Cold Spaghetti

We made it back to Mobile, safe and sound. We packed up the cats, some valuables, a few paintings by our grandmothers, and some other heirloom items that would be mourned in the event of a disaster. Paul tied down the shutters in the front of the house and had plywood on hand to cover the front door once we secured the inside. All the outside shutters are closed, plants are down, swing and trash cans locked in the outbuilding, etc. The house is as ready as we could make it.

Traffic was relatively light getting out of town. The slowdowns we had were actually related to news crews on the side of the road (!) and police direction of traffic to *increase* the lanes into the medians. Yes, widening lanes apparently slows down traffic! From the lines that were starting, I think we got out just in time to meet the rush. And *I* got to town just in the nick of time — a few hours later and they closed the roads to only go “out”, not “in”.

The strangest thing is that you would never know that anything was happening in New Orleans. A few homes are boarded up, a few people are getting in cars to go, but generally, folks were just out walking and shopping and going about daily lives. Granted, there weren’t as many people out doing those things, but enough to make us feel a bit silly. It’s an odd feeling: you don’t want your efforts to be for a non-event (like last time), yet you don’t want all your efforts to be in vain.

I’ll post pictures of the house secured later tonight! But the bottom line is that we are okay!

From the National Hurricane Center discussion on Hurricane Katrina, 10am CDT:

...IT IS NOT OUT OF THE QUESTION THAT KATRINA COULD
REACH CATEGORY 5 STATUS AT SOME POINT BEFORE LANDFALL.

So Katrina is looking bad for us in the Big Easy. Some thoughts.

Our house is actually above sea level, and in its hundred years, it has never flooded. This somewhat puts us at ease… in the sense that, if our house were to flood, it would basically be the least of our problems. You can see a good discussion on the possibility of New Orleans flooding here. And here, you can scroll down to an elevation map of New Orleans (it’s the fourth graphic going down on the page). Where will live according to the elevation map: in the “U” shaped curve along the Mississippi (hence our nickname the “Crescent City”) — inside this “U” to the left is a large blank area with no roads. This is Audubon Park. We live a few blocks of the park, about 5 blocks from the docks on the Mississippi. In other words, we’re actually on some of the highest land in the city and are definitely above sea level.

From the discussion on flooding, the issue is that a storm from the south or southeast would push water from Lake Pontchartrain (a huge, shallow body of water just north of the city) over the north leeves and into the city, filling the its interior “bowl.” (And not ironically, some of the poorest, most vulnerable, parts of the city.)

Our concerns in terms of evacuation are related to city infrastructure. Getting in or out would be impossible: the roads and bridges to leave the city would be flooded. Without question, there would be no power, and probably no water, for days — maybe weeks. It would take a long time for the city to recover. Other concerns (and why Paul is hestitant to leave) are that if water somehow gets into our house through the eaves or a crack in a window somewhere, the water would sit in our house for a long time until we came back to find it and start clean-up. But if this *is* that every 100 years type of storm, there isn’t much we can do about it.

And finally, logistics. Will and I are actually in Mobile right now. Paul was doing some very messy work with the door frames this weekend and we left yesterday. I would have to go back to New Orleans and get Paul… and then leave the city. We haven’t made any decisions yet on what we are doing.

My *first* academic, peer-reviewed publication (as second author!) is out and official!

The article, “Challenges for traditional birth attendants in northern rural Honduras”, is “in press” with the journal Midwifery. You can see the corrected proof and abstract online. Yippie!

Many people have dressed Will during his 21 months of life. But out of all those people, only *2* manage to regularly dress Will backwards in his clothing: my Dad and Paul. Here is an example of Paul’s style on our sleeping child. Paul accuses me of being a conformist by insisting on putting on clothes in the correct direction. I don’t know… doesn’t this decorative application imply to you that it should go in front??

Inspired by my a recent experience my friend Gwen had during an antenatal care visit, I decided to take a moment and reflect on epidurals.

Disclosure: I am an advocate of natural childbirth. I believe, have been told, and have seen that the natural process of labor and delivery can be a transformative experience where women may be surprised at the power and strength within themselves. This is not to say that a woman is better for having a natural labor or that women who try at a natural process and then decide to use drugs are failures. Women never fail in childbirth. My intention is just give some food for thought. And to begin to show how one intervention may easily lead to others – and ultimately, create emergencies and problems in an otherwise natural, perfectly normal, event. Birth is a miraculous, unpredictable process. Like nature itself, it challenges the rigor and boundaries loved by modern biomedicine. When we try to control it through medicine and machines, things can often go awry.

I believe that good maternity care means using science in support of this natural process, not in using science to manipulate controls over it. Sometimes, the best medicine is to use nothing at all. When you have a hammer, everything begins to look like a nail.

So, epidurals. Benefits: Labor is work, it is painful (the word is labor, not vacation). An epidural takes away pain but allows you to stay alert. An epidural can help a woman get needed rest or regain strength during a long and difficult labor.

But there are drawbacks and complications to consider.

— Epidurals require more intervention, which requires more intervention, which requires more intervention, and so on. Because of the risks involved with an epidural, additionally monitoring needs to take place: you must be hooked up to an electronic fetal monitor and an IV -– both of which carrying consequences within themselves. And having these interventions is strongly associated with additional interventions – see the next bullet, below. (Consider the reality of being hooked up to these large machines. Even if you did have enough feeling to walk, could you really experience a walking epidural? Not likely.)

— Pain signals your body and guides labor. Without that sensory experience (and with the combination of other factors) epidurals slow down, or prolong, labor. When this happens, women are often given synthetic oxytocin (called “Pitocin”) which causes stronger contractions. Use of oxytocin is (strongly) associated with higher rates of episiotomy, forceps, vacuum extraction, and cesarean sections – especially in first time mothers.

— With an epidural there is an increased risk of needing bladder catheterization (associated with UTIs). You are more likely to develop a fever because body temperature rises over time with use of epidural drugs. There is risk of excess fluid from the IV building up in your or the baby’s lungs.

— The anesthetic given in an epidural is administered into spinal fluid (cerebrospinal fluid). However, it easily passes into your blood vessels, crosses the placenta, and into the baby’s bloodstream. (Consider the craziness of this… you’ve spent months keeping your child away from a myriad of beverages and stimulants… and now your provider is giving your baby lidocaine and/or narcotics? Maybe drinking coffee isn’t so bad after all!)

— Henci Goer notes that two complications that can occur with the injection and tubing, the needle going deeper into the spine and the catheter migrating inward, have been reported to occur in as many as 1 in 3,000 cases. (These complications are serious and may result in convulsions or even cardiac arrest.) Drugs causing this type of serious reaction in that small of a range are commonly pulled from the market or put in very restrictive use.

— Spinal and epidural headaches are serious pain.

— Do you really want to make early breastfeeding more difficult for both of you?

— Finally, consider the look. All hooked up to machines and in a bed… versus unfettered and managing her labor with a group of trained supporters.

The bottom line. Few women are given the support they need to be successful at natural childbirth. Further, women go into the birth experience with very different expectations of what constitutes good medical care. Perceptions don’t change overnight, even if they are informed by biased or incorrect sources. What is important to me is that women understand the full scope of complicated procedures that are seen as so commonplace. Maybe if we asked more questions about the care we receive, we will eventually be more informed patients who can better advocate for improved childbirth experiences.

Further reading: Henci Goer, Robbie Davis-Floyd, Ina May Gaskin, Pam England. Email me for reading suggestions!

Will has a certain routine when we walk “around” the block. (See the post about “around”, which is more a fun-filled game of exploration than a walk, from back in April.)

Will is very enthusiastic at the start of any trip “around!”

Will peeks through a neighbor’s fence, looking for friendly dog Noel.

Sniff (snort) the flowers!

Action shot! Bouncing on Dad’s shoulders. “Around” usually ends this way as we get closer to home.