Thursday, August 29, 2013

Feminists were wrong, part 2

A couple of years ago I wrote a post on this blog entitled "Feminists were wrong," and I have recently had some new thoughts on the issue and I'd like to amend what I wrote earlier. In that post I argued that the reason women felt dissatisfied with their roles as housewives and mothers in the post-WWII era was that so much of their meaning was meant to be obtained through their role as consumer. So many of what would be their daily activities of running a household were being subcontracted to corporations (i.e. no more cooking, now there are TV dinners) and so the only decision they had to make was what to buy. They lost a lot of the efficacy you feel from actually cooking a meal or tending a garden or nursing a baby and felt the solution to this is to go into the workforce.

I think that this is where they went wrong. The solution was not to be away from their homes and then further subcontract their roles as mother to lower-paid women. I think in this recessionary economy women are beginning to realize this and are re-embracing their role as mother or wife in a way that really makes them feel good.

Okay, so that's what I argued in that earlier post, and I still believe it. What I have learned in becoming a mother myself has changed this a little bit. Being alone in the home with this baby can be frustrating at times, and not simply because my role as mother has been subcontracted out to corporations. I nurse my baby, cook dinners myself, bake bread, tend a garden, among other things. Yet, I long for conversations with other adults, for jamming out to music, for time to tend to the garden or go to the store or type a paper. My day is so baby-centered, I am not able to be a part of the world I once inhabited -- the world of normal social and economic activities.

So, I started to look into what other societies have done with child-rearing and found that among hunter-gather societies. I found that not only is child-rearing a shared activity among many adults, but most women resume normal adult social and economic activity very soon after a baby is born. That is, they continue spending time with other adults, many of whom cared for their child for them, and resume activities such as gardening, weaving, et cetera right away. It is only a phenomenon of sedentary societies, especially those societies that have private households (rather than living in a tribal, communal setting), that experience what might be called "professional mothering" (a term I stole from Morris Berman's book Wandering God). Professional mothering has an isolating effect.

All of a sudden, once you are a mother you are banned from some adults-only activities (think: going to the movies, work) and are banished to "mommy-and-me" type activities, the thought of which make me want to gag. Not only are stay-at-home mothers isolated, but the children of working mothers are isolated to daycare centers and schools. This is why so many women lack experience with children before becoming mothers themselves -- children are allowed only in child-friendly settings.

What would be better? A world where children and parents are welcome and tolerated at work and at play -- any place adults are welcome. I'd also like to see other non-parent adults feeling free to care for a child when it is in these settings, without some explicit paid babysitting arrangement. I'm going to try to implement this myself, but as usual I am swimming against the tide in this society and will be met with resistance (as I was when I went to the movies with Isa when she was only a few weeks old and making some very small cooing noises as she slept).

So, in reference to my previous post, I want to give a little more credit to these post-WWII women. They lost the usefulness they felt in keeping a house because corporations were doing many of these things for them. But, maybe more importantly, they were isolated from other adults and left alone with this intense focus on their kids. Being isolated in that way can be very difficult. Again, I don't think the solution was to go to work and leave kids in their own isolated institutional settings (daycare and state-run education), but instead to incorporate their kids into a world that contains adults. 

Wednesday, June 12, 2013

medical 'progress' in pregnancy and childbirth

Now I am almost at the end of my pregnancy and I've learned a lot about the state of modern pregnancy and child birth. I feel now the responsibility to put here what I've learned.

Although I had an inkling of this tendency before, now I know for sure that our society leans toward science, technology, and what it calls "progress." We often assume this is good. Take the polio vaccination, for example. It basically wiped out what was once a disease which hurt many, many people. We often think of medical progress in terms of the polio vaccine. However medical progress often (especially in the United States) comes in the form of unnecessary interventions. There seems to be an attitude in the US that goes something like "well, let's just do it just in case," or "it won't hurt to do more, so let's do more."

But it does, in fact, hurt to do more. I've seen this first hand throughout my pregnancy. Pregnancy and childbirth are a great place to see the effects of this kinds of medical progressive thinking because this is a unique kind of medical need. Ideally, and in most cases, women's bodies are capable of handling all of pregnancy and childbirth without intervention. Yet, we go to doctors "just in case." We go to make sure that we're healthy and handling the pregnancy well, and we have them attend births in case something goes wrong. Yet, if nothing goes wrong, you really don't need the doctor at all, for anything.

Even though we don't really need the doctor, as I haven't, they seem to want to make themselves useful. So, they spend a lot of time telling you about the very, very minute risks you may be facing. Some of those risks include: gestational diabetes, a too-big baby, group B strep, placenta previa, a breech baby, toxoplasmosis, blindness from maternal gonorrhea or syphilis, a baby without the ability to clot blood, the list goes on. The likelihood of being affected by any ONE of these things is very, very low. For example, about .01% of babies get toxoplasmosis - a disease contracted from eating undercooked meat (like deli meat). So doctors tell you to COMPLETELY avoid all deli meats, any raw meats or cheeses (including soft cheeses like brie), hot dogs, or any meat that's been sitting out for more than a few hours. Yet, there is a lot of evidence that says it's very important for all people to eat varied diets with lots of different kinds of bacteria in it. We may be over-sanitizing our gastrointestinal systems.

Take another example. Every single baby is given a gel antibiotic ointment on their eyes at birth. They give this to babies in case their mothers have gonorrhea or syphilis. I don't mind saying here that my doctor tested me as part of a routine battery of tests at the beginning of my pregnancy and I don't have these diseases. So, there's really no reason to rub my baby's eyes with a gel which makes it difficult for them to see and may slightly traumatize them. But it's so routine to do this to ALL babies, that in some states the hospital can report you to child services for refusing to put the ointment on your baby's eyes. I put my preference for no gel on my birth plan, but I still don't know if I'll meet resistance for this preference at the hospital or if the nurses will follow my wishes. It is just so assumed that all babies should get this gel, "just in case," that it is almost assumed to be child abuse NOT to opt into this unnecessary intervention. Really, there isn't a huge downside, the baby will just be a little disoriented by it. But, there hasn't been large studies on the effect of the widespread use of this eye ointment, so for me it is riskier to use it than not to use it. I know I don't have these diseases and therefore don't need the ointment. What I don't know is the long-term effects of this ointment.

Another intervention I have been running up against is this idea of a "big baby," medically called macrosomia. Pregnant bellies are supposed to measure, on average, how many centimeters as you are weeks along, plus or minus 2 centimeters. During most of my third trimester, I've been measuring about 3 centimeters larger than the week I am in. Keep in mind that it is normal to be within 2 centimeters of your week. For example, if you are 33 weeks along, your belly should measure between 31 and 35 centimeters. At 33 weeks, I was measuring 36 centimeters. Really only 1 centimeter above the "normal" range. It is also important to note that Patrick and I were both above the 95th percentile for our gender when born. So, genetics tell you that it's likely that this baby will be on the large side of the normal range. Very far on the large size. Yet, at a few of my doctor's visits, the doctor expressed mild concern about the size of the baby. Enough so that she ordered another ultrasound to see how big the baby is. But in most cases, you bear a baby that your body can handle! Your body is a very capable machine! When I went home and looked up online what doctors do about big babies, they often suggest to women that they need a c-section because their bodies can't handle the size of the baby. Even though ultrasounds have been shown to be as much as 4 pounds off in guessing the baby's weight! I have not faced this from my doctor, but what an absurd way to approach childbirth! There is so much to be gained from a vaginal birth in terms of the baby's health outcomes, but so much medical progress thinking leads to a third of babies being born by c-section.

I haven't even gotten into the interventions associated with child birth. It is considered progress to numb yourself from the waist down, getting a catheter shoved into you, being hooked up to an IV, told not to eat or drink for as much as 24 hours, and pushing the baby out by being told by a computer screen that it's time to push. Why is this progress? I can't even count the number of times I've heard "oh, just take the drugs and sit back." These drugs are not without risk! Babies born to mothers who've had an epidural are more drowsy and full of the drug. They often have a hard time taking to breast feeding. What else might be the risk to these babies, we don't know! Why do we avoid all drugs like saints for nine months just to shoot up like addicts at the last moment? Why are we told there is no risk to the baby? Epidurals do effect the baby, and often can lead to more intervention. What if the baby's heart rate goes down due to being drugged up, the medical staff freaks out and orders a c-section? Or they give you pitocin to move your labor along more quickly and it effects the baby's health and again they send you to the operating table? That's what's happening. There's no other way to explain this insanely high c-section rate.

The final example I have to discuss is the very widespread belief that women should not eat or drink anything for the entirety of their labor, just in case they need to get general anesthesia. It is important to keep in mind that this is VERY RARELY used in childbirth, due to the need to have the mother awake during the process. More often, as with c-sections, a local anesthesia is used. So, ALL mothers are told to not eat or drink anything for sometimes as long as 24 hours just in case of this very, very rare situation. What might you feel like doing the equivalent to running a marathon and not eating or drinking for the entirety of this physical feat?   Why might mothers be challenged by this unnecessary rule? Again, the "just in case" thinking of medical progress just doesn't line up with the needs of MOST mothers.

I try to remember that my body is built to do this. It'll be nice to be in a hospital just in case something *naturally* goes wrong. But I don't want the hospital itself to be the source of something going wrong, due to unnecessary intervention. I will try to be vigilant, have Patrick aware of my concerns and be my advocate and the advocate of our baby. It is sad that this irrational and unnecessary thinking pervades our medical system. It is frustrating going into childbirth and having to be a warrior against intervention. What kind of message does this send? It tells the woman "you can't do this" or "you are incapable without our medical help." When in fact she is much more capable than any doctor at growing and delivering the healthiest, most robust baby. I am happy that I know this, but so many women unfortunately do not have access to the kinds of information that I do as a sociologist and a college-educated person. It is the responsibility of society to change this kind of thinking for better outcomes for our babies and pregnant mothers. 

Monday, February 18, 2013

insurance company woes

Over the past few months, I have had some of the most mind-blowing experiences with my insurance company, and I want to share a few of the details here. The insurance I have is part of my graduate student health care offered by WSU. The first of my experiences started when I received an email claiming that the university was going to raise the rates on our insurance, making us pay part of the annual fee. They were doing this while at the same time hiring a new football coach whose salary is 5 times that of the previous football coach (we're talking millions of dollars). Why did they want to raise the rates? Because the Obama health care act made it so the insurance company had to cover basic things like ambulance rides in case of emergency (without previous consent) or gynecological exams every year. Why else? Because we were actually using  the insurance. Yes, this was said to us by an administrator. Our insurance company wanted to charge the university more because we were making claims on it. If we made less claims, the price could stay the same. The university's plan? To defer the cost to us, the graduate students. That is, we would no longer get health care as a part of our package, it would be something we would have to pay a portion of. While the football coach is getting paid millions of dollars. Is this an institution of learning or sports? What is the point of our colleges anyways? This university would crumble without graduate students, yet they want to make us pay another $500 out of our poverty-level $10,000 per year salary.

Okay, example number 2. While I was out of town I went to the doctor for a UTI. The doctor said they didn't take my insurance so I paid up front, asking for a receipt so I could be reimbursed by the insurance for this covered service. When I submitted a receipt to the insurance they said they needed further documentation from the doctor. When the doctor gave them this documentation it was a bill for more money than I paid in cash at the time of service. The explanation from the doctor is that I was given a discount for paying in cash. Yet, the insurance company is now saying this is the new bill and issued a check to the doctor for the services I already paid for! When I asked the insurance company why they didn't just reimburse me, they said the doctor sent them a bill and they paid it. But the doctor didn't send them a bill, they asked for documentation of services that I already paid for! The doctor's office now claims that it was a bill, simply to get more money for the services. It is important to keep in mind during this whole process, from May 2012 until January 2013, I called the insurance company repeatedly (think: more than 50 times) without sensible explanation, sometimes being told that they simply do not reimburse people, sometimes being told that they made a mistake, or I did or the doctor did. Speaking with all different people with all different levels of competency and familiarity with the case. Each time, I had to re-explain the situation and never once was I transferred to a supervisor when asked (each time I was transferred I got a voicemail with no return call). Needless to say, I never got reimbursed for the services.

Final example. Patrick went to the student health center for what he thought was a broken wrist. This health center deals with our insurance constantly. After he went there, he got three separate bills in the mail that all charged him directly for the services. These bills were from: the health center from the doctor who saw him, the local hospital which administers the x-ray machine, and the radiologist in spokane that read the xray. Why wasn't the insurance billed for these services? And why was he getting three separate bills for one visit in the same building? Well, the insurance company has decided that for each claim the patient needs to fill out a separate claim form which basically asks you if there's any way this sickness/injury can be covered by any other place (worker's comp, previous insurance) every time you ask for them to pay for services.  So, they are simply providing another hurdle to paying for services by asking you to fill out this form on your own before the doctor can submit a claim. So, in order for the insurance to be billed for this one doctor's visit for Patrick, he had to download and print three of these claim forms, fill each of them out, find out the billing address for each institution and mail each of them to three separate institutions who can then finally submit a claim to the insurance. He is still in the process of completing this from a doctor's visit from October 2012. The most infuriating part is that this was a big investigation process to figure out why the insurance wasn't being billed and how to fix it. It took multiple emails, phone calls and bills to piece together this mystery. In the meantime, he is getting bills sent to his student account through the university where late fees are being applied, and bills that are threatening to send him to collections.

How did this system come to be? How can we be so alienated from one another? Just based on these few experiences, this is the least rational system for caring for the health of one another in society that I can imagine. Sociologist George Ritzer calls this the "irrationality of rationality" where several independent rational decisions add up to make an irrational system. But I don't think that's what's going on here. Whomever decided at the insurance company that patients needed to fill out a claim form every time was not making a rational decision; he/she was making a selfish one. The company does not want to pay claims. The insurance company's goal is to make money, not to provide health insurance for the medical needs of its customers. So, someone decided to include this hurdle to paying out claims. I think what's going on here is the irrationality of greed. Not only are people alienated from one another or from the consequences of their decisions by the division of labor, they are also making decisions based on the bottom line of this society: profit. So, that's how it comes to be that someone dies on the emergency room floor while waiting for care. This is how it comes to be that even when you have insurance and you follow all the rules, you're sent to collection for bills you were never meant to pay, keeping the powerless down in a cycle of poverty while the powerful reap the rewards. I've got to get out of this place.