Friday 18 June 2010

'Science speak and minifisms': hiding the horrible truth

An article on the Bioethics Forum highlighted the way that medical jargon and a 'scientific' approach can be used to obscure ethical, moral and philosophical breaches in medical interventions.

Recent attention has been paid to the issues around genital mutilation, currently focused on the suggestion taken up and rapidly dropped by the American Pediatric Association that a 'ritual nick' in a young girl's clitoris would reduce the risk of parents taking girls overseas for more debilitating tradition based cutting

However, under the guise of medicine, a paediatrician, Dr Poppas, at Cornell University, is performing nerve sparing ventral clitoroplasty on baby girls. What that means is that his surgical team is cutting the sides out of a girl's clitoris. Why are they doing this surgery? The girl's clitoris is deemed too big.

Another blogger suggests that the reason for the clitoral reduction surgery  may be more to do with homophobia than cosmetics because apparently, a woman with a large clitoris is more likely to identify as lesbian. An interesting suggestion.

Whatever the reason, the medical explanation is not in any way acceptable to any thinking person. Far from being benign and helpful, the surgical reduction of a girl's clitoris has been associated with physical, emotional, psychological and relational harm. A most disturbing and chilling aspect of this surgery is the follow up process.

The girls, aged six and over, fully conscious, have their clitorises stimulated with a vibrator by Poppas. Their parents, other researchers and probably students look on.

Alice Dreger, Professor of Clinical Medical Humanities and Bioethics at Northwestern University's Feinberg School of Medicine and Ellen Feder, Associate Professor and Acting Chair in the Department of Philosophy and Religion at American University have been arguing that the surgery performed by Poppas and his team has no benefit for the last decade. Dreger and Feder have only just become aware of the follow up process, which is described in this way:
"Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue"
The article states that  "Study received medical institution review board approval".  I can only wonder how. Board approval could reflect the fact that people tend to over ride their ethical and moral compass in favour of the expert's view. Stanley Milgram provided a graphic example of that phenomenon in his research in the 1974. Researchers at Wellcome Trust Centre for Neuroimaging at UCL (University College London) in collaboration with Aarhus University in Denmark  have found activity in the reward centre in the brain shows that the opinion of other people matters and demonstrates why people change their mind to agree with someone they believe is an expert.

Milgram's experiment was repeated on a French reality TV show in March 2010. The show aimed to show how ordinary, decent people could become torturers. The outcome created an uproar.
  
Added to our tendency towards obedience, an illusory sense of superiority has been found to over inflate both self confidence and a sense of competence.  The Wiki page on illusory sense of superiority does a good job of bringing together a lot of the research about our ability to self evaluate and recognise our inherent biases.  There are some very good references on that page that are fascinating to follow up and explore further.

Back to our man Dr Poppas and his team. Does he/they suffer from an illusory sense of superiority and competence and because of that, posed as experts and managed to fool the board?

The webpage of the Pediatric Department at the Cornell University gives no indication that 'clitorplasty' is still contentious and criticised by both clinicians and patient advocates for the last 15 years.

The webpage states:
"The type of surgical repair performed must be tailored according to each individual patient's anatomy. The first important issue is the timing of the reconstruction. This has been a controversial area in the past, but presently the standard of care is to perform reconstructive surgery at an early age rather than delaying until adolescence. Reconstruction is generally initiated between the ages of 3 and 6 months old. An early one stage repair is recommended because female patients are able to undergo a more natural psychological and sexual development when they have a normal appearing vagina. The major features of reconstructive genitoplasty are clitorplasty, labioscrotal reduction, and vaginal exteriorization (vaginoplasty)".
The words on this web page sound so clinical, so medical, so scientific, so right. All those big words that mean nothing to most people. How would parents know anything different? Most parents believe what experts (paediatricians) say and are too intimidated to even ask questions, let alone ask for a second opinion.

Alice Dreger continues
"Yang, Felsen, and Poppas describe the girls “sensory tested” as being older than five. They are, therefore, old enough to remember being asked to lie back, be touched with the vibrator, and report on whether they can still feel sensation. They may also be able to remember their emotions and the physical sensations they experienced. Their parents’ participation may also figure in these memories. We think therefore that most reasonable people will agree with Zucker that Poppas’s techniques are “developmentally inappropriate.”
Each girl child from the time testing starts (about 5 -6 years of age) has her "thigh, her vagina, her labia minora, and her clitoris stroked with a Q-tip while she's asked if she can feel the doctor touching her. ("Can you feel me now?")"

There is doubt as to whether Poppa had/has ethics approval for the sensory testing he and his team conducted. That little detail seems to have slipped through unnoticed. 

We don't know what parents are told or not told. Talking through procedures such as Poppa promotes should take many hours of compassionate counselling and information sharing, shifting through the various ideas and schools of thought about these interventions on what appears to be variations on normal healthy genital structures. Many parents feel concerned about challenging the experts, even if the parents feel uncomfortable with a treatment that is being suggested. Parents can feel anxious about their child being victimised if they as parents 'rock the boat' and ask too many questions of health professionals.  Can you imagine what that 'sensory testing' would be like for those babies and young children and Poppa says testing is ongoing!  Poppa would prefer that the vibrators he uses to test the sensory ability of the surgically altered clitoris are referred to as a 'medical vibratory device'.  This abysmal story is full of 'minifisms' - words used to scale down the significance of the intervention. 

I'm reminded of the Butcher of Bega with this story.

Thank goodness for people like Alice Dreger and Ellen Feder who bring these abominable acts to light. Our job is to write to the authorities asking for an explanation.

Yang, Felson & Poppas (2007) Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability, The Journal of Urology, Vol 178, Issue 4, pp 1598-1601 Supplement (October)

Correspondence: Institute for Pediatric Urology, Rodgers Family Professor of Pediatric Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th St., Box 94, New York, NY 10021 (telephone: 212-746-5337 begin_of_the_skype_highlighting            212-746-5337      end_of_the_skype_highlighting; FAX: 212-746-8065).

Wednesday 16 June 2010

Judging Right and Wrong?

Great changes are happening to midwifery and women's birth choices in Australia. The government has passed legislation that on the one hand gives more autonomy and a wider scope of practice to midwives working in the public health system and on the other hand, restricts the services able to be offered by midwives in private practice. More women will be able to have their babies at home as more public hospital homebirth services are being offered. However women will have less ability to choose their own midwife. In accessing publicly funded services, women will have to, in the main, take 'pot luck' with their midwives. Women who have 'criteria' also known as risk factors will be denied a choice of birth venue, even though many of the risk factors are poor predictors of outcomes. With good midwifery care, these women birth  well.

I have had an email from someone recently who is absolutely distraught because her local hospital staff are bullying her into having another caesarean. The maddening thing is that the woman has given birth normally both before and after the caesarean birth. The hospital where the woman lives has a 'once a caesarean always a caesarean' policy and does not take into account the individual and her circumstances . The woman is unable to pay a private midwife and any other options are non existent.

Just yesterday, a woman who was booked to have a homebirth with a publicly funded service, was explaining to some midwifery students how she found out that her allocated midwife was off when she went into labour. She rang the phone number and got a midwife on the other end who she felt was not the least bit interested in her. The woman told the students how uncomfortable she felt and how she had to ring someone in charge and get another midwife allocated to care for her. She was finally allocated two midwives she felt good with. Once that arrangement was settled, she was able to focus on her baby and her labour. She went on to have a her baby at home.

I've found the various perspectives on the current changes polarised and distressing for many people. I can understand the distress. Change is always challenging. Many people feel we are losing too much. I believe that we have to stay focused on what we want and how we want maternity services to be. Focusing on the problem only adds energy to the problem. Looking clearly at what is going on and then choosing our path and taking action is a much better way.

I truly want everything - I want women led maternity services.  I want women and their babies to be safe and given the care they want so that their physiology works well and their safety is optimised. I want publicly funded birthing services, including venue of choice to be freely available.  I want midwives in private practice able to work to the full scope of their practice. I want 'no fault' compensation for women and their families when babies have problems as they occasionally do regardless of birth venue.  I want women, midwives and doctors to work together and with other health care providers as needed for any particular woman's circumstances.  I believe we can achieve these changes.

Imagine my delight when I found this email newsletter in my inbox from a wonderful man, Charlie Badenhop, this evening talking about right and wrong. Charlie is a fourth degree black belt and certified instructor of Aikido in Japan, and a certified trainer in NLP and Ericksonian Hypnosis. He is also a long term practitioner of various forms of bodywork, Self-relations therapy, the Japanese healing arts of sei tai and seiki jutsu, and Yoga.

I have found Charlie well worth listening to as he always has something interesting and appropriate to say. As I read the newsletter, I thought how pertinent Charlie's writing is to our circumstances. I wrote to Charlie and asked if I could share the newsletter. He readily agreed and to my surprise, told me that at one stage he had thought about becoming a midwife but ended up in Japan instead.

Enjoy!  If you like what Charlie has to say, you can subscribe to his newsletters down the bottom of the blog post.

"Pure Heart, Simple Mind"(tm) is the Seishindo newsletter written and edited by Charlie Badenhop (c).

Punishment, and the concept of "right or wrong"

"A lot of the best learning I received as an Aikido student came when we were outside of the dojo with sensei. We could be having a cup of coffee, or occasionally having a drink, and at some point it would become clear sensei had a message to deliver.

Once we were sitting in a coffee shop waiting for a train in the countryside.
Seemingly out of nowhere, sensei said, "I think there are many people in the world who act in a confrontational manner, and thus I wish more people understood the Aikido principle of non-dissension."

"Instead of spending so much time and so many human lives quarreling over who is right and who is wrong, I think the world would be a better place if we spent more time exploring how both sides are both right and wrong."


Myself, and the other two students sat there and said very little, knowing sensei was just beginning to get warmed up.

"You see," sensei said, "In Aikido we learn to refrain from engaging in confrontation, but that does not mean we shy away from protecting ourselves. It always intrigues me when new students attend a class and ask, ‘How can Aikido really be a martial art if you don't attack or retaliate against your opponents.' By this time the three of you have heard my reply many times over. In Aikido we have no attack form because we have no desire or intention to harm our adversaries. Instead we strive to bring hostilities to a conclusion that is respectful of all involved."

"If my opponent has never harmed me, never struck me, never hurt me, then why would I want to hurt or punish him? Do I want to punish him simply because he has thought about hurting me, or because he has made a weak effort that was easily rebuffed? You see, even in a court of law, you can't charge someone with murder simply because they thought about murdering someone. Attempted murder and actual murder are two very different crimes. When I am relaxed, aware, and fully present in the moment, then my adversary will have little opportunity to successfully attack me. Since he hasn't hurt me, since he hasn't truly threatened me, I have little desire to punish him in any way. His own thoughts, and the negative results he achieves in the world will be punishment enough."

"Related to punishing someone, is the idea of someone or something being either right or wrong. In Aikido, we learn to refrain from believing one path, or one way of thinking, is inherently superior to another. We also learn to refrain from engaging in thinking that any one point of view is the opposite of others."

"When we think in terms of opposites and disagree with someone else's opinion, we begin to oppose the other person's point of view. And this is exactly the kind of thinking that leads to resisting, combat, antagonism, and an overall disrespect for our perceived adversary."

"In Aikido, we do not attack, but we also do not concede or give up. In every day life the same can be true. Without attacking the viewpoint of others, without conceding or giving up our own viewpoint, we can still maintain ourselves, and continue to act in a way that is consistent with our beliefs."

"Keep that in mind," sensei said as he looked across the table. "More than once I've heard you arguing with other students, trying to prove your viewpoint was more correct than theirs. When you act like that, not only will you fail to convince them that you are right, and they are wrong, you'll also wind up losing them as friends and allies."

"Pure Heart, Simple Mind"(tm) is the Seishindo newsletter written and edited by Charlie Badenhop (c). All rights reserved. Click if you would like to subscribe.

Monday 14 June 2010

Distracted parenting: Hang up and see your baby - The Boston Globe

Claudia Gold, a paediatrician in Great Barrington, wrote in the Boston Globe today:
"RECENTLY I was on vacation sitting by a pool. I noticed a father with his infant daughter who looked to be about 3 months old. Perched on a table in her car seat, she sat kicking and smiling. Her father faced her, but was talking on his cellphone. He distractedly shook the rattle hanging in front of her as he spoke in an animated way with the person on the other end of the line"
Her article continues to talk about how the baby develops her/his sense of self by the way the mother looks at her/him and interacts on a moment to moment basis. Dr Gold cautions that parents are perhaps not aware of the critical importance of the first few months and the vital importance of attending to and engaging with the baby to optimise the way the brain develops and the infant forms her/his sense of self. Fathers are taking more and more of the primary caretaking role of newborns and infants. A recent article in the New York Times outlined the way that social norms are changing as fathers become more engaged in parenting. Gold discusses the role of oxytocin in the way that mothers are preoccupied with their babies. Perhaps males are disadvantaged in this biological aspect? As feminists in the 70's, one of our catch cries was that 'biology is not destiny' but perhaps we were and are wrong not to pay attention to biological factors and instead of seeing these physiological realities as 'biological determinism' we could reframe the way that hormones and other communication molecules behave as 'biological intelligence'.

Mothers behaviour and orientation to their babies displays what D.W. Winnicott called 'primary maternal preoccupation'. Mothers are meant to be fixated on their babies, attending to their facial expressions; responding and reacting to them. In the past, women were told that babies are such 'time wasters'; that sitting staring at a baby was of no value, however, neuroscience has proven the value of primary maternal preoccupation and those hours of staring, awestruck at the wonder of one's own baby. From the beginning, a baby's brain wires itself, connecting and associating neurons to other neurons in response to environmental cues and emotional experiences. These neuronal associations form patterns of connection that from the earliest days form a mental map for security, enabling an infant to feel safe (or not) in the presence of her/his primary care giver. This primary relationship sets the stage for the child's future relationships and how the child perceives the world. As an infant feels more and more secure in her/his attachment to her/his primary care giver, she/he is able to then turn outward to the world and start engaging with the people and events in his/her wider environment. In those early days, the mother's face provides a mirror which allows the infant to see him/herself and form a sense of self that reflects that image. When mothers are fully engaged, smiling, encouraging, reflecting joy in being, the infant emerges emotionally resilient. Research has shown that mothers with flat affect produce withdrawn, less communicative infants.

Walking through any postnatal unit or going to any home where a new mother and baby reside, you see the ubiquitous cell phone in residence, either next to the woman's ear or being pounded by her flashing finger tips as she dashes off messages to cyberspace. Is it possible that primary maternal preoccupation has, in many instances, been diverted to the cell phone. What message and brain patterning do you think the little ones are getting? What do you think Mary Ainsworth and John Bowlby would make of this phenomenon?

Sunday 13 June 2010

Life, birth and death: The horror of poverty

This video from Time, on Maternal Mortality in Sierra Leone, the story of Mamma - one woman's journey from pregnancy to death is a heart wrenching portrayal of what is happening to too many women in
impoverished circumstances.

The Time photo montage shows a photo of young woman with a glazed, far away look on her face, intravenous therapy in her hand, lying on a trolley bed, a baby on a chair beside her.  The photo's caption says:
"Birthing Room
Forced to marry at age 14, Mamma Sessay first gave birth when she was 15. Three years later, at the age of 18, she gave birth to the first of a pair of twins near her village, but when the contractions ceased for the second child, she traveled by canoe and ambulance to the Magburaka Government Hospital, where she waits, in the photo above, to deliver".
Read more at Time Photos: Maternal Mortality in Sierra Leone

The video of Mamma Sessay's life and death experience is recorded and reproduced here:

Video: Maternal Mortality in Sierra Leone

Poverty and the associated lack of clean water, sanitation, good food, contraception, respect for women, education, family planning, antenatal care, being married too young, having babies too early - the list goes on and on, is the real problem. The other real problem is social apathy and feelings of helplessness about women's lot in disadvantaged situations. Labour and birth are peak and demanding activities. Women do best when they are well nourished, well hydrated, informed, have good midwifery care during pregnancy, labour and postnatal period, are having babies when they want to, have been well prepared for labour and birth, are able to labour and birth with loved ones around and able to access good medical care if and when required.

The article in Time, called The perils of pregnancy is horrific, but the emphasis is wrong. The emphasis should be on the perils of poverty.


Why are our governments spending our hard earned tax dollars on war for oil, when we could spend our money on making life better for our brothers and sisters across the world. With a different way of looking at world affairs we could save the lives of women like Mamma.

There are some good signs. According to Dr Margaret Chan, Director-General of the World Health Organisation, in her opening address on behalf of eight organizations at the Women Deliver 2010 Ministers Forum Washington, DC, USA  on the 7th June 2010

"Domestic resources and donor funds are making a real difference to the lives of millions. The number of children dying before reaching their fifth birthday has been falling for several years. We are now seeing early signs of progress in reducing the number of women dying in pregnancy and child birth, in addition to the achievements in HIV, TB and malaria".
and added

"This progress is most welcome, but is fragile, uneven, inequitable and inadequate. Far too many women and children continue to die needlessly"

calling for a world wide, coordinated effort and finances, including:

"government leadership of inclusive partnerships at country and global levels to design, implement and monitor the commitments and promises of all stakeholders".

Letter writing and political activism required. 

What do you think?

Sunday 6 June 2010

Safe Bed Sharing

This montage is beautifully done by Kathleen Kendall Tackett, also known as Uppity Science Chick
Kathleen has written books on breastfeeding, Postnatal depression, and inviting serenity into your home.

The photos in the montage are delightful, soft, heartwarming. Wouldn't you love to have been one of these babies?  Good to see the Dads in the photos as well as the Mothers.   The messsage is clear and powerful. Well done Kathleen.  Please give Kathleen feedback, she would like to know what you think about this mini video.


Further to the 'ritual nick' - Effective Intactivism

I've been reading more about the circumcision debate and happened upon a couple of very good blog posts on a site called Peaceful Parenting in my net travels.

The following quote was from a post was about the purpose of the prepuce . The article is well worth reading as it contains a thorough and thought provoking run down on the astonishing functions of that little bit of 'useless' and 'unnecessary' skin on a penis. The prepuce is rightly defined as an organ by two human sexuality experts. A full description of the myriad purposes of the prepuce are on the Peaceful Parenting blog post, but the following information really stood out for me
"A circumcised male, or his partner, for that matter, can never know the intimacy of the normal penis and the ability of the foreskin to open and glide up and down the shaft. An entire dimension of sexuality has been lost to both the male and his sexual partner"... Intact males can be more tender, gentle, relaxed, and loving during sex because the slightest and subtlest gesture or motion evokes deeply satisfying sensations. Circumcised males have to work harder just to feel sensations. This is an unhealthy situation for both the male and his partner".
I know that female circumcision is popular amongst some groups because cutting out her clitoris diminishes a woman's enjoyment of the sexual act, not to mention any sexual feelings and therefore functions to keep women 'faithful' - and under control! I don't think that as a culture, we truly understand the way that male circumcision interferes with male sexuality to the degree that it does. Circumcised men often laugh when that suggestion is made, because sex is just fine for them. The reality is of course, that they don't know what they haven't got. If circumcised males have to work harder, thrust harder and for longer just to feel sensations and get that level of stimulation required to orgasm because the sensory nerves on the head of their penis have been traumatised AND they lack the sensory nerves of the prepuce, that level of activity would be normal for them. The leap to thinking about what that level of activity actually means for their partners is then an easy one to make. Our cultural practice of male circumcision is actually blunting the sexual pleasure of couples, not just the head of the penis's feelings.

Coupled with that reality, the fact that circumcision leads to trauma and even death for some boys is explored in another post by Peaceful Parenting's Danelle Frisbe.

Intactivism is gaining ground as social media takes up the case for keeping both girls and boys intact. The latest post on Peaceful Parenting is excellent, explaining why we need to focus on solutions and in this case it is keeping children safe by keeping them intact. Aubrey Taylor a social activist, explains that negative emotions are understandable when we really think about what circumcision means and how human rights are being violated by the practice. However, people don't respond to negativity and anger - such reaction tends to invoke resistence and opposition.  Aubrey talks about Effective Intactivism which involves getting our language and feelings 'right' and coming with clear vision of how we want the situation to be.

Effective Intactivism involves education, compassion, love, persistence and patience.

Thursday 3 June 2010

Power and Agency in Childbirth: Women’s relationships with obstetricians.

Trust, Power and Agency in Childbirth: Women’s relationships with obstetricians.

This great article by Monica Campo, a feminist sociologist and scholar, needs to be shared. Monica is doing her PhD at La Trobe University, in Victoria, and this article is part of her work for her PhD. The article is published online at Outskirts: Feminism along the Edge. Monica explains the content of this article this way:
"This paper has a twofold argument: that women participating in this study enter into a relationship of trust with their obstetrician based both on their class positioning and their belief and entrenchment within the hegemonic biomedical model of birth; and that their confidence and trust in their own ability to birth without medical expertise is subtly eroded in the medical encounter as well as through cultural fears surrounding birth. I use this evidence to make a wider claim regarding the limits of choice and agency within the obstetric encounter. Women in medical systems of maternity care are not ‘passive dupes’ of obstetric hegemony but their autonomy is nonetheless constrained by their relationship with their obstetrician and an increasing normalisation of medical birth".

Wednesday 2 June 2010

The Ritual Nick

What's the ritual nick?   A ceremonial pinprick or 'nick' in a young girl's clitoris.

Female circumcision otherwise known as female genital mutilation, has been illegal in the US and other countries, including Australia for some time. 'Intactivists' have been positioning male circumcision as male genital mutilation and campaigning to make male circumcision illegal too. In Dakar, on the west coast of the African continent, lawmakers from 27 African countries, together with envoys from the African Union and United Nations came together in early May 2010 to create a resolution which clearly bans female genital mutilation as a violation of human rights.

"The African Union's envoy Yetunda Teriba stressed that the West had a role to play in combating genital mutilations".

Just as the African nations are moving to ban the practice of FGM, the American Academy of Paediatricians recently  suggested a 'ritual nick' may be a good idea for girls from other countries to stop them being taken overseas for more severe forms of 'cutting'. What a confusing message to send!  That suggestion created a wave of criticism and caused the backdown of the AAP on this idea.


And now the clever country is getting in on the act. Our Australian doctors are considering this as a way  of dealing with female genital mutilation! What are RANZCOG thinking?  Obviously they are not thinking.

The 'ritual nick' is being called a 'modified' form of genital mutilation. Now that's a perfect example of a 'minifism' '

'Minifisms' is a word coined by Lawler (1991) describing behaviours which minimise the significance or severity of problems.

and get this:

"But experts are divided on whether to allow the practice, given that in some cultures it is used to remove the sexual feelings of women".
I'm speechless with that remark. I'd love to know which experts and experts on what exactly? 

Intactivists have considered the 'ritual nick' suggestion as a way to defuse and take attention from the growing call to have male circumcision made illegal.

This link is to the Intactivists page, where you will find recent media on the AAP moves and counter moves on 'the ritual nick'.


Marilyn Milos, a long time campaigner for the ending of circumcision said

"Circumcision is where sex and violence meet for the first time."
What do you think of that statement?

and finally, I refer you to Jeannine Parvati Baker's piece quoting Marilyn Milo's comment.

http://birthpsychology.com/violence/baker.html

What are your thoughts on all of this?


Reference:
Lawler, J. (1991). Behind the screens: Nursing, somology and the problem of the body. United Kingdom:
Churchill Livingstone