Birth: the final frontier

There’s a very good reason why decisions about birth provoke strong reactions. They concern the youngest, most defenceless members of society. Babies have no say in anything that happens to them. They depend on us as their caregivers to make the right choices for their safety and future health.

Birth of Muhammad Ali ;)I may not believe in the inviolable superiority of natural birth, but I certainly empathize with the sentiment. The major obstacle faced by proponents of natural birthing is practically the same as the one faced by proponents of breastfeeding (myself included). I may want to empower women to have confidence in their ability to breastfeed. But what about the woman who tells me she’s perfectly happy not breastfeeding, thank you - and I can stuff my empowerment?

The attitude of the mother herself is what I consider the “final frontier” in the struggle for higher rates of natural birth, and breastfeeding. The importance of tackling it is in inverse proportion to the degree to which it can be tackled. For no matter how passionately you feel about babies’ rights, you can’t commandeer another person’s body - whether it’s to get her to give birth naturally, breastfeed, or refuse an abortion.

The question is: is it ethically neutral for women to choose non-medically indicated cesareans?

The stated ethics of the natural birthers have to do with ensuring the baby’s (and to a lesser extent, the mother’s) safety and future health. But I would argue that the ethics that really drive them are more of the philosophical, ideological variety.

I should know: I feel the same way about breastfeeding. (I don’t doubt that “breast is best.” But where do figures like the breastfed baby’s additional “8 IQ points” come from? How many “facts” like this do I take at face value simply because they help confirm my beliefs about the superiority of breastfeeding?)

One “fact” that put me off choosing a cesarean for Naimah’s birth was the one about surgical births being associated with higher rates of childhood asthma (incidentally, so is a lack of breastfeeding).

I well remember my younger brother suffering with asthma throughout his early childhood. As it happens, he was born by cesarean. As it also happens, I wasn’t, and have never suffered from asthma.

Forming conclusions based on a sample size of two is never recommended. At the same time, it’s understandable for family memories, which involve the emotions, to play a significant role in the decisions we make.

So, what is the evidence for cesareans “causing asthma”? Sarena mentioned a “50 percent additional risk” - a figure I found referenced in the following study: http://cme.medscape.com/viewarticle/576897 (to access the article, Google the link). A 50 percent increase sounds bad. But what does this translate to in real terms?

The prevalence of asthma was 2.3% in women who delivered by cesarean delivery, 1.9% in those with instrumental vaginal delivery, and 1.4% in those with spontaneous vaginal delivery.

Rounding up and down, what this means is that for every 100 children born vaginally without instruments, you would expect 1 to get childhood asthma. For every 100 born by cesarean, you would expect 2 to get asthma. And for every 100 born by instrumental vaginal delivery, you would expect… well… about 2.

Wait a minute… I was born by instrumental vaginal delivery! That made my chance of developing childhood asthma almost exactly the same as my brother’s!

To be precise, the difference between my and my brother’s risk of developing childhood asthma, according to the study, was 0.4 percent. That equates to less than half an extra child out of every 100.

Of course, if you ignore the part about instrumental delivery (as the media did), it’s 0.9 percent, which you round up to 1 percent - which makes a 50 percent rise. Scary!

The natural birthers will also have us believe that mothers are themselves more likely to die if they choose a cesarean. Is this well founded?

Sarena linked us to an interesting article in the Telegraph, supporting her belief that cesareans are too dangerous to represent an ethical choice.

I don’t know whether Rebecca Smith, the newspaper’s medical editor, has any qualms about the U-turn her articles on birth have taken. But personally, I’d feel a little sheepish to be publishing Women choosing cesarean have low death rate less than 6 months after Death risk higher for women “too posh to push.”

Meanwhile, for the countless women calmly electing surgical birth every day, the fact remains that when a qualified obstetrician acquiesces readily to a cesarean, it is reasonable to assume that it is because it does not carry a significantly greater degree of “death risk” than the alternative.

According to Professor Philip Steer, British Journal of Obstetrics and Gynecology editor-in-chief, in his viewpoint C-sections “a rational choice”

Delivery by Cesarean section… is remarkably safe - certainly as safe as many of the cosmetic operations that do not excite similar criticism.

He also writes…

You would think that [the] technological advances [affording safe surgical birth] would be greeted with universal acclaim, but many women see childbirth as an essential “rite of passage” and exhort others of their gender to eschew technological assistance (is this “the female macho”?).

While I agree with Professor Steer’s article as a whole, I feel it’s too easy for a man to dismiss the idea of natural birth as a rite of passage. It’s a bit like someone who can’t get into university dismissing the aspirations of undergraduates looking forward to receiving their diploma. For, the fact of the matter is…

If giving birth naturally matters to you (= is a rite of passage, a spiritual womanly act), then it matters.

If it does not matter to you, then it does not.

I can’t make a woman want to breastfeed, and Sarena can’t make a woman want to give birth naturally. But let’s remember to be critical of the “facts” about birth safety presented to us in the media - particularly when they contain riveting or catchy phrases such as “death risk” and “too posh to push.”

As the contradictory Telegraph articles, and the medical community’s support for both vaginal and surgical birth would suggest, neither vaginal nor cesarean birth is significantly more dangerous than the other. Both can be highly dangerous without the proper support. Both have become remarkably safe - in developed countries at least - thanks to skilled midwives and doctors attending births.

Something worth mentioning…

I don’t normally write this kind of stuff on my blog - but I know how much every parent wants to save money (especially nowadays).

So I thought some of you might like to know that for the next few days, there’s an amazing deal on Little Reader and Little Math. It’s something our existing users know about, but not something we’re publicizing.

Basically, both LR and LM have gone through a massive transformation. They’re going to come with a curriculum from now on - so you just press play for your lessons; you don’t have to decide which words/equations to teach.

Click to read more…

Bookstuff!

Naimah’s Daddy bought her the Dr Seuss book One Fish Two Fish Red Fish Blue Fish yesterday. It was my first time reading it.

In case you think it’s all about fish, they only appear on the first few pages. No, the book’s actually wa-ay more surreal and tripped-out than that! :)

Liam had already introduced me to the genius of I Wish That I Had Duck Feet, and I thought nothing could top that one.

It still can’t. But One Fish Two Fish equals its brilliance!

A couple of times while reading on the ferry home, I laughed out loud…

Mouse over the images to read the text.

Who am I? My name is Ned. I do not like my little bed. This is no good. This is not right. My feet stick out of bed all night.

And when I pull them in, Oh, dear! My head sticks out of bed up here!

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The birthing conundrum

One of my not-too-recent posts has had a lot of comments recently. Birth preferences - particularly the less admirable-seeming one of wanting a cesarean - tend to stir up controversy.

In particular, I’ve had five - no, six - comments from Sarena (who I actually went to elementary school with - hello, alumna!). It’s nice to see such impassioned comments on my blog - especially from someone using their real name.

I’ve done plenty of thinking about this, since I actually share many of Sarena’s views - and shared even more of them before I gave birth. Not all of them, mind - since as I said, I was on the fence when it came to deciding how to give birth. I really wanted to be like Sarena and all the card-carrying Wild Women, but deep down I knew I could never completely relinquish caring how my body would fare (peeing when you sneeze, Sarena? Don’t pretend you didn’t see the phrase “fecal incontinence”).

Birth Day of the NimI mean, no one can ever guarantee that your vaginal birth will go as planned. And I stand by what I said before: It’s like rolling the dice and risking two 1’s as much as two 6’s. And in some ways, the near certainty (of course, a cesarean can always go horribly wrong) of two 4’s can be a wonderfully reassuring thing when you’re talking about your one and only body. Either way, you will have your lovely baby!

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Through the eyes of a child (II)

If you saw Part I, you’ll know the drill. I’m going to show you some photos of everyday (and in this case, not so everyday) objects; and you have to guess what they are. Then, I’ll tell you the “right” answers - Naimah’s answers!

This time though, things are a little more surreal than the last. So just in case you don’t know what any of them “really” are, I’m giving you each one’s dictionary definition as well. To read that, mouse over the image.

So, here goes… It might help to get into a trance-like state and squint your eyes a little (*You are 19 months old… 19 months old… What do you see?*)…

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First week of Little Math

This evening something amazing happened - right before I was about to post. Naimah came running into the study to see me, a huge grin on her face. “Ego!” (”Eagle!”), she said - which wasn’t too much of a surprise. She’s been obsessed with this song and video for weeks. (Play it to your baby or toddler - they’ll almost certainly love it!)

(While we watch this, Nim will normally point at the screen and tell me, over and over, “Ego… Ego.”)

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Why teach your baby math?

Naimah just had her first day of Little Math lessons. She is 19 months old today (wow!).

I’m going to describe the lesson experience in my next post, because I realize some of you may not be familiar with the whole teaching-your-baby-math thing. So here’s the skinny on why you would teach your baby math…

There’s this thing called subitizing and babies do it way better than adults. You or I can subitize - instantly see how many items are in a set (without guessing or counting) - up to probably a handful of items. Babies can subitize many dozen - right up to 100 (I’m not sure what the limit is - I’m trying to find that out actually).

The reason is that the right hemisphere of the brain is dominant in very young children. Same as it is in some autistic savants, who can also instantly perceive an “impossibly” large number without counting or guessing. Does that sound like Rain Man? Well, it is - babies are seeing like Rain Man.

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Through the eyes of a child…

Now, I want you to tell me what you see in the following pictures. Just the first thing that leaps to mind. Then, I will tell you the answers (according to Naimah).

Here come the pictures…

EyesSpoonTeeth

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It’s a big house, after all

Yesterday we took Naimah on her first trip to Hong Kong Disneyland. The park’s been open nearly four years, but it was my first visit too. I’d been to Disneys before (Anaheim and Euro), and wasn’t in any hurry to visit the smallest Disney park in the world (indeed, the Hong Kong park’s gone in for plenty of criticism for being “too small,” with “not enough attractions”).

I have no idea what I would have thought, had I visited in my previous incarnation - as a jaded, hard-to-please non-parent. All I can tell you is that as the mother of an 18-month-old, I have never visited anywhere more magical, wondrous or delightful! (We even bought annual passes for all the family!!)

It's a big, big house...I’d been to It’s a Small World before - I’d remembered it was pretty alright. Nothing could prepare me for the teary-eyed experience of going with Nim. Outside, the giant clock face (an actual face!) with its surreally lagging tick-tock (”Tuh! Tuh!” said Nim). Inside, pretty little lights dotting silhouettes of the house we’d just entered (visible, top left of the picture). Had it always been this romantic??

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Baby scientist

Child educator Glenn Doman says that young children are little scientists. When presented with an unknown object, they will perform a series of sensory experiments - looking, touching, tasting, and finally, trying to see how it’s made (i.e. breaking). ;)

Cognitive scientist Dr Alison Gopnik says, “It’s like children and babies are the R&D division of the human species.”

Yesterday evening I watched my baby R&D operative get to work on a wash bag of unused products. “Aben! Aben!” (”Open!”) she commanded, and I obeyed. Inside was a bottle of nail polish, a packet of tissues, and two unopened makeup compacts.

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