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…remember that part of your medical training about “do no harm”? Might be time to take a refresher course, okay?

The maternal mortality rate in the U.S. is the highest it has been in decades, according to statistics released this week by CDC’s National Center for Health Statistics.

According to the figures, the U.S. maternal mortality rate was 13 deaths per 100,000 live births in 2004. The rate was 12 deaths per 100,000 live births in 2003 — the first year the maternal death rate was more than 10 since 1977 (Stobbe, AP/Washington Post, 8/24). A total of 540 women were reported to have died of maternal causes in 2004, 45 more than were reported in 2003, according to the report (NCHS report, 8/21).

A rise in the number of caesarean sections — which now account for 29% of all births — could be a factor in the increased maternal mortality rate, some experts said. According to a review of maternal deaths in New York, excessive bleeding is one of the primary causes of pregnancy-related death, and women who have undergone several previous c-sections are at particularly high risk of death.

Now while the rising c/section rate and the risks it brings are one of my favorite rants, the other factors mentioned in the article are appalling. African American women are THREE TIMES as likely to die from childbirth as white women. That’s an astonishing statistic. And a sad one. Lack of care pre-and -post partum can be deadly.

Obesity (possibly) and improved reporting may also have increased the stats, which lets OBs off the hook a little bit, but our pitiful health care system not at all.

Universal care cannot possibly come too soon. It won’t take the morbidity rate down to zero, but it will allow us to keep women of childbearing age in a system of care, so that lack of access to care during pregnancy will not be a contributing factor. If how deaths related to pregnancy are reported vary so much now that it’s affecting our stats, then our stats still aren’t good; we need a national system to truly determine the effectiveness of care and the pinpoint the problems. How many of those women who died had no care at all until they showed up in labor, maybe with undiagnosed complications that could have been treated? How many were malnourished (which you can be while being obese), had low-grade infections (even an infected gum can cause premature births), had any number of problems that may not have been fatal if caught early?

Of course, I could say the same about all health issues, which is why I’m a universal care proponent. Preventative care is critical to everyone, but under our current system, will always be sacrificed by people without a lot of ready cash. People die from lack of preventative care every day; I’d be willing to bet a great many of the mothers in this study fall into this category.

So maybe it’s not the OBs I should be hollering at, per se, but a government run by people with lots of money who will always have access to care, but who take every chance they get to deny that access to their fellow citizens. Fellow citizens who work just as hard, who pay their taxes, but who are allowed to die for the sin of being too poor to buy their healthcare.

….or, how my last few days at Crazy Inc. have been a festival of screw ups on my part. I know, objectively, they are not all my fault; I’ve been handed the job equivalent of being dropped in a foreign country with the wrong guidebook, no money, and no language skills. No wonder I’m lost and confused.

But tomorrow’s the last day, so it’s moot. They were unsurprised at my exit, maybe because they’ve gone through several other people before me. I pity the poor schmuck they hire next.

It’s probably sounding egomaniacal for me to say “Oh no, I couldn’t possibly be truly incompetent at this” but you know, it’s not. I’ve been working long enough to know what’s actually beyond me and what is just something I haven’t been taught to do. No amount of training would make me a good nuclear physicist, though I might learn enough to run the microscopes. And I’m ok with that. Even a few days of training would have made me better at this job, though.

At any rate, Tuesday I start a real job, with an actual orientation, benefits, yadda yadda hey. I get a few days off, and while we remain butt-draggingly poor, we’ve already paid for Nathan’s school for the week, so they’re REAL days off, which, woot! Is cool. Days off which don’t require me to be Nathan’s monkey are still so new that I feel a smidge guilty for taking them. Not enough to pull him out of school though.

Oh, I forgot one sad/funny thing about giving notice today. Sane Copyeditor, who shares an office with me and Insane Copyeditor*, looked sad, and then whispered “If they have any openings…CALL ME.”

*Insane Copyeditor looks, oddly, a loy like Teri Hatcher, except only if she’d had a stroke. One side of her face doesn’t quite match the other, and while that wouldn’t bug me much, it seems somehow related to her being a bit cuckoo-bananas. She spends much of her time yelling at Sane Copyeditor for daring to offer to do some work if she’s overloaded, which she always is. “WHY DO YOU KEEP TAKING MY JOBS???” she roared, apropos of nothing, yesterday. And then proceeded to work for 14 hours instead.

Gina Kolata is a science writer for the New York Times. I picked up her new book Rethinking Thin at random, while I was browsing at the library new-books shelf. And now I’m all fired up.

Without giving away too many spoilers, I’ll just mention some of the things she discusses that were surprising:

1. Almost all diets out there today–including lo-carb diets, low-fat diets, eat-slowly diets, etc. etc.–have been around since the 19th century. In fact, many people have been struggling with their obesity (people like President Hoover, the writer Henry James, and others) and with discrimination against the obese, for at least that long. In fact, there are weight-loss regimens that date back to ancient Greece (in that case, for athletes). I don’t know about you, but I’ve assumed, and been told in many articles and books, that obesity is a new thing. That it’s an epidemic. That it stems from having so much food around, which didn’t use to be the case for your average person. That before, say, the early 20th century, it was pretty much confined to very wealthy people who didn’t have to walk everywhere. That Americans are a lot more sedentary than we used to be. According to Kolata, none of that is true. Intriguing.

2. That the goalposts for who is and isn’t obese or overweight have, over the last few decades, been moved further back. You can now be considered overweight at a weight that would have been healthy 10 years ago.

3. How a highly controversial but scientifically sound study (PDF format) which was published in the Journal of American Medicine in 2005 showed that overweight, except at the extreme end of obesity, does not increase mortality. In fact, overweight may even be better for you than underweight, in terms of how long you live. The study has been attacked by many researchers–almost all of them receiving some funding from the weight-loss/diet/pharmaceutical industry organizations. Even the Wikipedia mention of this study under “Overweight” appears highly critical, although, according to Kolbata, no one has actually debunked the findings.

“Fat Will Kill You!” has been the mantra for so long for most of us that all of this is pretty startling. Those who are supposed to do research on health and nutrition have also grown up in this environment, which makes it unsurprising to me that so many of them freak out at any statistics that might show an opposite result.

But science is supposed to be about facts, not presuppositions. And when there’s so much money involved in keeping people dieting, buying pills, buying workout equipment, and buying diet books, well…you have to wonder if, just maybe, the Fat Will Kill You crowd isn’t just the tiniest bit compromised. If there isn’t more to the story.

It isn’t just a fat-acceptance thing, though, for me. I mean, I am a fan of Big Fat Blog and extremely tired of fat people being the only people it’s acceptable to hate in our society. I’m not even that big by non-Hollywood standards, so I escape a lot of overt commentary, but I hate that it’s out there. It’s not right. And I’d think that even if being fat were really just a matter of will power.

What Kolbata’s book says is that the research implies that it’s not. That powerful hormones and neural pathways have far more to do with how often and how much we eat than our psychological issues or our parents telling us to clean our plates as children.

And so if heaviness doesn’t kill us faster, and we can’t change our weight outside of a certain range…what does that mean for what we think is an “ideal” body we “should” all have? For beauty standards in general?

A good read.

Listen to an NPR interview with Kolbata here.

I have been hired 3 times this week. I still have two of those jobs!

Let me explain. No…let me sum up.

Job 1: temp job, worked one day, got a call to Job 2 (better temp job), quit. Felt guilty, got over it.

Job 2: better temp job, cool office, cool people, INSANE work hours. But it doesn’t matter because on the first day, got a call for Job 3 (insurance job). They upped my offer 6k! I agonize briefly because Job 2 is so cool, but also, so INSANE. I accept Job 3. I have not yet told Job 2 about Job 3, because Job 3 doesn’t need me until my background check/drug test results come back. And I want to make as much money as possible in the meantime. So I might as well work Job 2 for next week.

Job 3: is having snippets of my hair processed for opiates, and possibly tut-tutting over my less-than-stellar credit history, but my lack of criminal convictions (for now!) will probably mean everything’s fine.

So on Monday I’ll let Job 2 know I’m just a temp, not a temp-to-perm like they wanted. But honestly…they should have just made me an offer if they wanted me to stay. Though I’m glad they didn’t. I might have said yes, and by now I would be having buyer’s remorse.

The first day there, I was a little giddy. It’s very seductive, the all-IKEA, Mac-only, hip-and-stylish office in a hip part of downtown vibe. I loved my desk, it had an awesome view, and liked being around “the creatives” as they’re called, working on big-name clients, enjoying the catered lunch.

But (and I assume many ad agencies have this problem) you are expected to give up the rest of your life to do this job. People are working 8am-11pm some days, weekends, etc. and I would have to do the same, at least some of the time. I would never see Nathan. I like my desk and my view, but I don’t want to have to put a pallet bed and a change of clothes in there and make it my new home. I love creative people, but nobody there has the time to tell me about their fascinating weekend projects or the indie movies they saw, because they’re sweating their 8 deadlines a day.

I have a serious beef with this way of working; it’s wasteful, and it’s disrespectful. Many companies that do this are the kind that use “creatives,” despite the fact that creatives need rest and downtime to remain creative. And the rest of us need it to remain balanced, sane and healthy. And while “the client” always gets blamed, it’s really just greed and/or stinginess on management’s part. If you have too much work for your people to handle in a 40 hour week, you need more people. Period.

This place, in particular, has a lot of Pacific coast clients, which means to me that those who handle those clients should come in at 10 and work till 7. And in general, that they need staggered shifts for all their teams, as a way of rotating out the exhausted ones. But that’s not been done, or anything else to alleviate the strain. After two days, I can see that everyone in there is on the edge of burnout, and like I said, that’s wasteful. Why bother hiring and training someone when you’re going to drive them off and have to start over? If you treat them decently, they’ll stay a long time. Even a temp like me would be more use to them if they actually managed the chaos instead of leaning on their staff until they break. As it is, I have to scramble up the learning curve and then take off because they’re not willing to invest in my position.

This place really made me homesick for my NY job, actually. It too had a lot of creatives, and plenty of crises, but they made us go home and discouraged working on weekends, and generally, treated us well. And people stayed there for years. I would have too, if I could have. It means something to have work you like to do with people who are like you, in a place where you are allowed to have a life and value.

That kind of respect means a lot more than money, in the long run, to most people. It gives you room to have a life rather than just an existence.

And that’s why I’m going with the more-boring insurance job, without a cool desk or a window view or lots of interesting people around. I won’t get the coolness points, but I will get to see my kid every day, and leave my job at the door when I go home. Maybe parenting has mellowed me, or maybe I’m just tired of killing myself for a pat on the head followed by a new batch of impossible deadlines.

I am so much a newbie and a bit-player in the whole birth-rights movement, but I still get so angry and riled up when I read stories like this one (warning; original link has some birth pictures, not gory, but nekkid).

The forces arrayed against women who want to have control of their own births seem so large and powerful. We trust doctors to tell us what to do, how to take care of ourselves and our children, how to be healthy and stay safe. We lionize them in shows like House , ER, St. Elsewhere, even MASH . Saintly, all-knowing doctors abound in our imagination. They may have messy personal lives, but you hardly ever see actual practices being confronted; just the occasional Bad Doctor, or lazy doctor, or drug-addicted doctor, whatever. Probably because the shows’ writers know how to write good soap opera, but only know what their consultants tell them about hospital practice.

Anyway, Sagefemme’s post echoes the frustration of people like myself and midwives in particular, who remain powerless to stop their clients from being abused and hurt by aggressive, hostile, and ultimately harmful practices.

I’m not talking natural vs medicated. I’m talking unhindered vs interfered-with birth. I’m talking about barely making it out without being cut one way or another. About your baby being handled roughly. About silence and intimacy not being a piece of your baby’s birth. There are even some homebirth midwives that don’t get the idea of unhindered birth. Really, it’s my new platform. It’s the reason why I’m so angry. We can’t keep bringing the hospital into the home! We have to do this radically different - ways that honor a woman’s physiological process of birth. We have to step back and ask if we’re doing things to really help a mamababy or are we just doing things to cover our ass in case we’re looked at by someone? Is this evidence-based or are we doing it because it’s what our peers believe is necessary?

There’s this mis-perception that the safest birth is the one with the most instruments, procedures, people, and processes involved. But every bit of interference in natural birth–from restricting the mother’s movements and ability to get protein and hydrate herself to dictating her positions to push and whether she has to use drugs–comes with its own risk.

Let’s take another natural process–say, eating. Now eating does have risks; we’ve all nearly choked to death on something, or eaten something that made us sick, or gave us an allergic reaction. At least some of those risks could be mitigated if we received all our nutrition via IV and feeding tubes, the way comatose people are fed. But of course, this would restrict our movements, introduce risks of infection and malnourishment, and be painful and psychologically damaging. It would rob us of our freedom in the name of protecting us from bodily mishaps.

Now let’s assume that for the convenience of the doctors observing them, those who wished to eat were required to lie on a table with their feet tilted higher than their head, being questioned and monitored constantly by anxious medical personnel, while trying to eat a ham sandwich, potato chips, and a coke. What are the chances, now, that the patient will have trouble swallowing, and may even start to choke? And what if every time this happened, the surgeons rushed into to install a “safer” feeding tube “saving” the patient’s life?

Birth is no different. The muscles in a woman’s uterus that handle birth are just as capable as the muscles in her throat and gut that digest her food. But being pressured “for her own good” by people she trusts in white coats, to lie down and push on her back, to be prevented from moving because she’s attached to cables and monitors, to have strangers hovering over her frowning as they check her machine readouts and dilation, has a physiological and psychological effect. She doubts herself, she feels afraid and threatened, and her body reacts by tensing and slowing down.

In rushes the surgeon with the scalpel, ready to save her from the emergency that might not have existed if she’d just been left the hell alone.

This model has got to go. It’s harmful, it’s degrading, it’s disrespectful, and it’s bad practice. It’s sexist, because it assumes women’s bodies are inherently broken and incapable, and they need someone to save them from their inability to birth. Practices that separate and interrupt mother and baby bonding postpartum disrupt a key psychological event in the relationship of a mother and child, and their loved ones, in the name of control and hospital convenience. There are no good medical reasons to drag a normal health baby off to a nursery for observation. Leave him in his mother’s arms and observe him there, where he’s safest and she’s most at peace.

Women are people, not pieces of meat, and they deserve that personhood at all times, especially as they do the hard work of bringing new life into the world. They are not born broken, but they are being broken by a system that doesn’t care about them or their babies. And more of them are realizing it all the time.

Alas. We did not go the festival in Big Spring. This was partly due to it being 800 degrees everywhere but inside our hotel, and also to Big Spring being a desolate wasteland that you don’t want to spend a lot of time in.

Apologies to any Big Spring-ers. But while there are some potentially scenic ridges around town, graced with wind turbines, right outside of town is an oil refinery, and the air has a permanent sulfury-sweet smell that made you calculate how long until your lungs started sprouting cancer cells. (Hopefully, it’s more than 48 hours). Empty storefronts and houses line the main street, and the whole thing looks set to blow away as soon as the oil runs out. Or maybe sooner.

The wedding itself was gorgeous and sweet. Beforehand, my genius toddler decides that a candle flame is something he should try to put his hand into. He has no experience with fire, since we’ve held off on giving him a flamethrower until kindergarten, so there was some screaming. But not any blistering, thank goodness. Poor thing. Since it was my nephew’s wedding, Matt was appointed to wrestle and wrangle Nathan; we decided early on that they would stay in the vestibule or elsewhere in the church during the ceremony, because we love our son, but he is not ceremony-ready. I got to sit in the third row and watch my brother get all choked up while he married off his youngest son, and Matt and Nathan got to sneak into the church’s Sunday school rooms and play with all the toys.

All that would have been fine, except that I managed to trip, fall, and twist my ankle coming down some stairs after the ceremony. Most everyone had already left, but my brother came running to take care of me, and I think I managed to keep my cursing to “crap!” only, though my ankle did indeed hurt like a mofo. My pride hurt even more. I’m just never going to get used to skirts and heels.

So the reception was lovely, I reveled in my new nickname of Gimpy, and our little trio survived two nights in a strange place with a toddler who usually refuses to sleep anywhere but his crib. I start my new job tomorrow, and Nathan starts his new daycare. My nephew is married, and life moves on whether I want it to or not.

So I got a job today. I know! Crazy. It’s just a temp, but it could last 3 or more months. The manager was concerned a little to hear I was looking for permanent work. “So you could find your perfect job next week?” “Well,” I said, “judging by how it’s going, that’s probably not going to happen.”

And then she calls today to give me the job. Decent pay, not very hard, might even be interesting.

So I’m all excited, call Matt, set up Nathan’s daycare for Monday, yadda. I take Nathan to Half Price Books to run around with all the other little hellions in the children’s section. Then I check my phone for the time, and see I’ve got a message.

“Hello, emjaybee. This is Bob, from Famous Insurance Company You’ve Heard Of. We’d like you to come back in for a writing test!”

Now I had written off Bob and FICYHO already, as it had been over a month with no response from them after my first interview. I had moved on, dealt with the situation. And now…he was reeling me back in!

And because I’m a Nice Person the first thing I thought was “The manager at the temp job is going to think I’m such an asshole.” When, you know, it’s temping. You’re not supposed to feel guilt. But I’d all but promised her no one else wanted me! And they didn’t. Not till I was almost off the market.

So tomorrow I go in for the writing test. How long will it take to get a response? My guess is, they’ll wait until I’ve been at Temp Job long enough to have been fully trained, and then make me an offer and ask me to start the next day. So that I’ll truly be the asshole. Happy to be fully employed, but still the asshole.

On Friday, our family trio will take its first road trip together, to the magnificent mecca of Big Spring, Texas. My nephew, who only yesterday was a solemn child in short pants and glasses too big for his baby face, is getting married. Married young, but that doesn’t make me feel any less old.

Her family is from the Big Spring greater metropolitan area, so to speak, and so get to have the wedding on their home turf. It will be a Baptist affair (the nephew’s daddy/my brother is a preacher, nephew himself aspires to Christian motivational speaking), so no booze. If they’re hard-core, no dancing either. I have never been entirely sure if the Baptist dancing ban extends to Chicken Dances or the Bunny Hop, so I guess we’ll get to find that out.

Well and good. But we get into town Friday night, and the wedding doesn’t happen until Saturday evening. In the meantime, what to do in Big Spring?

Well, the World Hang Gliding Championships are what to do, apparently. But watching hang-gliding isn’t something that really gets me going. So..what else?

Aha! The Big Spring Flight Festival!

Aww, who cares about a bunch of airplane-related festivities? Who cares about something that advertises:

Enjoy a variety of vendors ranging from food and games to information and crafts. View Classic Cars, Motorcycles and Model Airplanes. Hangar 25 will be silling changes for a grill [I think this translates: selling chances for a grill. But I’m not sure.] Get a Certificate to Adopt a Prarie Dog.

Oh no, my friend: the BSFF is so, so much more. Behold this breathtaking itinerary:

9:00 a.m. - Big Spring’s Got Talent Preliminaries

10:30 Dog and Master Look Alike Contest

12:00 noon Big Spring’s Got Talent Finals

1:00 p.m. Peanut Spitting Contest

2:00 p.m. Bug Race

3:00 p.m. Horseshoes

4:00 p.m. Big Spring Ugliest Dog Contest

5:00 p.m. Pepper Eating Contest

6:00 p.m. Winning Announcment of the New Hangar 25 Flag Design.

Bug races? Ugliest dog contest? Peanut-spitting contest? Never saw that in New York, I tell you what. Or, um, anywhere.

Now Matt has the advantage of being less-citified than myself, and so has his own angle on things. He maintains that most bug races use “some kind of beetle.” Also, while not a fool enough to enter the Pepper-Eating contest, he might think about the Peanut-Spitting contest.

Guess our Saturday’s all sewn up. If he really enters, I promise you all: PICTURES.

That sums up the summer so far. I got laid off about a month ago, and this is the longest I’ve been unemployed since…um, high school, I think. Matt’s working and it keeps the wolf at bay, mostly, but we keep it cheap around here when we can.

I’m interviewing, even getting the occasional second interview, but summer seems to have slowed everything down. People go on vacation, they move slower, proposals take longer to get approved, and so I stay unemployed a little longer. Also, I’m pickier about some things; I negotiate more than I used to, I have different requirements of a place that I work, and I’m not a 20-something eager young thing anymore. I don’t want to be on my feet all day, get screamed at constantly, or deal overly-much with bosses who expect me to be their mother. I already have a child.

I do as much as I can on the job front, then I try, very hard, not to freak out about it. I enjoy Nathan, reminding myself he will never be this age again, soon he will lose his sweet baby language and pretty baby skin and happy squealing. He’ll replace all that with good stuff, too, but I should pay attention, right now, while I can. Although I won’t be sad when diapers go away.

I finished another book for my ex-New York job, and I think it went pretty well, considering that I knew zero about the subject when I started. And Matt and I had an e-book we published picked up by a bigger e-book concern, so we’ll see if there’s any extra income as a result. Every dollar helps.

I am at a truce with my house, which sometimes seems like Enemy Number One to me, with the bugs, and the unusable back yard, and the stupid landlord, and the hateful bathroom, terrifying garage. OK, maybe not much of a truce. But I have learned to ignore the things I hate as much as possible, and enjoy the good things (lots of light, wooden floors, lots of big shade trees that keep our a/c bills low). It’s not really the house’s fault that it was abused and neglected by former (and current) owners. And it’s not my fault that I don’t have the money to fix it, or a landlord with a conscience. It’s still better than our old apartment, next to the freeway and right under the airport traffic, with no room for our stuff and our busy toddler.

Today, we went out in the front yard and I sat in a chair and cooled my feet while he splashed in his kiddie pool. Our front yard is fairly nice. Most of our neighbors don’t really seem to use theirs…I suppose their back yards aren’t poison ivy infested swamps. Or maybe they don’t care. But our front yard has thick grass, a water hose, and a big shade tree, and it works for Nathan and me. We’re getting by, in every sense of the word.