No, I am not “willing to reconsider” intuitive eating and Health At Every Size. And by your asking me that, I’m going to guess you don’t have much idea of what they are, so let’s start with a review.

Health At Every Size says that there is so much we can do to [...]]]> Dear Health Care Provider,

No, I am not “willing to reconsider” intuitive eating and Health At Every Size. And by your asking me that, I’m going to guess you don’t have much idea of what they are, so let’s start with a review.

Health At Every Size says that there is so much we can do to maximize health, and none of these have to do with a number on a scale. There’s no evidence that the majority of fat people can permanently become not-fat people, and lots of evidence that say that trying to make them be so is bad for their health. (I don’t care if you’re one of the 5% who could and did lose significant weight and keep it off for more than five years; I am one of the 95%, and I’m perfectly happy to be so, thanks.) So let’s work on the parts of health we can affect; let’s move with joy, and nourish with love, and address things like blood pressure and blood sugars and respiration as needed, rather than letting weight — so poorly correlated with health — dictate everything.

Intuitive eating, a related idea, says that when we listen to our bodies, they’re actually quite good at guiding our food choices. Intuitive eating helps us eat when we are hungry, and stop when we are full. It says to “Eat food. Stuff you like. As much as you want.” It acknowledges the first rule of nutrition (“Eat or die.”). It recognizes that there are more important things than optimal nutrition (no, really, there are), and tells us it’s ok to honor those as well.

These are not only healthy ways of thinking and living (so why would you want me to stop them?), I think they are the only ways for me to be healthy, body and soul, when it comes to food and weight. They are non-negotiable for me, and you need to accept that if we are to have a therapeutic relationship.

You say you might not be the provider for me if I’m not willing to let you do your job.

But here’s what you can do:

You can help my intuition be clearer. You can support my own trust in my body and its signals. You can ask about how well I feel I’ve been in tune with my intuition recently. You can query about whether I’ve had access to fresh, yummy foods recently, and you can offer assistance in increasing that access.

You can help me figure out whether there are any foods in particular that are adversely affecting my health; if there are, you can help me keep in touch with my intuition while replacing that food in my diet. You can help me see the abundance of what I am able to eat and enjoy and nourish myself with rather than feel deprived.

You can help me figure out ways to incorporate the movement I long for into my life. You can trust that I will do that as I am able. You can recognize that laziness is not what is keeping me away from the gym or the track — and you can ask about what is, if you are open to hearing the honest answers. You can offer to brainstorm solutions with me, or alternatives, or simply commiserate my factual, hopefully temporary, inability.

You can help monitor my vital stats: keep track of my blood pressure, and my heart rate, and my respiration, and all the gazillions of lab results you are sent when I visit the vampires. You can talk about what those say about my health, and offer suggestions to improve them, within the context of my life (see above).

You can make sure that there aren’t any obstacles in my way (other than, y’know, my life) to eating intuitively and living healthfully: you can optimize my thyroid replacement dose; you can help monitor my mood and stability; you can investigate other illnesses I might have; you can help me manage my anemia. You can help me get to a place where I have the energy and the body-trust to do my own work.

Saying that I will not “diet” and I will not seek to lose weight is not saying that I do not care about my health, and it is not saying I see you only as a med-dispensing unit. It is not saying anything except that I will not diet, and I will not seek to lose weight. You can still do so many things to earn your title as health care provider. The only thing you cannot do is harass me about my size.

I don’t see why my assertion of this boundary would possibly mean you cannot do your job — unless you see yourself exclusively as a diet pusher and weight loss promoter. No? We should be fine then.

Sincerely,

Arwyn

Welcome to the April Carnival of Natural Parenting: Parenting advice!

This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Hobo Mama and Code Name: Mama. This month we’re writing letters to ask our readers for help with a current parenting issue. Please read to the end to find a list [...]]]>

Welcome to the April Carnival of Natural Parenting: Parenting advice!

This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Hobo Mama and Code Name: Mama. This month we’re writing letters to ask our readers for help with a current parenting issue. Please read to the end to find a list of links to the other carnival participants.

***

Dear readers,

Perhaps you can help me. I don’t know the answers. I don’t know that there are any answers.

Let me tell you a story:

Three years ago, a child was born. His parents were so happy to see him, and from the very beginning they tried to honor his personhood and respect his wishes: they welcomed him into the world at home, in warm water, in a dim room; they warmed him against themselves; they brought him to bed with them, so he would never be alone; they helped him to eliminate his wastes away from his body when he indicated he needed it; they let him suckle sweet milk whenever he wanted. He was weighed in a sling, measured while lying in his mother’s arms, had his heel pricked while asleep in bliss at his mother’s breast. They left his perfect body whole, exactly as it was designed to be.

They fell in love with him, in an instant, in every instant they were with him, which was every instant from his birth. They were entranced with his perfection — smooshy nose (which straightened in a couple days) and bruised head and predilection for copious spit up and all. He was perfect. Simply, completely perfect.

Swimming in oxytocin, floating in joy, at one week out, they got a call.

Screening results positive: congenital hypothyroidism. Need a recheck. No, today. Now. What do you mean you don’t have a pediatrician picked out already?

Something… wrong? With their perfect child? Panic. Fear. Grief. They went through all this, and more.

Eventually, they realized it wasn’t the end of the world. Eventually, they realized their child was still perfect. Eventually, they got used to the new rhythm: pill crushed and delivered with breast milk every day, blood draws to test levels every month — then two months, then three months. The child grew up, and the pill part got even easier, with him asking for it and chewing it down plain every morning. Fears of his development being stunted proved false; confidence in the ok-ness of the diagnosis got easier. They clung to the hope — promised by everyone they talked to — that the blood draw ordeal would get easier too.

But it didn’t.

It got worse.

He learned to anticipate. He learned what it was “blood draw” meant, learned that it was the little room in which the trauma happened, learned it was when the people in the white lab coats called his name that it all started.

His parents learned hell. Learned that no amount of play-acting beforehand, no amount of promise of bribes afterward, no amount of distraction during would prevent his terror. They learned what it was like to hold a screaming, straining, snot-smeared child against their chest, legs locked around his to prevent him kicking the techs, while he pleads “Mama, dada, help me! Help me! Let me go, please! Please, help me!”

It had to be done — somehow, the blood had to be extracted, the tests done, the levels monitored, the meds adjusted. But what lessons were they teaching him, this child whose autonomy and bodily integrity they held sacred since before he was born? When the first step in raising a not-rapist is not violating his own body, when the first step in raising a sane person is not traumatizing his own psyche, how could they justify this traumatic violation? Repeatedly, regularly?

Of course, how could they not, either, when thyroid is vital for brain development? They could and did offer the child so many choices — when (a little), and in whose lap, and what color smiley face drawn on the bandage tape, and what toys to buy afterward, and where to go to lunch to celebrate surviving — but they could not, would not, offer the choice to not do it at all.

Here’s the question:

How does one do this? How do we get the necessary medical tests for our child without traumatizing him? How do we traumatize him and teach him to hold others’ bodily autonomy supreme? Endless suggestions for EMLA cream aside (and sending dismissals of his own right to autonomy directly to hell), how do we simultaneously respect his personhood and protect his health?

This isn’t a theoretical question. Third-person-distancing aside, this is a real dilemma, and we’ve six months at most before it comes around again. And it’s never going away, not for the rest of his life. He might outgrow the screaming, but he’ll never outgrow the testing.

Help us. Help him.

***

Visit Hobo Mama and Code Name: Mama to find out how you can participate in the next Carnival of Natural Parenting!

Please take time to read the submissions by the other carnival participants:

(This list will be updated by the end of the day April 13 with all the carnival links.)

• Replace hitting with…? — Acacia at Be Present Mama is at a loss on how to handle her three year old’s hitting.
• Two Questions — Alexandra at Breastfeeding Momma would like some ideas on how to strengthen her bond with her 8-month-old daughter; she’s also looking for input on an emotional topic: vaccines.
• Balancing Needs When Baby Trumps Mama — Alison at BluebirdMama wonders how her child’s need for noise and energy balances out against her need for quiet and space. (@childbearing )
• The McDilemma — Annie at PhD in Parenting is on the arches of a McDilemma. (@phdinparenting)
• Where is the mutually agreeable solution? When parenting calls for blood draws — Arwyn at Raising My Boychick has a child who needs regular blood tests that are torment for him. How does a parent honor a child when his health is on the line? (@RaisingBoychick)
• When To Wait To Nurse — Cave Mother wonders what age toddlers can be asked to wait to nurse.
• I don’t love you Mama! — CurlyMonkey wonders what to do with her daughter’s intense feelings. (@curlymonkey_)
• Help a Mama Out — Danielle at Born.in.Japan isn’t getting much sleep with her cosleeping, night nursing, cranky little guy and hopes you can help with some suggestions for shuteye. (@borninjp)
• Dear Abby: My daughter really misses her Daddy — Darcel at The Mahogany Way needs to know how to help her daddy’s girl get the connection with her father she needs — and not feel left out in the process. (@MahoganyWayMama)
• What’s Going on at School? — Deb at Science@home is in a quandary: how can she find out what really goes on at school without stepping on the teacher’s toes? (@ScienceMum)
• April Carnival of Natural Parenting: Parenting Advice — Dionna at Code Name: Mama wants to find volunteer work that includes her toddler. (@CodeNameMama)
• How do you deal? — Erin at Beatnik Momma does not want to engage in “mommy wars.” She’d like your input on how (and how much) to discuss her natural parenting choices with curious friends and family who parent differently. (@babybeatnik)
• Dear Abby — The Grumbles at Grumbles and Grunts gave her son a banana…and no solid food since. What’s the next step in baby-led weaning? (@thegrumbles)
• Excuse me, I have a poop question — Jessica at This is Worthwhile has a question for you about toddler tinkling. (@tisworthwhile)
• The Half Empty Nest Syndrome: What to do when Momma gets replaced by a cow? — Joni Rae at Kitchen Witch Momma is suffering from “half-empty nest syndrome”: what do you do when your babies start growing up? (@kitchenwitch)
• Peer Pressure — Kate at Momopoly worries what message her daughter’s new friend is sending — but how to break up such an infatuation? (@Momopoly)
• When I Fall Down — Katherine at Momioso.com needs your wisdom on how to be more gentle and at peace with herself. (@naturalparent)
• A question of sleep and sanity — KeepingMumSane needs your toddler cosleeping advice in order to, well, keep mum sane! (@keepingmumsane)

• April Carnival of Natural Parenting: Parenting advice — Lauren at Hobo Mama needs a chiropractor … or help getting her 36 lb toddler to walk up the stairs. (@Hobo_Mama)
• Driver’s Ed for Mommies — Maman A Droit is a self-confessed terrible driver and is scared to drive with her baby in the car.
• Solo Parenting — Mammapie at Downside Up and Outside In needs tips for being a single working mother while her partner’s away. (@mammapie)
• Itsy Bitsy Biter — Mamapoekie at Authentic Parenting needs your advice about her daughter, otherwise known as the pitbull.
• How Can I Avoid Beauty Obsession? — Melodie at Breastfeeding Moms Unite! is at a loss ever since her tomboys turned into wannabe princesses. (@bfmom)
• Seeking Stability in Chaos — Michelle at Seeking Mother is in a heart-wrenching position. She needs your input on how to make a toddler feel secure during a time of transition, the illness of a parent, and multiple (new) caregivers. (@Seekingmother)
• Mama, That’s Too, Too Boring! — Michelle at The Parent Vortex started out asking how to encourage her preschooler to get dressed — and four days later, she began to without prompting! (@TheParentVortex)
• Dear Lovey Hart, I am Desperate. — Mommy Soup from Cream of Mommy Soup has several questions for you, from how you play favorites when no one’s your favorite to how to tell off strangers curious about the ample size of your family. (@mommysoup)
• Diaper Duty Dilemma — Paige at Baby Dust Diaries has a simple request: talk to her about cloth! (@babydust)
• What Do You Need My Son — pchanner at A Mom’s Fresh Start wishes her calm four-month-old hadn’t turned into an inquisitive and dramatic six-month-old. How do you handle changes in baby’s personality? (@pchanner)
• Dear Natural Parenting Community — Sarah at OneStarryNight wants to know how to respond to criticism from family and friends over breastfeeding. (@starrymom)
• Natural Parenting Carnival — Help — Sarah at Consider Eden feels like either her to-do list or her parenting is suffering, because she can’t do both! (@considereden)
• To potty learn or not to potty learn — that is the question — Sheryl at Little Snowflakes wants to know whether it’s time to start potty training. (@sheryljesin)
• Seeking Patience — Starr at Earth Mama looks to the collective tribal wisdom of this community to learn how to teach patience to children.
• A Dirty Girl Comes Clean — Tashmica at Mother Flippin’ is struggling. How do parents deal with their inability to keep their children protected from danger? (@Mother_Flippin)
• Uli and the Pussy Cats — Thomasin at Propson Palingenesis has a toddler who likes to put kitties in headlocks and ride them like horsies. How best to separate the little beasties?
• Perceptions of Discipline — Zoey at Good Goog doesn’t use conventional discipline with her child — and doesn’t know how to respond around people who do. (@zoeyspeak)

And I think the slug just went into hibernation. (Do slugs hibernate? I bet I would know that, if my brain hadn’t been replaced by a maybe-hibernating [...]]]>

This is my brain. The leaves are my cranium. Or maybe hair. I don't know, look at my brain, can it reason these types of tricky questions out?

And I think the slug just went into hibernation. (Do slugs hibernate? I bet I would know that, if my brain hadn’t been replaced by a maybe-hibernating grey slug with four neurons in its slimy slug head.)

There’s this thing, this hormone, called thyroid. Consider it your body’s energy regulator. More thyroid = more energy, higher metabolism, better brain function. (Until you get too much, and then your body sort of burns itself up, which is what causes spontaneous combustion. Or something.) Less thyroid = less energy, metabolism like a bucket of very cold molasses, and slimy hibernating slug brain.

I’m in “less thyroid” mode¹.

It’s entirely my own damn fault, of course. I do this regularly — procrastinating on renewing my prescription for anti-slug fuel — but this time I not only left it too long, I didn’t want to go back to the same doc. And looking for a new primary care provider when one is fat, and has no desire to get fatter by trying to get thinner, is not exactly, shall we say, fun. So I put that off, too.

And when I finally did find a new PCP (a process about as enjoyable as I expected it to be, and I still don’t know if he’s willing to be unbigoted enough to work with long term), he wanted me to stay underthyroided long enough to get a “good baseline” from which to calculate a new, non-slug-brain dosage. Isn’t that special?

It is thanks to my new status as a humanoid Ariolimax that posting here has been slow of late. Because slugs probably do have a lot to say, but it mostly revolves around an abiding hatred for salt and beer, and I sort of figured y’all might not find that especially interesting. Although, I could be wrong. Insert yet another bad slug-brain joke here.

I’d be more concerned about this transformation, or offer predictions for its cessation, but that would require at least five neurons, and a higher order grey matter in my cranium.

In the meantime, all your veggies are belong to me. Nom.

Slimy, slimy nom.

First, go read Do you REALLY trust women? [...]]]> I’m pretty bad at planning ahead, and as usual I’m a step or two, and a day or two, behind the rest of the world (or the blogosphere, at least). So here is my belated entry to this year’s Blog for Choice Day, on the topic Trust Women:

First, go read Do you REALLY trust women? at FWD/Forward. I mean it. Skip the rest of this post if you only have time to read one thing right now: go read that. If this is to make any sense to you, you need to have read and understood that post.

Second (you read the FWD post, right?), an all-too-real example of the above: Kerry Robertson, whose story I linked to in Whose child is this?, has had her baby removed from her by Irish Social Services. Whether or not there is “more to the story” (there is always more to the story than what becomes public, though not always in the way people who say that mean), the fact that her learning disability has been used throughout as the public justification for these actions — blocking her marriage to her fetus’s father, removing her 4 day old breastfeeding baby from her care and her presence — is far more proof than I would ever care to have that we do not trust women, and that motherhood is a function of privilege, not a privileged status itself. Robertson made the “mistake” of being too young, too unmarried, too poor, having the wrong parents, and being disabled by her kyriarchal society: for that error, she has lost the child she chose to have.

Abortion rights are important, indubitably, indisputably. I would likely not be here if my mother had not had the right to choose when her IUD failed while she was a medical student. In my own very-much-tried-for-pregnancy, I found the knowledge that I had choice, that at any time for the first several months that I could change my mind, to be immensely, indescribably helpful and joyful. I’ve known women who are happier for the abortions they chose, and women whose lives were damaged by the abortions they wanted but could not obtain. We need 100% available, accessible, legal, safe abortions.

But there is so much more to reproductive rights, to real choice for women, than just abortion. And more than that, throughout history and throughout the world today (yes, in your country, in 2010), women who were not the “right” kind of women have been and continue to be coerced or forced into abortions and sterilizations and separations that they did not want.

My own grandmother was strongly encouraged to have an abortion — in the 1950s, in the USA — because of concerns over what the medical procedures she was undergoing at the time would do to her fetus and what the pregnancy would do to her; which is to say, because of ableism that says some babies are not worth having, and because of the misogynistic belief that women can’t be trusted to make the choice for ourselves. She was privileged enough (and obstinate enough: my grandmother did, in fact, wear army boots) that she was able to say no, to make another choice, to birth my mother, and only thus am I here today.

I am not anti-abortion. I am, it can easily be said, pro-abortion, in that I do not think of abortion as an “unfortunate necessity” or a “lesser evil”. But to be pro-choice, we need to think in far broader terms than just access to abortion, as important as that is.

“Trust women” means nothing if we do not also trust women to choose to retain her fertility (no matter how many children she has had or what gender she was assigned to at birth), to choose to not retain her fertility (no matter how many children she has had or what gender she was assigned to at birth), to choose what types of reproductive assistance to use when, to choose to carry her pregnancy to term or to terminate it, to choose to how much prenatal screening to have or not have, to choose the location and manner and attendants — or lack thereof — for her birth, to choose when and how and with whom to raise her child(ren).

We don’t have to agree with the choices any woman makes, and we damn well should work to make sure her choices are uncoerced and unconstrained by kyriarchy (classism, capitalism, racism, sexism, ableism, and so on), but we do have to trust her to make them and all the other choices that exist around reproduction if we are to claim we trust women.

Do you?

Here’s what I don’t talk about: all month, all [...]]]> For the 20th time since the Boychick was born, my uterus sheds its endometrial lining. For the 20th time since the Boychick was born, it all slides down my vagina, falls between my lips, is absorbed by the cloth between my legs. I’ve talked about that before.

Here’s what I don’t talk about: all month, all cycle, I am falling out, falling down. My rectum falls forward, my bladder back. My uterus to the left, cervix perforce to the right (deduction rather is vice versa: os is found to the right, therefore uterus must be falling left).

It’s not something that bothers me — except when it does. It’s not something I talk about — except now I am.

The technical terms sound sweet, seem sinister: rectocele, cystocele. This one doesn’t even sound pretty with my eyes closed: uterine prolapse.

Well, prolapse, maybe. Pro-laps. Doesn’t sound too bad, if I don’t think too hard.

A fact: the suffixes -rrhoid and -rrhage both mean the same thing. And yet hemorrhoid and hemorrhage? Not so much. Go figure.

I have the ‘rrhoids, too.

True story (no really, this is relevant): when I was 12 years old, I went on a rickety old wooden roller coaster, was lifted out of my seat, and slammed back down. I’ve had low back and sacrum problems ever since. It’s also probably why my coccyx is, itself, fallen — in, forward, to the right. And that one hurts.

How these are connected: every. single. time I talk to anyone about my coccyx pain (chiropractors, doctors, massage therapists, cis women with similar issues), the answer is a variation on this: “Have you considered internal coccygeal adjustments?” “Maybe you should see a physical therapist who specializes in pelvic muscles.” “I know an acupuncturist who does vaginal treatments.” Every. Time. If I mention the rectocele as well? They redouble their recommendations. (Silly ideas about anatomy, and connection of internal organs. Pfft.)

Everyone, it seems, wants their hands — or their needles, and as much as I love acupuncture I’m trying not to think about that one — in my pussy.

OK, so it’s a nice pussy. I don’t really blame them.

But pardon me if I’m also disinclined to allow them.

And yet…

Why?

I went to a midwife who knew the uselessness of vaginal exams in pregnancy, knew how rarely they were indicated in labor. The only time in the last five years fingers other than mine or my lover’s (or, as they were sliding out in birth, my child’s) have touched my vagina were after birth, examining for tears (I had none). That is as it should be, it seems to me. Too quick are OB/GYNs to poke us, prod us. Too often “medical need” is code for “physician habit” and becomes client’s trauma. I know this, and so I am wary of exams, wary of allowing unnecessary violation of my bodily integrity.

But, might there not be necessary non-violations? Or, even desirable, beneficial, honoring touches?

I’m sure there must be. I am told — by women I trust, women who trust their bodies — that there are.

Still, I resist.

And I hurt.

And I still resist.

And I still hurt.

I don’t like talking about pelvic organ prolapse. Inevitably, it seems, someone is going to blame my weight, my big baby (10lb 6oz, and no I wasn’t diabetic, thank you very much), my homebirth, is going to say I simply need surgery. From the other side will come pronouncements that I’m Doing It All Wrong — I’m not eating right, sitting right, standing right, breathing right. (And that I might even believe, because the mostly-sedentary American life I live is entirely unnatural and unhealthy on the human body, especially those of us with cis female anatomies.)

From any side might come fatalism, a proclamation of the profound brokenness of my body. But I don’t feel broken (except my tailbone, sometimes); I don’t want to feel broken. I don’t want to be warned off having another baby (eventually! not now!); I don’t want to be told I am too far gone to be helpable, fixable. I am, in short, afraid — afraid I will be told I am broken, afraid that I will discover it to be true.

My brain’s a little whacked too.

But if I am ever going to do anything that has a prayer of helping (have I mentioned the coccyx pain? Truly, it is a pain in my ass), I have to be able to talk about it. And so I am.

Today, it all falls down: my uterine lining, for the 20th time since the Boychick’s birth. My pelvic organs, constantly, always, starting well before his birth. My walls and defenses and impenetrable, impossible silences: now, and forever more.

Featuring lines such as:

nope, it’s all because American cis women of childbearing age apparently scarf narcotics, nicotine, donuts, dope, and dirty, dirty dick willy-nilly.

Reader maria raves:

this post made me seethe with rage, but also laugh. because you rule.

Go, read, laugh, seethe!

(Never fear, [...]]]> I blame American woman, who are all potentially mothers! by I, your cheating-on-you-with-another-blog-but-hey-I’m-letting-you-know-about-it bloggess.

Featuring lines such as:

nope, it’s all because American cis women of childbearing age apparently scarf narcotics, nicotine, donuts, dope, and dirty, dirty dick willy-nilly.

Reader maria raves:

this post made me seethe with rage, but also laugh. because you rule.

Go, read, laugh, seethe!

(Never fear, Dear Reader, I may be cheating on you, but I haven’t left you entirely. New content exclusively for Raising My Boychick coming soon! Some of which I may even write myself!)

Unbeknownst to me, just days before I published Just like athletics: exploring a childbirth analogy, the [...]]]> I do believe ACOG must stand for American College of Obtuse Gynohaters. (Other suggestions from Twitter friends: Appalling Care, Obvious Garbage; Aberrant College of Greed; American College of Oppressive Gits*. Feel free to add your own suggestions in the comments!)

Unbeknownst to me, just days before I published Just like athletics: exploring a childbirth analogy, the American College of Obstetricians and Gynecologists was releasing a policy statement that “relaxes” restrictions on fluid intake during “normal, uncomplicated labor”, and would “allow” women in labor to

drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks

– as opposed to the even more unfathomable current policy which restricts women in labor to ice chips. Ice chips! (By the way, if more than 1% of American obstetricians have seen a truly physiologically normal labor that they haven’t managed to unnecessarily complicate somehow, I’ll eat The Man’s angora Stetson.)

Today The Big Push for Midwives released a sufficiently ridiculing reply to ACOG’s statement (which includes another comparison of birth to marathon!), though I wish they had gone into the evidence more.

The rationale for denying solids in labor goes something like: Once Upon a Time, long long ago, when OBs routinely knocked women out during labor (ok, so sort of at our own request) and anesthetics were in their infancy, aspiration of stomach contents was kind of a serious problem. And, of course, since women were knocked out anyway, they figured we didn’t need frivolous things like fuel or energy, so they might as well reduce the risks by dictating Nil Per Os (nothing by mouth), right?

Only, anesthetic techniques have gotten half a century better (see? I do have good things to say about ACOG. oh wait, that’s the responsibility of the American Society of Anesthesiologists. nevermind.), and only a small percentage of the large percentage (but still — for now — minority) of those who need cesarean or other surgery in labor actually go under general anesthesia (which, remember, is much safer), and there’s no evidence that withholding all food or drink actually makes the risks of aspiration and aspiration-related complications safer (though it does make it less messy for the anesthesiologist to clean up), so that’s pretty well an unsupportable policy.

When I talked with my friends in Canada, Australia, and the UK about the ice-chips-only restriction (and this “relaxation” of rules), the reaction was universally a variation on “wait, what? hospitals actually DO that?!” And yet, all three of those countries (and, oh, almost 40 others?) have better maternal mortality rates than we here in the good ol’ USA do.

So if not based on silly things like evidence, or reality, or actual maternal health, how do we explain these seemingly-inexplicable restrictions?

Oh, I am so glad you asked that.

The name of the game, ladies and gentlepersons, is control. About thirty or forty years ago in the US, women started going “Wait, wtf? I’m not sure I want to be knocked out for this childbirth thing. I think I’d like to try to just, y’know, do it. I don’t really need or want you to shave my snatch, stick a bag of soapy water up my ass, cut my cunt, or dope me up. In fact, I think I’d like my husband/lover/friend to be the first to touch my baby as s/he enters the world. So… What are we paying you for again?” And so, slowly, grudgingly, American OBs stopped requiring we be shaved, stopped ordering enemas, and welcomed all and sundry into the birth room (though they’ve yet to stop mutilating our genitals). And the epidural and cesarean rates skyrocketed. At the risk of sounding like a conspiracy theorist, this was not a coincidence.

In the face of women demanding concessions in some areas (enemas, atmosphere, attendants), ACOG had to regain control of birth somehow. The perfect way, when what women were trying for was “natural” labor? Sabotage: set up so many barriers in our way, deny us the fuel necessary for such a strenuous endeavor, that they’d be able to (we’d be demanding them to!) swoop in and “save” us. This is all about misogyny, all about undermining the strength and power of our bodies, undermining women, making sure that (usually white, rich, cis) men have control in the one area that those with functioning uteri and those without are simply, absolutely, different.

(This is probably a good time for the obligatory interlude in which I make clear that I am talking about organizations, and cultural forces that often go unrecognized. Individual obstetricians are generally perfectly decent people. Most OBs really do want to help women and babies, and think what they do is good for us. I have an anesthesiologist relative who, in addition to owning a house that would make Solomon blush, is quite a lovely person. The problem is that most evil is done by persons who are basically good. It only takes a few “we know best” people making decisions, legions of “just doing my job ma’am” pencil pushers — or episiotomy cutters — and a culture saturated in sexist beliefs and imagery and rules, to the point we can’t even see them anymore, to create a birth culture in which blatantly misogynistic unsupported-by-the-evidence practices can be near-universal and none of the intelligent, well-meaning people inside the institutions question it.)

So much for the history lesson: back to the present, in which we are offered this “relaxation” of restrictions, and told:

As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common.

Oh William H. Barth, Jr, MD, of Massachusetts General Hospital in Boston and chair of ACOG’s Committee on Obstetric Practice, how you make me laugh. While it’s true that most persons in labor would frown at a four course meal, and many of us do indeed upchuck quite frequently (if not copiously), most DO choose, when presented with the option, to consume something in labor, from toast to soup to pasta to pepperoni pizza (to name a few that were mentioned on Twitter). Further, the idea that because most do not want much means that none should be “allowed” any is… well, completely kyriarchal.

But hey, it’s a step forward, right? At least it’s something, right? A move in the right direction? From the policy release: “Allowing laboring women more than a plastic cup of ice is going to be welcome news for many.” That’s true enough, so this is sort of a little bit good… Right?

No.

What it is is a morsel, a scrap, a teeny tiny tidbit that is supposed to make us feel grateful, that serves only to tie us closer to them, like when a nurse or nurse-midwife slips us a sucker in the sly, and says “Shh, don’t tell, because you’re only supposed to have ice”, but we are so grateful to finally have something of substance in our mouths, something with energy, no matter how little, to get us through, something to settle our churning stomachs, we are so grateful… that we forget that it’s their fault we’re starving in the first place.

To my American hospital-birthing friends: you know this matters to you, whether you wanted food in labor or not, whether you were at an enlightened hospital or not; know also that it matters to me. To my American homebirthing- and birth-center-using-friends: it’s not enough to just escape the system. We aren’t all that lucky (approximately 12% of intended homebirths transfer in labor), and we don’t all want to. The system has to get better for when we need it, for when our sisters need it, for when our sisters want it. To my non-American or non-birthing friends: Birth rights are reproductive rights are human rights. What happens to one of us happens to all. As voz_latina says: “There can be no equality until all women have control over all aspects of our bodies. Birth, transition status, personhood.”

This may seem like such a small thing, a tiny drop, hardly worth getting bothered about; but in a million such drops we are drowning. ACOG wants to be seen as our benevolent allies, offering us tea and juice and soda, but they’re only pouring more on while we sputter for breath.

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There are whole aspects to this I’m not addressing: the fatphobia slipped in toward the end of the policy statement (“Pregnant women who have additional risk factors for aspiration, such as morbid obesity… may need to be restricted from fluid intake on a case-by-case basis.”), and the undeniable racist disparity in maternal mortality rates, based largely but not wholly on the heartbreaking difference in quality of care based on class. And I hate to tag those intersections on at the end of a post like this, but I’m simply not up to juggling that many pieces today, and I beg your indulgence and forgiveness.

* “Git”, incidentally, is actually derived from “get” or “beget”, and refers to a person born out of wedlock. Thus, this will likely be the last time you’ll see it on this blog, as I do my best to refrain from misogynistic, kyriarchal language. (Which also happens to insult a group which includes my own child, though that shouldn’t matter. But it does.)

You were elected in large part on the topic of health care reform, including a public option. I voted for you in large part for health care reform, including a public option, only because there were no viable candidates that supported a single payer option, which is the only truly equitable [...]]]> Dear President Obama and Staff,

You were elected in large part on the topic of health care reform, including a public option. I voted for you in large part for health care reform, including a public option, only because there were no viable candidates that supported a single payer option, which is the only truly equitable solution. I voted for you because I believe you have intelligence, integrity, and the right intentions.

Unless you are to prove me wrong, you must, must, MUST insist on a full public option if the health care reform you enact is to have any meaning at all.

When I was pregnant with my child during the second Bush administration, I was unmarried to my partner of 10 years, and thus ineligible for his employee-sponsored health insurance. I was a student, and had no health insurance option of my own. And due to my medical history, no for-profit insurance company would offer me any coverage at all, let alone any we could afford. Because my partner, with whom I was (and still am) living, made just over the coverage cutoff, I did not qualify for state-sponsored insurance here in Oregon. I was uninsured and uninsurable, with a baby on the way.

Now, we had chosen to hire a Certified Professional Midwife to attend our birth at home — not because we couldn’t afford the hospital route (though we couldn’t have), but because it is a safe, humane, and yes, economical birth option (which, incidentally, should be covered by any public health care, due to that same safe, humane, and economic nature) — and we were able to work out a payment plan with her. But if I had had to transfer (as do approximately 12% of women who choose homebirth in the United States), the cost of any required hospital care would have crippled* us financially, just as we were starting off our new life as a family of three.

How is this acceptable? How can we purport to be a “world leader” when we lead the world in infant mortality rates, when we are among the last to ensure that all our citizens are insured?

I understand that compromise and cross-aisle support are necessary, but it is essential to remember that a “public option” instead of a saner, safer single payer system is already a compromise, and a gross one. To cave on the public option in the name of “compromise” is to confuse coming to consensus with giving the store away.

You must make good on your promise for meaningful health care reform. Any bill passed without at the very least a public option is no reform at all: it is merely more of the same. That’s not what I voted for.

Sincerely,
Arwyn [last name]

[*Note: this was how I originally typed and sent the letter, but I realized afterward that "crippled" is potentially offensive, and I wish I had used another phrase. I apologize for the ableist language. I am trying to learn better language to avoid slip ups like this in the future.]