science


Isabella Granick Stone and Calista Granick Stone were born healthy and squealing on December 8th, 2007. Here’s how it went down:

On December 7th, my doctor called to inform me that my test for preeclampsia came back positive. Preeclampsia is a pre-seizure condition marked by high blood pressure and protein in the urine. The cure is delivery of the baby. So now I had a medical reason for induction, and I went in to the hospital later that afternoon.
Given my condition, we all expected the induction to take quite some time. Instead, they gave me a hormone to “ripen” the cervix and that sent me into full fledged labor less than an hour later. I think they gave me a quick release rather than slow release dose by accident. I also think I was ready to have the babies, as I was at 40 weeks and 5 days.

After a difficult hour or two, I settled in and spent the next 10 hours in unmedicated labor. I remember it as the same 5 minutes over and over again. Sleeping, noticing pain, breathing and moaning 5 times, pain receding, breathing and moaning 5 times, falling asleep again. Early in the morning on December 8th the anesthesiologist came to put in the epidural needle “just in case” it was needed. There were several scenarios where I definitely wanted the epidural, including a breach delivery of Baby B. However, getting the epidural in wreaked my concentration and resulted in a pretty painful 45 minutes as I tried to find a position that exposed my back for the doctor, but was also comfortable enough for managing the pain. Once that was done I tried to settle back into my pattern, but I’d lost my concentration and was getting close to 8 cm dilation. I got the epidural at about 7AM.

It was odd after the night of contractions not to know if I was having one, and to be sitting there chatting with Brad but knowing I was in labor. It was nice not to be in pain, but it was a strange disconnected feeling. At around 11A, the doctors came in to tell me that it was time to push the babies out, a process for which Kaiser requires mothers of twins to be in the operating room.

The operating room has a lovely view of the city, and when I got there there was a blimp lazily floating above the houses. I was to look at that view for the next 5 hours as I attempted to push out Baby A. The problem was that my contractions were six minutes apart. So even though I was pushing very effectively, the baby was sliding back in the interstitial period. I needed more contractions. First I agreed to pitocin, but that didn’t work. Next I wanted to stand up to allow gravity to help me, but I wasn’t permitted/able because I’d had the epidural. The nurses suggested other potentially helpful supported positions, but those did not work.

I believe the problem was that I was on magnesium sulfate for the preeclampsia, and that is a muscle relaxant. Taking a muscle relaxant when trying to have a muscle, the uterus, do the difficult work of pushing out a baby, is not helpful. After about 4 hours of pushing, they asked me how long I was going to keep at it. I told them I planned to push until the baby came out, and that I felt fine and would keep going. Having had the epidural had given me the break I needed (and a few hours sleep) to feel strong and rested. Still, the doctors began to talk about delivering the babies by Cesarean, which I did not want. I refused steadfastly, at which point they offered me “one last option”. They would use the vacuum on Twin A’s head to hold her in place, and I was to push her out. Brad asked everyone to leave the room, and we discussed it. I agreed to the vacuum, but would not agree that it was our last option. Nonetheless, the previously empty operating room flooded with people, clearly preparing for the surgical birth of the babies. One of the doctors was trying to tell me why the procedure was necessary. I remember saying “Let’s not talk about that. Let’s just win this thing right now.”

They put the vacuum on Isabella’s head, a contraction came, and I pushed her out in a single effort. Calista came headfirst 24 minutes later. It was the most exhilarating thing that ever happened to me.
Regarding my last post about induction, risk, health and welfare, here’s what my experience has lead me to conclude.

One medical intervention leads to another. Because I was induced, I needed morphine for the first two hours. Because I was on magnesium sulfate, I needed pitocin and eventually the vacuum.

You need a lot of medical knowledge if you want special treatment. I credit Charity Pitcher-Cooper, my Bradley Method teacher, with helping me have the experience I wanted. Charity said or showed us films that said a number of things I didn’t agree with in our 12 week class. In the final analysis, however, it was because of her that I knew to ask for the labor stimulating hormone that was less powerful and had less side effects (I can’t imagine what would have happened to me with the stronger agent). I was able to agree with the doctor about what signs indicated the babies were having trouble and what the absence of trouble looked like. This emboldened me to resist the surgery just because it was taking longer than they liked.

I have other thoughts about the experience, but an election is coming up, and I’ve got other posts I need to make very soon. Remember, if you want to receive the Granick Slate Card, which should be out in the next day or so, you need to check back here, or subscribe by visiting here.

On Saturday in Brad’s and my natural childbirth class, we watched a video which (in a short segment at the end) claimed that male circumcision was sexual assault and that abolishing it was one of five or six things that would help improve infant mortality rates. (I have the video at home and I will post the exact claims when I have a chance to review.) I proclaimed this claim “not charitable to the Jews” which instigated a discussion about the health risks of the practice.
I am not a fan of circumcision, but the claim that male circumcision has any adverse health effects on little babies struck me as wrong. Our instructor (who is to be commended for following up) provided us after class with the following statistics:

No one keeps records of circ deaths in the US. Doctors agree the
number of botched circ’s are under reported. Deaths are even harder
to count- due to the fact that the death maybe attributed to another
cause- infection, menigitis, urethral blockage etc. There have only
been 2-3 circ deaths in the medical literature, as case studies, since
the 1950’s.

Guestimated death rate for Circ in the US is reported to be- 2-3 per
year, or as many as 229 per year, depending on the source.

Here is my response:

I’ll have time to look at these numbers later in the week, but these statistics prove my point, which is that the movie is deeply misleading, if not outright false, when it says that abolishing circumcision is one of 5 or 6 important things to do to improve the infant mortality rate. Even if I take Charity’s highest guestimate, 229 US deaths per year, as true, the death rate among boys from circumcision (with about 2M boys born alive every year) is .01%. (or .016 if we just count the approx 70% that are circumcised). This is hardly a killer worth noting compared with prematurity, birth defects, drug abuse, SIDS, or the other double-digit infant killers. If we wanted to stop infant mortality, there are far more productive places to put our efforts, ones which perhaps don’t have the ideological heft of “sexual assault”, don’t point the finger at the practices of religious minorities, but are more uncomfortable for the powers-that-be. For example, the number one cause of infant mortality last year was prematurity, and one of the three major causes of prematurity is carrying multiples (cigarettes and drugs are the other two), and so many more (rich, white) people are having multiples now because of fertility assistance like IVF. That would be a more productive thing to attack, but of course, its far more politically unpalatable.

Of course, the 229 number is flagrantly, recklessly false. About 28000 babies die every year. Of those, I assume half were boys, 14000. If 229 of them died from circumcision, that would be an incredible 1.6% of the deaths that occur attributable to circumcision. That would mean that circumcision, while still at the bottom, is a more likely cause of death than menengitis, heart attack, bronchitus or a host of other baby diseases. http://www.cdc.gov/nchs/fastats/infant_health.htm (Cover up, anyone?) Later if I have time I’ll try to track down where that number came from.

I’d be interested in what information and thoughts readers have, both about circumcision and about the broader question of how the medical establishment and the media dispense information about health risks. Maybe I’ll hear from my colleague Prof. Dan Harrison, who I know is an expert on the sociology of circumcision!

Will Bioterror Fears Spawn Science Censorship?

My latest Wired News column revisits an issue I wrote about in a law review article a few years ago for the Yale International Journal of Communications Law and Policy, The Price of Restricting Vulnerability Publications. In that article I compared proposals to limit the publication of computer security holes with the best practices in the natural sciences, including microbiology. Acceptable restriction guidelines were very, very narrow, and totally voluntary. Recently, however, a new task force organized under the National Security Act is proposing more restrictive guidelines, and while the proposal speaks in voluntary terms, the board reports are clearly resigned to the inevitability of future federal regulation of scientific publications. This bodes ill for advancement in science, and by analogy, computer security. In the column, I point to some other ways we can mitigate the risk that scientific research will be misused by criminals and terrorists.