Friday nights

They kinda suck for me....and they kinda rock.

The suck because as I'm coming to work, everyone else is leaving for the weekend. In a huge rush to get out of here and enjoy the gorgeous weather that we've been having. I wish I were with them...done with my day and ready to start the weekend.

But they rock because Fridays are generally super laid back and really quiet at work. So I can chill, get my work done with little interruptions (always a good thing) and have some pleasant chit-chat with co-workers. And then I also have the knowledge that while everyone else is returning to work 8 am Monday morning...I have the whole day off!

On another note, this baby girl is seriously practicing to become a gymnastics star. Really, all I've felt for the last 2 days is tumbling and rumbling inside my tummy. This afternoon I laid down and took a nap with Zachary on my bed. True to form, I had to pee when I woke up. I rolled onto my back and baby girl did some serious backflips right onto my bladder. THAT woke me up...I whelped a little and Chuck laughed as I screamed that I needed to pee NOW!

I had my 32 week appt on last Monday and everything is going wonderfully. I gained 3 lbs, but I knew I would this time. I feel like I had been starving...and was ravinously hungry. Plus, everyone and their brother decided I needed more and more food. Someone from work brought me a 1 lb bag of jelly beans because I like them so. I DO Like them...but I also don't want to become a whale. Well, an even bigger whale!

Last Friday night, I went home early and was laying up close to Chuck...resting my belly on him and he was acting like a little schoolboy. It was so cute. He kept saying...hey, I felt Elizabeth! Was that her again? Hey, are you feeling that? Wow, that's so cool! I can feel her so well! It was a big deal to him and on Sunday he was telling my mom about it. I think it's so neat to see a daddy so excited and so interested in being a part of the pregnancy. This one has been a lot more laid back than the other two...WAY more laid back than Zachary's....just because it's not new this time. But, he went and proved again what a great daddy he is.

I got MEAT today!!!

And, um, get your mind out of the gutter ;) Although Chuck was home from work today (sick, yea, right) we both took a nap while the boys were napping. That seems more important to this pregnant momma right now anyways!

But, we did go to the butcher and pick up our 1/4 steer. YAY! I'm soooo looking forward to having a nice juicy, home-grown, corn-fed Porterhouse steak on Saturday. AND it should still be nice so we can have it on the grill. It's the only way to do it!

I grew up with steers, hogs, and rabbits, so there was always fresh, home-grown meat in the fridge. I missed that for our first 8 years together. But now, I work with a woman who raises Holsteins for slaughter and we get our meat from her. There is just something so satisfying about having a deep freeze full of steaks, roasts and hamburg. Great tasting steaks, roasts and hamburg nonetheless!

But now, I guess I should be careful. There was a new study concerning the connection between the amount of beef consumed during pregnancy and your unborn son's sperm count. Soooo, wonder what the connection will be made next for girls. *insert some sarcasm*

I guess I don't take a lot of stock in these "studies". The basis for this is them asking mom's their consumption of beef. But were other things taken in account? Say, intake of caffeine? Location of the mommas? Maybe it's something like in Erin Brockevich where there is underground chemicals creating problems. I'm just so sick of everything being blamed on the "unhealthy" cow. Everything in moderation, people.

New Posts are at WordPress

Want to know about MRIs for breast cancer detection or anti-choice Eric Keroack resigning his position in charge of family planning? Head on over to Women's Health News's new digs at WordPress.

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Heroes and Superheroes

Ever wonder how a kid looks at heroes?

Like superheroes. That's what they relate them too. Heroes may not have cool super powers such as turning things to ice or having knives come out of their hands (Luke LOVES Wolverine from X-men) but they have powers none the less.

Wonder how I know this?

We were driving by a veterens cemetary and there were three flags plus the United States flag (which Zachary calls our national state flag). He asked what the three flags were for. So Chuck explained that they were for the Army, Navy and Airforce.

Zachary, being the questioner that he is, needed to know more. What does that mean?

Chuck explained that they fight for our country, to keep us safe and to protect us and our rights.

Zachary:

So they're all like superheroes?

Yes, yes, they are sweetie. And let's hope none of us ever forgets that.

Where to start?

I'm tired. That's a good place. I think I'm more tired now than I was in the beginning of this pregnancy. There are days I feel like I hit a brick wall and just can't move any longer. I talked to my midwife about this and the basic consensus is that is my body's way of saying "SLOW DOWN!" Today I slept from about 3 am to 8 am and then again from 10:45 to 11:45 and then again from 1:45 to 3:45. I'm so glad the boys are such good boys and still take naps with me in the afternoon!

But then I get to work and deal with bullshit. Constantly. I don't understand why people make decisions before they fully understand the concept of the job or what actually needs to happen or does happen. And then, when they don't know, they don't ask questions. WHY? *sigh* I'll be glad to be going off on maternity leave. My boss has been telling everyone for months now that I'll be off for at least 6 months (try more like 6 weeks due to financial reasons) but I'm seriously thinking a 6 month hiatus sounds like a freaking God send right now. Except for the fact that after 6-8 weeks I'd be itching to get back to work and have some quiet time and not the insanity of having 3 children in our home.

Next Friday is our first appointment with the psychiatrist for Zachary. This appt. is just for Chuck and I. I'm assuming to go over what we feel Zachary's issues and behaviors are, what the background is...both for him and for our family backgrounds, as well as see what this place has to offer and how they may be able to help. And I so hope they can help. Zachary has seemed to be in a bit of a funk lately and is crying at everything. Absolutely everything. It's driving me a little batty.

A few days ago, I had asked him to go potty before naptime. He said "It's okay, momma, I'm wearing a diaper" Now, this is where I should point out that Zachary is almost FIVE! He's been potty trained a full 1 1/2 years. Luke is now to the point where I would consider him potty trained as well (except for today. He's not feeling well and poop is just running out of him, poor kid). Anyway, I ask Zachary if he means his overnight pull up from the night before. Nope, he shows me. He's wearing one of Luke's diapers.

Zachary gets dressed by himself every morning. Picks out his own clothes and fully dresses himself in his room by himself. I never question it because it's never been an issue. But, yes, he's wearing one of Luke's diapers (also for at nighttime). And he peed in it! He'd wore it all morning at school and then peed in it! WTH? So when Zachary gets into bed for naptime, after changing into underwear at my insistance, he sighs. Really, really heavy-like. I asked him what the matter was. His response: It's just so hard being 4. *big sigh* I wish I were 1 again. It's easier being 1.

Now, it's so hard to not laugh. Because honey if you think 4 is hard, try being almost 30, pregnant with 2 kids and being a working mom. But I withheld the laughter. Because in a way it's kinda sad to me. My kid has such worrisome things on his mind that being 4 sucks. And his brain works in such a way that it upsets him and he worries and thinks about these things. And that worries me too.

So, I'm looking forward to talking with the dr. Plus, on a side note, Chuck and I have to go to the big city ALONE. Maybe we'll have a nice dinner out after the dr. appointment :)

News Round-Up - 3/27/07

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Again with the thinking that women having knowledge is dangerous or scary or just plain bad.

Birth control prices going up on college campuses.

South Carolina wants to force women to look at ultrasounds before having an abortion. Thoughts on that at Aunt B's and in this previous post. Also, the underlying assumption that these silly women just haven't *thought* about it is especially offensive.

Ohio Governor to defund abstinence-only sex ed.

The American Medical Women's Association thinks women 30 and over should also be receiving the HPV vaccine, and has released a statement on cervical cancer prevention.

Anti-abortion folks are targeting urban, African-American women with their campaigns.

The CDC has adopted recommendations on HPV vaccination.

The Lactivist issues a World Breastfeeding Week Celebration Challenge, and dissects TSA breastfeeding policy.

Texas wants to pay women $500 to place babies for adoption rather than choosing abortion. Meanwhile, Surrogate Mothers, Inc. provides estimates of the average cost of having a surrogate mother (equivalent to what these TX women would be) ranging from $15,000-$50,000, depending on the method of fertiization. The Center for Surrogate Parenting website Experienced surrogate mothers will receive $23,000 - $30,000 as their compensation." $500 is about 2% of that $23K figure.

The Women's Bioethics Project blog has an interesting piece on "Bioethics Quilt Project: Black Americans and Medicine."

The Washington Post ran an article describing a woman's battle to get a second opinion on a breast imaging find. Kevin, MD points how how her efforts didn't really lead to better care and incurred unnecessary costs. I can see both points - the woman didn't really get the information or explanation she needed, but her efforts didn't ultimately improve her outcome.

(Hat tips to Feministing, the Kaiser Network, the Lactivist, et al)

Stupid Bill Dies in Committee

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As Sean Braisted is reporting from the hill, and this vote tally page seems to confirm, HB1580 has been voted down by the Health and Human Resources Committee. The bill, covered in this previous post, would have taken authority to require vaccines away from the Commissioner of Health and given it to the General Assembly when the disease is sexually transmitted. Lawmakers made a grab for this authority in reaction to the new HPV vaccine.

Sean says:

The Christian Conservatives oppose this because they want to have cervical cancer as a threat to hang over their daughters heads so that they don't have sex; the state is looking out for the best interest of the girls whose parents are over-confident in their ability to control their daughter's sex life.

I wonder if these same Republicans who are questioning this vaccine, would have put the same grilling towards the polio vaccine? Debra Maggart is comparing the HPV Vaccine to Ritalin...seriously, what is with the Republican aversion to science?

Although much attention has been paid to efforts to make HPV vaccination mandatory, very little has been paid to attempts of this type to circumvent legitimate public health professionals for the sake of the agenda of those who would prefer to deny access to information and healthcare when it comes to adolescents and sex.

Kick Ass Condom Amulet

The condom amulet to the left was made for me by the blogger at a little red hen, knitting activist and fellow Oberlin alum Naomi Bloom, complete with NYC Condoms for my collection. Visit the Safe Sex section of her blog for more about her condom amulet and condom distribution work - Naomi is especially passionate about HIV/AIDS prevention work in women over 50, and is generally a kick-ass, impressive, and generous woman. Go visit her site.

Naomi - I apologize for the quality of the photo - I had to take it on my cell because the regular digital camera is on the fritz. Thanks so much.
Everybody else - The photo doesn't do it justice, but the amulet is styled in Oberlin colors with a knitted loop to make it wearable around the neck.

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Blogging Elsewhere This Weekend

I'll be guest-blogging at at NashvilleIsTalking, run by local ABC affiliate WKRN, this weekend. Come check it out.

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Increase in Cosmetic Surgery in the U.S.

The American Society of Plastic Surgeons released statistics on cosmetic plastic surgery, and reports that:

"Nearly 11 million cosmetic plastic surgery procedures were performed in the United States in 2006, up 7 percent from 2005. Surgical cosmetic procedures increased 2 percent, with more than 1.8 million procedures performed. For the first time, breast augmentation (329,000) is the most popular surgical procedure since the ASPS began collecting statistics in 1992. Minimally invasive cosmetic procedures increased 8 percent, with more than 9 million performed, and hyaluronic acid injectables (778,000) make the top five for first time. Reconstructive plastic surgery decreased 3 percent."

Among the overall trends, "vaginal rejuvenation" increased 30% since 2005, with 1,030 reported. I have mixed feelings about cosmetic surgery. On one hand, you have every right to blow your money that way. On the other hand, I think there's something awry when nearly two million people in one year choose to have elective surgery because they don't think they look perfect enough. I'm also distubed by the Society's piece on what they term "Mommy Makeovers," which apparently include breast augmentation, tummy tuck and breast lift:

"In this day and age, women are giving birth later, returning to their careers sooner, and have busier schedules than ever before. Many are finding cosmetic plastic surgery to be the answer to returning to a pre-pregnancy shape they are comfortable with," said ASPS President Roxanne Guy, MD."

Yeah, women, didn't you know that if you give birth and return to the workplace, you better not look like you popped out a kid? Weren't you just on vacation last week? Damn, you lost some weight. Sheesh.

The Society also reports that women represent 90% of all cosmetic surgery patients, and rates among women are up 55% since 2000. Rates among men are up 8% from 2000, but down 7% from 2005.

Previous related posts:
-Cruel Times for Vaginas
-News Round-Up - 3/11/07 (scroll down to "Feministing takes on vaginal rejuvenation")

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Tennessee Legislators Propose to Take Vaccination Power from Commissioner of Health

A bill introduced into the Tennessee State Legislature (HB1580/SB1958) and discussed this week would take away the power of the Commissioner of Health to require vaccines for sexually transmitted diseases and give that power to the General Assembly. The existing code (49-6-5001(a)) reads:

The commissioner of health is authorized, subject to the approval of the public health council, to designate diseases against which children must be immunized prior to attendance at any school, nursery school, kindergarten, preschool or child care facility of Tennessee.

The proposed legislation would amend that section to add:

provided, however, an immunization for a disease only transmitted sexually, for which a preventive vaccine has been approved and recommended for girls and women in a specific age group, shall not be required unless specifically authorized by the general assembly.

This move stems from controversy over the HPV vaccine, which some worry will promoting sexual activity among girls.

All of those signing on to the bills are Republicans, with the exceptions of Vaughn, J. DeBerry, and Pinion in the House, and Burks, Jackson, and Tracy in the Senate. The bill has been referred to the committees on Health and Human Resources for consideration on 3/28.

The Commissioner of Health is in charge of the Tennessee Department of Health, an agency staffed with public health and healthcare professionals with training in epidemiology and related issues. The current Commissioner, Susan Cooper, has "an extensive background in vulnerable populations, program planning and evaluation, health policy, healthcare regulation, and evidence-based practice." The current General Assembly has a bare handful of people who have ever worked in any healthcare-related capacity. In a segment on local news channel WTVF last night (look for "Lawmakers disagree on HPV vaccine"), Cooper, who is not currently for mandating the vaccine, stated, "I believe that as science changes, the Commissioner of Health is in the best position to keep up with the most recent science and make appropriate recommendations." In other words, she and her people are trained to keep up with this information, and have the skills to appropriately evaluate and understand the evidence. I don't think it's too big of a stretch to assume that the legislature is not trying to capture these powers in order to have better influence on money spent on vaccines, or to ensure that appropriate health-promoting measures are taken - they're doing it because of the "slut shot" hype.

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Benefit & Donations Needed for Shade Tree Family Clinic (Nashville)

The Shade Tree Family Clinic is a free walk-in clinic in East Nashville run by (supervised) Vanderbilt medical students "to address the acute and chronic health needs of uninsured and underinsured patients in the East Nashville area."

The clinic, located at 222 Grace Street, open from 12-4 on Saturdays and 6-9PM on Tuesdays, provides the following free services: sick care; blood pressure care; child physical exams; diabetes management; adult physical exams; STD testing; teen care; HIV testing; medications; birth control; lab testing. A community survey was conducted to assess healthcare needs before the clinic opened, which found that "35 percent of community respondents indicated they had no health insurance, 49 percent used the emergency room for primary care, and 14 percent chose not to seek treatment of any kind for a non-emergency health problem."

There are two ways you can currently support the Shade Tree Family Clinic
If you're in the Vanderbilt community:
A Wing-A-Thon is being held on Friday night, with teams of 1st and 2nd-year medical students facing off to see who can eat the most wings, with music provided by VMS’s own Shun Minutiae. Individuals can pledge to donate $X per wing eaten; the goal is to raise $2,000 for the clinic. The event will take place in the Light Hall student lounge at 8:15 PM this Friday, March 23rd. Via personal communication, organizer Jordan Yokley indicated that those pledging a per-wing donation should expect ~350-400 wings to be consumed. Flat donations will also be accepted and appreciated. VUMC folks should contact Jordan to make a pledge or donation (look it up in PeopleFinder).

Make a Donation:
The Shade Tree Family Clinic, incorporated as a 501(c)3 non-profit organization, accepts monetary and medical supply/pharmaceutical donations. A wish list for the clinic will be available soon.

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Reminder: Free Emergency Contraception Today

Back Up Your Birth Control
Planned Parenthood of Middle & East Tennessee will be providing free emergency contraception on March 20th at the following locations and times:

-Nashville
9:00am-4:00pm
412 Dr. DB Todd Blvd

-Knoxville
9:00am-6:00pm
8078 Kingston Pike, Suite 153

No appointment is necessary.

Blogger's Hospital Won't Allow Birthing Balls

Katie Allison Granju, Knoxville blogger and author of Attachment Parenting, is scoping out locations for her upcoming birth. Katie has specific concerns due to a genetic condition, but also has certain criteria for how she'd like to labor, and has hit several barriers in finding what she needs, as described in this post. Katie would like to labor in water, but the hospital only has two rooms with tubs. She suggested renting one and bringing it in, but was told by the head of nursing that they only allow women to labor in water "if their water hasn't broken and they aren't dilated." In other words, they don't allow women to labor in water. Why a healthcare professional who presumably knows what labor is would tell a woman that she can labor in water if her water hadn't broken and she isn't dilated is beyond me. Nurse Cranky took things one step further, telling her she can't use a birthing ball because she might fall off, and it's a liability issue. Katie also describes the hospital's "support" for women who don't want epidurals - "support" to them apparently means "we won't push drugs on you," but doesn't seem to include any techniques or strategies for helping laboring women otherwise cope with pain.

I did a medical literature search yesterday to try to find instances of birthing ball injuries or descriptions of liability concerns, but found no such evidence. This doesn't mean it has never happened, but it obviously isn't being discussed much in medical publications. Most of these balls, also used for physical therapy and exercise, are pretty sturdy, and are built with sitting, bending, and stretching on them in mind. They're also low to the ground and flexible, so a fall off of a birthing ball would likely be less dramatic than falling off of a bed, chair, or toilet. One commentary from The Practising Midwife, The Risk-Managed Birth Ball," mentions another U.S. hospital that didn't allow birth balls, because "they haven't been risk-assessed," and makes the point, "Instead of simply risk-managing the things that might help women in labour, surely what we really need to address is the culture of fear and litigation which has somehow enshrouded pregnancy and birth, and the ways in which we can break this down, for the sake of everybody concerned."

Kudos to Katie for pushing the issue and standing up against silliness. The dismissive attitude of the hospital staff tells me we have a way to go before the concerns of laboring women are taken seriously.


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Things I Don't Want to Hear Again (on the HPV Vaccine)

Okay, people, you really have to stop it with the "HPV vaccines will turn girls into sluts" argument. I'm serious. My brain might just explode. Today's Tennessean (Nashville's newspaper of dubious quality) has an article, "State official doesn't back mandated HPV vaccine." As you may know, mandating the vaccine for school entry (with generous opt-out provisions) is under consideration or has been enacted in several locales. Tennessee's Commissioner of Health, Susan Cooper, reportedly stated, "Do I think every female child should be protected against cervical cancer? If there's a way to do it, yes. Do I think we know enough about the long-term outcomes of this vaccine to say we ought to mandate it today? Maybe not." This is a common concern about the vaccine (see my concerns about Texas's mandatory vaccination proposal). You want to further examine the science and the money and the implications, fine, good idea.

However, Bishop George W. Price Jr., pastor of Bethesda Original Church of God in Nashville trotted out a already tired old line not based in science - "I'm not for it because it does encourage young girls to have sex outside of marriage, and that's now what it's all about."

Let's be absolutely clear:

• Most girls are probably not avoiding sex solely because of HPV and/or cervical cancer. A recent CNN article profiled a doctor who indicated that few of her patients are even aware of HPV. I would go out on a limb and say that pregnancy is the number one fear about sex for young girls.
  
• Existing data suggests that 9% of high school students report having been forced to have sexual intercourse, and 20-25% of women in college report being victims of completed or attempted rape. This suggests that there are an awful lot of women who may or may not choose premarital sex, but could nonetheless use some STD protection.
  
• Additional reports suggest that by age 44, 96% of males and 94% of females have had premarital sex. 70+% have had premarital sex by age 20. If these data are correct, 3/4 of people are having sex despite their parents' exhortations and wishes, and could also potentially benefit from this protection.
  
• Spouses cheat, and get divorced. The CDC reported a divorced rate of 3.6 divorces for every 1,000 people in 2005. Additionally, some marriages may include an abstinent-until-marriage woman, but a less abstinent husband.
  
• The vaccine is most effective before sexual activity begins (such as before age 20 for about 3/4 of people). This does not require tremendous understanding - we generally understand that we give vaccines for chicken pox, measles, the flu, etc. before people contract the infection, in order to prevent it.

Essentially, there are a number of factors outside an individual woman's control that may mean, even if she intends to be pure as the driven snow until marriage, she may end up with an HPV infection, and possibly resulting cervical cancer.

One anti-vaccination activist previously stated that, “What they are proposing is vaccinating a bunch of healthy girls that are responsible and that do come from good homes for the benefit of irresponsible people.” However, according to the CDC, “Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.” I suppose 80% of women just come from bad homes and are irresponsible.

Planned Parenthood's Mark Huffman responded to such concerns with, "For those parents who are concerned about what kind of effect this will have on their daughter's behavior, we can assure them that related studies suggest very strongly that vaccinating or providing young people with protection around sexuality does not increase the likelihood that they will engage in sexual behavior." Even the notoriously conservative Family Research Council has gotten with the program and realized that encouraging sex is an unlikely outcome - the organization once stated that it might be seen as a license to have sex, but later released a statement in support of the vaccine. One commenter on the story's discussion thread gets it just right - "Let's be clear on this: I got chlamidia[sic] from my husband. Young girls need to be protected, not so that they can go out and do whatever, but so that they will not be victimized in yet another way."

If you're going to oppose HPV vaccination, you can do it for any number of evidence-based reasons. Let's not use "it'll turn the girls into sluts!" Reefer Madness-style propaganda, given the number of holes in that particular argument. If you'll excuse me, I'm off to stick myself with rusty nails and roll around in a blood spill, because I've been vaccinated against tetanus and hepatitis.

FDA Plans to Fully Fund Office of Women's Health

The Washington Post is reporting that the FDA's 2007 operating plan includes full funding at $4 million for the agency's Office of Women's Health. Previously, it was suggested that $1.2 million would be withheld, essentially halting operations for the remainder of the year, which was perceived by many as retribution for the Office's evidence-based (rather than politically-based) stance on emergency contraception.

Women & War

Today's New York Times Magazine has a lengthy piece on women in war, beginning with a profile of Suzanne Smith, a 21-year-old Army specialist who went AWOL rather than be redeployed to Iraq. Swift claimed to suffer from post-traumatic stress disorder, and was pressured to have sex with her commander during her previous deployment. The piece reports that "a 2003 report financed by the Department of Defense revealed that nearly one-third of a nationwide sample of female veterans seeking health care through the V.A. said they experienced rape or attempted rape during their service. Of that group, 37 percent said they were raped multiple times, and 14 percent reported they were gang-raped," and cites findings that women subjected to sexual assault are more likely to develope PTSD.

Although the military has implemented new policies for reporting such abuse, the article reports a "a pervasive sense among them that reporting a sexual crime was seldom worthwhile. Department of Defense statistics seem to bear this out: of the 3,038 investigations of military sexual assault charges completed in 2004 and 2005, only 329 - about one-tenth - of them resulted in a court-martial of the perpetrator. More than half were dismissed for lack of evidence or because an offender could not be identified, and another 617 were resolved through milder administrative punishments, like demotions, transfers and letters of admonishment."

While some may look at stories like these and conclude that women don't belong in war, a more productive approach (given clear personnel needs) might be to take advantage of these individual women's willingness to speak out to tackle the larger problem, attempt to change a sub-culture of violence against women in the military (remember, these men come home to women and society as well), and to ask questions about how we can train killing machines without training dominance machines in general and how we can maintain killing machines if we have to acknowledge that they may be profoundly emotionally affected by their actions and experiences (because women aren't the only ones coming home broken).

More Nursing Hand-Offs May Be Associated Greater Risk of C-Sections

A study published in the current issue of the journal Birth examined the number of nursing hand-offs (switches in the nurse responsible for a patient's care) for women giving birth to determine whether this was associated with a greater risk of having a c-section.

Who Was Included
Researchers looked at the medical records at a university teaching hospital in Quebec, Canada 9with a c-section rate of 24%). They examined records for women who were admitted to the intrapartum (labor & delivery) unit, were having a 1st birth of a single baby, had a vertex presentation (baby coming out head first), and were at 37 weeks or more gestational age from March 1997-March 1998. Records for 467 women were included in the study that met the inclusion criteria and had complete data.

What Was Done
Medical records included the recording of the nurse (with date and time) responsible for each woman; the researchers examined the number of nurses caring for each woman during labor, the number of times care responsibility switched (patient taken care of by a different nurse), and length of time each nurse was responsible for the laboring woman. Data also included predictors of cesarean birth, such a length of labor, infant birthweight, day of week, maternal age, gestational age, method of delivery, physician attendant during pregnancy and birth, maternal height, type of rupture of membranes, epidural anesthesia, stimulation, and induction. This data was used to control for factors that might also influence c-section rate.

What They Found
After controlling for other factors that may lead to c-section, the researchers found that the number of nurses caring for a laboring woman was associated with number of c-sections. The authors state that "each additional nurse caring for the same laboring woman was associated with a 17% greater risk of cesarean section, with a range of risk 4-32% greater." Other factors ("switches" ≥1 per 2 hours, same nurse responsible for ≥33% of labor) were not statistically associated with a greater risk of c-section.

Comments
The authors note that it might seem strange that only one of the three nursing factors was associated with greater risk of c-section, stating: "Given that the 3 indicators are very closely related, someone might have thought that if one showed an effect, so too would the others. The lack of effect of the "number of switches," however, might be explained by the fact that several switches could have occurred among few nurses (e.g., nurses who are paired) such that a relatively high level of continuity of responsibility remained. Having the "same nurse responsible for ≥33 percent of the labor" likely provided some of the information already included in the "number of nurses," whereas the latter included additional information." They essentially found that while the total number of nurses and greater length of time (>1/3 of time) was not associated with increased c-section risk, the total number of switches is what mattered.

One of the findings that might be somewhat surprising is that the number of nurses per woman ranged from 1-17 (mean, or average, of 5.4), the number of hand-offs or switches per woman ranged from 1-31 (mean 4.5), and the range of length of labor that a single nurse stayed with a woman was 10-1,045 minutes, or from 1/6 of an hour to 17.4 hours (mean 126 minutes, or 2.1 hours). Mean length of labor was 14 hours, with 26% laboring less than 9 hours. Although more individualized data on length of labor and duration of care is not provided, it is clear from the 1-17 range of switches that none of the 467 women were cared for continuously by a single nurse throughout their labor.

Citation
Gagnon AJ, Meier KM, Waghorn K. Continuity of nursing care and its link to cesarean birth rate. Birth. 2007 Mar;34(1):26-31. Free Full Text

Girls' Weightlifting

From Florida, in today's New York Times: "She was an Atlas of the exurbs, hoisting a 210-pound barbell over her ponytailed head and holding it there, arms just barely aquiver, while the high school gymnasium exploded in cheers. At that moment on a recent Saturday, Jessica Reynolds, 17 and weighing in at 261 pounds, broke the state record for girls’ weightlifting, a high school sport sanctioned only in Florida..." According to the report, no other state has officially adopted weightlifting for girls, as the Florida High School Athletic Association did in 1997.

I think it's fantastic that "it’s pretty much understood that weightlifting is O.K. and you’re not a boy and you’re not gross if you do it,” as one senior weightlifter said, but it's telling that it supposedly took this to gain acceptance: "The presence on many teams of cheerleaders — who become better jumpers and fliers after lifting — has helped remove the stigma from the sport, several girls said. Many wear bows in their hair at competitions, and at a recent meet, one wore pearls with her singlet." Essentially, when the team became more stereotypically "girly," it became more acceptable in general that these strong young women were intruding upon traditionally male territory.

Union Pacific Wins Case to Deny Contraception Coverage

Yesterday, the 8th Circuit Court of Appeals ruled that Union Pacific's policy excluding contraceptives from its health plan does not discriminate against women. The Court's ruling stated that, "Union Pacific's health plans do not cover any contraception used by women such as birth control, sponges, diaphragms, intrauterine devices or tubal ligations or any contraception used by men such as condoms and vasectomies. Therefore, the coverage provided to women is not less favorable than that provided to men."

Female employees of Union Pacific sued the company for sex discrimination under Title VII amendment, the Pregnancy Discrimination Act, and a district court granted a partial summary judgment in July 2005. Union Pacific appealed the ruling, which the 8th Circuit Court reversed with this decision. The Court decided that the PDA does not apply, because contraceptive use occurs prior to, or to prevent, pregnancy, and so is not related to pregnancy discrimination, and that because contraception is not covered for men or women, it is gender neutral and not sex discrimination.

The dissenting judge (Bye) in the 2-1 ruling disagreed with the gender neutrality of the policy, stating that:

When one looks at the medical effect of Union Pacific’s failure to provide insurance coverage for prescription contraception, the inequality of coverage is clear. This failure only medically affects females, as they bear all of the health consequences of unplanned pregnancies. An insurance policy providing comprehensive coverage for preventative medical care, including coverage for preventative prescription drugs used exclusively by males, but fails to cover prescription contraception used exclusively by females, can hardly be called equal. It just isn't so...even if we were to look at its exclusion of coverage for vasectomies, the policy nonetheless discriminates against females. When a policy excludes coverage for vasectomies, the medical effect of this exclusion is born entirely by women, as the record demonstrates women are the only gender which can become pregnant...Women are uniquely and specifically disadvantaged by Union Pacific’s failure to cover prescription contraception. Because I believe such a policy is violative of Title VII, as amended by the PDA, I respectfully dissent.

The Court's Opinion [PDF]

Connecticut Lawmaker Tells Personal Story of Rape in Support of EC Access

On Tuesday, Connecticut State Representative Deborah Heinrich told a crowd gathered for a press conference of being raped while in college. Heinrich, in support of a bill that would require all state hospitals to provide emergency contraception, reportedly stated, "Every woman in the state must be assured that when she finds that last ounce of strength, that last bit of trust that will allow her to enter the doors of the hospital, that no matter which hospital she manages to stumble into, that she will be assured of having the highest standards of care. For a rape victim, that must include being offered emergency contraception." Heinrich indicated that only her immediate family had been aware of her rape prior to her announcement, and described the strength it took for her to seek help after her rape, stating that she would not have had the stamina to go elsewhere had a hospital told her to do so for EC.

Colorado Governor Signs Legislation to Require Hospitals to Inform Rape Victims of Emergency Contraception

Colorado Governor Bill Ritter signed into law today a bill requiring hospitals to inform patients who are victims of sexual assault of the availability of emergency contraception. The bill, passed in the Colorado Senate as SB 07-060 [PDF], states:

"All health care facilities that are licensed pusuant to this Part 1 and provide emergency care to seual assualt survivors shall amend their evidence collection protocols for the treatment of sexual assault survivors to include informing the survivor in a timely manner of the availability of emergency contraception as a means of prophylaxis and educating the survivor on the proper use of emergency contraception and the appropriate follow-up care."

It does allow healthcare providers to refuse to provide information about emergency contraception "on the basis of religious or moral beliefs," and does not require providers to provide emergency contraception if they determine that there is no risk of pregnancy or the victim was already pregnant at the time of the assault. The legislation calls it "critical" that victims have accurate information about the availability and use of emergency contraception, so "encourages" but does not require victim assistance/counseling and rape crisis hotlines to provice information on EC and for pharmacies in the state to distribute EC information. Further, the bill requires pharmacies that do not have the drug in stock to prominently place a sign reading, "Plan B Emergency Contraception Not Available."

The findings (or, the rationale) for the legislation included the following points:

One of every six women in the United States and one of every four women in Colorado will be the victim of a sexual assault

Forty-four percent of the victims of a sexual assault are under eighteen years of age, and eighty percent of the victims of a sexual assault are under thirty years of age

It is estimated that sixty percent of all sexual assaults are not reported

A woman who is the survivor of a sexual assault may face the additional trauma of an unwanted pregnancy or the fear that pregnancy may result

Each year, between twenty-five thousand and thirty-two thousand women in the United States become pregnant as a result of sexual assaults, and approximately twenty-two thousand of these pregnancies could be prevented if these women used emergency contraception

The findings go on to cite recommendations for EC information provision, and the drug's safety and efficacy in preventing unintended pregnancy. This legislation correctly locates EC, given the scientific evidence, as a means of preventing, but not terminating, a pregnancy. Previous Governor Bill Owens vetoed a similar bill in spring of 2004. When Ritter ran for the Governor's seat, he included a platform of reducing unintended pregnancies through better family planning, better access to health care including birth control and emergency contraception, providing responsible sex education, and promoting adoption. Ritter also stated, "Improving education, health care and our economy - which will be the top priorities for my administration - will do more to improve the lives of children and reduce the number of abortions in our country than a divisive focus on punishing the women who find themselves turning to it as a solution."

CHUCK!!!!

If you happen to read this, please call me at work.

The phone line switched over to the digital and the cordless isn't plugged in, so I can't get through to you. I left a voicemail.

I'm trying to figure out how to see if we have voicemails and how to retrieve them now :)

Women's Health News Also Available on WordPress

I'm playing around with WordPress to see if I want to move there from Blogger. If you want to take a peak, and let me know if you prefer one over the other, the site is at womenshealthnews.wordpress.com. I haven't committed to the move yet, and you'll have plenty of warning before I do. Please note that the WordPress page is still in progress, so the categories, blogroll, etc. are not yet fully developed.

Ongoing HPV Vaccine Debate

The HPV vaccine from Merck continues to make the news and inspire debate. The Nation published "Who's Afraid of Gardasil?" online ahead of the March 26 print issue in which it will appear. The piece indicates that as many as 31 state legislatures are considering requiring the vaccine, and estimates that Merck stands to make $4 billion per year on the product. Concerns about the role of Merck's political contributions in influencing legislators and the Women in Government group who have supported the vaccine push are described, as is the problem that Merck's swift push to require the vaccine has generated controversy and opposition where a slower, more measured approach might have had more success.

AlterNet also has two pieces on the vaccine, "HPV Vaccine Out of Reach for College Students" and "HPV Vaccine: Public Health Boon or Big Pharma Bull?"

Meanwhile, Feministing reports that New Mexico is close to requiring the vaccine, and the Texas Attorney General has issued an opinion stating that the Governor's executive order requiring the vaccine for schoolgirls does not carry the weight of law.

Random Thoughts Tuesday

Maybe I should make this a regular posting. Every Tuesday I spurt forth all my random shit for the week.

Have you ever felt like you are just nothing in this world. Like no one truly gives a shit about you other than to tell you what you are doing wrong and what you should be doing? No matter how much you care about other people and want to and try to get involved in their lives, you're just an insignificant particle of dust on their shoe to be wiped off? Yea, I feel like that tonight.

I hate know-it-alls. And I work with a few. One is telling me that the cold I have is bronchitis and I need to see the dr. NOW. And just why don't you take medicine? Doesn't matter that you are pregnant and don't want the baby to come out deformed. At least I'd be comfortablle. Pah! Oh yea, and then there is the know-it-all that is bound and determined that SHE did it right, so therefore it must be computer error. *sigh* I hate that. It's called "OE" honey. (That's operator error for those not knowing the lingo).

I think it's God's cruel little joke that men and women are on different horniness schedules. No, seriously. I think maybe it's like natural birth control or something. I'm not feeling well today...headache, sinus pressure, sore throat, just feeling pretty shitty. Today is the day Chuck decides to stay home from work and wants to get it on. Um, no. Seriously, I'm almost ALWAYS up for it but I feel incredibly UN-SEXY coughing up phlegm. Maybe our issue is also the night-day thing...because he's raring to go in the mornings...and I'm soooo ready to go when I get home from work at night at...oh....1:30 am. When he's sleeping. Yea, makes for some great times huh?

I think it's hotter than a stuffed pig in this building. I hate that the state can't regulate the temperatures any better than this. My hands are swollen, my feet are swollen, and I think I'm dehydrating. I need to be chugging more water that's for damn sure.

65 more days. Okay, I freaked out a little bit about that yesterday. 65 more days. That's like almost 2 months exactly till I have this baby! Yikes! Where did the time go? How the hell am I going to get anything done at all? I'm getting to the point in my pregnancy where I'm running out of breath really easily and fatigued a lot more. *sigh* Just running after the boys is wearing me out. I think I might suggest my brother's suggestion to Chuck of just hiring out the drywall job. We'll see.

I need new shoes. Period. And maybe a nice new purse/wallet combination. Mine sucks.

Free Emergency Contraception in Nashville & Knoxville, 3/20/07

Planned Parenthood of Middle & East Tennessee will be providing free emergency contraception on March 20th at the following locations and times:

-Nashville
9:00am-4:00pm
412 Dr. DB Todd Blvd

-Knoxville
9:00am-6:00pm
8078 Kingston Pike, Suite 153

No appointment is necessary. According to the organization's MySpace page, they will also offer free pap tests on May 19th, so mark your calendars and get screened.

News Round-Up - 3/11/07

D.C. moves closer to requiring HPV vaccine for girls entering 6th grade

Kroger groceries reiterates policy of providing access to emergency contraception. In response to questions, a Kroger spokesperson, "couldn't tell us which of the Nashville area's 60-plus Kroger pharmacies carry Plan B because those numbers are "strictly based on what kind of demand each individual pharmacy has...f they've never had a customer ask for that medicine, they may not have it."

Salon has a lengthy piece on sexual abuse of women soldiers and the military cultural barriers to reporting assault.

Some colleges may expel suicidal students.

The National Heart, Lung, and Blood Institute released an online guide to healthy sleep [download as PDF].

Older mothers more likely to deliver by c-section, and nobody can figure why. "Researchers funded by the National Institutes of Health have found that older mothers with normal, full-term pregnancies — particularly first-time older mothers — were more likely to undergo Caesarean delivery than were younger women with similarly low-risk pregnancies." Older mothers may be more likely to have certain complications, but c-section rates were higher in normal, uncomplicated pregnancies as well.

Belly Tales has a great post up discussion premature rupture of membranes at term, induction of labor, and the problems associated with active management in labor, and the evidence base on this topic, with lots of references. I hope The Student works this up for publication as a review article somewhere.

Feministing takes on "vaginal rejuvenation," which was featured in this recent article in the Washington Post. Although "the American Society of Plastic Surgeons began tracking vaginal rejuvenation in 2005 and recorded 793 procedures that year" and one doctor reports that "he has performed more than 3,000 in the past 12 years and has trained 140 doctors in a dozen states and 20 countries," one past president of Society of Gynecologic Surgeons states that "There is absolutely zero scientific literature that supports . . . the notion that firing a laser of any kind will tighten [vaginal] muscles," and calls the surgery 'a ripoff.'" Another doctor "who has operated on 18 patients, said he does not consider the lack of published studies to be problematic." Ladies, repeat after me, "If it doesn't cause me pain or otherwise have something medically wrong with it, spending $3,000 for unstudied, loosely regulated 'vaginal rejuvenation' is not going to fix what's really wrong with my self-esteem or relationship. If my partner thinks my vulva or vagina is not 'pretty' enough or 'perfect' enough, he can collect his stuff at the curb and look for a new one." Say it with me three more times. Got it?

High school girls suspended for saying "vagina."

If you're in Pennsylvania, you may want to contact your legislators to support a breastfeeding bill The Lactivist describes.

The Lactivist also notes that tv show SuperNanny may be trying to shock you with a baby still being breastfed at 14 months. Nevermind that the World Health Organization recommends breastfeeding up to 2 years and beyond.

The Well-Timed Period wants to know why a reporter would let a faith-based assessment of Plan B side effects in his story not be balanced by actual evidence.

CNN reports on radiation for breast cancer and heart disease risk

More crap for you to spend money on that you probably don't need, again with making you feel insecure for no reason.

International Women's Day Redux

As a follow-up to my previous post on International Women's Day, here is a selection of past posts related to non-U.S. women's health. Many of them make mention of news stories, films, or situations that are worth a look.

Frontline Program on Sex Slaves - information on the program covering human trafficking (including a link to a complete transcript), as well as links to organizations fighting trafficking and sexual slavery.

The Unfortunate Experiment - information on an unethical experiment in New Zealand that deliberately let cervical cancer go untreated in numerous women, often without their knowledge.

On Giving Birth in Iraq - information from and link to Washington Post story on the barriers women face when giving birth in Iraq
On Giving Birth in Iraq, Part II - follow-up link to Morning Edition with reporter's perspective on his wife's birth experience in Iraq.

One to Watch: Motherland Afghanistan - review of a documentary highlighting the broken state of maternity care in Afghanistan with links to the film's website and related resources.
Reminder: Motherland Afghanistan Airs Tonight - includes information on the Afghan Women Empowerment Act of 2007.

The Women of El Salvador - information from and links to a New York Times Magazine piece on El Salvador's complete ban on abortion.

Global Unsafe Abortion Resources - overview and links to additional resources.

99 Luftballoons

So, this really doesn't have ANYTHING to do with the song at all. Just a funny story involving my oldest son, Zachary.

I have a red bra. It's see-through and really hot and of course, my hubby loves it because it's the most uncomfortable bra I have. But my boobs do look good in it.

I was in my bedroom dressing one day when Zachary walked in. I told him to go out and get ready to go that momma was getting dressed. I hadn't put my bra on yet...and he asked what that metal bar was through your booby. I explained that mommy had a ring through her nipples just like I have a ring through my ears. I hurriedly put my red bra on (I had NO other bras washed that day).

He points to my boobs and says "Hey, look momma, you have 2 red balloons!"

OMG, I don't know how I stopped myself from dying of laughter. "Yep, buddy sure looks like it doesn't it?"

Chuck got a HUGE kick out of it, of course.

So, not much has been said from Zachary about it since I stopped wearing that red bra.

Until today.

I was picking him up from school and his little friend said "Hey Zachary, you're mommy is going to get a new baby!"

Zachary said "YEP! And you know what else she's got? TWO big red balloons right here!" and spreads his hands across his chest.

Luckily the teachers didn't hear, and there were no questions...so I chuckled to myself and high tailed it out of there!

International Women's Day

Today is International Women's Day and Blog Against Sexism Day, and I've decided to dedicate my commemorative post to online resources dealing with international women's health issues.

World Health Organization:

Statement by Dr Margaret Chan, WHO Director-General, on the occasion of International Women's Day

Sexual Violence

Women and HIV/AIDS

Gender and Other Health Topics

Sexual and Reproductive Health

Female Genital Mutilation

Others:

Amnesty International: Stop Violence Against Women

Black Women's Health Imperative - primarily US, addresses health disparities

Center for Reproductive Rights

Doctors Without Borders

EngenderHealth

Global Alliance for Women's Health

Global Health Council

Guttmacher Institute

Human Rights Watch: Women's Human Rights

International Women's Health Coalition

Latin American and Caribbean Women's Health Network

MADRE: An International Women's Human Rights Organization, and MADRE's report on gender-based violence in Iraq

Our Bodies, Ourselves: Global Women's Health and Global Access to Birth Control

Planned Parenthood - Where we work internationally

Safe Motherhood

Stop Rape Now

UNICEF: Child protection from violence, exploitation and abuse

United Nations Development Fund for Women

WomenWatch: United Nations Inter-Agency Network on Women and Gender Equality

Women's Global Health Imperative

World Alliance for Breastfeeding Action

The Youth Coalition

Bombing Our Own Territory, and Making Women Sick?

Women's eNews has a piece today, "Vieques Women Claim Navy's Toxins Destroy Health," regarding the U.S. Navy's decades of bombing practice on Vieques, Puerto Rico and women's claims that this has caused health problems such as cancers. According to Dr. Cruz M. Nazario, an epidemiologist at the University of Puerto Rico quoted in the story, "Before the Navy stepped up target practice, Viequens had one third the average risk of cancer. That risk is now 30 percent higher than average. There is no industry or other source of contamination here to release carcinogens into the environment, so many scientists believe the cause must be mercury, aluminum, arsenic and other pollutants left by the military."

Debate continues over the role of the bombings in the islanders' health problems. The story states that in recent years the U.S. government's "Agency for Toxic Substances and Disease Registry to conduct a series of studies of the island's air, soil, water and fish. All of this research, done in the early 2000s, concluded toxin levels were safe." Vieques has been designated a Superfund site deserving priority cleanup.

I haven't had a chance to do much background reading into this situation, but will post an update after I do.

33rd Carnival of Feminists is Up

The 33rd Carnival of Feminists is up at "The Greatest Blog You'll (Probably) Never Read." Last week's post on "Pelvic Exams and Informed Consent" is included, as are links to other bloggers' takes on feminism on Facebook, solo traveling, Barack vs. Hillary, women athletes, advertising, the HPV vaccine controversy, and more.

Hopes becoming realized

Have you ever had something that you wanted soo bad and then when it's just about on your doorstep, you step back and think "holy shit! What's going on? Did I want this?"

I'm freaking out a little. Just *a little*.

Last week, Zachary was observed for the first time by the KEEP counselor. Tuesday I was able to meet with Sheila and we talked for almost an hour. I was very upfront and forthcoming with her (as that's just who I am) and discussed some of our biggest concerns for Zachary. I explained that we saw a psychologist about 7 1/2 months ago who seemed like he would be on the right track but never got back with us. I explained that Chuck was diagnosed bipolar after a very, very rough few months. I explained that we've seen differences in Zachary since he was about 18 months old. I think because Chuck grew up bipolar and probably ADD, we look for things since it is highly hereditary. At first, we didn't know WHAT we were looking at, but I like to be somewhat knowledgeable and looked at a bunch of stuff and try to know my kid. So I gave her all my opinions and observations and background, and was told that we were seeing things way before most parents AND very astute for seeing these things.

She suggested that we (meaning her and us) contact this Dr. that specializes in bipolar and either rule it out or get a handle on it first. Especially since this Dr. is a big guru in the feild and runs a bipolar assessment clinic. I said GREAT! Let's see what he has to say.

Sheila called me this morning. Said things were moving a lot faster than anticipated and normal. Said that the Dr. emailed her back almost immediately and wants us to contact him directly to set up the appointments and get information. So, I googled his name.

Wow. Seriously, this guy has written books on the Bipolar Child. Has a bipolar child himself. Tours the country lecturing on the behaviors of bipolar children and teaches pediatric psychology. AND collaborates with another specialist on bipolar children and autism. (Aspergers is one of the things that has been brought up before). AND Dr. Glovinsky does all the testing for the gifted children for a big school in the Detroit area.

I feel so damn lucky to be able to have this opportunity to get Zachary in with someone GREAT. And for Free! Yes, free. He donates his time through the community health department (which is the program Sheila works with is through).

But I just feel like OMG...what's happening? What if it is these things? How do I deal and cope? What if it's not? I'm going to feel like a tool for making a mountain out of a mole hill.

Now, of course, I've already called the dr. and am waiting for a return call and we'll do whatever is necessary to get Zachary whatever help he needs for him AND us to be successful. But I still feel like everything is moving so fast now and I just don't know what to think or do.

I'm weird....I know that.

But this post is going to prove that.

There are a few people out there I find hot. Usually it has to do somewhat with an accent.

But there are a few that makes even me scratch my head.

Mr. Tumnus from Narnia. He's pretty hot AND he has an accent.

I think it has to do with the expressiveness in his eyes. I was watching Narnia the other day with the boys and his eyes and eyebrows just struck me as so sexy. I find a man who can talk with their eyes VERY attractive. One of the reasons I fell for my husband and why I love winks.

And then there is this one. Why? I don't know. I think it goes

back to the expressiveness in his features during the commercials. I wonder what he looks like WITHOUT makeup.

I was told by Chuck today that ABC has purchased the rights to make a sitcom of the Geico caveman from the commercials. I'll be interested to see it because quite frankly the commercials almost make me pee my pants. Well, it's not really that hard to do anymore BUT they are pretty funny.

Okay, so I find out that one of the cavemen is Ben Weber. Funnily enough he's not that hot as a non-caveman guy. Shucks.

It's very sad that I'm spending my lunch hour looking this shit up. Lately I've been all about deep random thoughts that mean absolutely nothing.

I AM SPEED!

LOL...I'm probably gonna have to explain that one later.

Best of the Web Today

The Wall Street's Journal's "Best of the Web Today" describes what it called "an amusing little dust-up from the Volunteer State," referring to my dispute with Bob Krumm regarding the response I received from State Senator Henry on the "death certificates for abortion" bill. It also refers to Aunt B's response, which smartly made the point that Krumm's comments overlook or misunderstand my concerns to focus on his perception that I didn't "jump through the hoops correctly" - and I do think B got that exactly right. My original post on Henry's letter is quoted, as is my response to Krumm.

"Best Of" author Taranto's most amusing comments? Referring to me as a "blogress" and stating, "We'd actually go beyond this and say Rachel clearly is literate." My parents will be thrilled.

My Boobs Look Funny

I jumped out of the shower at the gym this morning to find that I had either forgotten my regular bra or managed to lose it somewhere on the street/elevator. Thus, I'm stuck wearing the not-exactly-freshly-washed sports bra all day. I hereby declare today the Day of the Uniboob, and establish a 5-foot olfactory security perimeter around my person.

Senator Henry Dismisses Complaints About Campfield's Death Certificates Bill

Last month, I used NARAL's action form to contact my state Senator, Douglas Henry (a Nashville Democrat), regarding Stacey Campfield's proposed legislation to issue death certificates in abortion [SB1094 by Bunch in the Senate, HB0982 by Campfield in the House]. The letter pointed out that Tennessee already collects abortion statistics, and that serious privacy concerns are involved. I have already discussed my concerns about the bill, and Campfield's immature and unresponsive actions with regards to criticism of this legislation. Today, I received the following letter from Senator Henry (a member of the Senate's Health and Human Resources committee), which similarly addresses none of the concrete concerns raised regarding this bill:

March 1, 2007
Dear Constituent:

Thank you for your recent correspondence regarding Senate Bill 1094. It has always seemed to me that one's viewpoint on unborn children depends on whether one views the matter from the standpoint of the child on one hand, or from the standpoint of the unwilling prospective mother on the other hand. There are certainly strong arguments in favor of the unwilling prospective mother, but I decided long ago that I would come down in favor of the child. Appreciating your having written,

I remain,

Very truly yours,
Douglas Henry

Let's be absolutely clear. In addition to the question of whether Campfield understands the implications of his own proposal and/or is being honest or mature about it, Campfield's bill does nothing to reduce unwanted pregnancy. It does nothing to provide access to or information about contraception or related health services such as prenatal care. It does nothing to provide the kinds of support women need to successfully carry a pregnancy to term and raise a subsequent child. What it does is create an additional means of bullying, shaming, and potentially endangering women who, for whatever reason, find it necessary to seek out a legal abortion. Receiving a pithy talking points memo from Henry as a response, one that does nothing to address the legitimate concerns about this bill, is an insulting demonstration of how unwilling certain Tennessee legislators are to appropriately respond to constituents and engage in meaningful discussion of proposed legislation that could profoundly affect women's (and constituents') lives.

Note: I don't have a scanner at home, but if anyone would like to see proof of Henry's statements, I will be happy to access one and provide it.

Update: Bob Krumm, who was defeated by Henry in a recent election, responds to my post here. What Krumm fails to recognize is that it doesn't bother me if Henry sent the same form letter to everyone writing to him on the bill. What bothers me is that his letter did not substantially respond to any of the legitimate concerns raised regarding this piece of legislation. More of my response here and here. Also, Aunt B and her commenters get it exactly right.

Technorati Tags: abortion; legislation; reproductive rights; tennessee

What's Missing From Model Pelvic Exams

As mentioned in a previous post, some medical teaching institutions have switched from having medical students perform pelvic exams on (often unaware, non-consenting) live women with technological devices, such as this pelvic ExamSIM from Medical Education Technologies, Inc. An author comment (1) following the article reporting disturbing attitudes toward consent (2) rightly points out that these models omit important information about performing pelvic exams, namely the patient's experience of pain or discomfort, and the interaction with the patient as a whole. It takes but a glance at the image to the left to realize that existing models are disembodied and standardized. How many of you would look at your own genital region and think that it is similar to the model shown? What can a medical student learn about pain and natural variations in human anatomy from a model so removed from real women's anatomy and experiences? While anatomical models may be a better option than assaulting unconscious women, I've yet to see a woman's body that looked anything like the image shown.

The authors state, "Students are not learning how to palpate for pain—an extremely important indicator of pathology—and the surgical focus on anatomy does not emphasize the importance of examining each woman with gentleness, with sensitivity to her psychologic state, and with respect for her intellectual presence. When these repeated preoperative educational examinations are performed without the patient's informed consent, the cost to both patient and student is even greater. A tremendous number of women describe these examinations as a form of violation; that fact alone should warrant change. Additionally, our survey research has shown that medical students place less value on the importance of informed consent after participating in the third-year obstetrics-gynecology clerkship than they placed on it before the clerkship. The bottom line is this: teaching institutions should make sure that students do not examine patients, whether alert or anesthetized, until someone first receives the patient's informed permission."

Another published comment (3) in response to the article more pointedly states, "hospital administrators who allow medical students in their facilities to perform pelvic examinations on unconsenting anesthetized women ought to consult with their legal counsel concerning the definition of rape in their jurisdiction."

Citations:
1) Ubel PA, Silver-Isenstadt A. Author reply. Am J Obstet Gynecol. 2003 Dec; 189(6):1808-1809. [Full-text]
(2) Ubel PA, Jepson C, Silver-Isenstadt A. Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003 Feb;188(2):575-9. [Full-text]
(3) Coxe MF. A change in medical student attitudes of obstetrics-gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003 Dec;189(6):1808 [Full-text PDF]

Where did the tags go?

Now that I've been forced to switch to the new Blogger, which includes a "labels" feature for posts, I'm pondering whether I want to continue adding Technorati and MeSH tags to each post. If you have a preference, please let me know in the comments.

Pelvic Exams and Informed Consent

The New England Journal of Medicine has a perspective piece by Adam Wolfberg in the current issue (1), "The Patient as Ally — Learning the Pelvic Examination," which addresses the issue of teaching pelvic examinations to medical students. It provides some telling information about the history of how this exam was taught, stating, "in contrast to ambulatory care, the gynecologic operating room has historically provided medical students with an opportunity to learn this exam: they could perform it in anesthetized patients immediately before surgery." This practice became extraordinarily controversial when it became more widely known that pelvic exams were often performed on anesthesized surgical patients without their knowledge or consent, as a teaching tool rather than for medical care. According to the piece, "Academic gynecologists were accused of using patients as unwitting "training dummies" — a reaction exacerbated by the report's revelation that students who had completed an Ob/Gyn clerkship were less likely than other students to believe it is important to obtain the patient's consent for such an exam."

The study cited (2) found that only 51% of those who had completed an OB/GYN clerkship thought consent prior to pelvic exam was "very" or "somewhat" important - 24% were "neutral," 15% found consent to be "somewhat unimportant," and 9% thought consent was "very unimportant." Those who had not done an OB/GYN clerkship were only somewhat better on the issue of consent, with just 70% stating it was "very" or "somewhat" important - still far short of the 100% consent women might reasonably expect. Interestingly, the survey was conducted in 1995, but this paper reporting the results wasn't submitted until 2002 or published until 2003. Women familiar with the practice of performing pelvic exams without consent may assume it happened "a long time ago," but these findings suggest otherwise.

Wolfberg provides disturbing insight into how complaints about this practice are perceived by physicians. Regarding the distinction made by those opposed to the practice who insist that the patient's consent is absolutely necessary for procedures done solely as a teaching tool, the author states, "This stance rankles physicians who downplay this distinction — particularly those who are uncomfortable asking their patients to give written permission for a medical student to perform an operating-room examination. Patients, they argue, are already nervous about surgery, especially when they must sign the surgical consent form describing everything that can go wrong; the last thing they want at that point is to be asked to allow a medical student to examine them." This paternalistic attitude is extremely troubling, a sign that some physicians think women shouldn't have to worry their pretty little heads about what might be done to them without their knowledge while they're knocked out in a hospital. Rather than coming to the conclusion that the exam should then not be performed without explicit consent from women, individuals and institutions have in the past jumped to the conclusion that they simply shouldn't ask or tell when violating women's vaginas.

In response to the controversy, Wolfberg explains, many medical schools have clarified their policies, banned this activity, and switched to teaching the exam with a paid live volunteer or with technological device (such as the Pelvic ExamSIM, a ~$19,000 device), which may not reflect the full range of women's anatomy and experience of the pelvic exam. Others have decided that a fully informed consent approach might actually work - contrary to physicians' fears that women would refuse to be examined for teaching purposes, one OB/GYN residency director found (3) that "more than 80% of patients agreed to let a student examine them in the office if they were asked in advance and didn't feel that they were being pressured."

Citations:
1) Wolfberg AJ. The patient as ally--learning the pelvic examination. N Engl J Med. 2007 Mar 1;356(9):889-90. [Extract - 1st 100 words]
2) Ubel PA, Jepson C, Silver-Isenstadt A. Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003 Feb;188(2):575-9. [Full-text]
3) Berry RE Jr, O'dell K, Meyer BA, Purwono U. Obtaining patient permission for student participation in obstetric-gynecologic outpatient visits: a randomized controlled trial. Am J Obstet Gynecol. 2003 Sep;189(3):634-8. [Full-text]

Women's History Month at the National Library of Medicine

March is Women's History Month, and the National Library of Medicine in Bethesda, MD is celebrating with this lecture:

"Leona Baumgartner and the New York Department of Public Health: Déja Vu All Over Again."
Julia Frank, MD, George Washington University,
Tuesday, March 13, 2007, 2:00 - 3:15 p.m.
Lister Hill Auditorium, Building 38A

A graduate of Yale's School of Medicine, Baumgartner was the first woman commissioner of New York City's Department of Health, from 1954-1962.

Information for visitors to NLM (at the National Institutes of Health) is online here.

The National Library of Medicine also hosts the online "Changing the Face of Medicine" exhibit, which explores "the many ways that women have influenced and enhanced the practice of medicine." A searchable directory of female physicians is provided, with profiles for each addressing the women's inspirations, biographical details, Q&A with the living physicians, and photos. A profile of Baumgartner is included in the exhibit.

Friday News Round-Up - 3/2/07

I ususally do these on Saturday, but had the content all set up and ready to push through, so here you go:

New England Journal of Medicine (free full-text) - Cesarean Delivery and the Risk-Benefit Calculus - this perspective piece states, "As practicing obstetricians, we find that the risk that women are now willing to assume in exchange for a measure of potential benefit, especially for the neonate, has changed: for many, the level of risk of an adverse outcome that was tolerated in the past to avoid cesarean delivery is no longer acceptable..." without asking whether this is linked to the number of unnecessary c-sections physicians have advocated for and insisted are necessary over the past decades. More on this later.

The Mommy Blawg has a roundup of midwifery-related legislation (found via Belly Tales)

UN Dispatch on community-based interventions to reduce violence against women

Could the REAL ID Act endanger victims of domestic violence? Melissa Ngo thinks it could.

Statehealthfacts.org has added information on women's health, including "new state-by-state and national data for 2006 on state mandates for cancer screening, inpatient mastectomy stay, post-mastectomy breast reconstruction, fertility treatment and osteoporosis screening. In addition, information on mandates for direct access to ob-gyns and for ob-gyns as primary physicians has been updated."

From the Kaiser Network, Increasing Number of Hospitals Banning Gift Bags Containing Samples of Infant Formula. Ban the Bags works to increase these bans, as providing samples of formula is thought to discourage breastfeeding. (found via Katie Allison Granju)

March 8 is "World Kidney Day"

Does bad PR for Merck help or hurt sales of Gardasil? (found via Kevin MD)

CNN - Rising STD rate sparks online dating sites

National Cancer Institute Hosts Meeting on Preoperative Therapy in Invasive Breast Cancer

NYTimes - New Options (and Risks) in Home Care for Elderly

NYTimes - Updating an Old Way to Leave the Baby on the Doorstep

Virginia to Make HPV Vaccination Mandatory

The Washington Post is reporting that Virginia Governor Timothy Kaine will sign legislation requiring the state's 6th-grade girls to receive the HPV vaccine. The bill passed the VA House 80-17, and unanimously passed in the VA Senate on the 3rd reading. The legislation updates existing vaccination requirements, adding to the list of required vaccinations the language, "12. Three doses of properly spaced human papillomavirus (HPV) vaccine for females. The first dose shall be administered before the child enters the sixth grade."

Parents may opt out under the provision, "3. After having reviewed materials describing the link between the human papillomavirus and cervical cancer approved for such use by the Board, a parent or guardian may elect, on an appropriate form prescribed by the Board, for his child not to receive the human papillomavirus vaccine," which requires them to be informed about the issue but allows them to refuse for any reason.

According to the Washington Times, "In Virginia, Merck [maker of the only currently available HPV vaccine] spent more than $70,000 in lobbying fees since 2005. The company also has donated to numerous political campaigns. Delegate Phillip A. Hamilton, Newport News Republican, who sponsored the HPV bill, has received $10,000 in Merck contributions since 1997, according to the Virginia Public Access Project. Mr. Hamilton said Merck played no role in his decision to sponsor the bill. He said nobody from the company approached him about the idea of proposing the vaccine." Merck's 2005 corporate political contributions document indicates that Hamilton received $1,500 from the company in 2005; VPAP also reports another $1,500 to Hamilton in 2006. This table on the VPAP website details Merck's contributions to Hamilton since 1997. No contributions to Kaine are listed, and a search of multiple data sources did not turn up any direct contributions from Merck to the Governor.

Full-text of the legislation as passed
See previous post regarding concerns about mandatory HPV vaccination legislation in Texas.