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In honor of my last day of NaNoBloPoMo, it snowed. Well, mostly it iced and drizzled and made semi trucks jacknife on the highway.

It’s been fun, posting every day. Even if Matt likes to snark about my post quality going down. He’s just jealous that he doesn’t have a blog and so it takes him a week to wrote a post and update his website using Dreamweaver.

I guess since Nathan provides the bulk of my posting material many days, I will have to close with his picture; here’s one with his great-grandma kissing his ENORMOUS baby cheeks.

Blog ya later.

Yay me and my NanoBloMo self. 11/29! Woot!

I am really enjoying my new job, for a lot of reasons;

1. At least two terrifying but awesome women (one my boss) who know EVERYthing about this business, and take no crap from anyone. And are sharp dressers. I’ve had very few good female bosses, and a startling number of ones that were in fact cuckoo-bananas (actually one was a drug addict, so technically, she was only high. I don’t know if she was still crazy when sober). Whereas my male bosses have either been decent or sleazy, but none crazy (although two were convicted criminals!). Anyway, yay for sanity and competence.

2. Overhearing the writers debate whether “Ode on a Grecian Urn” is better to include than “She Walks in Beauty” in the curriculum. Oh my gawd, it’s cultchah!

3. Working in a very “interesting” neighborhood that includes the Lew Sterret Justice Center (jail), which means if you want get your coffee, you’ll be standing in line at the convenience store with bail bondsmen, guys going on day labor jobs, guys drinking their 8am 40-oz, and transvestites. Don’t see that every day.

4. Same neighborhood also includes a Mama’s Daughters restaurant, and oh my LORD it is sooo good. And reasonable. If my New York friends ever visit again, I will drag them here.

5. Talking to one of my co-workers who is a film editor about her working for the Barney show, and how the dwarves(!) inside the smaller dinosaur costumes told filthy jokes at breaks. Did you know the guy (not a dwarf) who wears the Barney suit has to use his mouth to bite down on the flaps that work Barney’s mouth? The smaller dinosaur characters just nod their heads up and down to make the mouths flap. She didn’t get to see the vat where they grow the evil Barney pod-children, but that’s just as well. They’d have had to kill her.

6. Experiencing the nice (Trinity Railway) and the stupid (DART buses) ends of the Metroplex public transit system on the same trip. Though the buses are never running at convenient times or in places you need them to, the drivers are usually pretty nice and will drop you almost anywhere you want along the route. It’s all casual, just us bus-riding freaks hangin’ out.

Words I am having to learn or redefine in my job so far:

Rubric: I had vaguely understood it to mean “purview of” but it’s actually closer to this definition:
“a scoring guide for evaluating the quality of work or products to answer the question: What does mastery, and varying degrees of mastery, look like? Has three essential features: evaluative criteria, quality definitions, and a scoring strategy, which may be either holistic or analytic.”

But at least my guessed-at definition was not completely off; according to this, it sometimes means something similar: “Rubrics are the instructions that form chapter headings or titles that are not a part of the text. The word rubric is derived from the Latin word, rubrica, which means “red” because the color of the ink used to write rubrics was red.”

How educational academics got from “chapter heading” to “scoring guide” I have no idea.

Objective: (in education, it’s not a synonym for “goal” but a highly complex three-part process).

And while I am learning, I also spend a bit of time flailing. There are lots of acronyms and internal program names that I don’t know yet. So various conversations end up being something like “I need you to revise the scheidenflugle using the cratsken, and check it for any similarities to our lumpenshin guidelines.”

And then I nod, and my head explodes.

It will all clear up, I know, before long. They hired me for my organization and publishing skills, not my educational background. Still, I wish I knew how to parley-voo more of their francois, por favor.

Nathan, honey, what is UP with the mood swings? You were manic, you were so happy and giggly and cute and huggy all day. You were quiet and sleepy at bedtime. So we put you to bed like we always do.

And then, the hollering. Not screaming, but more of a full-throated angry howl. You weren’t wet/hungry/in pain/lonely (we tried sitting with you in your room, too). Backrubs, blankie, Dora doll…nothing worked. Mystifying.

Finally, after switching off with Matt several times to avoid either of us getting frustrated enough to sell you on Craigslist, I laid you down again with the Dora doll and sat in the rocker where you could see me. It hadn’t worked before, but this time it did, and you went out.

And what was the point of all that hollering anyway? Or the point of suddenly deciding that you didn’t love baths, you hated them! As though bathwater was suddenly acid burning your tender baby skin? I have no idea. Maybe you just got bored and decided to mix things up like a reality show, change the rules to keep mom and dad hopping. Thanks for nothing, bucko.

**

My first day at my new job was good, and not really stressful, yet. I don’t think the work is going to be too difficult for me to grasp, but as we seem to be already behind on a number of deadlines, I can see a Crunch looming ahead and it may not be pretty. I like the people in my department, but really hit it off with the IT guy who manages the Sharepoint server thingy where all our digital files are kept. He’s set it up in a very orderly and sensible fashion to keep track of revisions and keep things backed up. It’s always fun to have somebody teach you something they really enjoy, and this guy has a passion for orderly job flow, which sounds super boring, but really, is an art form.

I love the little randomnesses of various jobs. My last job would let you order platinum-plated trash cans if you pleased from the office supplier, but had a crappy little break room and nowhere to park. This place has plenty of parking and a very pretty break room, with the fanciest auto tea-and-coffee-making apparatus you ever saw, but refuses to keep enough paperclips or pushpins in stock–you have to get them special ordered.

There are also turf battles being waged; I was set up in Cubicle A, but found out later in the day that it was spoken for for an as-yet unhired person–so I would have to move one cubicle over. Why the new person couldn’t just take that identical cubicle, I know not.

Good thing I hadn’t set up my Pikachu homage collage yet! Nothing says professionalism like an obsession with crappy Japanese children’s shows/marketing schemes.

Starting my new job tomorrow. I bought some grownup work clothes this weekend which I will get to break in, and I’ll have to get up at 6 (ouch) to make the commute. And that’s all ok. I’m ready. I’m just hoping I won’t have to feel too stupid at first, until I know what’s actually going on.

I’ve been thinking a lot about where I am and where I’m liable to be in a few years. I’ve never been at all sure I could stay in Texas forever, even though I hate to be too far from family. And it’s not that I don’t think Texas has beauty and culture–despite all the gay-hating and racism and bungling of educational funding, it does.

Over at Pandagon, Amanda started an interesting discussion about the “creative class”, where they live and where they move. I guess Matt and I count in that; we do creative things and sometimes make money for them. And we think art is important (though we don’t define it the way most people are taught to in school).

New York was not a home for us for very long, and that was supposed to be the place for people like us. But it’s too crowded, too cold, too insular, and too far away from the other things that turned out to matter to us, like big skies and a slower pace. Still, it’s been the only creative game in town for a long time. So when we had to come back here, I was doubtful that we wouldn’t regret it. That we wouldn’t feel stifled and need to move again–to Portland, to England, to somewhere else (I think even New Zealand came up once or twice).

But things aren’t the same as they were four years ago. We’ve started meeting other progressive parenting types, who’ve moved here from elsewhere, who don’t want to give up their ideals for themselves and their families. The influx of Katrina refugees* has had an impact on Dallas that hasn’t been sorted out yet, but an awful lot of Democrats got elected there this year.

Other progressive ideas about the environment have gained some traction. Well, people can see the gridlock and haze for themselves after all. Some local small farmers have capitalized on the subsidy-subscription model, where suburbanites agree to pay for a box of organic produce once a month, which is still a lot cheaper than Whole Foods.

None of this is very evident, but having been away, I can definitely *feel* a difference and shift taking place. Repubs keep a stranglehold on the govt. and they’ll take some dislodging, but some Texans are rubbing their eyes, looking around, and wondering if “God, guns and gays” is really all that their government should be concerned with.

I didn’t expect to find this job in this place, so I don’t know if it’s a fluke or a trend. I’m hoping there’s some change in the air, because honestly, I don’t want to have to move to New Zealand.

*I’ve met a few of them, and can definitely say N.O’s loss has been Texas’ gain; they bring a little touch of N.O.’s love of culture with them, which Lord knows we could use.

Totally forgot about yesterday. I was at the relatives’ doing Turkey Day II: Revenge of the Ham, and dropped off as soon as I got home and got the kidlet to bed. I’ll post a makeup post later today.

Said kidlet, by the way, is walking while assisted! If you hold his hands (sometimes just one hand) he will walk all over, making pleased little “ooooh-ha!” noises and grinning maniacally. It helps to make up for the fact that he is perpetually covered in still-draining snot from the cold he just got over. His newest trick is to act all cute and “hug” you, and then use that opportunity to wipe his nose on your shoulder.

His blocked tear duct is acting up too, which means Gooey Eye, which in combination with the teething drooling means my darling child is exactly the kind of crusty mucous-covered little monster that makes young people swear off reproduction forever. At least he’s cheerful about it, though.

We hope to at least get his eye fixed next month; this may means he wears an eyepatch for a bit after his surgery. But since eyepatch=pirate, that’ll be ok. Maybe we can get a Christmas themed one.

We expect unassisted walking any day now. And while we know it brings trouble, our aching, 30-pound-toddler-lifting backs will be happy as all get out.

The two classes in question; midwives and OBs. They have a history of opposition from the earliest days of the invention of obstetrics, when men first began to enter the realm of birth, and targeted the women who were already serving there as their enemies and competition. 19th century ob’s ran the midwives mostly out of business, and set back our knowledge of birth and labor by refusing to record or learn from centuries of knowledge that those midwives had accumulated. A loss all women who give birth suffer from today.

The latest salvo, via Home Birth Talk’s blog; the American College of Obstetrics and Gyneocologists issues a stern reprimand to those who dare to think birth can be safe outside a hospital setting (i.e., one where they are getting paid):

ACOG Statement of Policy
As issued by the ACOG Executive Board

OUT-OF-HOSPITAL BIRTHS IN THE UNITED STATES

Labor and delivery is a physiologic process that most women experience without complications. Ongoing surveillance of the mother and fetus is essential because serious intrapartum complications may arise with little or no warning, even in low risk pregnancies. In some of these instances, the availability of expertise and interventions on .an urgent or emergent basis may be life-saving for the mother, the fetus or the newborn and may reduce the likelihood of an adverse outcome. For these reasons, the American College of Obstetricians and Gynecologists (ACOG) believes that the hospital, including a birthing center within a hospital complex, that conforms to the standards outlined by American Academy of Pediatrics and ACOG,1 is the safest setting for labor, delivery, and the immediate postpartum period. ACOG also strongly supports providing conditions that will improve the birthing experience for women and their families without compromising safety.

Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous.* The development of well-designed research studies of sufficient size, prepared in consultation with obstetric departments and approved by institutional review boards, might clarify the comparative safety of births in different settings. Until the results of such studies are convincing, ACOG strongly opposes out-of-hospital births. Although ACOG acknowledges a woman’s right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births.

1American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 5th Edition. Elk Grove Village, IL, AAP/ACOG, 2002.

*emphasis added

In response, the American College of Nurse Midwives cites their position on homebirth, referencing 28 citations from supportive studies about positive homebirth outcomes. Exactly how “rigorous” does the ACOG need study of this topic to get?

But of course, it’s not about evidence; it’s about money and control of the highly lucrative birth market. According to the CDC’s estimate, in 2005 4,140,419 live births took place in the United States. The cesarean rate rose 4 percent to 30.2 percent of all births.

30% of 4 million plus is a lot of operations, and a lot of employment for surgeons. If the c/section rate were to decline to the 10% recommended by the WHO…what would all those surgeons do for a living? How would they use their expensive skills?

I have to say this a lot: I don’t believe doctors are evil, OBs or any other kind. But even good people can be trained and coerced into doing unethical things. Often, to do the right thing is to risk your job. It is going to take pressure from outside, as well as from good people within, to change things.

Our system does not reward preventative, evidence-based medicine that can be peformed by midlevel professionals like midwives; it rewards expensive, emergency procedures requiring specialists with lots of fancy equipment and prescriptions for the complications afterward. Not just in birth, but everywhere. Health is not profitable, but chronic illness can be. Unless you count the well being of patients as more important than profit, which happens less and less.

I think this bias has severely skewed the system, and skewed the people forced to work under it, until “do no harm” is far less important than “protect your job and do more tests in case you get sued.” And partly it’s the lawyers’ faults, sure; but lawyers are responding to a need created by the system itself, for patients to regain some control over what happens to them inside it. Currently, they have almost none. They turn to lawyers because the healthcare system has stopped listening to them at all.

Anyway, a far more succint summation of this struggle can be found in this 2002 article from Midwifery Today magazine. I particularly found her information about conflicting presentation of evidence in the New England Journal of Medicine very interesting.

In the July 2001 issue was a study on vaginal births after cesareans (VBACs) that showed that the risk of uterine rupture (the complication that OBs usually cite when refusing to do VBACs) women faced climbed dramatically when hospitals used prostaglandin to induce labor–but otherwise remained nearly as low as for a woman who’d never had a c/section.

The writer mentions wryly that an unbiased observer might then conclude a) don’t use prostaglandins on VBACs, and b) try to avoid those first cesareans at all, so as to reduce uterine rupture rates. Instead, the editorial accompanying the article castigated those who supported VBAC and made the case for “once a c/section always a c/section” despite the risk of surgical complications that far outweighed those of uterine VBAC rupture. The press, of course, mostly reported on the editorial’s message, and many hospitals have stopped doing VBACs at all in the years since.

There are more chilling bits further down in the article about the twisting of birth studies to support more and more interventions in birth regardless of the increased potential for complications…and inevitably, lives lost due to those complications.

Which means that for some women out there, this class struggle isn’t about privilege or autonomy…it could be the difference between life and death.

First things: hey, family! I know you read…so you shouldn’t be surprised if I blog about our conversations!

Anyway. Had a long and heartfelt discussion with some family today, about the state of the world, and partly also about the state of my soul, in general. Which did not bother me as much as it could have, considering I had initiated the discussion by a) writing about it in my blog and b) letting my family know my blog existed. Stuff that I publish on the internets is fair game for my readers.

There are gulfs between me and some of my family, of politics and religion, that would take longer than we ever have to get to the bottom of. I can’t really seem to explain why the religion I was raised in can’t work for me anymore, why Bible study isn’t enough to resolve my doubts. Because I don’t think that’s what the Bible is for, for one (if it is for anything at all). And because I have made my peace with paradox, as much as I can.

For the most part, I do believe in a…person, whom I could describe as God. I cannot in any way prove that this belief is not, in fact, completely delusional. All the religious writers and thinkers of any depth will say essentially the same, that belief in a deity requires faith, and is not something you find from “evidence”, whether you classify that evidence as “intelligent design” or Bible verses.

Intelligent design is a religious theory, not a scientific one–so it doesn’t really apply as any sort of proof.

Bible verses prove nothing but the views, memory, or beliefs of the writers of the Bible. That’s why I can’t be a fundamentalist. The Bible didn’t float down from Heaven on a little fluffy cloud. It was written by human beings, with all their prejudices, ignorance, and limitations. And its rough, patchwork, sometimes contradictory contents show all the marks of many different documents cobbled together over time. None of this is any real dispute. It is imperfect, and as such, is subject to discussion and even dismissal.

Neither of which would prove or disprove the existence of a deity.

I really think a lot of churches have stopped worshipping Jesus and worship the Bible instead.

I would be sad if the Bible ceased to exist, because I think it is a rich repository of the evolution of some particular human cultures, and because it contains some wisdom and truth, some poetry, and some fascinating history. You have to understand it to understand western culture.

But I don’t think it would affect my belief at all if the Bible ceased to exist. Because my belief is not based on the Bible per se, though it is colored by it, since I grew up in the time and place that I did. Though it is fascinating to think what my belief would look like if I’d never seen a Bible.

Anyway–I believe because I feel a need to believe. I talk to God out of need, not out of a calculated desire to avoid hell, or because I know someone is there with absolute certainty. It is quite possible that humanity creates an imaginary God because of a genetic quirk in our brains. But then, our need could be a reflection of some greater reality, a natural desire of a created being to speak to its Creator. I really don’t know. More strangely, to a lot of people, I am ok not knowing, for now. I am not searching for God, so much as listening…kind of like the Very Large Array in New Mexico, listening to the heavens for a communication that may never come.

If it doesn’t come, or can never come, I will live my life the best I can, and I will die, and that will be it. If it does come, presumably it will communicate something to me to guide me what to do.

Every now and then, I think I hear something. But it might just be space static. I can’t be sure, and neither can anyone else, which is why religious wars are perhaps the stupidest kind of all. All we know for sure is this world, and that’s where we have our work. If it exists, the next world can take care of itself–we’ll all get there soon enough, anyway.

I was reading the blog of a doula who’s training to be a midwife, and in one post, she mentioned that one of her clients was birthing with a particular OB practice she was familiar with. She knew two of the three doctors were good ones, but the third…well, she’d heard things.

I recently took on a new doula client. I struggle so hard with my clients to help them with the informed consent stuff. I want my client to know that the OB practice she has chosen includes two amazing OB’s who I’d be delighted to birth with myself, but also one physician who (nurses report surrepticiously) is almost single-handedly responsible for the hospital’s not insignificant c-section rate and abusive horror stories from teenage and other under-served mothers. I can’t tell her this.

It took me aback. I’d been reading her blog for awhile, and she was a very pro-natural/homebirthing/woman-centered birth kind of person–or seemed to be. None of which explained why she would let her client who had specifically hired her as a doula, risk birthing with an OB who might lie to or coerce her into interventions she didn’t want.

Especially as she went on to say:

I fear for my hospital birth clients more often than not. I have been sifting through why that is, why I just can’t relax. I am aware that part of my anxiety springs from my own experiences birthing within the American medical model and also the births which I have attended as a Doula. I’m thrilled that my clients love their primary OB. I worry myself sick that her doctor won’t be on call when she presents at the hospital and that the nasty one will. It’s a sick, twisted lottery which defies acceptable explanation. But it’s how things are done here. I can’t share this with my clients and it leaves my heart heavy and my stomach sour. I hate that so frequently my role, intended to be that of dedicated support and love for the laboring women, so often requires me to stand witness to some awful, awful abuses of women and their babies.

So..she sees a woman vulnerable to abuse walking into a possible bad situation. But yet she feels that she cannot say anything to warn her, or prepare her for it. I don’t understand this. If you saw a friend about to go out with a guy who had a bad reputation for slapping women around, wouldn’t you tell her? Shouldn’t you?

So in the comments I asked her. Was it a legal issue? Why couldn’t she tell her client? Was that ethical?

She responded:

…Why can’t I tell her? Because I have no right to, and it’s not part of my job description. I have no first hand evidence too substantiate my claims, just hearsay from doula friends and nurses who work with the doctor in question. Furthermore, I plan on one day working with women in this community as a midwife, so I walk a very fine line as a doula in hospital birthspace. Frankly, I represent all doulas and all midwives when I am in that space, when my clients invariably share that I am a student midwife. If I found myself in a situation where I was seeing something completely unacceptable happen and/or my client was being abused, I would absolutely speak up in her defence(and probably find myself in a whole lot of trouble)and devil take the consequences.

And I still don’t understand, really. I can see that she fears retaliation if she breaks the code, if she passes on a rumor…even if she tells the client it may just be a rumor. I get the feeling there are consequences for breaking the protective silence around patient abuse that nurses, midwives, and doulas witness, apparently. That’s the only sense I can make of her post. She has to choose whose side to be on, and being on the woman’s side is too risky. Even for a doula, who might be a midwife there someday.

And that is deeply, horribly wrong. Who will be on her client’s side, if not her doula? How are patients supposed to know about doctors with bad reputations if no one will speak out? It’s too late when you see the abuse already occurring–the unwanted exam, the pitocin turned up surreptitiously, the scapel poised to cut. It’s too late, because the woman’s will has most likely already been broken, she’s already been convinced she can’t do it, she needs those interventions, the baby will die or she will die, and it will be all her fault.

I am sympathetic to the blogger’s position, but I can’t say I agree with it. It is a very hard thing to risk your career before it even begins, and I won’t be arrogant enough to say I wouldn’t struggle with what to do either.

But.

If I were her client…I would feel utterly betrayed. I would feel there was no hope of fighting the system so long as those in the know refused to stand with me. What good do the doula’s tears do, if she won’t help in any meaningful way? Why have a doula or a midwife at all…what good is all this claptrap about natural, respectful birth if the fear of the hospitals and the doctors always keeps them silent when they should speak out, for God’s sake??

I’ll tell you how I feel–how I felt about my midwives, who let me walk into that meat grinder of a hospital without a word of warning. It’s a stab in the back. It’s worse than nothing, because if I had never trusted them in the first place, at least I would have known and accepted the abusiveness at the beginning. Being betrayed by someone you trust is much worse than simply being hurt by someone you already knew was hostile to you.

I hesitated to post this, because I want to understand. I want to be a midwife myself one day. I fear I’ll alienate a midwife blogger I respect.

But you know what? Fuck that. I don’t give a rat’s ass about some midwife’s career or fears of retaliation. Either be on the side of your clients or don’t, but don’t you dare let vulnerable trusting women walk into a war zone without so much as a scrap of knowledge to arm them against what’s coming. And then have the gall to feel sad when they get hurt! I mean, what the hell do we expect to happen here?

I don’t go around starting internet fights, and this isn’t really one. She’s certainly not the only midwife I’ve seen have these kinds of fears dictate how she acts. And it is a system that punishes those who speak out–that’s part of the reason it’s gotten so bad.

But speaking out, being an ally of the women giving birth, is the only–the only–way to make it better. One thing that feminism has taught me is that you can keep asking nicely till the sun burns out, and you’ll be ignored. It’s not till you start making trouble that things begin to happen.

Being a natural birth advocate of any kind, in our current system, is a political act. It is an act of defiance. And there’s no use doing it half-assed–in fact, if you do, it gives cover to the bad guys. We will not change this system with gentle throat clearing and heartfelt pleas. We will change it when we stand up, call people on their bullshit, and starting making a stink too big to ignore.

Short introductory sentence.

Paragraph of explanation. Long involved story that is actually kind of boring, referencing some domestic misunderstanding, job dissatisfaction, or cute thing my kid did.

Ironic acknowledgement of boringness designed to keep you reading.

Posting of cute picture of my kid with semi amusing (to me) caption that no one really gets.

Semi heartfelt paragraph about how things felt bad, but now they’re getting better, thanks to Jesus/drugs/family/nature-based epiphany of some kind.

Concluding sentence that tries, but usually fails, to wrap all this up in one pithy line.