Meet My Niece

Presenting Vivienne Hope Morrison Davis…

She looks just like me, don’t you think?

Liveblogging Labor

6:30am EST — Well, what else am I going to do sitting in a hospital while my sister is hooked up to a monitor trying to rest?

Yes, it looks like the membrane stripping and castor oil helped, as Joy went into labor on her own last night, midnight-ish, and things started kicking in good around 2am. Around 4:30am she decided it was time to start thinking about heading to the hospital. So here we are.

Getting here was a little nuts. My brother-in-law Tim came home from work last night with what seemed to be a bad case of the flu . We were worried about him making it but now he seems to be feeling somewhat better. The van was snowed over and I spent some time with the scraper before we finally left around 5:30am.

The baby’s heartbeat apparently sounds better now than it did yesterday.

6:45am — The midwife just checked her. She’s still at 4cm and not completely effaced, pretty much where she was late yesterday afternoon when she stripped her membranes. All those contractions haven’t gotten her far so the midwife is recommending breaking her water. Joy is reluctant but Nancy and the nurse clearly think that’s the way to go. Tim also wants her to do it.

6:52am — Still discussing breaking her water. I’m trying to ask questions I figure Joy would be asking if she weren’t breathing through contractions and being tired. The nurse and midwife say the baby is OK but not great based on the monitoring and they agree she could still be in labor this time tomorrow if they don’t do something to jump start her cervix.

7:01am — Joy and Tim both want to make sure they will give her plenty of time after breaking her water to let her body do its thing before they start pushing Pitocin on her. Tim said “If you do this, I don’t want to see you dragging in the Pitocin at least until after lunch.” So now Nancy is waiting with for the current contraction to pass…here goes the crochet hook….Joy is breathing with it like a champ…fluid is clear, all good.

7:35am — Contractions are getting serious. Joy is on the bathroom floor with the yoga mat, but no hot water in the tub yet.

7:55am — Well that was fast. I had barely finished that last sentence when Joy called me over. Tim had left the room a few minutes previously, mentioning that Joy already sounded like she was in transition but figuring he had enough time to run to the cafeteria to get honey for his hot tea. I quickly put down the laptop and when I knelt down next to her to start rubbing her back, Joy said “She’s coming” in as calm a voice as a woman on the verge of pushing out a baby could possibly manage – low and soft but absolutely steady. Since she was on hands and knees over the birth ball on the bathroom floor, it was easy to look back and see what was happening. Sure enough, the baby’s head was just about there. I asked if she wanted me to get Tim or stay, she told me to stay. I looked again and the baby’s head was right there so I ran to the door to call for a nurse – then right back to make sure somebody was there to catch that baby in case the nurses took too long. In a minute about 7 people converged on the bathroom, Tim finally ran in just when I was starting to think he was going to miss it. I ran for the videocamera and managed to film the action for posterity. With so many people in the bathroom, I moved back behind Tim to perch on the back of the corner tub. Joy stopped right before the baby’s head came out to say she wanted to get up and catch her, but there was just no way that was going to happen with the limited space in the bathroom. I was a little worried for a second, right after the head came out she started to turn a little blue and it took a minute to get her shoulders out. They are still all on the bathroom floor, the baby latched on pretty quick and is nursing. No name yet.

8:31am — Still working on passing the placenta but otherwise the room has calmed down. The baby weighs 9 lbs 4 oz, 20.5 inches. As her hair is drying it is looking light red. Eyebrows are light red too. At first I couldn’t tell who she looks like but when she opened her eyes she looked like my sister.

9:13am — Finally got the placenta out a little over an hour after the birth. The midwife was working and working with her, it looked quite painful. At some point Joy noted that this was probably the right time to declare that she is never doing this again. Eventually the doctor came in and managed to get the placenta out. Now Joy is recovering and looking tiredly at what I’m sure is a delicious hospital breakfast. The contractions are still painful though.

So there you have it. My niece sure is gorgeous — and her mom sure is a champ.

NieceWatch 2008 and the Medicalization of Birth

My sister, who was due with her second child on February 1, will be induced tomorrow morning. She went for her 41 week check up today and the doctor and midwife got concerned about the heart rate (including a minor arrhythmia identified previously) and insufficient fetal activity. She’s got gestational diabetes, but it is mild so at least up until now there hasn’t been a concern about getting the baby out on any timetable.

The midwife is stripping her membranes shortly and hopefully this will get labor started. Joy is scheduled to be at the hospital at 7:30am at which time they will hook her up to the Pitocin, which can end up stressing the baby more than regular labor. They’ll probably do continuous monitoring given the existing heart rate issue (that is, if my sister lets them), and even normal dips in heart rate during contractions will probably make the L&D staff and doctor nervous. Joy is worried (with good reason, in my opinion) she will end up being rushed into a C section after the Pitocin contractions really kick in.

This is a perfect example of the pros and cons of medicalizing childbirth. On one hand, it is great that we have the pharmacological and technological means to monitor and address potential and actual problems. Modern pharmacy and medicine save countless moms and babies that otherwise would have died or been disabled/injured in years not so far past. On the other hand, the first intervention to address a problem can set off a cascade of additional interventions that might not have been necessary, often resulting in a surgical delivery that could have safely been avoided had the doctor chosen a less aggressive first response.

Maybe more with childbirth than just about anything else, hindsight is 20/20; nobody wants to look back and regret not taking every available step to prevent a stillbirth or injury. Still, when the potential risks are minor or moderate, women like my sister (like I was) who desire a labor and delivery with no interventions end up struggling to sort out what level of risk is acceptable and responsible. I wouldn’t necessarily say it is easier for women who just go with whatever the doctor recommends, but when you have a strong preference for natural birth it can be really hard to decide when your doctor is overmedicalizing and when the potential risk should drive your decision.

Commercialized Health Care

Richard Kuttner, American Prospect co-editor and Demos senior fellow, argues that market-based health care cannot compete with a nationalized system when it comes to controlling costs and ensuring appropriate health care.

Changing demographics and medical technology pose a cost challenge for every nation’s system, but ours is the outlier. The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system.

 

Markets are said to optimize efficiencies. But despite widespread belief that competition is the key to cost containment, medicine with its third-party payers and its partly social mission does not lend itself to market discipline. Why not?

 

The private insurance system’s main techniques for holding down costs are practicing risk selection, limiting the services covered, constraining payments to providers, and shifting costs to patients. But given the system’s fragmentation and perverse incentives, much cost-effective care is squeezed out, resources are increasingly allocated in response to profit opportunities rather than medical need, many attainable efficiencies are not achieved, unnecessary medical care is provided for profit, administrative expenses are high, and enormous sums are squandered in efforts to game the system. The result is a blend of overtreatment and undertreatment — and escalating costs. Researchers calculate that between one fifth and one third of medical outlays do nothing to improve health.

 

Great health improvements can be achieved through basic public health measures and a population-based approach to wellness and medical care. But entrepreneurs do not prosper by providing these services, and those who need them most are the least likely to have insurance. Innumerable studies have shown that consistent application of standard protocols for conditions such as diabetes, asthma, and elevated cholesterol levels, use of clinically proven screenings such as annual mammograms, provision of childhood immunizations, and changes to diet and exercise can improve health and prevent larger outlays later on. Comprehensive, government-organized, universal health insurance systems are far better equipped to realize these efficiencies because everyone is covered and there are no incentives to pursue the most profitable treatments rather than those dictated by medical need.

He’s right, but I don’t believe the political or popular will is there for a single payer system. Americans are too in love with competition and the market and dismissive of government competence. Its possible that costs will get high enough to move single payer from the fringes more toward the center, but we aren’t there yet. I am afraid Kuttner is close to the mark when he says “Sometimes, we Americans do the right thing only after having exhausted all other alternatives”.

Waiting For Baby

My kids and I are in Lexington, KY visiting my having-a-baby-any-day-now sister. We got in Friday and are supposed to leave Thursday, a timeframe which coincides with a short lull in the schedule of my current project. Joy’s due date is February 4 but my nephew came several days early and she’s been 50% effaced and a couple centimeters dilated for coming up on two weeks. So we’ve all been expecting her to deliver this baby before the due date as well. In fact, I really thought the baby would get here before I did. Now I’m wondering if the baby will even come before I leave.

My sister and her husband drove in from out of town to be there the day I brought my first child home from the hospital (she wasn’t there earlier only because she had surgery the same day my daughter was born). She came to Austin again to take care of my daughter while I was in the hospital having my second. I and my family were here in Lexington when her son was born and it is important to me to be here, with my children, when her daughter is born.

Welcoming a new child into the world and into a family is a big event that, at least in my experience, creates a special extended family bonding experience: being there together right at the beginning becomes a celebration not just of the new little person joining the family but of the family itself and the unique bonds among all its members. Weddings do it to a lesser degree, funerals do it but are sad.

One day I hope my daughters and my sister’s children will make fun of the two of us and laugh at all our common idiosyncracies, just like my cousins and my sister and I laugh about my mom and her sister.