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September 6th, 2008

_Having Faith_, Sandra Steingraber

Subtitled: An Ecologist's Journey to Motherhood

The paperback I have (Penguin/Putnam) has a horrible cover. And I don't much care for that subtitle, either, since the book extends until her child is a few years old. Most important, however, I would like to note that I _FULLY AND COMPLETELY SUPPORT HER POLITICAL PROGRAM_. I ABSOLUTELY agree with her application of the precautionary principle, initially to the list of POPs and with the intention of extending it to anything that persists in the human body and breastmilk with the potential to harm the next generation.

I want to make sure that nothing I say about the book in any way detracts from her overall message. Because, boy, howdy, do I have some issues with the book, some of which I have already mentioned.

The book is structured in two parts: pregnancy through to the birth, and then after her daughter is born. The first section has chapters titled by named moons (harvest moon, sap moon, hungry moon, etc.). The second section has no obvious chapter title conceit (at least not obvious to me). The rhetorical structure of the book, however, is completely unified from start to finish and it is that structure which in many ways I find most objectionable. It goes something like this: Sandra feels something (nausea, Faith kicking inside her, Faith _not_ moving noticeably for long stretches of time, her milk coming in, etc.). And when I say Sandra, I mean the author-as-protagonist. Then there is a detailed discussion of the (then-) current state of the research (if her area of expertise) or contents of guidebooks (obstetrical or aimed-at-pregant-woman trade) as it might (or might not) relate to what she is (or is not) feeling. In general, this detailed discussion takes what is typically a normal and relatively innocuous experience and really explores the True Possibility for Terror in that experience in a weird confluence of anesthesia through inundation with data and Horrors Found By Science. The notes, for the adventurous, expand further, but they can be ignored because there are no little indicators in the main body of the text when there will be a note.

In general, I think a lot of the people who complain about stuff like _What to Expect When You Are Expecting_ are complaining about the wrong problems. They get all worked up about how Every Possible Thing That Can Go Wrong is explained in loving detail. _I_ get all worked up about how they _don't_ explain a variety of things that an expectant woman really could make use of (like, separate calcium and iron supplementation by as much time in the day as possible, if you're going to supplement at all and have it do anything other than constipate the heck out of you and then be wasted anyway). What I see in _Having Faith_ is an attempt to use Fear, Loathing, Disgust and Terror to motivate political action. I have mixed feelings about that with respect to smoking cessation; when you do that associated with breastfeeding I start wanting to kick someone.

Again, to reiterate, I _fully support the political program in question_. Totally. Awesome. Needs to be said. Etc.

A second problem I have with this book revolves around whether I can trust her. I wanted to finish the book, not give up in irritation partway through, so I did _not_ meticulously annotate every factual error I found (altho I blogged about a couple). But they were _littered_ throughout the information on pregnancy and breastfeeding. I _assume_ that she is more competent on the subject of birds, forests and embryology. I sure as fucking _hope_ she's more competent in those subjects. But would I use her as a source? It is to laugh. Don't you either; confirm _everything_. I am apparently the only person who has this problem with this book, judging by online reviews. YMMV. If you live on a planet where men never breastfeed (I recognize that most people think they live on a planet where men never breastfeed. They are Wrong. Or we've got more undocumented aliens than most Republicans realize. Altho not, perhaps, than the producers of Men in Black).

And now, a little digression on the subject of baby books. I know, from reading my own baby book, that at least my mother (and, as near as I can tell, the mothers of a lot of people around my age) did some Bat Shit Crazy stuff to me when I was very, very small. While I was raised to believe I was breastfed, the book clearly indicates it was "ever" rather than "exclusive" or even predominantly. There are these difficult to believe notes about how I was given orange juice (mixed with honey because I didn't like it) when I was a few weeks old. I mean, you just don't know what the fuck to _do_ with something like that, these days, but apparently it was not uncommon. No wonder I had so many health problems.

Thus, I believed I had a good handle on how shocking Sandra's expedition into her baby book with her mother (who adopted her) might be. I was so, so, so totally wrong. After noting that she had forgotten her childhood allergies and having to take meds at breakfast and never sleep on feather pillows (okay, _how_ do you forget this? I think I'd call that dissociation. Honest. Words fail.), on p. 237 there is this paragraph that stopped me cold for about 20 minutes:

"I also learn that we both [she and an unrelated girl who were both adopted] suffered from mysterious digestive pains and, after a battery of x-rays and electroencephalograms, were diagnosed with abnormal brain waves ("excess electrical discharge down the vagus nerve, contributing to a spastic sphincter in the stomach"). For this disorder we were placed on Dilantin, an anticonvulsive medication, which we continued to take until adolescence."

I'll give you a moment here to catch your breath. Remember, they're both already taking antihistamines every day, and the diagnosis in question could easily have been _caused_ by the stress of the medical tests which detected it.

"Before she was even a year old, Julie was also taking Phenobarbital, a sedative, because she woke up crying every hour of the night, seemingly because of cramping and gas."

And people bitch and wail because of whisky? Baby tylenol? Simethicone? Benadryl? Hell, who the fuck would even _care_ about Ritalin if people were doing this to someone born in the late 50s or early 60s?

"By the time I was four, I was also taking a daily dose of Thorazine, a powerful tranquilizer, because of "emotional storms." By the time I was seven, I developed a liver infection severe enough to land me in the hospital for a week."

We learn elsewhere in the book that she also had bladder cancer as a young adult, and when she was anemic, went down the stool sample/colonoscopy route and had polyps removed. With this in her history (which she did _not_ know at the time of the cancer and cancer scare), it sort of starts to make sense, doesn't it?

Never mind that Dilantin _causes_ major stomach problems. Dilantin + Thorazine is a particularly Bad News combination, as is Dilantin + Phenobarbital. The liver infection was, in all likelihood, a direct result of the Dilantin and/or Thorazine. Characterizing Thorazine as a tranquilizer is a little bizarre; it is an antipsychotic. Specifically, it is one of _the_ antipsychotics that emptied the asylums. (I think adding the antihistamines available at the time must have led to total zombie children.) It _does_ look like Thorazine is still being prescribed for children with "severe behavior problems".

Not only did Sandra forget her childhood illnesses, _so did her mother_. Their ensuing discussion is so bizarre it defies summary:

"Mom, nobody's blaming you."

Are you kidding me?

"We don't know if breast milk would have made any difference."

Dude, four year olds _have_ emotional storms. It's just the way it goes. You don't goddamn take your kid to medical specialists for temper tantrums, or Really, Really, Really Bad Shit is basically inevitable, now as then. You do _not_ have to be particularly bright to see this. It has been true for thousands of years. We get _waves_ of people who just flat out avoid doctors because of how bad and nasty the stuff they prescribe is. This is not about _breast milk_. This is about exposing your child to abuse.

"Not that it was even an option for you. [Oh, don't go there. At the time, it would have required moving heaven and earth.] I'm just glad for the chance to breastfeed Faith. Maybe she won't have allergies. Maybe she won't have stomach troubles."

My mother, for all her numerous sins for which she feels no remorse and has done no penance but instead believes her actions fully justified and Right In Every Way, didn't bring us to the doctor for stomach pains that resulted in prescriptions for Dilantin and Thorazine. Doctor's visits were limited to important things (when we were that age), like, not breathing.

Her mom, now: "I always did think it was strange that you girls had so many of the same health problems even though you weren't related genetically."

I have mixed feelings on the subject of Blaming Mothers. (Like, where the hell was the father, and can we sue any of those doctors now? Also, the pharmaceutical companies that made and marketed the drugs. Not to mention the unrealistic expectations promulgated by the baby-advice-books.) It is clear, from the back matter, that the author and her mother worked together on this book and the author credits the mother with "proofreading and fact-checking assistance and showed me how the book should read". I think based on that, I'm prepared to blame some of the rhetorical problems on Kathryn Steingraber, and perhaps some of the factual errors as well. More importantly, some of that rhetorical structure may well have grown out of an early childhood in which "emotional storms" as a four year old were responded to with extensive medical testing, Dilantin and Thorazine.

I cannot recommend this book in general. I specifically would not recommend this book to pregnant women who appear to be the target market. It's just nasty, unpleasant reading and not particularly trustworthy. It's overly trusting of the medical system (altho at times, Steingraber breaks free for a few pages, she inevitably returns to those who have clearly done her so much harm over the years, "grateful" to them for saving her). It has some utility as an argument for improving policy; I wish had I something better. It's possible that other people may react to this book so differently, that my experience is no valid yardstick; my regular readers, I would expect, have a sense already as to whether that is the case. If you got here via google, good luck to you.

I wish the author, her extended family and kinship network all the best. I specifically hope that she is successful in effecting very much needed changes in regulation of chemicals.

_Birth_, Tina Cassidy

Subtitled: _The Surprising History of How We Are Born_

IIRC, I picked this up at a Barnes & Noble around here within the last year; I have the paperback copyright 2006 which is compatible with that recollection.

Cassidy's front matter summarizes her birth experiences and the birth experiences of the women in her family going back a couple generations. The conclusion rounds out the book nicely by describing the birth experiences of some of her friends, and that birth is and always has been defined by the culture of the time and place.

Between those reasonable bookends both personal and philosophical, Cassidy sketches the usual territory: bipedalism and big heads, midwives vs doctors/obstetricians, location of birth, pharmaceutical pain relief, c-sections, instrumental delivery, birth attendants other than the midwife and/or obstetrician and what rituals, support system and so forth occur post-partum. For a highly readable 300 page book, Cassidy covers the material extremely well. Of course I could wish that along with her description of incubators she had mentioned kangaroo care, just as I could wish she didn't take Odent's opposition to the presence of the father quite so seriously. And I have to say that my experience of midwives does not match her summary (aging hippies, as near as I can tell); she really missed an opportunity to get into the concessions made in exchange for licensing and the impact that has on what options are available to women.

I was extremely impressed by her description of Friedman and his curve, a story that I do not recall reading anywhere else in any detail.

I noted several passages as really standing out. First, the attitude of the Catholic Church towards craniotomy. Cassidy is particularly fascinated by this procedure, because she asked what would have been done in times past had c-section not been an option and this was described to her. On p. 105: "In 1733, doctors had asked theology specialists at the Sorbonne in Paris whether it was religiously acceptable to sacrifice the mother by performing a most likely lethal cesarean if the baby could not be vaginally delivered. The scholars said the conflict of having to choose which one should live -- woman or child -- favored the baby because it had to be baptized, or else its soul would be stuck in purgatory.

In his 1930 encyclical, Pope Pius XI declared that doctors could not take a baby's life to save the woman's. After the pope's directive, cesarean rates spiked, as indeed did maternal mortality".

I've known for more than a decade where the anti-choice crowd was headed: they may have started with particular forms of abortion or abortion under particular circumstances, but their goal was ultimately the complete destruction of women's health by banning contraception, and by always placing the soul of the unborn at the center of the debate. They're headed that way because that is, ultimately, where they came from.

On page 120, Cassidy comments in passing that, "cerebral palsy...stems from lack of oxygen either at birth or before labor", which as near as I can tell is no longer believed to be true. I _thought_ we'd understood that was no longer true quite a while ago, but surely the latest on magnesium sulfate should have made that abundantly clear (true, _that_ revelation occurred after the time of writing).

Finally, in several places in the text, including page 140, rickets is attributed to failure to consume milk. Which is really stupid. Rickets happens when people are covered up too much to manufacture vitamin D, or never go outdoors, or have really dark skin and live really far north and use sunblock a lot or whatever.

On the whole, a remarkable single-volume survey of the topic. I'm a little stunned. I didn't have very high expectations.