'Too posh to push?' Really?

So my daughter was at a Pilates class the other day and overheard a conversation between several young  pregnant women. It covered a lot of ground involving designer baby clothes and baby carriages du jour, there was some talk about epidurals and lots of shuddering about childbirth and various negatives about breastfeeding. 

My daughter reported to me that she felt like going up to them and saying 'Get over yourselves! Just push it out and put it on the boob!' 

And I was proud. 

Welcome to the third compartment of my brain! Work/women's stuff. (Home/ family, and World events/Jewish stuff being the other two.)

My question is this: What has gone wrong when we have Caesarian rates of 33% overall in Victoria? By overall, I mean that private hospitals are nudging 50% rates. That's one in two to three births being surgical deliveries. That's not counting other interventions such as epidurals and episiotomies and suction and forceps. 

Now, I am a doctor and I trained in the 70s and we were told then that '80% of women could deliver in a paddock', in the charming words of Sir Lance Townsend, famous OBGYN and Dean of O&G Melbourne Uni. That left 20% who needed some sort of intervention. That included episiotomies and forceps. So about 10-15% would need a C-section. This figure tallies pretty closely with the current WHO predictions of 15%. So what has changed?

Well, older mums. Ok. So the 'elderly primigravida' ie 37 years plus, having a first child, could be expected to have more difficulty. Although 37 is a bit of a spring chicken in some circles! And IVF and other sorts of reproductive technologies mean that women in their 40s+ can give birth, pretty much out of the old range. And we can see the shift in general to older first timers. 

(If I wasn't writing this on my iPhone but on a real computer I would do some quick research and give you exact figures, but I don't think it's really necessary for this blog post. Another time maybe.)

Another shift since the innocent 70s has been the growing litigiousness of the community. Anything wrong with the baby is the OB's fault. Even though it has been shown that most cases of , gor example, Cerebral Palsy, are not birth-related but originate in utero, enough high profile cases make everybody scared, so the C-Section is the cure-all. So higher risk births, eg breech, twin, are generally operative deliveries. Short stature, older mum, narrow pelvis, high head at term, unstable lie. Posterior position! I don't know when that happened, but suddenly that too has become dangerous and needs CS. 

(I'm sorry if I'm using terms you may not be familiar with, but if you're reading this far already, I think you know what I am talking about. )

Back in the day, you could go 2-3 weeks overdue also, but there are statistical risks with this. So even though nowadays we can easily assess placental function and fetal well-being, many doctors either get a bit antsy, or, in many cases, mums have had enough, and hello, induction. 

And the trouble with inducing labour is that once you intervene in this process, you often set up a chain of events. Prostin gel, break waters, synocinon (pitocin) drip, slow progress, pump up the volume, maternal distress, epidural, failure to progress, fetal distress, failed suction, failed forceps, emergency Caesarian. 

We saved your baby! We saved your life! Thank you doctor! Thank you so much!

I'm not saying that there should NEVER be an induction or epidural or whatever. But NOTHING should be routinely done. Because when interventions are done routinely, all you are left with is the side-effect risk. 

So when pregnant women are shopping for the perfect pram or the loveliest blanket, well, that's ok. A consumer-driven decision. But it's not ok to let the consumer drive the kind of delivery. 

If you ask an OB with a high CS rate why he does this, he might say that he has a lot of high-risk deliveries. But he will also say, if that's what the mum wants then fine, that's what I will do. 

Because it's a consumer society. A highly litigious consumer society. And he is a bit scared, a bit undermined and he pays enormous medical indemnity. And many OBs have lost the attitude of 'masterly inactivity' or 'watchful waiting' because they need to make a lot of money to pay their huge insurance fees, and time is money. And mama is in a hurry too. So chop-chop! Let's get this over with. 

So have the rates of maternal deaths home down? Not really, they've been pretty steady at 3-4 a year for the last 30 years or so, in Victoria. How about perinatal death and illness? Well, not so straightforward because with better fetal diagnosis, many pregnancies are terminated for chromosomal or genetic conditions, so they don't make the count. Prematurity is still a major cause of perinatal illness and death. 

In general, when the rate of CS went from 20% to 33%, it is not at all clear that mothers or babies did better. In fact, having a CS, which is major surgery, comes with its own passel of problems, not only for that delivery, but for subsequent deliveries. 

In 1970, in Victoria, the rate of initiation of breastfeeding was around 20%. You read that right. One in five babies was even offered the breast. This came about mainly because of the attitude of the day among doctors and nurses that formula was just so much better and more modern and civilized, cleaner and more convenient, than the breast. There was not much research in the field, therefore not much evidence, and shameless marketing from formula companies.  Most young mums, migrants or children of migrants, less educated than the clever doctors and nurses, nodded and bought the bottle. It took a grassroots movement of housewives, the Nursing Mothers Association of Australia (you couldn't say 'breast' in 1964, now it's the Australian Breastfeeding Association) who forced change through activism, education and support of mothers, to turn that ship around. Breastfeeding rates still aren't what they could be, but around 90% of mothers at least give it a shot. That's for another post. 

What I'm saying is, if we wait for OBs to suddenly say, 'Hey! I'm doing too many C-Sections! What's with that? What, have women's bodies become unsuitable for vaginal birth, after millions of years of evolution??', well, don't hold your breath waiting for that to happen. (Although some have suddenly woken up to the fact that they don't even know what natural birth looks like any more, and most have lost the skills needed to apply forceps properly, and there is some minimal change afoot. Because if the only tool you have is a hammer, then everything looks like a nail.)

Change must come from the grassroots. If the mums ask for a chance to give birth naturally; if they know about the positives of natural childbirth rather than scare themselves with negatives; if they put some trust in their own bodies, in Nature or in G-d or whatever; if they seek education through LaMaze or whatever; in short, if they CARE; then there will be change. There has to be. 

Jihadis and other curses

I've been avoiding posting about world events (one of my 3 brain compartments) because what is there to say? Syria. Boston marathon. Stephen Hawking. London jihadists. It's sickening and it's terrifying. And what can I say that hasn't been said by people who are smarter and better connected than I? 

But after this last atrocity where David Cameron and Boris Johnson are simpering about Islam, the religion of peace, and as usual, no Muslim leader that I have heard about has stood up to sincerely denounce the shocking slaughter in London of an off-duty soldier, well, I don't know. And now apparently some 'extreme Right' types- ie Neo Nazis- have been gathering to 'take back the streets' or whatever the euphemism is for anti-Muslim race riots, well that's not good either, is it. I mean, nobody to barrack for there. 

Embedding Stephen Hawking among all these horrors might be considered overkill, but in our celebrity-obsessed culture, and even NOT in our culture, the word of a famous scientist has some Influence. So he has lined up with BDS and their lies and refused to go to president Peres' 90th because Israel is an Apartheid state. You would think that a smart guy like that would do some research and find the truth. I'm wondering if the Saudis  have dangled an endowment for a Stephen Hawking chair in Physics at Cambridge or something so he's smart enough to know which side his bread is buttered on. Just wondering. 

And have they figured out what to do with Tamerlane Tsernaev's body yet? I sure hope they didn't send it back to Jihadi Mama. I can tell them what to do with it: wrap it in a pigskin and bury it in Potters' Field, unmarked. Or cremate it and dump it in the sea to keep Bin Laden company. 

And Lord Ahmed, the 'first Muslim peer'! I must say, I had never heard of this guy and I don't know how he became ennobled by Her Majesty, but Mr Interfaith Dialogue sure knew who to blame for his prison sentence after he killed a pedestrian while texting as he was driving! The Jews of course! The Jew judges and lawyers, according to his interview in Pakistan, in Urdu of course. In English, the good lord is less than forthcoming. Maybe he did say that, maybe he didn't, he can't quite put his finger on it. 

Now we have the London Declaration on Combating Anti-Semitism, which sounds great! At last! Except that's not going to touch the phenomenon of Anti-Zionism, which is basically anti-Semitism with a college degree. So there, Lord Ahmed. Rap on knuckles for you! But not for Prof Hawking. Or BDS. Or all the slanderers of Israel. 

So it's over and out for now, I'll leave further  commentary  for the real pros. Professional journalists, that is. 

MY BRAIN HURTS

Now that I am ensconced in solitary (almost- spouse is here with me) glory in Shoreham, the family weekender, I actually have a few minutes to think and write. It's been nuts with work, looking after grandchildren, and still no washing machine. 2 weeks now. Been taking it to my sister inlaw's place. 

As an aside, may I give you a word of advice? If you are looking for appliance repair, and you google, and you find a nice, easy to use website with email contact, BUT the only phone number is a cell phone - don't go there. This guy is probably a one man operator who calls in his mates as needed and has no inventory of parts and thus any part will take forever. So Mr Washing Machine, you stooged me. You sound nice on the phone but you really got me good. I paid $138 ( Cash! Because you are having some temporary banking issues and so cannot take a credit card; more bullshit!) for your 'technicians' - 2 Lebanese wogboys, all struts and attitude,  to walk in the door the day after my SOS and look at the machine for 20 seconds; your assurance that I won't have to pay for the visit when they return to affix the part, trapped me. I even offered to courier or FedEx the part from wherever, but no.  So it will be another week. 3 weeks or more! Without a washing machine and 3 little kids in the house. Folks, here's an anti-endorsement: do NOT use Mr Washing Machine. So there. 

I just did 2 loads of laundry here in Shoreham and I actually enjoyed it. 

Enough about domestic shit. 

My brain is split into 3 compartments. One has got all the house stuff stuffed into it, family and all that too. One thinks about Israel, Jewish stuff, world politics, anti Semitism, the Jihadist threat to the world and stuff like that. And the other is relevant to my work: Breastfeeding, birth, mothers and babies. There's been so damn much going on in all three compartments that I haven't had a chance to think, but now... Oh crap, it's nearly Shabbos. 

To be continued. 

A Soul in Transit

There's an apocryphal story about a Westerner who attended a Chinese wedding with a friend of the young couple. During the celebrations there were speeches, and the first speech was made by an elderly relative. The wizened old man stood up, slowly walked to the microphone and beamed a huge smile at the young couple. The crowd maintained a respectful silence. The elder made a short speech in Mandarin, smiled, bowed to the bride and groom and returned to his seat among enthusiastic applause. 

'What did he say?' asked the Westerner. 

'He gave the bride and groom a wonderful blessing. He said, 'Grandparents die, parents die, children die.''

 The Westerner was taken aback. 'What kind of blessing is that? He just said that everyone in the family should die!'

'No, no, listen carefully to the order,' said the friend. 'Of course, eventually everyone will die. But the blessing is that old people will die first, then their children will die in the right time, in their old age, and then the children of the children. Because the greatest sorrow is for children to die before their parents. The greatest blessing is to die in the correct order.'

There is no greater heartbreak than the death of a child. In spite of all the medical advances, in spite of cutting edge medical procedures and medications and all the hope and prayers, in spite of the Tehillim and the community prayer vigils and group challah baking, in spite of the love and support of family and friends who are all good people who give tzedaka and help their fellows, in spite of everything, a child dies. 

We all weep together at this time of communal loss. We are speechless and impotent. We pray for an end to these tragedies which we cannot fathom. We ask 'Why? Why this child, this family, this community?' There are no answers. We try to comfort the bereaved knowing that there is no comfort and no reasons. 

Grandparents. Parents. Children. At least give us this, death in the right order at the right time. 

In memory of HaTinok Boaz ben Ilana veBinyomin.  

May his parents, grandparents, great-grandparents be spared any further heartbreak. May his pure neshoma be a shining light in Gan Eden, may he be a 'gitteh better', an intercessor on behalf of us all. May G-d have mercy on us all and send Moshiach, immediately. 

Amen. 

TRADIE HELL

I may have mentioned that I live a privileged life in a lovely large house in a leafy suburb in Melbourne, one of the world's 'Most Liveable Cities'. I work largely form home, so I spend a lot of time in this lovely home, and although I have a daily housekeeper, I don't have a house manager or butler or whatever; I alone am responsible for the maintenance of the house. And believe me, the house needs a lot- A LOT- of maintenance.
It was built pre WW1 and has been renovated and extended and rewired and replumbed and you name it. It has high ceilings, polished floors, (some carpet though- this will become relevant) and lovely gardens back and front. And I have a pool. And everything needs maintenance and attention from tradesmen. When I say that not a day goes by when I don't have tradies in the house, I am not exaggerating. NOT. A. DAY.
Sometimes all the stars come into alignment and everything comes up at once. Yesterday was one of those days.
At 7.30 am the guys working on the security system turned up, third day running; replacing defective sensors etc etc and since there is also a 'smart house' interface (and what an oxymoron is that expression, 'smart house') called a Crestron, and everything has to be programmed through the Crestron, there was also the guy with the laptop as well as the 2 guys in overalls. Who were fiddling (third day!) with the alarm system, going beep-beep-beep-beep and setting it off from time to time. Did I mention that I work from home?
At 7.45 the aircon-heating maintenance guys came, 2 of them in boots and shorts, climbing up ladders, removing and cleaning filters, searching for missing controls, prowling and lurking around every corner, all day.
Then the pool guy came and did his thing, but he doesn't get in the way much. I still had to talk to him about a problem with the pumps. He was only there an hour.
Meanwhile, the lawn guy was adding to the symphony with his mower and whipper snipper. This guy is a legend. He comes every 2 weeks in spring-summer-autumn and every 3 weeks in winter, come rain or shine, come drought or flood. When the lawn was little more than a dirt patch during the recent 10 year drought, he would still come. I had to beg him to only come once a month. He is a robot. But he was done in an hour too.
Then the carpet cleaning guy came. He was supposed to come 3 weeks ago but didn't due to some dental problems. He didn't call, of course I had to chase him. Then he was supposed to come Monday. So he came Wednesday, in the middle of all of this. He sprinkles this powder which get on everything, and then has this machine which adds to the ambient sound mix. I think the powder dust has affected his brain after all these years because he's always cheerful and always loves to chat no matter how late he must be for his other jobs. (He should have come an extra day late to clean the carpet after the aircon guys in boots tromped all over it.)
What are we up to? 3 cable guys, 2 aircon guys, one pool guy, one carpet guy, one lawn guy, and a hassled housekeeper.
AND THEN. The washing machine broke down. So I had to call a repairman, and I got some info off the net and picked up the phone to call- DEAD. The phone wasn't working.

Actually it had stopped working the night before, so I assumed that the cable dudes had screwed something up; so I called their boss an told on them. But it turns out that the problem lay outside, in the street; the whole area was out because some workmen who were out there slowing traffic and looking very serious while being hoisted up in scissor lifts and cherry pickers to look at power lines and junction boxes, were cutting back trees etc, and it looks like they cut more than trees.

Today, day 3 of no phone, or fax, it occurred to me that I should call Telstra and find out how long this lack of phone will last. (I might add that we had Optus for the internet connection so at least I had THAT, or else I would have topped myself.) And a recorded voice told me that there was a damaged cable and would I like to speak to someone? Well, yes, why not. And a very nice young Indian (of course!) fellow came on the line, confirmed the damaged cable, said it should be fixed by the evening and THEN suggested diverting my home/work phone on to my mobile! For free. Immediately. And he told me how to undivert it once the cable is fixed. I was very impressed by the service, and my inner cynical pessimist was almost silenced. We will see how young Sanjay's advice turns out. (I don't know if his name was Sanjay; if I asked him he would probably say he was Kevin from North Balwyn, not Bangalore. I just like the name Sanjay.)

And yes! The washing machine guys came and told me after 20 seconds that I need a part which they didn't have but they will order. And it turns out that it will take 7-8 working days to get the part. But there will be no service fee when the return to actually fix the machine. Well, $138 well spent! What the hell am I going to do with all the dirty laundry? Shavuot next week, too. I might visit my mother-in-law's washing machine.

And then my housekeeper mentioned that the polished floors were looking a bit ordinary and maybe we need to call the floor guy. Also the marble tiles in the en-suite had some weird blotchy marks, so we should get the stone guys out (again).

So after the cleaners and the gardener leave, I'm leaving my house to go to the mall, to look at a fridge for my newlyweds. I need some peace and quiet.

FOREVER YOUNG?

I am a huge fan of Peter Alexander pyjamas. Yes, I know they are overpriced, but they are so CUTE. And I have grandchildren. And little kids always need PJ's. PLUS it's so easy to shop on-line; it's the friendliest website ever. And because I am a good customer, I also get a printed catalogue which has immensely high production values and is bright and cheery and full of pretty girls and boys modelling their jammies and trackies and bootees, as if anyone actually looks like that when slopping around in these clothes, in bed or out.
So, as Mothers' Day (please note placement of apostrophe; it is MOTHERS' not Mother's. I always feel a surge of rage and despair at poor apostrophic placement. I am not alone. There is a world of punctuation nerds out there. But I digress.) is around the corner, the catalogue featured stuff for Mum too, modelled by the famous 'femme d'un age certain', (older lady- in this case VERY older lady) Carmen Dell'Orefice who is 82. Yes, you read that right- 82.

http://www.peteralexander.com.au/shop/en/peteralexander/catalogue

Now, the thing about Carmen is that she does not resemble in any way, any 82-year-old woman I have ever seen. There is no way that she has not had 'work' done, no matter what G-d gave her. And G-d did bestow upon her height, slenderness and great cheekbones. But you don't get that smoothness of complexion without a fair bit of nip and tuck. The catalogue states that there was no photoshopping used on the images so one can only assume that she herself has been - well, photoshopped for real.
So when it says 'Beauty is Ageless', I can only agree; but in the end, it's a pretty limited view of what beauty is.

http://www.peteralexander.com.au/shop/en/peteralexander/catalogue?utm_medium=Email&utm_campaign=PA1305WK3D&utm_source=Shop+Catalogue+Footer&cm_mmc=Email-_-PA1305WK3D-_-Shop+Catalogue+Footer-_-NA&link#look12

Because it's still all the same 'beauty' isn't it?! She is trying, pretty successfully, to hang onto the chimera of youth, right? Smooth skin, tall and straight and slender. Ageless. With some help.

She has been modelling since age 15 and has had an interesting (read 'difficult') life, so good on her for her long and successful career, even though now it's not the catwalk or Vogue, it's Peter Alexander and his PJ's;  but you can see the humour and the elegance.

But beauty has to come in more diverse packages than youth, or faux-youth. It has to.

What is WRONG with us?

Last night I watched the first episode of Arrow. I had been anticipating this rather keenly, in fact, I had even seen the first 2 episodes on a plane a few weeks ago and I actually wanted to see it again. I don't do this new-fangled internet thing, I don't have cable, I just watch free-to-air from time to time. I can barely work the TV remote, since I never get to hold the thing, being female and all.
Anyway, I do love a bit of the comic-book hero rehash, and DC's JLA (Justice League of America) was a personal favorite back in the day, PLUS, I admit I like a bit of eye candy and a good fight, so Arrow it was. This is the Green Arrow like nobody ever would have thought of in the JLA of the 1960's. As with many of these re-imaginings, the hero is a dark vigilante with a Secret yada yada, but mmm-mmm does he look good. And the parkour (free running or what have you) is amazing. And the fights are great. And he gets the baddies etc. So that was good.

Then I made the mistake of continuing to watch the next program, The Following. Now, this has been acclaimed as a great drama with great performance from the main character, played by Kevin Bacon, who is a damaged ex-FBI agent who hunted down and brought to justice a nefarious serial murderer who keeps escaping and killing more people. The hook on this one is that the baddie (sorry, I missed his name) is a sort of cross between Hannibal Lecter (genius, charismatic, evil killer) and Charles Manson (the same, but minus the genius, plus he actually does exist) and has A Following of people whom he has in thrall and who will do anything for him, literally kill and die for him. He was some sort of professor and he managed to turn many students to the Dark Side.
So Kevin Bacon is the one who knows most about him and thus has been brought back from his alcoholic depressed retirement to get him. Look, there's all sorts of plot happening, and it's really well acted and very tight and chilling; but it is appalling.

The act of killing is so eroticized it is sickening. This is more than the stylised violence that we have become used to, guns and biffo and roundhouse kicks and what-have-you. In this one episode I saw, not even from beginning to end, we saw the Master whatever his name is, teach a student how to kill a bound and gagged terrified woman, with a knife, almost as a caress, with ecstatic eye-closing etc; a shocking fight between a captured cop and one of the followers, egged on by other followers, involving metal pipes and knives with the cop being stabbed and rescued in the nick of time by Kevin Bacon who comes in guns blazing (well, at least nobody was gettin' it on, apart from the bloodlust, that is); a scene where one of the followers offers his life to the Master as a gift and as punishment for himself because he didn't succeed in his duty, and the Master taking him up on the offer and stabbing him in the most erotic, even homo-erotic, way, all embraces and sighing and gasps and murmurs, while standing on a plastic sheet which had been thoughtfully placed on the carpet by another disciple to avoid bloodstains; one of the male followers beating up on and almost strangling one of the female followers, as some sort of foreplay to violent consensual sex; and there was more, but these were the standouts. Knives and knives and knives; the parallels with sexual penetration were not lost on me. Duh.

We've had vampires all sexed up and neatly packaged for teen consumption; and we've had Hannibal 'the cannibal' Lecter, all Mr Exquisite Sensibility, tucking into a victim's liver, while listening to Glenn Gould's Goldberg Variations; and we've had sado-masochism gone mumsy mainstream in good old Fifty Shades; and every time I put on the TV there's more crime and police procedurals and Criminal Minds etc etc ad nauseam. But this is on free-to-air TV, 9.30 on a weeknight. And never have I seen such a juxtaposition of sex and violence and cold-blooded murder, such a blurring of Eros-Thanatos, life wish-death wish stuff, it would have Papa Freud spinning in his grave so fast he would drill his way to China.

What the hell is the matter with us? Why do we want to watch this? Why are these programs being made? Do we really want more and more graphic and disturbing violence? We sure have come a long way from Miss Marple and Hercule Poirot on the Orient Express. People getting sliced and diced, so easily abducted and murdered, and hohoho hahaha creepy Dexter only kills the bad guys, except sometimes he accidentally kills innocent people, whoops! That's entertainment, folks, 2013 style.

I am definitely sticking to comic-book heroes. Definitely the buff dude doing the ascending muscle-ups and the parkour chases to get the baddies has it all over this sick stuff. Is it just me?