Monday, September 9th 2013
When I was pregnant with my daughter in 2007/2008, the anti-vaccine movement was strong and hadn’t been fully debunked. My daily – hourly – thoughts revolved around the fear of a C-section. I was also consumed with doubts as to what we would do once I gave birth and my husband and I were responsible for meeting the baby’s daily needs. How would we keep a helpless human alive with no prior experience?
A friend I trusted recommended a book about vaccines – one of those “what doctors don’t want you to know” deals. I bought it and read it, and even as a scientifically literate person, was somewhat swayed by what the book said. My husband and I talked it over, and from what we could tell, the best decision to make about vaccines was that we would agree to all of them, but just that we would space them out. At the time, we were worried that too many vaccines at once might not be good for a newborn immune system. We had never had a baby before, and the prospect was terrifying. Every decision we made seemed dramatic and life-threatening. Our pediatrician turned red with anger when we told him what we wanted to do, but he assented.
This is a major confession. I was one of those people who infuriated her doctor with an alternate vaccine schedule. I know I will lose serious science cred by daring to say so. But I think it’s important for me to admit that this was my previous thinking on vaccines, because regardless of what you may think of me, I’m pretty confident I’m not an idiot.
Why do so many non-idiots get swayed by the anti-vaccination movement? Well, there were celebrities on the bandwagon who were given plenty of chances to share their thinking. At the time, there was supposed data linking autism and vaccines, since shown to be faked. There is the way that our culture suffuses parents, especially mothers, with fear during pregnancy and childhood because they are made to feel as though all their decisions will decide the fate of their kiddo, from ridiculous limits on food and exercise for pregnant women to the pressure to ensure perfect mother-infant attachment upon birth.
And finally, there is the fact that a lot of us harbor some distrust of medicine. This one comes from the fact that most oppressed groups have had pretty horrible experiences with medical science, from twilight sleep to the Tuskegee syphilis experiment. And given my expertise, I was able to read scores of original science articles demonstrating that current obstetric care was not good, nor was it that evidence-based. With my growing skepticism of the state of obstetric care, a skepticism of infant care seemed natural.
A lot has changed in the last few years. One of the turning points, to my mind, was Seth Mnookin’s 2011 book A Panic Virus, which identified the culture that contributed to the anti-vaccination movement, explained the sometimes-problematic history of vaccines, and fully and conclusively debunked the autism-vaccine link. In the last few years, I have noticed that derision towards anti-vaxxers has grown. And some anti-vaxxers are certainly willful in their ignorance.
But many are not. Many of them are just I was – scared, not really knowing any better, and wanting the right information to make the right choices for my child. There are moms being told not to eat soft cheese or allow their heart rates to exceed 140 beats per minute. There are pregnancy forums with people endlessly debating different induction protocols and sharing horrifying experiences with epidurals, episiotomies, hypnobirthing, hospitals, homes, standing or sitting births. It’s hard to parse our fears for our kids with the actual evidence for what interventions help or harm them.
A friend of mine just pointed me to a new app that I hope will bridge this gap, at least when it comes to childhood vaccines. The Vaccine Education Center at CHOP, the Children’s Hospital of Philadelphia, has just released a new iPhone/iPad app called “Vaccines On the Go: What You Should Know.” The VEC is directed by Dr. Paul Offit, co-creator of the rotavirus vaccine and preeminent scholar and educator on vaccine safety and efficacy.
Unfortunately, I can only view the promotional video and not test out the app myself, because I own Android machines. The good news is that CHOP is considering options for an Android version of this app. Since most US and worldwide smartphone sales are for Android operating systems (I looked it up, since I was a little upset that I couldn’t actually try it out myself), this means the app could have a greatly expanded reach in the future.
Websites and apps that provide accessible, evidence-based answers to parents’ questions are big ways that science can push back on misinformation. And I wonder if building trust in parents in turn helps build that trust in kids. The more transparent we make scientific thinking and information, the more science literate, rather than science averse, people may emerge from the debate.
Wednesday, September 4th 2013
Something has been sitting in my craw for a while since reading that clickbait “manifesto” on how people who put their kids in private school are bad people. The author’s gleeful and unapologetic anti-intellectual attitude for one (I didn’t read any books AND I’M TEH AWSUMZ!), troubling coming from someone writing on education. The claim that rich kids (the author’s operating assumption of what kind of student predominates in private school) make public schools better because money equals better (a point disemboweled neatly by the always-brilliant Dr. Emily Willingham). Barftastic both, but I still couldn’t identify the sense of unease the whole thing gave me.
Then, I happened to be hanging out with my dear friend Dr. Anne Jefferson (of Highly Allochthonous, also a badass geology professor at Kent State). Anne is the one who made the connection to something Dr. Isis said recently around Open Access. Dr. Isis made the point that the most radical thing minority scientists can do is get tenure, which means not always (if ever) prioritizing the Open Access movement. Pushing minority scientists to do this ignores their experiences around inequity and discrimination, and what they need to do to succeed and help other underrepresented scientists succeed. Anne followed this up by saying no movement is worth sacrificing disenfranchised or oppressed people on some principle of a “greater good.”
That is why this value judgment about public versus private education, a thinly veiled iteration of the Mommy Wars, is wrong. Children can’t give consent, they live their lives at the whims of their caretakers. One of the reasons kids often develop picky eating habits, or push back on bedtime, or misbehave at school comes from their trying to find some way, any way, to get out from under the oppression of being a constant second class citizen. Once you see how the author’s whole argument is that we should improve education at the cost of kids, it becomes ridiculous.
When it comes to any movement – open access, public education, feminism, or others – do we put the burden on the backs of the most disenfranchised, or those with power and privilege? And how do we lift up all kids and give them better educational experiences?
Being a kid ambassador
My kid learning about mammals through Dr. Katie Hinde’s Mammals Suck March Madness last year
In the case of kids, parents play many roles, just one of them being ambassador. Ambassadors screw up and don’t always quite get the job right of course, but you’re supposed to do the best job you can amplifying the voice of who you represent. Maybe an even better metaphor would be kid union steward.
As far as I can tell, my kid wants me to build the best life I can for her, and to put her in situations that help her grow, that challenge her, but most of all respect her as a human being. Her current school, a private school and research lab affiliated with my university, does that. She is treated with respect as an inherently good person and learner not because it’s private but because it subscribes to Reggio Emilia’s project-based approach.
I am a complete convert to this approach because I’ve seen the wonderful ways it manifests across preschool, kindergarten and elementary education. And I’ve seen what these teachers and this approach have done for my kiddo. The way that school works directly contradicts the kinds of pedagogy we associate with academically “rigorous” schools. Yet my kiddo is internally motivated and explores her interests while advancing in literacy, science, art and math. She is only five, yet is on the brink of understanding fractions, just because they seem kind of cool to her. She once spent three days with her friends building a “pony house” out of recycled materials, and ended up putting a lot into the basic needs of an animal AND basic architectural structures. She reads everything — labels, signs, menus, books. And folks, I love my kid, but I don’t think she is a genius. I just think that when learners are treated respectfully and given resource and attention, they tend to figure out a lot on their own.
Rather than see my role as my kid’s ambassador as one that puts her in situations for supposed benefit of all kids but not necessarily optimal for her, I would rather make the kid ambassador job easier for all the other parents who want access to the right education for their kids. I’ve done plenty of those things, which I won’t document here because it would be obnoxious to do so, but examples include working with your school to lower tuition, or expand classrooms to increase access. You can also learn about the broader historical context of why schools work the way they do, and evidence-based ways to improve it. Because our school is university-affiliated, the director’s job is only half directing the school: the other half of her job is outreach and training with public schools. Supporting this school actually does support public education in our local school districts.
My educational awakening
I remember what it was like to not be respected as a learner, and to have quiet obedience prized over understanding the material. When I was younger, I acted out in response to this oppression. In my Montessori preschool and kindergarten I was constantly sent to time out for being disruptive. In first grade I regularly pretended to be sick to get out of class (I have vivid memories of pushing my stomach into my desk until it hurt so that I could go see the nurse). Second grade doesn’t count, because I really was sick all the time and was hospitalized a few times, so I wasn’t even in school that much. Then by third grade I was stuffing my assignments into my desk and reading my own books because the worksheets were so dreadfully boring.
This experience in third grade might have been the most humiliating of my elementary school years. After weeks of crumpling up assignments and stuffing them in my desk for one class, a change in desk assignments for another class that met in the same room led to the discovery of my discarded work. A parent-teacher conference quickly followed, and my balled-up assignments smoothed out and stapled together. My punishment was having to do all of the worksheets after school.
That same year, I was tested and placed into the gifted program, still a public school institution. I stayed in the gifted program from fourth through sixth grade, until our school district cut the program because they didn’t have the money. My parents were involved, and tried really hard to save it. But in seventh grade it was back to regular junior high.
I loved the gifted program I was in, because it was the first real experience I had where I was respected as a person, where it was assumed I was smart and could do stuff. Now the goofing off I did made me precocious rather than disruptive. Teachers found ways to help me change my behavior without forcing or punishing me into submission – but I was also a lot less obnoxious while there. We had endless opportunities to be creative with the ways we learned. We were trusted.
Respect and trust are in short supply in some school settings, because these are the hardest things to give kids when there are a whole lot of them and only a few of you… particularly if you’re under additional stressors to make these students perform a particular way in a test so you don’t lose your job.
Lifting up all kids
My kiddo spent a lot of time in front of this kaleidoscope projector at the Monterey Bay Aquarium this summer, just trying to figure out how it worked.
Back when one of my research projects involved working in a public school, I was given that school district’s curriculum guide. The “science” section had only four bullet points, which boiled down to:
-Learn to use lab equipment safely when testing hypotheses
-Describe interactions between people and the environment, including space exploration
-Know the basic cell structures and functions
-Observe the properties of energy: heat, light and sound
Fine arts was the real loser with only three points, where phys ed had six points, eight for math, and fifteen for literacy. Fifth grade is a big testing year and so the teachers have to focus all their attention on literacy and math. I’m sure they’d love to do more with art and science, but their school could lose out if they don’t teach to the test.
Science, or the scientific method, is one of the major “ways of knowing” children use to interact with their environment and stimulate their natural curiosity about the world. Yet throughout a child’s educational experience, at least in the US, it receives very little attention. It’s no surprise that over time so many children develop an idea that science is for a specific set of people – a set that rarely includes them.
My daughter’s school experience is inherently scientific: she has some guidance, through the semester’s main topic (this semester it’s “trees”), but then it’s up to her to inquire and learn about the world. The kids get put into interest groups after a few weeks of giving them time to feel out what they find interesting about that semester’s topic. Then the main projects of the semester are motivated by what the kids want to learn and do. Their exploration tends to involve the scientific method in some way.
While we’re working on respect and trust for all children, it would be nice to prioritize science as a way of knowing that helps defend curiosity against boredom, and provide a perspective to children that all kinds of knowledge is accessible to them. We should be working towards a pro-intellectual, pro-science, pro-child educational system. Pitting parents or kids against each other, or wearing a lack of an education as a badge of honor rather than something one might want to independently overcome, is not the way to get there.
Tuesday, August 27th 2013
The following is a guest post from “Grace,” a fellow tenure-track professor. She wished to share her story of miscarriage, because reading the stories of others comforted and guided her as she experienced her own. You may also find my miscarriage science post When a Beginning is Not a Beginning useful (a revised and expanded version of which appears in next month’s issue of Anthropology Now).
I invite you to comment below to show support for Grace.
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At 27, getting pregnant was hard, but staying pregnant was easy. It took 17 months before I got a positive pregnancy test, but from that time on the baby developed perfectly on schedule and arrived one day before the due date. Seven years on, the child is happy and healthy. This is the motherhood story we like to hear and which is told millions of times over by delighted parents.
At 34, getting pregnant was easy, but staying pregnant was hard. We got pregnant the very first month off of birth control, but staying pregnant was… unsuccessful. At my first ultrasound, at 8 weeks, there was an embryo with no heartbeat. This is the motherhood story that we don’t often hear or tell, but happens with approximately 30% of all pregnancies. This is the story that I want to tell, because reading the few stories I could find was a key source of information and solace for me as I responded to the shock of the terrible ultrasound.
(Disclaimer: I am neither a ladybusiness anthropologist nor a medical doctor, so please consult your doctor before making your own health decisions.)
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As a busy pre-tenure woman, I was thrilled when I got the positive pregnancy test 32 days after the start of my last period. The due date was near the beginning of spring semester, so I would be able to take almost 8 months “off” before resuming teaching. And I wouldn’t have to face months of crushing disappointment of my period arriving unwanted, signaling my failure to procreate. This was off to an insanely good start. But it also felt too good to be true, and, truthfully, a little surreal. It happened so quickly that I hadn’t quite wrapped my head around the possibility of my life changing dramatically in nine months.
Within days of the pregnancy test, I had the classic early pregnancy symptoms, sore breasts, a pulling, stretching feeling at the base of my belly, an aversion to my favorite tea, and the fatigue. Oh the fatigue. I remembered that one from the first time around, and I pulled out my old pregnancy journal to see when it peaked and how long it lasted. I was glad I didn’t feel really any nausea, just as I didn’t with my first pregnancy.
I called and scheduled an appointment with the local ob/gyn practice, something with a midwife in week 7. My husband and I started to toss around names. It started to seem a bit more…likely, but that surreal quality never really dissipated. And I never felt at ease about this thing growing in my abdomen. In the seven years since my first pregnancy, I’d heard a few stories, read some things on the Internet, and grown a lot more circumspect about the possible ways a pregnancy can go. My 27-year-old self seemed naïve to have told family at 6 weeks and my boss only a few hours after the first ultrasound. I was waiting on that first doctor appointment, when I would get to hear the heartbeat on the ultrasound. Then, I told myself, I would feel better and it would seem really real.
Seven weeks in and I had my first appointment. The midwife and office staff were friendly and congratulatory, and asked lots of questions about my health history and first pregnancy. And as I answered those questions, I looked around the room for the ultrasound, for that magical moment when I would hear the heartbeat and it would feel real. Then the midwife told me that this office didn’t have an ultrasound, and I’d have to make an appointment at another location, a week later, before I could hear the heartbeat. I was tremendously disappointed, but I tried to push it aside. I ordered the recommended pregnancy guides on Amazon (my old ones had long since been given away) and picked out a maternity dress to wear to a wedding I’d be attending at ~14 weeks. I silently talked to my belly in the shower, telling it how lucky it was to be arriving into such a happy family.
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Eight weeks and 4 days. We drove to the next town, and I peed in a cup. We were taken into the ultrasound room, and I put on the lovely gown. The technician came in, stuck the wand up my vagina, and proceeded to move it around and measure things, providing a bit of commentary along the way. There’s my cervix. There’s my uterus. There’s something inside my uterus. To me, it looked vaguely babylike. But I noticed that the commentary had stopped. The technician asked me if I was sure of the date of my last period. I was. I asked whether the vaguely headlike thing was a head, and was told “No, that’s the sac.” Silence. I asked whether we would be able to hear the heartbeat. “There is no heartbeat.” I squeezed my husband’s hand and closed my eyes, looking away from the big screen on the wall that showed the thing that was not going to be my future child.
“You’re only measuring 5 weeks and 5 days, and there’s no heartbeat. I’m sorry, but this is not good.” A few more words of condolence, as the technician moved the wand around some more and made other measurements and I realized for the first time that the radio music was on way too loud for the silence in the darkened room. The technician removed the wand and left the room for me to get dressed before a consult with an ob/gyn (already on the schedule). I got dressed numbly and stood hugging my husband close while waiting the eternity for the technician to come back and lead us to the next room where radio played too loudly. Another eternity passed there. I refused to sit on the examining table. I was no longer a pregnancy patient.
A doctor I’d never met came in and said something sorry-like. I don’t remember all of what he said, but he told us that there was almost no chance this pregnancy would end well. I asked what happened next. He said that there was a very small chance that I’d just misdated my pregnancy, and that we could come back in a week for another ultrasound and see if there was a heartbeat. But he also talked about D&Cs, and that a miscarriage could go quickly or last for days, and making sure I knew my blood type (B+) and how I was likely to need a D&C even after a miscarriage. He said he knew it was a shock and that we would likely have other questions, so we could call him with any that afternoon, or we could reach a different doctor anytime. I think I expected to begin bleeding at any moment, even though I knew nothing had physically changed just because we’d seen the truth about the pregnancy in that ultrasound room. We made an appointment for an ultrasound 7 days later and my husband drove me home.
—
On the way home, I considered the doctor’s words. Could I really have mis-dated the pregnancy by a full two weeks? Was there really a glimmer of hope? No. I knew my timing and I knew my body. I’d never gone 32 days without a period except when pregnant or heavily lactating. My periods had been 22-25 days apart before I’d gone on the pill the last time. And how could I have gotten a positive pregnancy test at 32 days, and yet be off by two weeks? That would require the pregnancy test to have been positive within a few days of conception, far better than any pee-on-a-stick kit claimed to be. There was no question in my mind that pinning our hopes on an ultrasound heartbeat in 7 days was an exercise in self-delusional futility. I’m a scientist, and the data were clearly rejecting the hypothesis of a healthy but mis-dated pregnancy.
I felt like I had dull cramps, but I was sure they were psychosomatic as much as real. No bleeding, not even tiny spotting. I felt like my body had let me down tremendously. How could it not produce a thriving embryo? And how could it delude me, maybe for weeks, into thinking I had one? The sense of disappointment in my body and loss of the possibilities I had only begun to allow myself to think of was suddenly far more real than the pregnancy had ever felt.
If I was going to suck at being pregnant, it seemed unfair that I was also sucking at miscarrying. What happened to having spotting or waking up to bleeding or intense cramping? How long was this going to take to get started? Was I going to need to figure out childcare for the weekend? I gave birth without any pain medication, and as much as the thought of a bloody, crampy period-but-worse sounded unappealing, I would do this the “natural” way. But when?
I googled “miscarriage”. The top results on miscarriage didn’t say anything useful. I wasn’t bleeding; I wanted to know when it would start. The only thing those first websites told me was what the doctor had said: many women who miscarry also end up having a D&C.
I remembered Maggie Koerth-Baker’s post from last summer: “The only good abortion is my abortion.” Here was a woman, like me, who found out through medical technology rather than her body that her embryo would never be a baby. She was deciding whether to have a D&C rather than a miscarriage +/- D&C at some indefinite time in the future. But how long would Maggie have had to wait for that miscarriage? How long would I wait? I googled some more…something like “waiting for miscarriage” and read more stories. Along the way, I found the term “missed miscarriage” and learned that sometimes it can be weeks before a miscarriage starts and that it can take days or weeks to complete.
My commitment to a natural miscarriage wavered. I remembered two more women who had blogged about pregnancy loss. Isis miscarried and seemed to take it in her usual impeccably-dressed stride, but it still didn’t exactly sound like a good time. Jo(e) lost a pregnancy and wrote simply but beautifully about the miscarriage. I didn’t feel as strong as Jo(e), and the line that stuck with me was “The waiting part was the hardest, waiting to go into labor when I knew that the contractions would not lead to a birth. I just wanted to get it over with.” I read a few other stories, but most of them started with the bleeding, not the waiting.
Then I re-read Maggie’s D&C decision story. Here was another busy, professional woman experiencing a tremendous loss on an uncertain timeframe and considering a D&C as a reasonable option. It dawned on me that there was no competition or bragging rights in waiting for a miscarriage; my entry to the secret sisterhood was the pregnancy loss not the bleeding. There’s no merit badge for miscarrying in your bathtub, and even if there was, I wasn’t sure I wanted it.
I read Zuska’s account of her D&C and it didn’t sound too bad. Not fun, for sure, but significantly better than waiting uncertainly for time bleeding in a bathtub. And, I reminded myself, the bathtub was the best case scenario, a “complete miscarriage” confirmed on another ultrasound….one showing an empty uterus. Less good scenarios included a trip to the ER, followed by a D&C. Being able to schedule a D&C on my terms, walk in without pain, and leave knowing it was over was seeming like a better ending of this ugly and heart-wrenching development. The thing that appealed most about the D&C was that it gave me some sense of control in a situation where I had no control. It let me be master of the calendar, and it gave me back the body that had let me down.
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The next day I got an appointment with yet another MD in the practice. I wanted to talk things over and figure out what my timetable and options really looked like. This ob/gyn had looked at the ultrasound results and and agreed with my conclusion that given what was known about the timing of the pregnancy, the size of the sac, and the lack of a heartbeat that mine was not a viable pregnancy. I asked how long I might wait to miscarry, and the doctor confirmed that it could be weeks before I did. Weeks was a timeline that did not fit in my busy summer schedule. She offered that we could schedule a D&C at the local hospital for the next day, a Saturday. Saturday didn’t work, because we needed care for my child, but could I have one on Monday? Yes. The doctor said it was very unlikely that I would miscarry over the weekend, but that if I did they could do a D&C right away to get it over with. This was a level of control I could coexist with, a timeline of days not weeks, and still an out for my body to get on with the miscarriage if it could do it soon.
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On Monday morning I had a D&C at a hospital surgical center. It was very hospitally and included a healthy dose of general anesthesia, but I was home and on the couch by early afternoon. The doctor said I could work the next day, but it took me about three days before I felt well enough to get out of the house much. My back hurt a lot for a day or two, and I ate ice cream and watched my favorite movies. Remembering Isis working through her miscarriage, I also allowed myself to dive back into my research from the comfort of my couch – taking my mind off the reality of my loss. By the end of the week I was back on campus. It took more than a week before I could sleep through the night without thinking or dreaming about the miscarriage. Two weeks post-D&C, the doctor gave me the all clear without so much as an exam or ultrasound and encouraged us to try for a summer vacation baby.
Two months later I don’t think about it very much, except when I do. We only told a very few people about the pregnancy and loss, but I do find myself referring to the “time when I wasn’t feeling well” that encompasses the fatigue of the pregnancy, the days of loss and sorrow, and the recovery from the D&C. While June was a pretty crappy month, I also feel like I got off easy in a lot of ways. I got pregnant quickly, so there wasn’t months of waiting to precede the loss. And I lost the baby early and fairly physically painlessly, before I’d shown a baby bump, told many people, or decorated a nursery. Since I know that most early miscarriages are the result of chromosomal abnormalities that are incompatible with life outside the womb, I can be relieved that it happened rather than carrying a baby to term, delivering it and watching it die in minutes or months. I have a wonderfully supportive partner, and the insurance and legal ability to make my own healthcare decisions.
I feel lucky that I had stories of women who’d gone down this road before me, and that through those stories, I was empowered to make the best decision for myself. My first motherhood story was about finding the patience to wait for a baby. My second motherhood story is about finding the strength to lose a pregnancy and reassert control over a body. I don’t know what the third one will be or if there will be one at all. But I do think it is through telling stories of motherhood won and motherhood lost that we give power to our own experiences and share whatever wisdom we have gained with women who will weave their own motherhood stories. I hope that by sharing my story here that at least one woman will find information or solace for her own journey.
