Personal WOO WOO

I'm going Personal WOO WOO on y'all for a moment. When I started this blog, I decided not to decide what it was going to be about in particular, on the theory that the more options I had for stuff to write about, the more I'd write.

Today, class, I'd like to talk about my theory of the personal mythology. And while you may think that someone else made up this theory first, no. It was me.

My archetypical personal mythology is the one about the blade of grass. One of a handful of memories I have from the house I lived in before age 5 is that my dad and my older brother and I were roughhousing outside and I swallowed a piece of grass. And ever thereafter, when I get out of breath, the piece of grass stabs me a little bit in the back of the throat in an unpleasant way. I really did believe this for years, way past the age when I should have realized it made no sense, because I had gotten so used to thinking 'oh, there's that blade of grass in my throat again.'

Another, of more recent vintage, is that my critical period for language learning overlapped with my high school German classes, in which I did awesome. I developed this theory when I started taking Georgian in college and it was completely impossible and made me cry a lot. (Obviously, my age was the only difference.)

Not really saying anything with this photo. Just, how awesome are those pants + glasses?! Source.

Lately I have been thinking about a different genre: personal mythologies about the abstract future. Places and things that inspire me to ponder my forward-looking personal mythologies include: libraries (in the abstract future I will read all the things), non-rainy days in the city (in the abstract future I will spend hours walking outside each day), NYT real estate and home and garden tours (in the abstract future I will live in spacious bright rooms with classy but cozy mid-century furniture), smart and funny people online (in the abstract future I will be a smart and funny person online), pictures on Pinterest or in Country Magazine when my grandma sends clippings of cozy indoor winter morning scenes (in the abstract future I will be the kind of person who gets up early, sips cocoa, looks out the window at deer, and wears slippers), et cetera et cetera ad nauseum.

They're funny to me because when I catch myself entertaining them, I generally can't tell if they're realistic or not. I think it's partly because I'm sort of attached to them as personal mythologies and if all of them turned out not to be personal mythologies but instead what my life was actually like, I think I would feel their loss. So I have an incentive to not dream up personal mythologies about the abstract future that are so realistic they could conceivably come really true.

Tell me, do you have personal mythologies? Backward-facing or forward-facing ones?

Navelgazing

Lots of navelgazing lately about what I'm about regarding childbirth.

I would say right now I am mostly trying to hash out a spot somewhere between three angles on the topic:

One. The fact that many or even most aspects of modern American birth are not optimal for healthy mothers and babies, aka the public health angle.

Two. The severe lack of information, choice, and agency most women face in their childbirth experiences, aka the feminist angle.

Three. The devious little inner know-it-all birth nerd that thinks everyone should have a non-interventive birth and breastfeed as long as possible, aka the asshole angle.

Woops! I let that one come out of my virtual mouth. You know, I'm working on this, and I'll be frank and say that I haven't whooped it yet. I can talk big about how both One and Two are problems on a population/society level, not an individual level, but talk to me about a pregnant woman and the asshole wheels start spinning, true story.

In my head, this is wrapped up with a few other issues, which I hope to write about in the short term future:

A. The question of what actions my convictions about these issues compel me to.

B. Issues I seem to have with advocacy. And you know it's true because I once had to get told by a certain BU professor interested in childbirth that "Advocacy is real, you know." Doy!

Twitter Questions

I always get a little excited when I find myself wondering something that's not easily googleable. I like asking these things on twitter, but despite its awesomeness*, I have not found it to be a great question-answering forum. Here are some answerable questions I've posted on twitter that have gone unanswered - and that I am still wondering about. Virtual gluten-free vegan coffee cake for anyone who comes up with answers!

"What are best predictors of c-section? (I know previous CS - what else?) looking for demographics to maternal health to hosp procedures." (13 April)

"Educate me - what does it mean if an NP works in obstetrics "in ambulatory"? Who does she treat and for what?" (6 April)

"so the oft-quoted '60% of women do not meet their breastfeeding goals', supposedly a CDC study ... anyone know what study?" (3 April)

"Of those not breastfeeding, are there more who want to but couldn't, or who didn't want to start? Very diff problems - which to target?" (3 April - and followed by "Regretting words 'problems' & 'target' in last tweet. Try again: very diff strategies to up rates in those 2 cases.")

"What's the history/rationale for the divisions perinatal/neonatal/post-neonatal/infant/child (in the context of mortality)?" (31 March)

"When a tweet stops in the middle of a sentence with an ellipsis at the end, does the rest exist somewhere? Or a link ending w/ an ellipsis?" (24 March - my newest theory on this baffler - cross-posted from facebook or tumblr and just gets truncated?)

"Has anyone written about benefits of midwifery care for preterm or low birthweight babies? Anyone got links?" (21 March)

"anyone have a rec for textbook type reading on women's studies/feminism? think undergrad intro class - i want it light but contentful." (11 March)

""Hospitals...have to report metrics such as...how many women get episiotomies during childbirth." http://huff.to/aNmqi. Anyone know where?" (1 March)

"still don't know the answer to this question - how do we define "preventable" when talking about morbidity or mortality?" and "I'm interested in thoughts on balancing risk of mortality w/ risk of morbidities, esp where conflict arises in practice. blog/twit rec.s?" (15 February)

"Is there a word meaning offspring that is 1)non-gendered + 2)relational like parents(cf child: does not imply 'belonging' like 'parents')" (9 Feb)

"[asking people how healthy they feel =good proxy for measurable health.] [asking about patient satisfx w/ HC =?good proxy for HC quality?]" (31 Jan)

"Does anyone have any general research articles on diet as a confounder in studies that show associations btw obesity and morbidities?" (26 Jan)

"Ok brilliant people: someone point me to a solid bit of reading on W*stboro B*ptist. Not what they do, but why. Socio/anthro/etc answers." (9 Dec)

*I sort of want to post about how awesome twitter has been for me, but it seems silly to ode a social networking site.

Casual lunch conversation about VBAC and government intrusion

I had a casual conversation with my boss the other day about my class and interests in public health and childbirth. (For any readers who don't know me personally, I do not currently work in an area related in the least to public health.) Well, we got talking and before I knew it I was letting loose all my favorite appalling statistics about childbirth in the US. Yes, I said the word "vaginal" to my very male, very straight-laced boss, and the heavens did not come crashing down. I was proud of myself. I'm always nervous that if I start talking about this stuff I am going to weird people out. He did ask the source of my interest, and when I said "I'm not pregnant" we both laughed - three other co-workers just returned from their maternity leaves, so it is baby season at my office. He also told me his sister used to work at Yale in their Nurse-Midwifery program! How cool is that?

I also talked about the basic idea that we tend to think of individuals as being responsible for or capable of controlling their own health outcomes, though research shows that this often isn't the case. He objected strongly to the claim that the government has a place in issues of say, childhood obesity - for him, it is solely the parents' job to deal with their children's health. He is devoutly Libertarian. I had to admit to myself after the conversation that I have not spent enough time thinking about the idea that it is a political belief that government should care for its citizens in the way that public health often advocates. Is it possible to be on the right-wing, less-government side of things and be an advocate for public health? I feel like my thinking on this issue is so simplistic as to be laughable. I guess it will have to come with time and a better understanding of what roles the US government does and does not actually play on public health issues.

When we were talking about childhood obesity, I pointed out that lower-income neighborhoods often have a paucity of accessible supermarkets with reasonably-priced and appealing produce sections. He argued that the market would take care of that, and if it were the case that people would buy the produce, the stores would have it. That seemed all wrong, but I didn't have a rebuttal until the next week, when attending the kick-off breakfast for the annual Project Bread Walk for Hunger. One of the speakers was Lauren A. Smith, who is the Medical Director of the Massachusetts Department of Public Health. She was explaining how hunger and obesity often go hand-in-hand in communities. I don't have the exact quote, but she said that fast food is the economically smart choice for people who are struggling with hunger. Fast food is often extremely calorie-dense - a lot of calories not only per gram, but per dollar. When your first priority is eating at all, it only makes sense to get as many calories per dollar as you can - and an apple does not fit that bill.

I leave you with two awesome links:
Maybe this is part of the problem/solution?
And as much as I roll my eyes about not eating "weird chemicals that should never be in food zomg?!?!?", this is disturbing.

Am Anfang

Before class today I popped up to the 12th floor library and checked out a book that At Your Cervix recommended, Midwifery and Childbirth in America by Judith Pence Rooks.  I'm a little nervous about my first birth-related book.  I have a bad habit of obsessing over a topic, then checking out a stack of books and never reading any of them - losing interest because the effort involved in continuing to learn is too great.  I'll keep you updated on progress.

In other news, class was fun.  This was the session I'd sat in on last semester, so the material was familiar.  We covered the Health Belief Model and the Theory of Reasoned Action, both in much simpler form than Wikipedia presents.  The professor is making the argument that most public health interventions are based on these or similar models, which are inaccurate representations of human behavior.  One of the texts for the class is Dan Ariely's Predictably Irrational, which I read after sitting in last semester.  I am definitely willing to buy that we should stop depending on human behavior to be rational.  What I haven't heard yet is an example of a successful intervention based on a model that takes this into account.

It also occurred to me to wonder if you get better results from these models for health behaviors that are less dependent on broad issues (socioeconomics, social inequity, lack of access, etc.).  The only example I can think of at the moment is hand-washing, say in the US, so we can assume the presence of clean water, bathrooms with soap in public places, and so forth.  Also assume with me for the moment that hand-washing habits are not greatly shaped by fundamental, underlying factors like those mentioned above.  Can you motivate people to adopt better hand-washing habits using one of the models above?  Is it that the models just completely don't capture behavior-related decision making, or is it that behavior-related decision making is usually so much more complicated and tied to all these other things?