nicholas Kristof has a depressing column today about women dying in childbirth, and Bush administration cuts to our (already feeble) funding of efforts to combat the problem"

Kristof is deceitful, as usual. The money is still being spent but it is administered through the United States Agency for International Development (USAID) to support family planning and reproductive health care. The US has issues with a number of UN agencies and has been shifting funding away from them while continuing to provide comparable aid through organizations it likes.

A more honest article could dispute the US trend to defunding UN efforts in favor of US efforts. That might be a long discussion that would have to examine the effectiveness of various delivery methods as well as the politics.

[back40]

"...we should be able to import, domestically manufacture and consume all the uncooked, fermented pork products and stinky unpasteurized cheeses we want."

The greatest opposition to this comes from the dairy industry. Every time there is a food illness event they lose sales even if it was caused by bathtub soft cheese bootlegged from Mexico.

[Invisible Adjunct]

"She said the childbirth educators were going to lie like crazy about the level of pain, and talk about "pressure", and not to believe a word of it. No, she said, that hideous agony stuff you read about in great works of literature is all true."

The other term they use is "discomfort." Yeah, right. We're talking agonizing pain, and a violent upheaval at the very core of one's being.

I did it the "natural" way, at a birthing center attached to a hospital (so medical help was on hand if needed, which thankfully it wasn't). I'm very uncomfortable with hospitals, white coats, noise, etc, so for me it was the best of both worlds. But though I'd do it the same way again if I could, I have to say that I despise all the earth mother crap that surrounds it. If a woman wants an epidural, she should go for it.

And yes, the natural childbirth educators have a highly romantic mythology of how warm and cosy it all was before the "male medical takeover." "I think that if we could travel back in time and poll mothers throughout the ages, my view would be dramatically in the ascendant." I think you're right about this. Once upon a time (and not so very long ago) in the western world, and still today in some parts of the world, certain kinds of breech positions, e.g., mean almost certain death for the infant and possibly for the mother too. And I think the ability to now have an uncomplicated nonscary "natural" birth is precisely a function of modern improvements (improved diet, iron supplements, vaccinations, and the like), with the safety net of medical staff and medical interventions on hand if needed.

[T. Gracchus]

"Nicholas Kristof has a depressing column today about women dying in childbirth, and Bush administration cuts to our (already feeble) funding of efforts to combat the problem." I thought you were in Singapore.
Kidding. Good post.

[Claudia]

Wholeheartedly agreed.

Here's why:

(The good news at the beginning -- everything turned out all right.)

Our first born was two weeks overdue and was induced. Eek! Talk about uncomfortable. It made me go from no contractions to contractions-all-the-friggin'-time in about ten minutes. Remember those childbirth classses where they tell you to breathe through the contractions and relax in the breaks? Hah! I didn't have no breaks. Not a single one. Just a teensy bit less pain but nothing you'd actually call a break.

I'm no wussyfoot. My husband regularly despairs over my reluctance to take pain killers. But after two four hours of excruciating pain I whimpered for an epidural. Oh, man. Or better, oh woman! Those rock! I could talk intelligibly with my husband again. I was not a writhing, sobbing creature anymore. I was a human being again. It felt so good. Modern medicine is wonderful.

The constant heart beat monitoring? It turned out to be a blessing for us. The baby's heart beat started dropping when I was about 8 cm dilated and 8 hours into labor. There is hardly a worse feeling as to know that with every contraction you have, your child's heart slows down dramatically. Without the monitoring, we wouldn't have known. The whole issue of oxygen deprivation... another big brownie point for modern medicine. The doctor managed to take some blood of Alan (while still in uterus, don't ask how). It got whisked off to the lab and within five minutes, we could breathe a (momentary) sigh of relief.

I was clearly heading towards c-section. I was stuck (or better, the baby was stuck -- failure to progress they call this in med talk). The doctor recommended to wait a bit and see whether Alan would finally be of a mind to join us, but to consider surgery and decide what to do. I had not a moment of hesitation -- my body tried to kill my baby! Just cut me the hell open and get the kid out before I succeed, was my take on it. In some countries, even today, I wouldn't have had this option.

I'm going to omit the details of the following hour or so -- suddenly, things deteriorated very quickly and that they didn't cut me open on the way to the operating room is something that still amazes me.

But here's the moral: Alan just turned two. He is a lively, active little boy who loves trucks and his little girlfriend Illinka. He started walking at nine months, jumps, and runs, and understands three languages. He can identify scrapers, graders and rollers in his "My first Truck Book". He was a bit slow on the talking side but is just now having a verbal explosion of the third kind.

I thank modern medicine every day for this healthy little miracle. And thanks to the doctors, the nurses, the midwife, I have a thrilling story to tell and not a tombstone.

One more thing: I think one of the major attractions of the writings of Lois McMaster Bujold to me has always been the "uterine replicator" she has invented in her books. Not sure I would want to use one myself but it sure would be nice to have the option.

You can all relax now. This rant is herewith over. ;-)

Best wishes to you, Belle!

Claudia

[Doctor Memory]

Huh, color me surprised that the same cohort of drive-by naturalists who crapped all over Belle for "outsourcing the central part of her family life" (roughly paraphrased) by hiring a nanny haven't turned up to scold her for heartlessly ducking the "central part" of the childbirth experience.

Either I'm haunted by the hobgoblin of consistency, or they just haven't woken up and spotted this post yet.

[Walt Pohl]

You are of course right to love modern medicine; god knows how it's inspired so much distrust. But doesn't it seem odd that childbirth is so painful? If it was that painful in a state of nature, you would expect all of the mothers giving birth to have been eaten by tigers or something.

[Teresa Nielsen Hayden]

Human childbirth really is that painful in a state of nature. As a species, we decided to stand up on two feet instead of plonking around on four, and in the process turned our previously horizontal birth canal into a vertical one with the opening at the bottom. This is bad. The natural tendency is for stuff to fall out. We compensated with a walloping set of muscles at the opening, which is fine until you actually want something to come out.

Our enlarged cranium is a problem too. Having a bigger brain is survival-positive, but the payback for that comes due during childbirth, and it's a bitch.

[Belle Waring]

It does seem strange that human childbirth should be so very painful, but there are structural reasons for it (as Teresa mntions.) Look at a newborn's head sometime, and then just think about it. Brrr. That's why humans have to band to gether, so someone else can stand around and fend off the tigers. I have no doubt that many an early human mother who somehow ended up giving birth alone on the veldt has perished in just this way (well, or lions.)

[Maria Farrell]

Here, here on vaccination Belle. My best friend's baby was hospitalised with viral meningitis several years ago (thankfully, she made a full recovery). But most of the other babies in the PICU were there with complications of measles - simply because a rumour had run around Dublin that MMR vaccinations were harmful. None of them should ever have had measles in the first place, and many of them were brain-damaged, left blind or deaf, or even died.

Even before the retractions and general discrediting of the MMR/autism claims, it used to astonish me that no one seemed to have run the numbers to compare the likelihood of complications of measles (brain damage, blindness, deafness, death) and that of developing autism post-vaccination. Surely unvaccinated children still carried a higher risk of harm? But then you'd also have to factor in their (parents') free-riding on herd-immunity, which was the part of the equation that really disgusts me, given the parents' assumption that vaccination itself carred a significant risk.

[Chun the Unavoidable]

Am I wrong in believing that lions and tigers have an instinctual fear of man? The man-eaters are old and crazy, yes?

If it is an instinctual fear, would it not have developed since before the emergence of homo sapiens ("man" having a broad hominidic definition, above)? Thus, wouldn't a mother giving birth alone, which I agree is highly unlikely in most situtations, have little to fear from lions?

Hyenas, on the other hand, I'm not so sure about.

[Cosma]

Chun:
> Am I wrong in believing that lions and tigers
> have an instinctual fear of man? The man-
> eaters are old and crazy, yes?
"Yes", and "yes, these days", respectively --- the survivors seem to have a sensible learned fear of humans, and the man-eaters, now, tend to be old and crazy, but that definitely wasn't always the case. (Singapore used to lose a few people a year to tigers, for instance.) In general there's good paleoanthropological evidence that hominids have had it together enough to threaten large predators only in the last c. 100,000 years, or maybe only 50,000, out of c. 3 million years of genus Homo. (There's a nice summary of this work in Barbara Ehrenreich's Blood Rites, which is not to endorse all the rest of it.)

[Carlos]

And the learned behavior can go the other way as well. IMS, there was an appalling instance where human corpses, used by hunters as bait to draw the man-eater out, caused _other_ big cats in the area to view the local bipeds as food. Iatrogenic.

[Chun the Unavoidable]

What's to say that those Singaporean tigers weren't old and crazy?

I believe their fear is instinctual. What's the minimum length of time an instinct can develop in a population?

And isn't 100,000 years the magic number? I wasn't talking about the entire genus Homo.

[mattH]

There are actually stories of Massai boys, entrusted with cattle, who find themselves facing lions intent on eating their herd and the occasional human. In fact, one individual who imparts his experience killing a lion implies that if it had smelled him, it would have immediately turned and killed him.

He also relates another instance of lions attempting to kill cattle in and enclosed kraal during a storm, after the fire they started had died. I'm willing to bet that a lone female, screaming at the top of her lungs, is going to get eaten if there's a lion around.

[Fred Firebrand]

Btw, speaking of giving birth... what do y'all think of the Melissa Ann Rowland case (woman in Utah being charged with MURDER for refusing a c-section)?

http://www.cbsnews.com/stories/2004/03/12/health/main605537.shtml

[Susan R]

The health care system in my country also needs some major changes and the government must play its roles for its progress.