Thursday, November 23, 2017

Of Science, Religion and Faith: My Declaration of Faith

I recently got slammed on a LDS homeschooling moms group for recommending some materials from FAIR for questions about teaching science. I was told in no uncertain terms by a couple of women that LDS apologetics is dangerous and not in harmony with Church doctrine.  (I find this hard to believe since they have a regular slate of BYU professors as contributors.) They said that my belief that science and religion don't conflict is against the scriptures. There were two other members of the group who were nice enough to stand up for me though, which I very much appreciated. I posted links from the Old Testament manual which states that the scriptures should not be used  as a method of dating the age of the Earth and the recent video where Elder Nelson (a former heart surgeon) and a LDS molecular biologist talk about science. Those materials were also rejected by several of the group members.

Well, after listening to scientists, reading several science magazines and medical journals and reading and listening to many of the materials from FAIR, this is what I believe:

I believe that we have a Heavenly Father and Heavenly Mother who are the parents of our spirits. I believe they are exalted beings who progressed to a state of divinity through their righteousness. I believe that they have a view of time and space that far exceeds our own. (Perhaps they have access to the event horizon of a black hole and can see the future of the universe? But Stephen Hawking disputes that black holes in the traditional sense exist. But he might be wrong. But it's an interesting idea.)

I believe that the Earth was formed and progressed over a course of billions of years, grace to grace, line upon line. I believe that the use of the word "day" in the Bible meant a period of time. I believe that the 7 is used for the Hebrew symbolism of "perfect" or "complete"- in other words, a perfected and complete creation. I believe that first the Earth and solar system and galaxy were organized from existing elements (the nebula of older stars). Once the Earth and solar system had formed to a point where life could exist, life started in the great oceans of the Earth, progressing through each stage of plants and animals in preparation for God's crowning creation, humans. I believe that the Earth was created as a "school" for us to obtain physical bodies and challenged to reach our divine potential.

I believe that a loving Heavenly Father prepared a Savior for us to repent of our sins. I believe that Savior to be Jesus Christ and that only through His atonement and out continued striving can we reach a state of exaltation.

I believe the Bible, Book of Mormon, Doctrine and Covenants and Pearl of Great Price (one of my all time favorite books of scripture) contain the words of God. I believe that these books of scripture contain many different and inspired documents that have different purposes in our spiritual education and development. Some, like Leviticus, are manuals or handbooks, others like the Four Gospels are firsthand accounts from different perspectives of Christ's ministry, some like the epistles are letters on how to deal with specific concerns from an ancient Church administrative and doctrine standpoint, others are works of literature or poetry like Psalms, Ecclesiastes and Proverbs. I do not believe that everything in the scriptures is meant to be taken as historical accounts or scientific fact. I think Mormon's repeated admonition that the Book of Mormon was an abridgment which contained not even an hundredth part of the writings and history of his people should inform our reading and interpretation of scripture. They are not meant to be read as historical documents, but rather as materials to inform our spiritual and moral development. Jesus never said the parables were fact- based accounts of actual happenings. That doesn't mean they aren't important and valuable in our learning.

I believe that God has prophets on this Earth and their stewardship is to lead the general body of the Church and give general warning and counsel to the world. When they speak with authority from God, they are giving commandments. I do not believe that prophets are infallible. I know our Heavenly Father has put us each here to learn, so He never gives everyone all the answers to everything. His prophets have a calling to receive revelation for the Church, not to get involved in matters of politics, medicine, historical accuracy, or quantum mechanics. If I want to know about the implications of a new law, I would ask someone familiar with the political and social background of it. If I want to know about the latest developments in the human brain and body or medicine, I would ask an appropriately trained physician. If I want to better understand something from history, I would ask a historian with training particular in the question, and if I want to understand the latest thoughts on astrophysics or timespace, I would ask a physicist trained in those areas. I look to the General Authorities to hear information on God's commandments to us, His children.

I believe that my Heavenly Father is more concerned with how I use my time on this Earth rather than if I believe the Earth was formed in 7 days, 7,000 years or 7 billion years. I believe that God is more concerned with whether we are listening to the commandments and warnings of His prophets rather than if we believe in a global or local flood in the days of Noah. I believe God is more concerned with how I carry out my role as a woman, wife and mother and support my husband in his roles rather than if I believe Adam had one more rib than Eve.

And lastly, I believe that the warning against learned men who think they are wise, applies to everyone  and not just those who have advanced degrees. Everyone who believes they have had all the knowledge they need and rejects wisdom is in danger of this pride. I believe that faith means keeping God's commandments even when you don't know all the reasons why, not that you stop asking questions and never examine an issue or idea from a different perspective.

 So there you have it. The declaration of faith of one who has been corrupted from reading "Discover" magazine, watching The Cosmos with Neil DeGrasse Tyson and Contact, and yes, listening to lots of FAIR podcasts.

Monday, October 23, 2017

Inaccurate Things About Big Love

Supposedly the creators of the series spent years in Utah researching it. The first few episodes were pretty good. They seemed sincere in understanding the characters' desire to worship God in the way they see fit. And it was an interesting exploration of the difficulties of families and relationships in a culture that is little understood by most Americans.

 But the whole series started going really far downhill about season 3. It quickly devolved into a soap opera of wild side show freak storylines with zero character development.

 Now, you might be saying, "Oh but it's just a TV show."

True.

It is just a TV show.

Though I wonder how the creators (who are gay) would feel if Latter Day Saints took their culture and beliefs and reduced it to a series of inaccuracies for entertainment. And many of the mistakes were just plain lazy...

And the writing got really bad after season 3.

Geography 

Bill and Barb's old bishop makes several visits and invites them to come to their old ward, even though have moved. In reality, it's pretty difficult to become a member of a ward unless you actually live within the geographic boundaries or go to a local branch or ward that serves a different need like young single adults or conducts meetings in another language.

Mormons and polygamy 

Contrary to Bill's assertions, there is no evidence that Joseph Smith had sexual relations with any of his wives other than Emma. It's possible that he may have fathered other children, because some of the women he was sealed to did have children while he was alive, but it's hard to know for sure. The ones who grew to adulthood and had their own children do not carry Joseph Smith's DNA, so we know he couldn't be their biological father. There were a couple of infants that died though. Since they don't have any descendants for us to test DNA, we can't establish paternity one way or the other. The LDS Church has an essay on Mormons and plural marriage here. One of FAIR Mormon has an extensive research on Mormons and polygamy, I recommend it. Looking for something from non-Mormons, but based in history and scholarly study? I recommend the PBS documentary The Mormons.

Missions in the Middle East 

In Episode 1, Tina Majorino's character says she wants to serve a mission in the Middle East when she turns 21. There are no LDS proselyting missionaries in the Middle East. In the 1990's, the Church officially established a policy of not teaching, proselyting or baptizing any Muslims planning on returning to the Middle East in order to respect the laws of Middle Eastern nations that prohibit proselyting of the LDS faith.

Mormons and Gays

The portrayal of gay Mormons isn't entirely inaccurate- but not entirely accurate either. While there are many Latter Day Saints who deal with hostile families in relation to their sexual orientation, others choose to marry a spouse of the opposite sex- even while openly disclosing their sexual orientation. Many gay and lesbian Latter Day Saints who choose to be active and get married have their children the old-fashioned way through sex, pregnancy and birth. (See Josh Weed.) The episode where Sarah interviews a LDS couple seeking to adopt where the husband is gay and the wife is mentally ill is not an accurate representation of LDS couples seeking to adopt. Most LDS couples who are seeking to adopt are struggling with infertility (a painful struggle on its own). 


Chastity literature

This is no pamphlet called "Satan's Thrust" as depicted when Bill's son confesses his sexual activity to his bishop. There is a pamphlet called "For the Strength of Youth" that covers sexual purity and other topics. I am doubtful that his old bishop would intervene in this if the family had moved geographic boundaries. (See above.)

Surrogacy

The LDS Church does not encourage the practice of surrogacy for infertility. So the Henricksons' neighbors asking Margie to be their surrogate is not impossible, but unlikely. Latter Day Saints do not generally espouse a belief that their children's spirits will go to a drug addict if a couple is infertile. Many Latter Day Saints who adopt after infertility express a belief that their child was meant to come to them, even through adoption. One celebrity example of an LDS mother who has adopted children is Marie Osmond who has said that she feels her children were all meant to come to her.

Laws and politics

The LDS Church does not run Utah. Some people have a hard time understanding how a state that is largely LDS could have laws that are so steeped in Mormon traditions. These people have an extremely difficult time understanding cause and effect. Oh and it was just so progressive how Barb suddenly becomes an intern after Bill is elected. Sleeping with a politician gets a woman into political roles. That's just so feminist. Portraying the LDS Church as some dark puppet master became a more frequent motif in the last two seasons of the show. Every time the writers were faced the fact their protagonist did some pretty morally questionable things (like violating his own standards of chastity, making his friend take the fall for him on polygamy during his run for office, "marrying" his third wife when she was still a minor), they would quickly turn the episode to a "LDS puppet master" plot line.

Help For Those Fleeing Polygamy

"Big Love" consistently displayed a picture of Utah as a place where little help exists for those seeking to flee polygamy. In one episode they even go so far as to portray a legislator as threatening to have all "Lost Boys" tried as adults. (This is a legal inaccuracy since trying a juvenile as an adult is dependent on the violence and nature of the crime, not the background of the offender.) Utah does not typically prosecute "Lost Boys" as adults. During the 1990's, leaders of the FLDS church began taking many more wives and the problem of exiled boys began to steadily increase. In the early 2000's the state of Utah began funding groups that help exiled boys transition into the outside world. Tapestry Against Polygamy was one of the earliest groups in Utah that was formed to assist women and girls in leaving abusive polygamist sects, others have formed since.

The Temple Ceremony Episode

Oh this was a good one. Let's just say that there are maybe 5 minutes of accuracy in the whole episode. And by the way, Mormons don't believe that being excommunicated will send someone to outer darkness. Outer darkness is a concept about which Latter Day Saints have little revelation. However, its residents are theorized to be people the likes of Judas Iscariot, Cain and Satan and his angels. FAIR Mormon has written an excellent article here.


Oh yeah, and freeways

I have lived in both Utah and Southern California. It's pretty obvious where the show's creators and actors hail from. In Utah, people say "I-15" or "I-215" not "the 15" or "the 215". Only in SoCal do people use "the" before a freeway number.

Monday, October 2, 2017

I Have Holy Envy For Atheists

You may have heard the term "holy envy". It's having a healthy admiration for the good things in other faiths and even incorporating some of those good things into your own life.

I have found many things to admire from other faiths. But lately, I have been reflecting on the things I admire about atheists. Many of the atheists I have met have a deep dedication to living an ethical life and doing good to others. Because they don't believe that any being is coming to save us, they act as if the world depends on their actions to make it better.

I feel like it really embodies that Young Women's value of choice and accountability:"I will choose good over evil and will accept responsibility for my decisions." I contrast this with the behavior I have seen from some Latter Day Saints who use forgiveness and the atonement as reasons why they shouldn't have to suffer unpleasant consequences from their decisions.

I do believe that God is there and interested in our lives and the world. But I believe that as a highly developed moral being Being, He expects us to do our best in the world and not rely on Him to shield us from the consequences of our actions.

And so, I have holy envy for atheists.

Wednesday, January 20, 2016

Before Worrying About The Latest "Epidemic", Consider the Following...

Ebola. Measles. SARS. H1N1. The media has no end to diseases that they want you to panic about. Add to that to freak out about the small possibility of something like post-earthquake radiation leakage from Japan and people's fears about an apocalyptic crisis (like government takeover, economic implosion, Armageddon...) and you have a population in a near constant state of anxiety over some crisis.

But after completing my first class in my Masters in Public Health, here are my thoughts...

Heart disease, cancer and accidents are more likely to kill you. More likely than what? More likely than just about everything. About 610,000 people die of heart disease in the United States every year. 589,430 estimated cancer deaths occurred in 2015. (Around 2,000 of these deaths were children.) 130,557 people died of accidents in 2013. OK, let's put a few things in perspective...

The number of people in the United States who died from ebola (as of March 2015) is two. Remember the SARS (severe acute respiratory syndrome) scare in 2002-2003? Eight cases in the United States were confirmed and none died. Hitting a little closer to home on a hot button topic, remember the panic about measles? Roughly one person has died each year of measles since 2000, most of which were immunocompromised individuals in their 30's. By comparison, before the measles vaccine was introduced, about 450 deaths annually were attributed to measles.  Now, H1N1 is a hornets' nest, but I'll wade in anyway for comparison's sake on both sides. According to the CDC, 12,469 American deaths were caused by H1N1 influenza during the global pandemic of 2009. (Which is interesting because initial numbers from the CDC claimed 36,000.) However, several people in the medical, public health and statistics fields have questioned these numbers because of liberal inclusion of deaths that were the result of secondary complications of the flu. (For example, a person who is in poor health from an underlying heart condition becomes sick with the flu, it exacerbates their condition and results in death. Or someone develops the flu, but the infection moves into the lungs developing into viral pneumonia.) Some estimates place the actual H1N1 flu death numbers at 500 for the flu season.

You and your loved ones are much, much, much more likely to die of heart disease, cancer or an accident than the latest media crisis disease.

It's a lot easier to panic about something that isn't happening to you at the moment and is unlikely to actually take place. It distracts from dealing from the actual threats in our lives. Whatever, exotic, rare, blast from the past disease or rare crisis you have heard about, remember that it's probably pretty unlikely to happen. Eat healthy, take preventative measures against cancer, and practice safety precautions. It's a lot better use of your time and effort than worrying about ebola.


Tuesday, January 5, 2016

What I Would Tell Another Parent Who Is Having A Baby With A Birth Defect

The other night we took CJ on his nightly adapted tricycle ride at the park and we met a man named Mark. Mark was born without arms. The cool thing he is that he was playing the electric guitar- with his feet. Mark drives, has had many great jobs, has had girlfriends, been married and was even a single dad to his three kids for several years on top of playing in a band. He drives a car with no adaptive equipment. We talked with him about growing up as a "disabled" kid and he confirmed what we have felt all along- it's about your attitude. If you or your parents think it's no big deal- it won't be to anyone else.

When we parted ways so Mark could charge his amp before another show, I was left with such a feeling of gratitude to God. Gratitude that my son is missing part of his spine. I had an epiphany and I realized what I was so grateful for- the chance to raise a kid who has challenges.

Seriously. It is a privilege and a gift. Yes, it's a challenge. Yes, there are days when I want to pull my hair out. But I believe there is a lesson that God has been trying to teach me through CJ the entire time. Actually, I think it's a lesson CJ was put here to teach the world. And here it is: It's not about the hand you are dealt, it's how you play it.

I know people who have big houses, the use of all their limbs and senses, plenty of food, clean water and clothing and the capability to pursue many good things. And they are miserable. And then I know people who were born with some kind of physical challenge who are happy and fulfilled. I'm ashamed to admit it, but there have been so many times in my life where I feel like I was dealt a raw deal and that I can't move on because of it. But this has been a big year for CJ. He took his first steps. Now, he can do a couple of yards unassisted- after we were told that he would never be able to walk unassisted and that even with assistance he would never do more than a very short distance. I have thought so many things were impossible in my life, but I believed in this one thing. And because we believed it, we were able to make it come to pass.

So after being the parent of a kid with a birth defect for over five years now, here is what I would tell someone who has just found that they are going to have a baby who will be a little different:

Accept it. One of my favorite Dr. Phil-isms is this: "You can't change what you don't acknowledge." This is absolutely the first thing you must do to be an effective parent. I saw parents in the NICU whose babies were in the NICU much longer than needed because they kept trying to avoid learning and demonstrating the skills needed to care for their babies at home. It can be devastating to find out that the things you planned and hoped for your baby won't happen in the way you wanted. (CJ isn't going to be hiking with us any time soon.) But until you acquiesce to the reality that your child is going to be a little different in some way you can't improve on the situation.

I really love the 1991 Disney movie Wild Hearts Can't Be Broken. It's based on the true story of Sonora Webster who was blinded in a horse diving accident and then taught herself to continue to riding and diving with horses. There is a scene in the movie that demonstrates this principle. Sonora tells her fiance Al that her blindness will go away; she just needs some rest or some time. And Al tells her that it is permanent. She can be angry, she can fight it, but none of that will change that it just is.Once she accepts that her blindness is a permanent condition, she's able to work with it and dive again, before that she's just waiting and staying stuck.

There are two books I recommend 110% to anyone who has found out that their baby has a birth defect: How To Stop Worrying and Start Living by Dale Carnegie and The Obstacle Is The Way by Ryan Holiday. (Actually I recommend these to anyone who is breathing and has troubles. And even if you're a ghost they might be helpful too.) If you've just been hit with a diagnosis on your  baby I'd specifically suggest chapters 2 and 9 in How To Stop Worrying and Start Living ("A Magic Formula for Solving Worry Situations" and "Co-operate With The Inevitable") and the chapter called "The Art of Acquiescence" in The Obstacle Is The Way.

Prognosis can be a fluid concept. I think that doctors often don't want to give parents a false sense of hope. So they hit them with the worst thinking they're preparing them to deal with the challenges ahead. In reality, this false despair is just as corrosive.

The reality is that every kid will have different challenges. When CJ was born we were told there was no chance he could walk unassisted or that he could relieve his own bladder or bowels. The specialists were wrong on all counts. If your baby has just had a diagnosis for something like spina bifida or Down Syndrome- especially a prenatal diagnosis- please take a page from Hitchhiker's Guide to the Galaxy  and DON'T PANIC. You will probably not know the full extent of your baby's function until he gets older. You also run the risk of assuming your child will have a problem or a severe form of a condition that he or she may not have and then creating that reality. I have seen kids with myelomeningocele who are running around like crazy but have multiple shunt revisions, adults with myelomeningocele who use mobility devices and have had their shunts removed because their bodies no longer use them, kids who need catheterization, kids who don't and on and on and on. It really depends on the individual.

I will forever be grateful that the first doctor I talked to after CJ was born was positive with us. I asked if my baby would have brain damage- I wanted to know so I could be prepared for that. He told me that CJ might have hydrocephalus and might need a device called a shunt to control fluid build-up in the brain, but if the hydrocephalus was under control there was absolutely no reason CJ couldn't be valedictorian of his graduating class. Nice! Honest answer, but focusing on ability- not disability.

Here is what I wish doctors and specialists would tell parents when giving them a diagnosis- especially a prenatal diagnosis: "Your baby has X Diagnosis. These are some of the conditions we often see with this diagnosis. Your baby could have several of these conditions or only a few. We need to watch and be aware of these things, but at this point we can't predict what particular abilities and limitations your baby will have in life. We need to focus on maximizing whatever abilities your child has." When you're looking at your baby, remember Will Smith's words in the movie Hitch: "You is a very fluid concept right now."

This is not a "parenting hall pass". You still have to parent your kid. All kids need discipline, you may have to adapt things a bit for your child's particular needs and capabilities, but they still need discipline. We still have to teach CJ to be polite, to be nice to his brother and that he can't everything he wants when he wants it. Another benefit is that people are charmed by a child in a walker with good manners. Do not get sucked into the trap of "Oh, she's been through so much, how can we say 'no' or punish her?" Otherwise, you may end up with this scenario dramatized in The Miracle Worker:

Oh, and you're not off the hook for talking to your kid about sex either. Depending on your child's intellectual level and physical condition you may need to make some adaptations, but they'll need to some things- especially about appropriate and inappropriate touches. (All kids need to know that for their protection.) With CJ, things are pretty basic right because he's only five. New babies provide a great opportunity to talk about some introductory aspects of human development. 

But we know that we'll have to have some discussions tailored to his needs as he gets a little older since fertility impairment and some other issues might be part of his condition. That's OK. We want CJ to have great friendships and later great dating relationships. We want him to find that special girl and get married and start a family. We think the best way to make that happen is for him to have frank, honest knowledge about human sexuality, relationships and his condition and understand the possibilities that are open to him.

Your kid still needs exercise, healthy food, hobbies/interests. One of the things I kept seeing in the information about myelomeningocele is how kids with it are at a higher risk for obesity. Based on my experience, I think this has a lot to do with parents and specialists who don't think the child can exercise. We are strong believers in the power of exercise to keep people healthy and wear children out. When CJ got his first walker, we made it a priority to take him out for exercise every day. As his endurance increased, we've had to make sure we get him out for longer or more intense walking or tricycling. We started taking him to the zoo and he has done some serious mileage there. Just like we need exercise every day, he does too. He's better behaved and goes to sleep more easily. And he needs healthy food just like any other kid. I think a good diet and plenty of exercise are part of the reason he is in such good health. He rarely gets sick and is at a normal weight for a kid his age.

As he gets older, we want him to try out some different activities. The really great thing is we live in an amazing time where there are more options available than ever before for adapted recreation. Wheelchair rugby, sledge hockey, adapted basketball, you name it. I once saw a YouTube video (unfortunately, I can't for the life of me find the link) which showed a man in a wheelchair who was doing martial arts and showed how he could disarm a standing opponent who had a knife. Some ballroom dance competitions even have wheelchair dance events. There are people hiking with prosthetic legs and paraplegics who go swimming. A new trend I've been seeing is dance studios that offer special needs dance classes for children with intellectual delays. 

Some of history's greatest people have had some kind of disability. Stephen Hawking's mind is sharp despite his physical limitations from ALS (Lou Gehrig's Disease). Franklin Roosevelt was paralyzed after developing Guillain-Barre Syndrome and went on to become the President of the United States for four terms.  Many historians say that he would not have been the leader he was if he hadn't had the challenges of losing the use of his legs. (I've always loved the irony that Hitler considered disabled people inferior and yet a paraplegic man was one of the instrumental figures in kicking Hitler's @$$.) James Earl Jones had a speech impediment and didn't talk for several years as a child. Even with limitations, we're all capable of a lot. I can't wait to see what CJ is going to do next. And other kids like him.

Tuesday, December 22, 2015

Investigation: Australian Mother Dies Giving Birth At Home

Note: This post is part of a series called "Birth Apologetics". "Apologetics" comes from the Greek and means "to speak in defense". (Often used in relation to defense of a particular idea or viewpoint, such as "Christian Apologetics".) In these posts, I will be taking blog posts and articles that are critical of home birth and natural birth and doing a critical analysis on the data and arguments. The idea is that if natural birth and home birth are safe for most women, arguments against them will have serious flaws.
Claims: Australian homebirth advocate Caroline Lovell suffered a cardiac arrest an hour after the birth of her second baby at home and subsequently died at a hospital. This is yet another proof of the dangers of homebirth and childbirth in general. A detailed news article is here, many of the facts cited in this post will come from this article.
Analysis: The first thing to understand in dealing with an individual case is what it can and can't tell us. The death of Caroline Lovell is one incident and can not be used alone as proof of the safety of homebirth in all cases. What it can tell us is what happened in her specific case and possibly whether a homebirth was a bad decision for her individually, or if in this specific case the midwives were some how lacking in the care they gave to her. It could possibly highlight problems within the homebirth and medical communities within Australia specifically. It can not tell us about homebirth as a whole, especially when we consider that other countries like the Netherlands and the United Kingdom which have a greater degree of cooperation between midwives and doctors than countries like Australia and the United States.
While this proved to be a very emotional topic in the media, we would all do well to remember that mothers also die in hospitals. For example, when a London mother died after an elective c-section at an upscale maternity clinic, there were no news reports about the dangers of elective c-sections or calls to outlaw elective c-sections, even though elective c-sections carry an increased risk of neonatal death and c-sections have an increased risk of maternal death as well. So I really feel that there is a double standard the media and the public have when it comes to maternity care.
However, examining the case of Caroline Lovell as an individual incident has definite merits. If something went wrong at the birth that could be prevented by better preparation on the part of the midwives or by giving birth in a hospital I think we need to know so that we can learn from it.
During 2015, most of the news reports have had little to say about the actual facts of the inquest or any new developments. Most have been speculation about whether the midwives called an ambulance soon enough or whether midwives were competent. Some of the more concrete data came from 2014. As of 2014, the inquest had narrowed the cause of death down to what the  experts think are the three most likely causes of death: postpartum hemorrhage, pulmonary embolism or amniotic fluid embolism. So let's take a look at each of these possibilities.
Postpartum hemorrhage: The news media has paid a great deal of attention to the possibility of postpartum hemorrhage and reports of Caroline Lovell having lost "litres of blood". However, when understood from a clinical standpoint, the possibility of postpartum hemorrhage becomes less likely. The inquest found that the midwives knew that Caroline had a uterine fibroid, but did not know that she had a history of postpartum hemorrhage from her previous birth at a hospital. It seems the records they received about the previous birth may not have been complete. Uterine fibroids do carry an increased risk of postpartum hemorrhage, though most women with uterine fibroids have uncomplicated pregnancies. Much of this depends on where the fibroid has grown. Fibroids in the pelvic area can be especially problematic, where as those in the upper part of the uterus tend to cause fewer problems. For a great discussion from several UK midwives on fibroids during pregnancy and labor, check out this link here.
In areas of the United States where midwives are allowed to attend homebirths, it is typical for the midwife to be required by law to carry pitocin with her to the birth to stop postpartum hemorrhage. (If you've seen The Business of Being Born, you might remember the New York midwife who talked about having pitocin ready before hemorrhage becomes a problem.) So while it's possible that Caroline Lovell was at an increased risk for postpartum hemorrhage, there are ways to handle it at home. Also problematic with this theory is the fact that the amount of blood she lost was 400 milliliters of blood and postpartum hemorrhage is generally defined as a loss of 500 milliliters or more. A minor postpartum hemorrhage is usually defined as between 500ml and 1000 ml, and a major hemorrhage is usually defined as a loss greater than 1000 ml of blood, so the amount of blood loss is not consistent with a severe hemorrhage.
Pulmonary embolism: A pulmonary embolism is when the pulmonary arteries of the lung become blocked, usually by a blood clot. A pulmonary embolism can cause cardiac arrest, which was the cause of death for Caroline Lovell.  Cardiac arrest from pulmonary embolism usually happens very fast and is typically fatal, and usually the cause of death is only discovered during autopsy. The symptoms of pulmonary embolism are consistent with the symptoms Caroline displayed after the birth such as fainting and loss of consciousness. In fact, pulmonary embolism is one of the leading causes of maternal death in the developed world. (As a side note, research has found that there has been a significant increase in pulmonary embolisms during pregnancy because of the increasing cesarean rate.) So there is a pretty strong case for death being due to a pulmonary embolism. If that is the case, a hospital may have been able to provide resuscitation if the staff figured out that a cardiac arrest was about to occur, however, this would be no guarantee. One study found that of patients who died suddenly and unexpectedly in hospitals, 80% had died from a massive pulmonary embolism. (Interesting trivia bit- If I am remembering right, the Ben Affleck/Liv Tyler movie Jersey Girl attributes Jennifer Lopez's character's death in childbirth to a blood clot.)
Amniotic fluid embolism: This is a rare, but very serious complication where amniotic fluid enters the mother's bloodstream. It is very hard to detect, even by doctors in hospitals and it kills the mother very quickly. In fact, there was a recent case of a mother dying in a hospital from an amniotic fluid embolism, even with a c-section. Amniotic fluid embolism presents with some of the symptoms that Caroline displayed, such as anxiety and circulatory failure. However, often the baby goes into distress as well and Caroline's baby did fine during and after the birth.

Conclusion: Of the three causes of death listed as most likely by the inquest, postpartum hemorrhage is treatable at home with the right skill and preparation. This is probably the least likely cause of death considering that Caroline Lovell's blood loss at autopsy was not within the range of a hemorrhage. A pulmonary embolism or amniotic fluid embolism is more likely, (with pulmonary embolism being the most likely based on the evidence given). However, even in hospitals, mothers die from these conditions. While this was a homebirth and the mother did die, there is strong evidence that even in a hospital she may still not have survived. This does not mean that the midwives were necessarily providing adequate care- this is a subject of much debate. But even with excellent midwife care or excellent hospital care, Caroline Lovell still may not have survived as maternal pulmonary embolisms remain frustratingly difficult to diagnose and predict, even with current technology.

Saturday, December 19, 2015

Birth Apologetics: Waterbirth- Friend or Foe?

Note: This post is part of a series called "Birth Apologetics". "Apologetics" comes from the Greek and means "to speak in defense". (Often used in relation to defense of a particular idea or viewpoint, such as "Christian Apologetics".) In these posts, I will be taking blog posts and articles that are critical of home birth and natural birth and doing a critical analysis on the data and arguments. The idea is that if natural birth and home birth are safe for most women, arguments against them will have serious flaws.
Case: The American College of Obstetrics and Gynecology released a bulletin in 2014 saying that waterbirth has no known benefits for babies and many potential dangers and should be limited only to controlled studies for research purposes. Full text of the ACOG's bulletin can be found here.
Analysis: The ACOG's position is based on individual case reports and case series of complications, which they acknowledge are not uniformly reported and there fore make it impossible to assess the actual incidence of these complications. The ACOG also bases their position on concerns about possible complications like "...higher risk of maternal and neonatal infections, particularly with ruptured membranes; difficulties in neonatal thermoregulation; umbilical cord avulsion and umbilical cord rupture while the newborn infant is lifted or maneuvered through and from the underwater pool at delivery, which leads to serious hemorrhage and shock; respiratory distress and hyponatremia that results from tub-water aspiration (drowning or near drowning); and seizures and perinatal asphyxia." They also state the they have believe that waterbirth could be potentially dangerous because of the possibility of the baby breathing in water: "Although it has been claimed that neonates delivered into the water do not breathe, gasp, or swallow water because of the protective “diving reflex,” studies in experimental animals and a vast body of literature from meconium aspiration syndrome demonstrate that, in compromised fetuses and neonates, the diving reflex is overridden, which leads potentially to gasping and aspiration of the surrounding fluid."
So let's take a look at these arguments in detail.
  1. Incidence of serious complications: The ACOG states that the information they have is not enough to actually find what the incidence of complications would be on a large scale. However, The United Kingdom provides a nice counterpoint to this. As stated in the ACOG's bulletin, approximately 1% of all birth in the UK have at least a period of water immersion. It should be noted that the United Kingdom has lower rates of neonatal mortality (3 deaths per 1,000 live births) than the United States does (4 deaths per 1,000 live births), so if waterbirth is as dangerous as the ACOG seems to be representing, then the UK would likely have higher rates of neonatal mortality than the United States, but this is not the case. Also, because the usage of waterbirth is not well regulated in the United States, the chance for problems to occur because of ill-informed and untrained attendants could be a significant (but very avoidable) risk factor for complications. Furthermore, the ACOG dismisses studies involving thousands of births which show that with a competent attendant water birth is very safe. One study from England showed that of 4,032 births in water that took place between 1994-1996, there was a mortality rate of 1.2 per 1,000 but none of those deaths were not attributed to waterbirth, but rather other causes. Out of the entire 4,032 births, two babies were admitted to the NICU for possible water aspiration, but recovered.
  2. Concerns over certain conditions: The ACOG very rightly brings up that there are risk factors for waterbirth. However, in the 2006 joint statement from the UK's Royal College of Obstetrics and Gynecology and the Royal College of Midwives, good practice of waterbirth requires taking measures to avoid these problems. For example, the Guidelines from the RCOG and RCM state that all birthing pools and equipment should be sterilized or disposed after use and that the water should be kept free from debris and fecal matter to prevent infection. They also state the need to watch for umbilical cord rupture and plan and prepare for it. Guidelines from Waterbirth International for waterbirth state that sterilization of all supplies and parts of the tub must take place and that no one should allowed in the tub if they have an infection. These guidelines also include recommendations for control of the baby's body temperature by monitoring the temperature of the pool or tub water and keeping the baby in the water with head out and close to the mother initially. The UK's policies for hospital waterbirth (similar to those of UK midwives) state that women who are at least 37 weeks along with an uncomplicated pregnancy and have well-established, spontaneous labor are candidates for water birth or water labor. This reduces many possible complications. One large study from Switzerland (which has a neonatal mortality rate lower than that of the United States at 3 per 1,000 live births) compared waterbirth to maia stool births and bed births for spontaneous, singleton babies in a head down position and found that there was no greater risk of infection with waterbirth. (In fact, out of the natural births, births in bed had a greater risk of infections, primarily in the eyes). They also found that waterbirths had far less complications with bleeding and hemorrhage than other birthing options.
  3. Concerns over drowning: Take note of the language in ACOG's comments on the possibility of drowning: "...in compromised fetuses and neonates, the diving reflex is overridden..." (emphasis mine). So the ACOG acknowledges that the diving reflex which keeps babies from gasping under water does work under normal circumstances. Their concern lies with babies who have been compromised, inhibiting the diving reflex. However, the RCOG and RCM's guidelines state that "If the woman raises herself out of the water and exposes the fetal head to air, once the presenting part is visible, she should be advised to remain out of the water to avoid the risk of premature gasping under water." Guidelines from Waterbirth International state: "The baby should be born completely underwater with no air contact until the head is brought to the surface, as air and temperature change may stimulate breathing and lead to water aspiration. If a change in position during delivery causes the baby to come in contact with air, the birth should be finished in the air." Both organizations advise the monitoring the baby's heart rate with a Doppler heart monitor to watch for problems. So those who are experienced, educated and competent in attending waterbirths acknowledge that the baby's protective diving reflex could be overridden and have guidelines in place to handle such a situation. Also, once the baby has been fully born a competent waterbirth attendant will quickly and gently get the baby's head out of the water and into the air while leaving the body in the warm water, held by the mother.
Conclusion: It is curious that American OB-GYN's have a habit of criticizing the birthing options of countries that have lower rates of neonatal death than that of the United States! Waterbirth is successfully used in many other countries to deliver babies and with competent and educated attendants has a great track record. For the most part, the ACOG's reasons against homebirth surround bad or incompetent usage of this tool. But we can't write something off as dangerous just because it has been used improperly.
Let's take for example, Cytotec (a.k.a. misoprostol). Cytotec is a drug for preventing stomach ulcers caused by non-steroidal anti-inflammatory drugs. However, doctors in America have been using it for about  20 years now to induce pregnant women because it works faster and causes stronger contractions than pitocin. This usage is in opposition to both the FDA and Cytotec's manufacturer Searle. Cytotec is contraindicated for use in pregnant women and not approved by the FDA for labor induction and has been associated with a large number of uterine ruptures and the deaths of many babies and mothers. Cytotec has proven so problematic that its manufacturer Searle issued a letter in August of 2000 warning obstetricians not to use it for labor induction.
Now, just because some doctors have chosen to use Cytotec in a way that it was never designed to work with resulting injuries and deaths does not mean that Cytotec itself is dangerous. Cytotec may be very helpful for someone with stomach ulcers from NSAID's. Cytotec is simply a tool. The results from its use depend upon the discretion of the practitioner. The same can be said of waterbirth. Waterbirth is a tool and while the improper use of it can result in injury or death, when used competently the evidence shows that it can have enormous benefits.