Tuesday, October 12th 2010
As you all know, we now have a marvelous #wsb friendfeed that aggregates women sciencebloggers. You can follow it on friendfeed, you can add it to your RSS reader, you can follow it on scienceblogging.org.
The problem is, it needs some work. There are still most of Dave Munger’s compiled list of women sciencebloggers registered with researchblogging.org that I haven’t added. There are still some feeds that I can’t get to work. And I just don’t have the time to do the up-front work to get this in optimal shape, AND commit single-handedly to maintaining it.
That’s where you, dear reader, come in. Would you like to become a #wsb feed administrator? I am just looking for one or two people to get it up to date and help me keep it current. And I don’t know about you, but I plan on putting it on my CV. (Grad students, junior faculty, if you’re looking to add some outreach, this is the way to do it!)
If you’re interested, let me know in the comments! And as always, if there are missing feeds you can ask to have them added by emailing womenscienceblogs@gmail.com.
Monday, October 11th 2010
This is the fourth and final post on my experience with IVF and pregnancy, and my thinking on its broader meaning to the public and to anthropology. Find the first post here, the second here, the third here.
While I spent a lot of time reflecting on my IVF experience, pregnancy and childbirth while they were happening, I didn’t think much about how others viewed my reproductive decisions. Maybe it’s because I’m from Massachusetts, which is a pretty liberal place, where gay marriage is legal and I had my choice of two different birth centers within an hour of my home. I had a supportive family who was delighted at the prospect of a grandchild, and friends who were rooting for me every step of the way. Friends in particular helped me maintain a rational perspective, and keep emotion and desperation from coloring my decisions.
I think that’s why I was so surprised at how vitriolic the comment thread got over at my CNN.com interview last week. Most of the nastiest comments have been removed (flagged by me and my husband), but I remember them just the same. Some commenters thought I should have let my brother in law “have a bit of fun” with me to get me pregnant (some put it worse than that, I won’t print it here). I thought this was interesting because to them, this had nothing to do with me or my choice. This explicitly reduced me to breeder status, and implicitly, to someone it was okay to rape.
Then there were the comments about the Catholic church condemning IVF. I’m not Catholic so I moved on. I also saw a lot about “bad genetics” and that it’s too bad we don’t have better mechanisms to weed out people with them anymore. I don’t even need to address that one.
Then there were the comments about all the babies who are waiting to be adopted. While commenters soundly took that one apart, I’ll also point you to this recent post in Feministe about the ways in which adoption is more expensive, more time-consuming, and potentially more exploitative than IVF.
And then there were two other threads: first, the folks who thought the whole thing was unnatural, messing with God’s plan, disrupting natural selection, and so on. Second, the folks who thought women who undergo IVF were evil, angry feminist career women who just waited too long to have babies and it was their fault they had old, dried up wombs.
Let’s focus on these two, shall we? Turns out I have a little expertise to offer.
IVF is unnatural
Let’s start with what I teach my students: the naturalistic fallacy. The naturalistic fallacy is committed when someone tries to equate “good” with “natural.” Hurricanes are natural, and yet can damage homes and cities, and are responsible for the loss of human life. Body odor is natural, and yet I shower and put on deodorant each day. Infanticide and sexual coercion in primates are quite natural phenomena too. So why is it a criticism of something to call it “unnatural?” That person is committing the naturalistic fallacy.
Those who asked “whatever happened to natural selection?” are committing another error. You could say we disrupt natural selection with the use of vaccines, prenatal care, chemotherapy, and many other medical treatments, but only a few people refuse these things, not because they wish to be weeded out by the selection pressures that made them sick, but for religious reasons. So really, the “natural selection” argument is another way of committing the naturalistic fallacy. I would argue that medical treatments are another environmental variable, rather than a disruption of natural selection. Besides, we have a wealth of evidence to suggest that natural selection is continuing to shape human evolution, and human health, in a number of ways (Byars et al. 2010).
Evil, angry, old feminists
 |
Figure 1. Ellison et al (1993) Figure 5D of midluteal
progesterone concentrations across three
populations. Notice the highest concentrations
are between 25-35 years of age. |
The average age for most studies I have read on IVF have an average maternal age of 29-34 years – even though, as you might expect, women get to the point of using IVF often after exhausting many other options and trying for years (for a completely random smattering that I pulled from Endnote, see Amir et al. 2007; McWilliams and Frattarelli 2007; Menezo and Barak 2000). That means that the many women undergoing IVF are within the 25-35 year range of maximal fecundity (Figure 1, Ellison et al. 1993). That’s right, folks, women are not maximally fecund when they’re eighteen, not even when they are twenty. The highest hormone concentrations and most consistent ovulatory cycles are in the 25-35 year range (Ellison et al. 1993). It’s true that this range isn’t necessarily ideal for most professions, including my own. But it just so happens that evil, angry feminists such as myself are taking our reproductive health and careers both into account when making reproductive choices.
I was twenty eight years old when I got pregnant (I turned twenty nine days later). The timing was not ideal for me professionally, as it meant I had a five month old while starting my first tenure-track position, the one I now hold here at Illinois. But I wanted to do my best to control for any factors on my end that could reduce the probability of conception, since the fertility issue was my husband’s, due not to his cancer, but his cancer treatment.
Something else I have noticed is that most of the criticisms, in the story’s comments and in wider circulation, are launched at infertile (or older) women. Nowhere have I read criticisms of men dealing with infertility. When we think of reproductive choice, we tend to launch all of our feelings – good and bad – at women. This leads to an overrepresentation in our minds of people who seek IVF as being pathological women.
For diagnostic purposes, medicine lumps people into two categories: healthy, or diseased (we could quibble over subclinical, or pre-diabetic, etc, bins, but bear with me a moment – I am talking not about the nuances of what a doctor understands, but the effect institutionally on patients). This is a very smart thing for a large number of diseases. You usually have a cold, or you do not. You have chicken pox, or not. Unfortunately this model of disease fits poorly on female reproductive functioning. Both the female and male bodies are responsive to environment, from psychosocial or immune or energetic stress to behavior. But the variation produced by these features in women is enormous, and simply more obvious. Cycle length, menses length, hormone concentrations, conception rates, ovulation: these things are easy to measure, and many are easy to observe without special technical equipment. They change over the course of a woman’s life and even fluctuate based on environment from cycle to cycle. We can’t really draw a line, where on one side they are healthy and the other pathological, and yet this is done every day when women reporting irregular cycles are given hormonal contraceptives without a thorough workup to determine the cause of the irregularity. For some women it may relate to marathon training combined with stress at home, for others a diagnosis of polycystic ovarian syndrome is necessary.
Further, the medical definition of normal is very difficult to achieve. How many women experience a twenty-eight day, ovulatory, symptom-free menstrual cycle month after month? Likely not many, if the data from my lab are any indication. This puts most women in the pathological category for huge chunks of their lives… even if nothing is actually wrong with them aside from having bodies that adaptively respond to environment.
I would suggest that this has led to a general perception – in the media, among the lay population, and elsewhere – that women’s bodies can go wrong easily (as opposed to vary naturally and adaptively), and that we should look to women when there is an issue getting pregnant. This is even though I am guessing medical doctors have a much more nuanced understanding of reproductive functioning than the model I described above. Because most laypeople don’t actually know how bodies work, and in particular how and why bodies vary – it is easy for subconscious sexism to seep in. So this model gets mixed up in the sexism in our culture, and this is part of what has led to demonizing users of IVF, pathologizing female athletes, encouraging young teens to take hormonal contraceptives to stabilize their cycles, and placing severe cultural limits on food and activity in pregnant women that are not evidence-based, to name a few.
Reproductive choice
It seems to me like we have a long way to go before we can appreciate and think well about the complexity of reproductive choice. The CNN.com story’s comments, and others (Pharyngula has a very nice takedown of another article where IVF babies’ personhood is questioned), demonstrate that a lot of fear comes up when women have a say over their bodies. With more flexibility in terms of our reproductive decisions, we can have children at a later age or not at all, we can terminate pregnancies, we can enter into spaces and professions where normally only men have exercised choice. These are dangerous ideas to some. But we need to continue to talk about them, and think about what it would take, from all perspectives, to move away from an emotional standpoint, and towards a rational one.
References
AMIR, W., MICHA, B., ARIEL, H., LIAT, L., JEHOSHUA, D., & ADRIAN, S. (2007). Predicting factors for endometrial thickness during treatment with assisted reproductive technology Fertility and Sterility, 87 (4), 799-804 DOI: 10.1016/j.fertnstert.2006.11.002
Byars, S., Ewbank, D., Govindaraju, D., & Stearns, S. (2009). Natural selection in a contemporary human population Proceedings of the National Academy of Sciences, 107 (suppl_1), 1787-1792 DOI: 10.1073/pnas.0906199106
Ellison PT, Panter-Brick C, Lipson SF, & O’Rourke MT (1993). The ecological context of human ovarian function. Human reproduction (Oxford, England), 8 (12), 2248-58 PMID: 8150934
McWilliams GD, & Frattarelli JL (2007). Changes in measured endometrial thickness predict in vitro fertilization success. Fertility and sterility, 88 (1), 74-81 PMID: 17239871
Menezo, Y. (2000). Comparison between day-2 embryos obtained either from ICSI or resulting from short insemination IVF: influence of maternal age Human Reproduction, 15 (8), 1776-1780 DOI: 10.1093/humrep/15.8.1776
Friday, October 8th 2010
This is the third post of four on my experience with IVF and pregnancy, and my thinking on its broader meaning to the public and to anthropology. Find the first post here and the second here.
“Why are you just standing there?”
Last time, I ended with my water breaking all over my bedroom floor. Thankfully, it was a hardwood floor and was easy to mop up. But I’m getting ahead of myself.
I slept terribly for my entire third trimester. My doula serenely said it was my body’s way of preparing me for sleepless nights with a newborn. You will be happy to know I didn’t strangle her. I ended up having to take a nap every afternoon to even approach five hours of sleep for every twenty four, because I was uncomfortable and restless at night. Unfortunately, I often even struggled to read or work at night, because the discomfort that kept me from sleeping also kept me from concentrating.
So when I got a decent night’s rest on the evening after my due date, and found myself roused once groggily in the night, felt a little wetness that made me worry I had peed myself, and decided to drift back to sleep, I hope you won’t think too ill of me.
Chances are good my amniotic sac started to tear sometime in the night, and the movement of standing up blew open that tiny rip.
I looked down at the floor. Brendan looked down at the floor. We looked at each other. I started to laugh. “Why are you just standing there?” he asked incredulously.
“What should I be doing?” The more I laugh, the more I leak.
“I don’t know, get in the tub or something!”
So I do. Brendan hands me the phone while I’m standing in our bathtub, and I call the birth center. The midwife is pleased to hear my water has broken, is unconcerned, and says to keep her updated in terms of if and when labor starts. She wants me to come in in twelve hours to do a non-stress test, but otherwise recommends I go about my day.
This one of many major differences I experienced with a midwife versus a doctor. Hospital protocol is to bring a pregnant woman in if her water breaks, even if labor hasn’t started, and they are a lot more aggressive about inducing labor if it doesn’t start on its own.
I convince Brendan to go into work for a few hours so he can do some things that really needed to happen that day, and I lounge around a bit. By mid-morning I am having very mild contractions that are seven minutes apart or so.
Brendan and I spend the day grocery shopping, baking cookies, and going for walks along the Charles River. I was feeling triumphant and strong. I was kicking ass at this whole labor thing. It must be my athletic background, I told Brendan, and my high pain threshold, that is making me have such an easy time of things. I was buoyant, even as I started to need to pause and concentrate on the contractions when they happened.
Around six in the evening we went to the Birth Center, where I completely believed they would check my dilation and say I was at four centimeters. I had been laboring all day, after all. My midwife checks me. “Maybe one centimeter,” she says.
Are you kidding me? I begin to feel nervous, like maybe my vision of hanging out in the birthing tub while playing cards with my sister and husband was not going to happen. Maybe I had underestimated labor a little bit.
My non-stress test comes out fine. I’m starting to really feel contractions, and my body keeps trying to move away from them. I have back labor, which isn’t so great.
At this point, time starts to feel different. I know we went home for a while, where my sister joined us and she and my husband got some good. I know I lay down on the floor, then the bed, that I tried to take a hot shower, and that nothing really worked. I was starting to feel miserable, and a little panicked. I am a perfectionist, and I had had this idea that somehow labor would be different for me, than, you know, the millions upon millions of women who have come before me.
Time to go
I asked to go back to the birth center, probably around eleven at night. We get there and I’m maybe three centimeters dilated, and I can’t be admitted until I’m in active labor, which is at least four centimeters. We hang out in the lobby with my two midwives (one is in training). They inject little subcutaneous sacs of water into my lower back that burn horribly, but reduce my back labor pain by half. I am starting to moan with each contraction, and while I want to be holding someone’s hand, I don’t really want to talk. I really start to wonder what I was thinking with this whole natural labor thing.
By one thirty or so in the morning, I am considered in active labor so we can go upstairs to one of the birthing suites. No one else is there that night so I get the best one (though all three are great). I get into the tub as soon as the water is ready. Nothing feels right, the water temperature feels wrong, it doesn’t seem deep enough, I can’t position myself to get comfortable, I hate everything. Over the next few hours the pain gets worse. Yes, contractions are like menstrual cramps. They are like menstrual cramps that cover several orders of magnitude more surface area, are several orders of magnitude more painful, and they come in waves of pain that crest, only for you to know that in another minute and a half you’ll have another one. I am a natural birth advocate, but I am not going to tell you labor is fun.
There were some highlights, of course, like the times Brendan carefully smoothed the hair from my face and got me to sip some water, like the way he and my sister watched out for each other over that long night. The moment I opened my eyes between contractions to see every midwife and doula sitting on the floor of the bathroom, reading their own copy of my birth plan while they waited for my next contraction.
After a while, the midwives smartly decided I needed to move from the tub, since a change of pace might help move my labor along. I labor on all fours on the giant king-size bed for a while, but am starting to panic about the pain and how long everything seems to be taking (again, it’s actually all taking a normal amount of time). The midwives suggest a gentle intervention – how about an injection of Benadryl? It won’t harm the fetus and will make me a little sleepy, which will help me rest between contractions. Amazingly, it works: I am alternately screaming and sleeping for a few more hours, giving me the strength I need to ride out my dry back labor.
Transition
Those of you who know anything about birth know how women act during transition. This is the point at which a lot of women tell everyone, in no uncertain terms, that they have decided not to have the baby and are going home. They start packing their things or otherwise give up on the process. For me, I started apologizing. I thought, though no one had indicated it in any way, that I was about to be transferred to the hospital for an epidural, that that was my fate. “I’m so sorry, Brendan. I can’t do it. I’m sorry.”
“You are doing it, though,” he said. “You are doing it.”
I thought I saw a hint of a smirk in the face of my doula and midwives, who have seen hundreds more births than we have. They got me to move to another position, and told me maybe I might feel like pushing soon, and if so that I could. They also said, gently, maybe we should go over to the bathroom again. You can pee, and maybe we can set up the tub for you again.
So I pee, and then when I get up I get the URGE TO PUSH. The URGE TO PUSH, to me, was the most delightful, empowering, wonderful part of childbirth. Labor is all about getting out of the way of your body so it can do its job of dilating your cervix. Pushing is something you get to do. Of course it hurt. But it was also one of the most awesome (not as in awesome, dude, but awesome, full of awe) things I have ever done.
It turns out I am good at pushing. So when I felt the URGE TO PUSH I started to push my baby out. I felt the well-named ring of fire as the baby’s head crowned. “Wait, wait!” my midwives yelled. “We aren’t ready!” They sprinted to get everything together so they could catch the baby.
And that is how I ended up giving birth to my amazing daughter standing up, at 9:45am on a drizzly day in March 2008, holding on to my husband’s shoulders, standing by a toilet.
Bonding to our baby
This gorgeous baby troll (let’s just be honest, all newborns are a little troll-like) was passed to me from between my legs where my midwife had caught her. I looked at the baby. I looked at the baby again. “It’s Joan!” I shouted. “It’s Joan!” It was a baby girl, a rather purply-blue baby girl, but a girl nonetheless.
We had wanted to let the cord pulse a bit more and not cut it while I held her, but the midwives were understandably concerned about the color of our daughter, so they encouraged us to cut the cord now so they could warm her up and make sure she was breathing well. Brendan cut the cord, then followed the midwife to the bedroom where they put Joan on a little warming table and ran some oxygen near her face. I am guessing that the reason Joan came out looking a little blue was due to my rather overzealous pushing, rather than there being anything inherently wrong with her. They slowly walked me away from the bloody massacre of the bathroom over to the bed, where I could push out the afterbirth and hold my baby.
Because I had lost so much blood (they estimated I lost 500cc, which is the technical definition of postpartum hemorrhage), the midwives decided to give me an injection of pitocin to speed up the afterbirth so they could be sure I wasn’t hemorrhaging. I pushed out the placenta and thankfully I was fine, but it was a smart intervention anyway.
There are so many other pieces of this story I could tell, from the sound of my sister crying with joy as she videotaped the birth, to the doula who held my hand as I was sewn up (I had a second degree tear). All the grandparents got their moment to hold Joan. Brendan went to Christina’s to buy us milkshakes (this was a very important part of our birth plan). And I sat in a darkened room, staring and staring with a mix of fear, delight, and unadulterated love at the bright pink, eight pound three ounce baby in my arms. We were home by five o clock that same night, where the grandparents greeted us again and we celebrated our wondrous, gorgeous, perfect child.
* * *
In the final installment next week, I’ll reflect on the experience and broader issues around sexism and overpathologization regarding both IVF and reproductive choice.
