Knitters and Crocheters Needed To Honor Infant Loss

The International Center for Traditional Childbearing (ICTC) is trying to call attention to the issue of infant mortality.

They are asking that as many people as possible knit baby hats (preemie or full-term) and send them to their local ICTC chapter by Sept 15th.

September is Infant Mortality Awareness Month. We are drawing attention to infant mortality by knitting or crocheting one baby hat for every baby that did not reach its first birthday.

I am sure many of us in the birth community (and outside it too) have known women whose babies have died and never made it to their first birthday. There are many difficult things in the world, definitely, but this surely has to be one of the hardest.

One of the difficult things about working in the birth community for an extended period of time is that sooner or later, someone you know loses a baby. Several beloved friends of mine have lost babies over the years, mostly to stillbirth, and I honor the memories of these babies. In addition, a dear online friend of mine lost her baby at term just a few months ago, so this is near and dear to my heart in particular right now.

While stillbirth is technically not the same as infant mortality (infant mortality are the babies who die in the first year after being born alive), that's stastistical hair-splitting to me. Yes, I understand the statistical reason for separating these categories, but to me emotionally, a baby's death is a baby's death, and they are all tragic.

Therefore, I still feel I am honoring my friends' stillborn babies by drawing attention to the ICTC project, even though technically they are not part of the infant mortality stats. In addition, I am honoring the babies of other women I know who are part of the official infant mortality stats because they died from SIDS or similar causes. Regardless of cause or timing, I mourn them all and I honor them all.

Here is a link to an organization (http://www.birthinghandsdc.com/) that is working with the ICTC on this project, and which also has links to infant hat patterns right on the site. If you'd like to help but don't have any patterns, be sure to go to the following site and then follow the links:

http://www.birthinghandsdc.com/BHDC-infantknithats.html

The same patterns can also be found on the ICTC website at:

http://www.ictcmidwives.org/component/content/article/85

Here is the full description of the project from another website:

ICTC is asking every able body to join us in knitting or crocheting at least ten infant hats and sending them to the ICTC State Representative in your state by September 15th.

The ICTC State Representatives are listed on http://www.ictcmidwives.org/, or you can send them to ICTC, PO Box 11923, Portland, OR 97211.

The hats will be displayed at an infant mortality awareness rally in the week of September 26th. At the end of the public awareness project the hats will be given to infants as “Going Home” gifts when they leave the local NICU units. What a comforting gift to an ill baby and support to worried parents. By participating in the “Heads Up” Campaign, we can increase awareness about the causes of infant mortality and then create the solutions to reduce infant deaths.

The International Center for Traditional Childbearing (ICTC) is an international organization established in 1991, and head quartered in Portland, Oregon. It is an infant mortality prevention, breastfeeding promotion and midwife training organization. The mission is to increase the number black midwives, doulas, and healers, to empower families, in order to reduce maternal and infant mortality. ICTC educates on the causes of infant mortality and provides solutions through education, direct services and training midwives and Full Circle Doula Birth Companion Training.

This campaign is being co-sponsored by Birthing Hands of DC and other supporters. To learn more, visit http://www.ictcmidwives.org/ or call 503.460.9324.

Pig Pen Lives

Yes, it's true, "Pig Pen" from the Peanuts comic still survives, and in fact is living in my house, masquerading as my younger son.

This child is the sweetest kid on the earth, very sensitive, loving and kind, with a particular affinity for animals. He has a huge stuffed animal collection that must be kissed every night before bed, and he absolutely DOTES on our cats and our bunnies. He really is a sweet, wonderful, loving child and a real light in my life.

But Oh My God, he is the most hygienically-challenged child to ever live on this earth.....or so it feels sometimes.

My husband, Mr. WellRounded, was packing to take the older three kids to a special camp this weekend. He told the kids what they needed and told them to go pack it in a back-pack. He wouldn't check up on whether they actually packed what they were supposed to, though, and knowing my younger son the way I do, I decided I'd better check.

The child had simply "re-purposed" a bunch of dirty clothes from his last Cub Scout campout. He had dirty, smelly socks in there, dirty pants and wadded up shirts, and worst of all, some rather nasty underwear with major "skidmarks" all over them (I may end up burning them). Thank goodness I made a point to check his pack!

So off we went, down to his room to get clean clothes. I had told this child to clean his room several times over the last few weeks but had not personally checked it recently. He swore to me it was perfectly clean. Uh-huh.

Well, it was "clean" in that there was a path from the door to the bed, but that's about it. Every inch of dresser and bookshelves was covered in the "treasures" of childhood, there were piles of books and comics all over the floor, and the dirty laundry was overflowing from his hamper (despite a number of requests to bring it to the laundry room the week previous).

I'm concerned this child will be a pathological hoarder because he seems to be unable to edit his own stuff. No paper is ever thrown out, no matter how trivial or inconsequential. Anything he has ever made, no matter how cheesy, can ever be discarded. I work with him on editing his schoolwork and paintings and such, and he helps me choose what to keep and what to recycle....but he doesn't seem to be able to do this on his own. Even with my help it's very difficult, much more so than with his siblings.

I asked him this summer to bring up any clothes that were too small so we could give them to the cousins. Nothing ever came up. When I went down to his room yesterday, he had so many clothes in the drawers that he couldn't shut the drawers. He had everything from a size 8, 10, 12, and 14.....all at the same time in those drawers. Even though most things were clearly too small for him, he couldn't manage to organize them into a pile or consider letting them go. It was just too much for him to do on his own.

Well, I don't expect that a 9 year-old will be able to edit everything on his own, but by now he should be able to edit some stuff without me there during the whole process. His older siblings could at this age. And while cleanliness is a struggle for all of them (they think I'm a cleaning fanatic; trust me when I say I'm not!), none of them struggle quite as much as this child does.

He's also a walking stain-attractor. You can give him a perfectly clean shirt first thing in the morning, and before he leaves the house for school it has a stain on it. All of his clothes are covered in stains. I should buy him stock in the "Shout" company because we use so much of it on his clothes. Every kid gets some stains and I'm not that uptight about that.....but this kid is a walking petri dish.

Clean socks? Sometimes.....but often not. Often it's regular shoes with no socks, rather than go get a pair of clean ones. I don't know what he has against clean socks, but he doesn't like changing them.

Clean underwear? A concept he actively resists. I actually have to resort to "cheek-checks" some days to see if he really has put on clean underwear, even after he swears he did. Often, his cheeks fail said checks.

Now, I'm not a believer in keeping kids spotless. If they are out playing like they should, they're going to get dirty sometimes. That's okay with me. I can deal with that kind of mess, and I expect it. It's a sign of good imaginative playing.

But I also know how kids can be ostracized among friends and adults for looking filthy and in particular for smelling bad. I don't want that for my kid, so basics like clean underwear, clean socks, and occasional changes of pants and shirts are non-negotiable.

Even so, it's really a struggle with this one. He really is like Pig Pen from the Peanuts comic. You can practically see the clouds of dust and grime around him as he walks.

He is as sweet as the day is long......but what person is ever going to be romantically interested in him when he looks and smells like Pig Pen? I just hope this is a stage he outgrows......but I'm not holding my breath waiting for it to happen (or maybe I am, just to deal with the smell).

Do you have a Pig Pen in your life? What did/do you do to help him/her?

Refusing Free Veggies

This year, we built lots of raised beds for vegetable gardening. Last year I was in a car accident that did a real number on my knee, so I decided I wouldn't garden much if I had to be down on my knees to weed. It just hurts too much.

So we built up instead, into nice high raised beds. (Most of mine are higher than the ones you see above; some are knee-high, some are waist-high.) It's more expensive to set up, but hey, I'll actually use the garden this way and therefore get more fresh fruits and veggies into my family. I can live with the extra capital outlay when I look at it that way.

This has been GREAT. I love the raised beds! And they are so much easier to plant and harvest from. I think that will be a big deal to me as I get old and creaky, and will help keep me gardening longer.

We planted spinach, lettuce, peas, potatoes, carrots, onions, green beans, cukes, broccoli, peppers, corn, pumpkins, canteloupes, watermelons, cabbage, and about a thousand tomatoes. We also planted (or have existing plantings in) strawberries, raspberries, blueberries, cherries, pears, apples, grapes, and plums.

(Yes, we have a fair-sized garden area now. But even when we had a house with a small yard we managed to do tomatoes, cukes, peas, potatoes, lettuce, green beans, and spinach on a regular basis, often in containers or very small raised beds. You don't have to have a huge yard for it.)

Well, now we are harvesting our larger garden like mad, and of course we have more food than we can eat. So whenever I go somewhere, I take along a bag of tomatoes or green beans or cukes or whatever (no, I don't try to pawn off zucchini; we don't plant it cause I can't stand the stuff).

I view this as a lovely gift I can offer to other people if they'd like some, and certainly it represents some major time, effort and money from me.

To my shock, a lot of people turn me DOWN!! Fresh veggies, organically grown, vine-ripened......you'd be paying a MINT for this in the stores. And I'm having trouble giving it away, can you believe it? To people who don't have room for gardens, even to people who are pretty marginal in terms of income. You'd think they in particular would love to have some fresh-grown veggies as a treat....but no.

Do people really hate veggies that much?

I know I have a reputation in my house for being a bit anti-veggie, because there are many veggies I can't stand and won't eat (squash, brussel sprouts, etc.). I'm not a huge salad fan either; I do eat salads, just not with much enthusiasm some days. So I don't always get in the three-to-five-veggies-a-day I really should get, though I try. (And I usually make up the difference with fruits, yummmm.)

But gees, I'm a vegaholic compared to some of these people. I can't believe they are turning down this beautiful organic stuff!!

Well, the food bank won't turn it down, so I'll probably take it there. But I'm more than a bit miffed....and mystified too.

This really surprised me. I understand that not everyone loves tomatoes, of course; even two of my own kids won't eat them. And I understand that some folk like their food out of a can instead of out of the dirt. To each his own. I know that not everyone will welcome this food, and I expected that some would turn it down, which is fine....but I'm most surprised at how many have refused it.

Do all those people really hate veggies like that? Is our national veggie intake really that bad? (No, trolls, the turn-downs have not come from fat folks, but mostly from skinny folks.) I know that we as a country could certainly eat more fresh fruits and veggies, but most people I know personally grow at least some of their own food at home or buy it at farmer's markets. I guess I thought that kind of intake was fairly normal among most people. Apparently not.

I guess I'm especially miffed because some of these people are very ungracious in their refusals, acting like I'm trying to pawn off giant zucchini or gross Christmas fruitcake on them or something. You'd think I was trying to insult them or inconvenience them in some way.

Hey, a little gratitude here!! I'm offering something of significant value here, grown with my own sweat and toil and money; no one said you had to take it. If you don't want it, don't take it....but you could be at least a little appreciative and gracious in your refusal!!

Grrr. Yeah, I'm a little miffed.

Oh well, I know my mother-in-law won't turn down anything; she cooks and freezes and preserves everything. However, she does have a limit on her freezer space.

I do put up some freezer preserves and applesauce myself (and hope to learn to do some canning next year), but I'm too busy this year to really preserve everything we grow. But I just have sooo many wonderful tomatoes on hand right now (with many more about to ripen as well), I may have to investigate making some home-made spaghetti sauce and freezing it. (Anyone got a good recipe they want to share?)

At least the food bank won't turn down any extra stuff we don't use. Someone should get some benefit out of this lovely stuff.

Question: Would you turn down fresh home-grown veggies if they were offered to you? (I would if it was zucchini or other ones I didn't like, but assuming it was something you liked, would you be glad or upset if someone offered you fresh veggies?)

Celebrity Plus-Size Mamas

I don't really care about pop culture shows like American Idol, etc., but sooner or later even an out-of-touch old geezer like me hears about some of the people who emerge from these shows.

One of these is Jennifer Hudson, who I admit I mostly paid attention to because she was a woman of size. (Winning an Oscar and a Grammy didn't hurt either.)

I'm happy to report that she just became the most recent celebrity plus-sized mama.

We know very little about the pregnancy or birth, just that she gave birth to a son, David Daniel Otunga Jr., on Monday, and that the baby weighed 7 pounds, 14 ounces. (So much for the idea that all fat women have huuuuge babies.)

Congratulations to Jennifer the Dream Girl on her new little "Dream Boy." Way to go, mama! You deserve a little happiness in your life now.

Jennifer Hudson photo found at Wikimedia Commons.

Banker's Hours

I have to air a pet peeve of mine.

I am really ticked off at all the dentists, doctors, etc. who expect us to pull our kids from school in order to schedule routine appointments. What kind of message does this send to our kids?

I took my kids to the dentist this week for a cleaning. Afterwards, they wanted me to schedule the next appointment, in six months. Fine, we do this all the time.

In the past this was easy because we had a different school schedule that gave us periodic time off during the school week, so we always scheduled it for those days so as not to miss any lesson time. However, the school's schedule has now changed. We now have early release on some Fridays, but of course the dentist doesn't work then. Heaven forbid he actually work a normal work week like everyone else in the world.

So fine, I ask about apppointments after school. Oh no, the dentist doesn't stay late. Heaven forfend he might be inconvenienced at all.

No, no, instead, he basically expects kids to MISS SCHOOL in order to get a routine dental cleaning.

Never mind that he just hired another dentist to lighten his load. He could have her work some later hours......but no. That's far too much to ask.

No, instead, they have to send the message that school is unimportant, that everything else in the world takes priority over learning, that his precious time is far more important than mere education.

Well, I find that totally unacceptable. School is very important, and it's very difficult to make up missed classroom time. Sure, you can get any assignments missed, but any teacher will tell you that it's JUST NOT THE SAME.

You just don't "get" it the same way if you don't hear the teacher's lecture or get to ask interactive questions right then and there. If there's a science lab or a special hands-on learning activity, that kind of stuff simply can't be made up. And frequent absences makes the teacher and the kid's jobs SO much harder.

Now, some absences are just going to happen. It's a rare kid that doesn't ever miss school. And dental emergencies happen, or sometimes there are other circumstances that dictate having a dental appointment during school time. Sometimes it just can't be helped.

But these absences should be kept to a MINIMUM and they shouldn't be for some routine thing like a cleaning, for heaven's sake.

It makes me just furious that basically, I have almost no choice but to have the kids miss school in order to get their dental cleanings. To minimize this, I always schedule one for the summertime, but you simply can't expect everyone to have winter and summer cleanings. Some are going to have to be in the spring and fall. Why can't there be some appointments available outside of school hours?

And what about parents who work outside the home? I do, but I work part-time and my schedule is fairly flexible. I can make dental appointments and doctor appointments work if I must....but what about those parents who can't?

Some parents simply cannot take time off for things like dental cleanings. With this dentist's practice, they'd be out of luck. They'd have to take personal or vacation time in order to get regular dental cleanings for their kids.....or their kids would have to go without. In fact, I'd bet that's one of the barriers for getting regular cleanings and dental care for many kids.

In the end, I made an appointment for the last time slot of the dentist's day, one where we won't have to miss school if we RUSH off right at the end of school......but I will have to do this multiple times in order to get all my kids in. It's not a short drive, so this is no minor inconvenience. I could make only one trip if I was simply willing to ditch school and schedule earlier in the day....but what does that teach my kids?

I think good dental care is important....but I don't think I should have to sacrifice my kids' learning for it.

You would think in particular that a pediatric practice would have at least some extra hours appointments available.....but no.

I communicated my displeasure pretty clearly to the receptionist and asked her to pass it on to the dentist in the strongest possible words.

I have to say, though, much as I like this practice otherwise, I may just have to find another dentist over this issue.....one that offers enough appointment times that missing school is not our only real option.

Hopefully there are still some dentists out there that don't keep banker's hours and expect their own convenience to supercede everyone else's learning and school and work commitments. I sure hope that there is, because child #3 is going to be needing braces within a year or so. I simply could not countenance taking him out of school that often.

What do you do for dental appointments for your school-aged kids, assuming they are not home-schooled?

Famous Women of Size: Marie Dressler

"Fate cast me to play the role of an ugly duckling with no promise of swanning. I have played my life as a comedy rather than the tragedy many would have made of it."
---Marie Dressler

Have you heard of Marie Dressler? She was a famous actress on both stage and screen in the early part of the 20th century. At one point, she was more famous and popular than many of the Hollywood stars we hear about today.

She was the top draw at the box office for most of the early 1930s, and the highest-paid star in Hollywood for several years. She was so famous and so popular that she was the cover of Time Magazine in its August 7, 1933 issue.

She was nominated as Best Actress for two years, and won it in 1931, despite being an older woman (in her 60s) in Hollywood, which, as today, worshipped mostly the young and beautiful.

Oh yes, and she was a woman of size.

I had to know more. How come there was this famous fat movie star and I'd never heard of her?

How I Came To Know Her

Several years ago, I was doing a research project, and looking at silent movies was part of that research. I was surprised at how much I enjoyed them, really.

(To my surprise, I particularly enjoyed Buster Keaton. If you ever get a chance to watch some of his early silent movie work, you should definitely take advantage of it!)

At one point I was watching some of the old, early Charlie Chaplin movies, and there he was, dancing with a big, tall, fat lady in a comedy routine.

The movie was titled, "Tillie's Punctured Romance," and it was made in 1914. Chaplin was not a big star yet; it was his first really big film.

I was entranced. So I made it a point to research her more.

Her Life

Marie Dressler was born as Leila Marie Koerber in 1868 or 1869 (sources differ) in Ontario, Canada. Her family moved frequently, so she learned to make people laugh early. She started her stage career at 14 by running away to be in traveling acting companies, and changed her name to Marie Dressler because her family didn't approve of her stage ambitions.

She eventually made a career in light opera and on Broadway, but always felt the pull of the vaudeville stage, where she was known for her "full-figured body." Her sense of humor and natural comic timing helped create a career for her there and strongly influenced her broad acting style.

She became a film star only in middle age, appearing in her first film at the age of 42. Her first really big film was the afore-mentioned "Tillie's Punctured Romance" in 1914 at age 46 with Charlie Chaplin. It was based on a stage play she had starred in called "Tillie's Nightmare."

After "Tillie's Punctured Romance," Dressler made two more "Tillie" movies: "Tillie's Tomato Surprise" (1915) and "Tillie Wakes Up" (1917). However, bad business decisions killed her film career.

She left movies and went back to Vaudeville in 1918, but soon got into trouble:

In 1919, during the Actors' Equity strike in New York City, the Chorus Equity Association was formed and voted Dressler its first president. In 1927, Dressler was secretly blacklisted by the theater production companies due to her strong stance in a labor dispute.

Out of work and broke, she fell upon hard times for quite a while in the 20s until her career was revived near the end of the decade with the help of friends. From 1927 to 1930, she played a series of smart-alecky older-woman supporting roles, which slowly gained her notice in Hollywood.

Her Stardom

By the 1930s, she had become a major star and had moved into mature (and sometimes serious) leading lady roles, quite an accomplishment for a woman in her 60s who was known for her homely face and "robust" body.

In 1931, she won a Best Actress Oscar for "Min and Bill." In 1932 she was nominated again for her leading role in "Emma."

In 1933, she appeared in "Dinner at Eight" as "an aging but vivacious former stage actress" opposite Jean Harlow. Her scene with Harlow at the end is considered a classic.



Indeed, it is her over-the-top acting skills that really make Dressler stand out. By today's more naturalistic standards, she overacts a bit......but remember that she was working from the more stylized standards of the day.

Matthew Kennedy, author of a biography of Marie Dressler, says this about her acting:

She played to the camera as if it were the back row of a vaudeville theater, mugging and overreacting shamelessly. But because she was so good at it, and so experienced, it became who she was as an actress. It’s Marie and her character becoming one. And behind all that mugging is someone so warm, so funny, and so human, that she makes a beeline straight to your heart. Call it overacting, but it’s hard to deny her entertainment value, even today. Once you see Marie Dressler on the screen, you don’t forget her!

Her many years in Vaudeville had honed her vocal skills and her facial reactions until she was a master of comic timing and delivery, especially in the imperious grand dame roles.

However, she also proved that she could be memorable in humble working-woman, down-on-her-luck serious roles. It was for these roles that she was nominated for Best Actress.

This picture is from "Min and Bill," the movie for which she won Best Actress. Hardly a glamorous Hollywood role, but Dressler made it her own.

She showed that she had a wider range of acting range than most people expected her to have, and was able to use her looks to her advantage against all expectations.


Death

Alas, at the height of her career, Dressler was diagnosed with terminal cancer. Even though she was in great pain at times, she insisted on continuing to work and made both "Tugboat Annie" and "Dinner at Eight" while seriously ill. She died shortly afterwards:

Her newly-regenerated career came to an abrupt end when she was diagnosed with terminal cancer in 1934. MGM head Louis B. Mayer learned of Dressler's illness from her doctor and asked that she not be told. To keep her home, he ordered her not to travel on her vacation because he wanted to put her in a new film. Dressler was furious but complied.

[She died] on Saturday 28 July 1934 in Santa Barbara, California and is interred in a crypt in the Great Mausoleum in the Forest Lawn Memorial Park Cemetery in Glendale, California. For her contribution to the motion picture industry, Marie Dressler has a star on the Hollywood Walk of Fame at 1731 Vine Street.

Dressler died at the height of her career, and was one of the most beloved and popular movie stars of the early Depression.

Kindness to Others

One thing Dressler was known for was her kindness to fellow actors. Two of these actors later paid her back by giving her the jobs that launched and/or revived her career.

For example, during her stage career, she helped get fellow Canadian Mack Sennett (of Keystone Cops fame) a job in the theater. When he became a director, he asked her to be in the "Tillie" movies, thereby igniting her film career. They later had a falling out, but his support in the early years was crucial in establishing a wider audience for her.

Another influential friend was Frances Marion, one of the most influential and famous women screenwriters in Hollywood. Marion helped revive Dressler's career after Dressler was blacklisted because of her pro-labor activities. According to Wikipedia:

Dressler had shown great kindness to Marion during the filming of Tillie Wakes Up in 1917, and in return, Marion used her influence with Thalberg to get Dressler a number of supporting roles, including the queen in Breakfast at Sunrise and a snappy maid in Chasing Rainbows. She was then established as a funny supporting woman.

Marion persuaded Thalberg to give Dressler the role of Marthy, the old harridan who welcomes Greta Garbo home after the search for her father, in the 1930 film Anna Christie. Both Garbo and the critics were impressed by Dressler's acting ability, and so was MGM, who quickly signed Dressler to a $500-per-week contract.

Marion also was a writer on many of Dressler's biggest films, including "Min and Bill," "Emma," and "Dinner at Eight." They remained close for years.

Even after she became a big star, Dressler continued to be generous to other actors. She helped cement the career of Richard Cromwell by insisting that he be cast in the lead opposite her (on loan from another studio) in 1932's film, "Emma," for which she was nominated as Best Actress.

MGM Studio boss Louis B. Mayer called Dressler "the most adored person ever to set foot in the Metro-Goldwyn-Mayer studio."

Musings On Dressler's Popularity

Some authors contend that it was the Depression that helped make a woman of Dressler's "looks" so popular.

According to that theory, her ordinary appearance, plain face, humility and grace.....combined with her sense of humor and self-effacing nature.....made her seem like just another one of the folks, like all the other people struggling to make a living in that time.

Her face and body looked well-lived in, like she had seen a lot of troubles in life, yet had triumphed over them with grace and humor and sheer grit. It made her audience readily able to relate to and identify with her and want to see her succeed.

In his biography, Matthew Kennedy discusses her appeal:

An overweight, jowly, elder actress came to represent the optimism necessary to endure the Depression. One man I interviewed who remembered her said that people flocked to see her movies because she gave them hope. One look at her and you could believe that she was a symbol of love, courage, and survival, which was exactly what the times needed. Her stardom is one of the great anomalies in Hollywood history, a kind of adoration that isn’t supposed to happen to an older, homely woman.

She was a woman of size who carried herself with dignity and pride, but who wasn't afraid to make fun of herself either. She was a woman of considerable talent who refused to let others' biases about her looks keep her down, and in the end, turned her greatest liability into her greatest asset.

She died at age 65, a pretty good lifespan for people in that era, but sadly too early. Imagine the work she could have done in Hollywood with a little more time. What a loss to us all!

Marie Dressler Quotes and Pictures

There are quite a few Marie Dressler pictures out there. These two are among my favorites because they show her sense of humor and silliness.



There are several movie clips of her on YouTube, including this one called "For I'm the Queen," which highlights her Vaudeville comic skills. It has a fat joke in it at the end so I won't reproduce it here, but it's still worth watching for her sheer presence and varied facial expressions.

She also seemed to be a thoughtful person, full of wisdom from a life of some very hard knocks. As I pass into perimenopause, I enjoy her musings on being middle-aged, a time when women are particularly devalued in our society:

“By the time we hit fifty, we have learned our hardest lessons. We have found out that only a few things are really important. We have learned to take life seriously, but never ourselves.

And of course, she had a lot of wisdom to offer for those of us born with less-than-traditional good looks, whatever those challenges may be.

“I contend that every woman has the right to feel beautiful, no matter...how indifferent her features.”

Amen to that.

And of course, my favorite quote of hers, which I used at the top of the post but which bears repeating:

"Fate cast me to play the role of an ugly duckling with no promise of swanning. I have played my life as a comedy rather than the tragedy many would have made of it."

Other Marie Dressler links:

http://www.mariedressler.ca/

http://www.altfg.com/blog/actors/marie-dressler-matthew-kennedy/

http://www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=300

http://www.amazon.com/Marie-Dressler-Performances-Filmography-Discography/dp/0786428449/ref=pd_cp_b_1

The Skin Yeast Manifesto

Since the summer hot and humid season is upon us, let's talk about something many of us probably struggle with from time to time.......skin yeast infections.

The official names include "Intertrigo" or "Cutaneous Candidiasis" or "Dermatophytosis." Personally, I just call them the yeastie-beasties.....because they really can be a beast to deal with.

If you are young, maybe you haven't encountered these yet. I didn't have it very much in my younger years, but as I've aged, it's become more common, probably as my insulin resistance has increased with age and hormonal changes. Chances are that as you get older, you'll have a lovely encounter with it too, sooner or later. Supposedly a significant portion of the adult population has issues with skin yeast/fungal infections at any given time.

Who Gets Skin Yeast/Fungal Infections?

Of course, some people are simply more prone to skin yeast/fungal infections than others. This includes people who have been treated recently with antibiotics, those on corticosteroids like Prednisone, those on birth-control pills, fat folk, those who are immuno-compromised, and those with diabetes or significant insulin-resistance issues.

Interestingly, women who have had cesareans often find that their c-section scar suddenly becomes a magnet for skin yeast infections. Because of the way the surgeons fix things up after a cesarean, there is often an overhanging "flap" of skin and fat with a cesarean scar. Even skinny women often have this lovely "flap" or "shelf" after a cesarean, and as with fat women, this moist fold tends to promote yeast/fungal growth.

Anecdotally, there seems to be some extra vulnerability to yeast in the cesarean scar afterwards, for whatever reason. Women of varying sizes who never had issues with yeast before often experience skin yeast there afterwards, sometimes chronically. It can be one of the more frustrating small annoyances of having had a cesarean....and yet another reason to avoid an unnecessary cesarean.

And of course, after the birth (vaginal or cesarean), yeast can become a chronic problem for any mother and baby, especially if antibiotics were used during the birth. Oral thrush (in the baby's mouth) or yeast infections in the mother's nipples can be a painful and frustrating "welcome" to parenthood.

A Fat Person's Issue Only?

Yes, it does appear that "obese" people have more issues with skin yeast/fungal infections. This may simply be because many fat people have PCOS and/or strong insulin-resistance issues, but it may also be because skin folds tend to be warm, moist areas that promote fungal overgrowth. Likely, it's a combination of both.

On the other hand, it's a mistake to think that skin yeast only affects fat folk. Many people of average size struggle with it too, as I discovered through the birth community. It's just more talked about in the fat community.

Identifying a Skin Yeast Infection

So how do you know if you have a skin yeast/fungal infection?

If you get a nasty, intensely itchy (or burning) red rash, especially in the skin folds, this may be a skin yeast infection.

Although yeast infections are sort of a sub-type of fungal infections, for the purposes of this article we will consider the two together under the imperfect term of "skin yeast." When someone gets a red, itchy rash on the skin, it may have candida (yeast) involvement or other fungal involvement, or both.

Technically, the correct term for this is "Intertrigo," which simply means any skin rash of the body folds. This can involve yeast, it can be bacterial, it can be fungal, it can be viral.....it's any rash of the skin around the body folds.

But the general public is not usually familiar with the term "intertrigo" and it's not what would someone would search on when looking for this information. Therefore, it's probably best for us to use some other term.

Most people usually think of skin infections as "jock itch" or "athlete's foot," and usually think it's caused by yeast, even when it may actually be some other fungal (or something else entirely). Because it's popularly called skin yeast, that's what we'll call it here, even though it's not always yeast, or not always only yeast.

Still, it's important to note that some intertrigo is caused by candida (yeast), some is due to other fungi, some is both, and sometimes there are other causes as well. This may be why some of the popular remedies work better for some people than others; various remedies will no doubt work differently on different types of fungal infections or degree of yeast involvement.

What Are Skin Yeast/Fungal Infections Like?

At the top of this blog entry is a picture of a skin yeast infection, and other pictures of skin yeast infections can be found here and here. [These are not for the faint of heart, so be forewarned!]

Typical skin yeast infection locations include groin folds, under the breasts, in the armpits, in the belly button, under the belly, in the folds of the elbows and knees, between the toes, etc. "Athlete's Foot" and "Jock Itch" are usually skin yeast/fungal infections, as are dandruff and ringworm.

Wikipedia describes jock itch (tinea cruris) in the following oh-so-attractive way:

Affected areas may appear red, tan, or brown, with flaking, rippling, peeling, or cracking skin.

The acute infection begins with an area in the groin fold about a half-inch across, usually on both sides. The area may enlarge, and other sores may develop in no particular pattern. The rash appears as raised red plaques (platelike areas) and scaly patches with sharply defined borders that may blister and ooze.

If the rash advances, it usually advances down the inner thigh. The advancing edge is redder and more raised than areas that have been infected longer. The advancing edge is usually scaly, and very easily distinguished or well demarcated.

The skin within the border turns a reddish-brown and loses much of its scale. The border may exhibit tiny pimples or even pustules, with central areas that are reddish and dry with small scales.

If infected with candidal organisms, the rash tends to be redder and wetter.

[Now, mind, there can be other reasons for itchy or burning rashes on the skin, so it's always good to have a rash checked out if you aren't sure. A few years ago I had a bad rash that I didn't get checked out becase I thought it was the world's worst case of yeast.....turns out it was shingles!!...yeowch!!! If I hadn't automatically attributed that burning/itching rash to skin yeast, I might have gotten into the doctor in time to be able to get an anti-viral that would have lessened my suffering. So don't hesitate to get it checked if you are unsure or if it seems worse than normal!]

Treatments for Skin Yeast Infections

If you have developed a skin yeast infection, you usually want immediate relief. Sometimes the infection is mild and just annoying, but usually it makes a person pretty uncomfortable. Some of the really bad ones can make you downright miserable, or even cause secondary bacterial infections which can become very serious. So what are your options for treatment?

There are many choices for skin yeast treatment, from the traditional medical approach to many folk remedies and "alternative" medicine options. What works for any one person varies a lot, so I have included a full range of choices so that you can experiment to see what works best for your body.

I put these together by listing all the treatments I personally had tried over the years (both successfully and unsuccessfully), as well as treatments others have said were effective for them (but I had never tried). Then I did a search about treatments that were recommended in various online sources and included many of those as well.

When people discuss what works for them for treating skin yeast, there is often a strong difference of opinion about the "best" treatments. I think this boils down to "Your Mileage May Vary"......that is, that various treatments vary in their efficacy for different people. This may simply be because different people have differing types of fungi affecting them, it may be because of subtle differences in body chemistry, or both.

I would also note that yeast/fungal strains can develop resistance to treatment over time. As a result, you may find that over time, the effectiveness of one type of treatment declines for you. Therefore, it's good to have multiple options in your arsenal and to switch them off occasionally. Keep experimenting, and keep mental notes on what works best for you.

Finally, a number of sources make the valuable point that it's important to continue treatment for skin yeast/fungus for quite a while after the symptoms disappear in order to fully extinguish the fungus. Discontinuing the treatment too soon may cause a cycle of recurrence.

Medical Disclaimers

Of course, any time you discuss stuff like this online, you have to include the obligatory medical disclaimer.

I'm not a doctor nor a healthcare professional. I have not personally tested out all of these, so I CANNOT attest to their safety or efficacy. Therefore I'm adding lots of caveats. Do further research about the safety of these possibilities, get medical advice as necessary, and go cautiously if you decide to try any.

This list is provided for informational purposes only and not intended as medical advice; I assume no responsibility for any actions taken on your part. Consult your healthcare provider as needed, yadda yadda yadda.

Traditional Medical Treatments for Skin Yeast Infections

Traditional medical treatments include anti-yeast creams, like those used with a vaginal yeast infection. Other options include anti-fungal creams, powders and sprays used for athlete's foot and jock itch.

Some of the most commonly used anti-yeast meds include the "-azole" family of drugs (including miconazole/Micatin/Monistat Derm and clotrimazole/Lotrimin AF). Sometimes these are mixed with mild anti-steroidal creams for symptomatic relief of the itching while the anti-yeast drug works on the yeast. (Some people feel this addition is harmless, while others feel it can act as a "fertilizer" to the yeast.)

But how do these medications work? From http://firstaid.webmd.com/yeast-infection-skin-rash-treatment:

Azole medications are a family of antifungal drugs that end in the suffix "-azole." They block the manufacture of ergosterol, a crucial material of the yeast cell wall. Without ergosterol, the yeast cell wall becomes leaky and the yeast die. Fortunately, ergosterol is not a component of human membranes, and azoles do not harm human cells.

Nystatin is another common anti-fungal cream that is used. It is part of a group of drugs called "polyene antifungals." Again from http://firstaid.webmd.com/yeast-infection-skin-rash-treatment:

Polyene antifungal medications include nystatin and amphotericin B. Nystatin is used for thrush and superficial candidal infections. Doctors reserve amphotericin B for more serious systemic fungal infections. The antifungals work by attaching to the yeast cell wall building material, ergosterol. These medications then form artificial holes in the yeast wall that cause the yeast to leak and die.

An over-the-counter "antifungal cream" often used for athlete's foot or other skin yeasts is "Tolnaftate" cream, usually in the 1% strength. This same drug is often found in aerosol sprays for athlete's foot under brand names such as "Tinactin" or "Desenex."

Other drugs include Allylamines, which inhibit the enzyme required for ergosterol synthesis. Some of the more common ones include "terbinafine hydrochloride" under the brand name of Lamisil, naftifine (Naftin), and "butenafine hydrochloride" under the brand name of "Lotrimin Ultra."

Because all of these common anti-fungal products are made with different drugs and have slightly different mechanisms of action, it may be useful to occasionally switch off brand names and try a new product if the old one is not working as well as it used to. Also remember the importance of continuing to treat for a while after symptoms have subsided to prevent frequent recurrence.

If a healthcare provider suspects that a yeast infection has gone systemic, oral antifungals may be prescribed. Examples of oral antifungals include terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan). However, oral anti-fungals can have severe side effects and anyone using them must be monitored carefully.

"Folk Remedies" for Treating Skin Yeast

Most people try the traditional yeast/fungal treatments first. For some, they work like a charm. For others, they are really not very effective.

Some people actually find better (and faster) relief with some of the so-called "folk remedies" or alternative treatments. Still others find the best results when combining traditional and folk/alternative treatments.

Here's a list of some of the most common and widely used "folk remedies" for skin yeast/fungal infections:

• Vinegar (usually white vinegar)
• Garlic paste (fresh-crushed garlic)
• Listerine (original formula, the yellow kind)
• Grapefruit Seed Extract (dilute before use!)
• Gentian Violet (will stain so use carefully)
• Tea Tree Oil (may sting if not diluted a bit)
• Probiotics (orally and also topically via the powder inside the capsules)

Some less commonly seen "folk remedies" for skin yeast/fungal infections include:

• Oil of Oregano (diluted)
• Oregon Grape Root extract
• Coconut Oil
• Baking Soda (may help lower the pH in the area)
• Plain yogurt with probiotics
• Lemon Grass
• Urine (soldiers with foot infections in the field were often told to pee on their feet)
• Aspirin dissolved in rubbing alcohol (used as a soak in the area)
• Vicks Vapo Rub
• Colloidal Silver
• Goldenseal
• Citronella Oil
• Orange Oil
• Onion extract
• Patchouli
• Lemon Myrtle
• Selenium and/or Zinc supplements
• Calendula with aloe vera gel
• Whitfield's Ointment (3% salicylic acid and 6% benzoic acid; can create a burning sensation)
• Hydrogen Peroxide
• Rubbing Alcohol
• Epsom Salts
• Cod Liver Oil (applied topically)

Alternative Treatments for Skin Yeast

Among alternative healthcare treatments for skin yeast/fungal infections, a surprising entry is acupuncture, which I personally have found very useful (to my great shock).

Naturopaths like to treat skin yeast/fungal infections by considering whether there is a candida (yeast) overgrowth problem internally as well as externally.

Although there are oral anti-fungal prescription meds, these can have toxic side effects and must be monitored carefully. Therefore, many naturopaths prefer to use herbs to treat suspected systemic yeast.

Some of the commonly used over-the-counter herbal formulas for systemic yeast issues include Candidastat and Candicyn. Any health food store will probably carry these products or other, similar brands.

An Ounce of Prevention

Better than trying to cure skin yeast, of course, is trying to prevent it in the first place, or at least trying to prevent it from becoming a chronic, recurring problem. This is particularly critical for those with diabetes or immunocompromised systems.

Hygiene Issues

Hygiene is an important part of preventing skin yeast from recurring. If you have a skin yeast infection, you need to change/wash everything that comes into direct contact with it, EVERY SINGLE DAY.

In other words, you need to change your bath towel/washcloth DAILY, change your bra/socks/underwear daily (duh), change your sleeping clothes, etc. Wash these items in vinegar and HOT water; with bleach if chronic yeast is a problem. Otherwise, you may be chronically re-infecting yourself each day.

Washing your body occasionally with an anti-dandruff shampoo may be useful for preventing recurrence in some people. Nizoral shampoo has ketoconazole (an -azole drug) in it, Selsun Blue has selenium in it, and Head and Shoulders and Pantene Pro V have zinc products in them.

Treating your sex partner for yeast/fungal infections may also be necessary. Many women chronically re-infect themselves with vaginal yeast infections because their partners unknowingly have been affected too but do not receive concurrent treatment.

Wearing fabrics that "breathe" better around areas that are prone to skin yeast may lower the rate of recurrence. Many women find they have less issues with vaginal and skin yeast when they wear cotton underwear, and people who suffer from chronic athlete's foot often find better results with cotton socks and leather shoes.

Swimming pools and public shower common areas are common sources for getting a fungal infection. Wear sandals or flip-flops when walking in these areas. Also, if you or another family member has experienced skin yeast/athlete's foot, be sure to disinfect your shower floor daily for a while.

Keeping the area dry is important in preventing recurrence. Some people find that using a blowdryer set to "cool" after every shower on areas that tend to get skin yeast is effective in lowering the rate of recurrence.

Nutrition

Every yeast resource out there will tell you to cut carbs if you are truly facing a problem with yeast overgrowth. Cutting down on simple carbs like sugar, white flours, fruit juices, etc. in particular may help some people, especially those with diabetes or strong insulin resistance, because the yeast needs sugars in order to grow. Cut out the food source and theoretically the yeast should die.

On the other hand, sometimes cutting carbs makes no difference whatsoever. It's something that should be considered and tried in order to rule it out, but the slavish overattention to carb consumption demonstrates how strongly some in the medical field (and especially in alternative medicine) believe that yeast is always a function of overeating, of overindulging in sugars and refined foods, of what they assume are weight-related behaviors. Their implication is that if you just wouldn't eat those foods, you'll never have a problem with yeast. Yeah, right.

For some people, cutting out/down carbs helps, so it's worth trying.....but it's by no means a sure cure or totally necessary in all cases, especially since "skin yeast" is caused by a number of different fungal organisms, not all of which are sensitive to carb intake.

Another nutritional recommendation often seen is to cut out foods that contain yeasts or fungi. This is another unproven but commonly seen recommendation. Like carbs, it can't hurt to try and see if it helps, but it is based more on assumptions and tradition than on proven fact at this point.

Preventive Powders and Creams

Some people swear by daily dusting with powders to prevent/reduce the incidence of skin yeast. This may work because it helps keep the area dryer.

Some strongly prefer baby powder (with its high degree of corn starch, which makes the skin feel less "sticky"); others contend that corn-starch powders actually ultimately feed yeast and make the problem more chronic.

Another option is medicated powders like Gold Bond Powder; these don't have corn starch but do have menthol and other active ingredients in them may discourage yeast/fungus. Zeasorb AF is another powder sometimes mentioned that is highly absorptive but doesn't contain corn starch.

Some people find that daily use of creams like Balmex or Desitin (zinc oxide paste) tends to discourage fungal infections. Others prefer daily application of vinegar, tea tree oil, or other anti-microbial/anti-fungal substances.

Other people swear by applying antiperspirant to areas prone to skin yeast. You don't want to do this while you are having a skin yeast outbreak so you don't infect your deodorant stick, but between outbreaks, reducing the amount of perspiration there may help lower the risk for recurrence. Or so the theory goes, anyhow.

Probiotics

Many people have an imbalance in their gut flora, especially after illness and antibiotic use. In some people this can become chronic.

The theory is that if you use antibiotics and kill off both the "good" and the "bad" bacteria, yeast organisms may take the opportunity to overgrow instead, causing a constant problem with yeast overgrowth.

Probiotics are "good" bacteria that help colonize your gut and re-establish a better balance between yeast, "good" bacteria, and "bad" bacteria. This may then help improve digestion, absorption of nutrients from food, and reduce external yeast/fungal infections as well.

What's Worked Best for Me

Years ago, I rarely suffered from skin yeast issues. However, as my insulin resistance has intensified over time with PCOS, it's become more of an issue. Also, as I've gone through childbirth and breastfeeding (and now perimenopause), the hormonal changes associated with these things seem to trigger more skin yeast/fungal infections. Many other women report similar struggles during times of significant hormonal changes.

So, as a result, I've tried a number of these cures. Now, I can't tell you what will work for you....I'm sure it depends on the type of intertrigo you have. Your fungal infection or degree/non-degree of yeast involvement may be different from mine.

Still, I can share what things have worked the best for me, with the caveat of course that Your Mileage May Vary and See Your Healthcare Provider and all that.

For daily prevention, I find Gold Bond medicated powder works much more effectively for me than baby powder. It doesn't prevent every outbreak, but it sure cuts down on them and makes me more comfortable too.

I find careful attention to hygiene is very important, especially clean towels and nightshirts every day during an outbreak. I also find that occasional prophylactic bouts of probiotics are very beneficial as well.

Although some people swear by vinegar for skin yeast issues, I've never found it useful. Nor have I found Tea Tree Oil helpful, nor garlic. However, enough people have found these useful that they probably would be worth trying.

I have a nurse-practitioner friend who swears by Grapefruit Seed Extract for oral thrush in babies and mamas. I never had thrush or yeast problems while breastfeeding so I've never had to test out this theory, but I've heard very good reports from other breastfeeding moms who have had issues with thrush.

For everyday skin yeast issues, I didn't find Grapefruit Seed Extract that useful, but I may not have used it correctly. I tried it topically (highly diluted) and didn't find it that effective. So I tried it again, less diluted.....no help. Then I tried it full-strength, directly on the skin. BIG MISTAKE!! (It didn't hurt at first but after a while, wow, did it hurt. So always dilute grapefruit seed extract!!!)

From what I read online, I think Grapefruit Seed Extract may be very helpful to some, especially breastfeeding moms with thrush issues, or women with lots of candida involvement in their intertrigo. But for me personally, so far it hasn't helped that much.

When I develop an actual outbreak, the first thing I try is Tinactin, the over-the-counter athlete's foot "powder" spray. I don't just use it for feet; I use it externally wherever I need it. That usually is enough to knock the intertrigo out.

If it's not enough, I will alternate it with [yellow] Listerine applied topically to the problem areas. This was surprisingly effective.

I have tried some of the other anti-fungal over-the-counter remedies.....Lotrimin and Lamisil, I believe. I didn't find them nearly as effective as Tinactin, at least for me personally. YMMV.

Tolnaftate cream (over-the-counter antifungal cream) has also been useful at times. I have never found the vaginal yeast creams (Monistat etc.) helpful at all for skin yeast, but the Tolnaftate anti-fungal skin cream has been.

When things are at their MOST itchy and miserable, I often find that probiotic powder (from the capsules) applied directly to the worst spots helps reduce the itch. It doesn't seem to "cure" anything, but it really does seem to help lessen the symptoms.

Surprisingly, acupuncture has been very effective for yeast issues for me. I don't use it as my only or main treatment for skin yeast/fungus, but if I have a very bad flare-up, acupuncture is one of the fastest and most effective ways of getting rid of the worst of the problem.

I don't find that it prevents recurrences very well, but it does seem to take all the "oomph" out of an outbreak pretty quickly. I still have to follow up with other treatments, but it can dramatically improve things for me pretty darn quickly. Lest you attribute this to a "placebo effect," I hasten to add that I was a total disbeliever that this would help.....but it's helped enough times now that I seek it out if I have a case that's not responding quickly to the usual treatments.

These are the things that seem to work best for me, personally. What works for others seems to be highly variable, so don't limit yourself only to these. Explore all your options, both traditional and "folk/alternative." See what works best for you. And don't be afraid to try new things, because sometimes you get a different fungal strain or your strain becomes resistant to treatment. Keep exploring your options, and keep notes on what seems to work.

Summary

If you are at higher risk for skin yeast issues (insulin resistance, recent antibiotics, steroid use, diabetes, etc.), then it probably behooves you to be especially vigilant about preventing skin yeast issues, or being very proactive about treating them sooner than later if they do occur.

However, don't feel bad if you get skin yeast issues. Most people, fat or not, have a bout with it sooner or later in their lives. It can cause a lot of misery, so don't be shy about getting out there and getting some treatment.

What works best for prevention and treatment varies in each individual. Some folks do great with traditional medical treatments; some do better with "alternative" treatments. It's helpful to explore a variety of choices to see what works best for YOU.

For some people, treatment X works like a charm, while in others it doesn't help at all. Sometimes treatment X works well for a while and then suddenly doesn't work as well, so it's good to have an arsenal of choices available to you.

If you have a favorite skin yeast treatment that's not listed above, please feel free to share it in the comments section. Or you can share which treatment has been most effective for you.

Skin yeast is an annoyance for many many people of size, and often for people of average size too. It's good to know the variety of treatments and preventive methods available to you.

Cesarean Central: Miami Florida

I recently found this blog entry from Our Bodies Our Blog on the mind-bogglingly excessive cesarean rates in many hospitals in the Miami area in Florida.

Now, I knew the cesarean rates in Florida were bad, but wow, just wow.

The blog entry links to this article from the Miami Herald, which discloses that the cesarean rate in the Miami area now hovers around 50%, or HALF of all women who give birth in Miami.

That means that more women are giving birth surgically than are giving birth vaginally.....and that it's considered business as usual, no big deal.

But that's just the average; some hospitals are lower, while many are higher. In one hospital, the Kendall Regional Medical Center, the cesarean rate is an astounding and shameful 70.3%.

This absolutely boggles the mind. SEVENTY PERCENT??? Almost 3/4 of women there are subjected to the risks of surgery in order to have a baby?

Here's a quote from the article:

Last year, for the first time, more babies in Miami-Dade County were born by cesarean section than were born vaginally, according to state records, and Broward's not far behind, with a rate of 43.7 percent -- both far above the national average.

At Kendall Regional Medical Center in Southwest Miami-Dade, seven out of 10 babies were delivered by C-section, a rate that University of Miami obstetrician Gene Burkett called "just astounding.''

Want to know some of the reasons the doctors in Miami blame for the high cesarean rates there? Wait for it.....wait for it......yes, one of the top reasons cited in the Miami article is obesity. Sigh.

I keep saying it, again and again. If obesity were truly an intractable CAUSE of not being able to birth vaginally, there would have been a consistently high rate of cesareans in "obese" women over time. Yet the cesarean rate for "obese" women used to be MUCH lower than it is now.

Yes, "obesity" is a risk factor for some complications, and that can lead to more cesareans. But obesity was a risk factor for those complications then as well as now......yet somehow they kept the cesarean rate far lower then than now.

What's really changed is the perception of the risks of obesity and the highly interventive protocols around management of obese women. That has greatly increased the cesarean rate in women of size, not obesity itself.

But enough about that, back to the cesarean rate debate.

A Blast From The Past

Contrast the 50%+ cesarean rates from Miami....and the lack of concern about them from many of the local Miami OBs.....with the cesarean rates cited in this 1989 L.A. Times article about how the cesarean rates need to be reduced, and how perhaps half of all cesareans done are "unnecessary."

About half the Cesarean section surgeries in the United States in 1987 should not have been performed, according to a new report designed to focus attention on what it terms "an onslaught of unnecessary and dangerous surgery."

The report by the consumer advocate group includes Cesarean rates for about 2,400 hospitals in 30 states, including 1986 statistics for California hospitals, and statewide figures for an additional 11 states....

Cesarean section rates show "extraordinary variations between states and between hospitals within states," according to Dr. Sidney M. Wolfe, director of the Health Research Group and one of the authors of study. "The national rate is twice as high as it should be."

The Cesarean rate nationally--the percentage of all deliveries performed by Cesarean section--has increased steadily over the last two decades--from 5.5% in 1970 to 24.4% in 1987. Cesareans are now the most common major operation in the United States.

The study said the 475,000 "unnecessary" Cesareans performed in 1987 resulted in 25,000 serious infections, 1.1 million extra hospital days and a cost of more than $1 billion. These conclusions were based on an analysis of data obtained from 41 states, a review of studies published in medical journals and other publicly available data.

A Change in Attitudes

Didja see my keen and subtle sense of irony in contrasting these two articles?

The "too high" national cesarean rate cited in the 1989 article was 24.4%, and everyone was up in arms over its rapid rise and excessiveness.

Yet the national cesarean rate now is almost 32%, and of course now there are hospitals in the country with 50%, 60%, even 70% cesarean rates.

Where is the outrage now? The Miami story was largely ignored by the national press.

If you've read my earlier blog entry, A History of Cesareans and VBACs in the USA, you will know that the cesarean rate rose rapidly from 5% to ~25% in the 70s and 80s. Such a rapid increase set off alarms in many public health groups, and a strong campaign to reduce cesarean rates was instituted. Here's a quote from my article, slightly rearranged:

Remember when public health officials got all up in arms in the late 80s because the cesarean rate had spiked to around 25%? Well, they did reduce it for a while (it dropped down to 20.8% by 1995), but now it has spiked again, even higher than it was then. Now the cesarean rate has soared up to over 30% nationally...and is still going up.

Only this time, almost no one cares.

Having areas of the country---like Miami----where more babies are born by surgery than vaginally is a disgrace, and it's leading to poorer outcomes in babies, an increase in maternal mortality, and higher healthcare costs. (If you want to read more about the risks of cesareans, read this recent Medscape article about it. It's not just some benign minor surgical procedure.)

The epidemic of cesareans has become, in essence, a giant medical experiment.....with most of the subjects not given any choice about whether or not to participate. If you circumvent nature's highly evolved way of doing things, there are inevitably unexpected outcomes, and often more harms than are initially anticipated.

As Dr. Sarah Buckley, a family doctor and author from Australia writes (emphasis mine):

Caesarean delivery is not safer, and our high rates (especially among first-time mothers) may be setting a reproductive time bomb. A US study published in September 2006 found that low-risk babies born by caesarean to healthy mothers were almost three times more likely to die in the first year of life, compared to babies born vaginally. A French study, published at the same time, confirmed the risks to healthy caesarean mothers, who were three times more likely to die after a caesarean, compared with women giving birth vaginally.

As Dr. Lucky Jain, a pediatrics professor at Emory University School of Medicine in Atlanta who has studied respiratory problems in C-section babies says, "We have created a monster here without knowing what the long-term impact is."

Where is the outrage?

Yet despite increasing evidence of the harm of an overly high cesarean rate, it's very difficult to get anyone to care about this now, unlike in 1989. Where is the outrage? Where are the voices from within for reform?

Where is the outrage from healthcare proponents who bemoan excessive healthcare costs? Cesarean births cost more up-front than vaginal births, and when you factor in the costs of rehospitalization afterwards for wound complications and the costs of placental complications in future births, vaginal birth is more cost-effective by far.Yet why is over-intervention in maternity care being left out of the healthcare reform discussion?

Where is the outrage from feminists about women essentially being forced into unnecessary surgery, often against their will? These days if you have a breech baby, twins, or a previous cesarean, it's almost always an automatic cesarean, with the mother basically having no say in the matter, whether she wants the surgery or not. And that doesn't even count the women who are pushed into cesareans via excessive intervention during labor over which they have little say. Why are women supposed to be arbiters of their own bodies and choices in everything else except giving birth?

And most importantly, where has the outrage from doctors gone? In the late 80s, many doctors were alarmed by the quintupling of the cesarean rate from 1970 to 1988 because they recognized the harm that this was causing. They got behind a national campaign to lower the cesarean rate, and they succeeded in at least lowering the cesarean rate to 20% before they suddenly just abandoned the campaign in 1995 and started cutting women left and right.

From a "low" of 20.8% in 1995, the cesarean rate has now rebounded to almost 32% nationally, with pockets of the country (see table 14, page 19) like Florida, New Jersey, parts of the deep South, and Southern California having widespread cesarean rates of 35-40%. And Puerto Rico has a cesarean rate of nearly 50% already.

Even worse, there are individual hospitals in New Jersey and Florida (and probably elsewhere) where the cesarean rates are 50%, 60%, and as we see above, even 70%.

Where is the pressure from fellow doctors to reform such outrageous rates, to insert the voice of reason, to speak up and advocate for the women who are being cut unnecessarily every day? Consumer advocates can only do so much; until doctors get on board and push for reform, consumer-initiated change will only go so far.

To their credit, there are a few doctors and other healthcare workers who are speaking out against the high cesarean rate and trying to reform a runaway system. Bravo to them. It takes a strong person to speak out against injustice, and especially to face down pressure to be silent from your peers and colleagues. May more doctors and healthcare workers gain the strength and bravery to join the ranks of those speaking out.

But right now, most doctors are hiding behind excuses. They blame the high cesarean rate on mothers, saying that it is women who are driving the cesarean rates by being older, fatter, or being too selfish to go through labor. They bring out that tired old excuse, fear of liability, as a fig leaf to cover up and excuse every excess.

Well, bullshit. Doctors are not innocent bystanders in the rising cesarean rate, forced against their wills into higher rates simply by changing demographics, supposedly riskier mother profiles, liability concerns, and maternal demands.

The truth is that the cesarean rate is being driven primarily by doctor-initiated protocols that promote excessive intervention, excessive attention to physician convenience factors, and excessive hospital financial gain.

Providers need to acknowledge that the way they manage births has been a very significant factor in the tremendous rise in the cesarean rate. They need to take responsibility for their own contributions to the cesarean rate, and they need to get off their asses and start advocating for the benefit of the patient again.

And a 70% cesarean rate is definitely not for the benefit of the mothers or babies.

We plan, God laughs

So, I haven't posted in a while. Time to fix that!

At the end of the school year, things were just sooo busy.....yet I still managed to post at least sometimes. I thought, well, when school is out and I'm not responsible for this and that and not constantly driving here and there, I'll get sooo many of my projects done and get so many new posts done.....!!

Yah. We plan, God laughs. Especially when children are involved.

Why do I always forget just how distracting it is to have FOUR children in the house with me instead of just one? I sit down at the computer, and someone is ALWAYS interrupting me. I do what I can to avoid distractions and prevent interruptions.....and still they find ways. Oy.

Now mind, I have gotten some things done. My veggie garden is in and thriving, we've been camping/on vacation, we've had fun with relatives visiting from out of town, we've had swimming lessons galore, we've seen several plays, we've had quality time with the family, I've gotten the kids to various camps and cool activities, we've gotten some projects done around the house, I've got some research in progress.......but writing has really gotten the short end of the stick. Bleah.

So be patient with me. I have several posts in the works. Hopefully they won't have to wait until school starts to get done.....!! I've carved out a little child-free time this week....nothing major, but a few hours.....so hopefully I'll get some of my backlog moving again.

Hang in there, I'm still here. Keep checking back!!

[And if there's something you are just dying for me to write about, feel free to mention it in the comments. Can't promise when I'll get to it, but I always listen to feedback and appreciate knowing what's on people's minds.]

Cesarean Prevention Webinar

Want to lower your chances for a cesarean?

The International Cesarean Awareness Network (ICAN) is pleased to announce a new online webinar! The ICAN Birth Class: Cesarean Prevention is scheduled for Tuesday, June 23rd at 10 p.m. EDT (7 p.m. PDT).

This webinar is perfect for the mom expecting her first baby, or for the mom who is planning a VBAC.

The $20 fee for the class goes directly to support ICAN's mission of promoting maternal-child health, providing emotional and physical support for women who have had cesareans, preventing unnecessary cesareans, and promoting Vaginal Birth After Cesarean (VBAC). ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery. It is also active in advocacy for childbirth issues nationally and internationally.

Remember, women in the USA have about a 1 in 3 chance in having their childbirth end surgically; for "obese" women, in many places, the chances are more like 1 in 2.....or higher.

Taking a webinar can't guarantee you won't have a cesarean, but it can certainly help raise your awareness of the factors that commonly lead to unnecessary cesareans.

That way, hopefully we can keep cesareans reserved for the cases in which they are truly necessary, and avoid exposing women and babies to the risks of surgery when it's not really needed.

[Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.]

You can find out more about the ICAN Birth Class: Cesarean Prevention here:

http://ican-online.org/none/ican-birth-class-cesarean-prevention

Attendees may register here:

https://www2.gotomeeting.com/register/999201490

*Don't worry, I'm still working on my post about prenatal weight gain and women of size! Almost there! Just wanted to get the word out on this cesarean prevention class so interested folk have plenty of time to register.

Yes, I've seen the new Institute of Medicine guidelines on how much weight "obese" women are supposed to gain (or more accurately, not gain) during pregnancy. (See Yahoo "health" news.) Wanted to reassure you all that I will be commenting on it soon.

But first I have to put top priority on some mom stuff, some end-of-the-school-year activities and big events that need my more immediate attention, and then I'll get to this. Sometimes blogging has to take a back seat to real life, but wanted to reassure you that I'm aware of this story and have plans to discuss it.

In the meantime, feel free to talk among yourselves about the new guidelines. What do you think of them, how do they make you feel, what are your concerns, are they realistic, what do you think the practical application of the guidelines will be in clinical practice?

I'll publish comments frequently until I have time to blog more fully about this, but in the meantime, let's start some dialogue on the topic.

What do you think about the new IOM guidelines?

Holiday Fluff: No. 1 Ladies' Detective Agency

Although I'm busy like crazy right now, trying to get through end-of-the-school-year activities, I did find time recently while I was doing laundry to watch a new TV series. Now I'm a big fan and I have to spread the word!

The series is called "The No. 1 Ladies' Detective Agency" and it's on HBO. They just finished the first run of the series but it will get repeated soon so if you haven't seen it yet, put it on your "record" list ASAP.

The series stars Jill Scott, an American singer and actress. She is a woman of size. Huzzah!

The thing that's most refreshing about the series is that this well-rounded woman is portrayed as a completely well-rounded human being too. How often is a woman of size allowed to be more than a one-note caricature on TV? Yet this character is. She's smart, she's sassy, she's vulnerable, she's assertive, she makes mistakes, she falls in love, she solves cases, and oh yeah, she's funny too.

I haven't yet seen the first couple of episodes in the series because I only heard about it partway through its run. I set my DVR to record the rest of the series, but I was so busy I didn't get to watch it for quite some time. In fact, I almost deleted it, thinking I'd never get around to it anyhow......but thank goodness I took a chance and peeked at it while folding some laundry one night! I quickly got hooked.

It's not a laugh-out-loud, smile-a-minute series. It's quirky and atmospheric, and the humor is more chuckle-y and character-driven. It also has some sad moments and a little romance thrown in for good measure too. It's just charming overall, and was definitely quite enjoyable. Even my husband got hooked after a while, despite initially thinking he wouldn't care for it.

Jill Scott, the star, was pregnant for the filming, so there's even a well-rounded mama connection!! How cool is that!

I was watching her in the series before I knew she was pregnant and just had a little inkling of something, that little intuition I get sometimes when people are pregnant. It was just the way her body was shaped and the way she moved, I think....kinda rang a memory bell for me. I shrugged it off at the time but now that I know she was pregnant during the filming, I get a little chuckle out of it. My "babydar" is still going strong!

The good news is that she had her baby last month. What a lovely gift for her after experiencing years of infertility, and what a note of hope to other women who have been through the infertility rollercoaster too. Congratulations to her on her new son!

I should note that the series is not perfectly fat-friendly. There are a few remarks here and there about "overeating" or vague insults about her shape from others, and they did pad her some for the role.........but the director and author were adamant about having a woman of size (what they call a "traditional build") in the role, and for the most part, she is treated with real respect and portrayed as a woman of beauty.

And she really is beautiful in the role, too. Look at her picture there. What a gorgeous woman.

There are also occasional people of size in other characters as well. Usually, on the rare occasion there is a fat person in a movie or series, he/she is the token fat person, rather than having a cast full of people of varying sizes to represent the diverse spectrum in most societies. So that diversity of size among multiple characters in this series was refreshing too.

The show is based on a book series by Alexander McCall Smith, and the action takes place in Botswana. Others have said that it stays very true to the culture of Botswana and is very respectful of its people. It is a fascinating and gentle introduction to this very inviting culture and definitely makes you want to learn more about it.

The series has quite a pedigree of famous people. The two-hour series pilot was directed by the late Anthony Minghella (Oscar winner for "The English Patient"); it was co-produced by the late Sydney Pollack ("Out of Africa") and co-written by Richard Curtis ("Four Weddings and A Funeral"). Famous guest stars in the show include CCH Pounder ("ER" and "The Shield") and Idris Elba ("The Wire" and "The Office").

The lead in the show is Jill Scott, a Grammy Award-winning singer, poet, and actress. She plays Precious Ramotswe, a woman who ends an abusive marriage, then takes an inheritance from her father and turns it into a detective agency, supposedly the first in Botswana. Although she is a detective and the show features some mysteries, they are refreshingly less graphic than the usual "CSI" style fare and feature some unique African twists to the stories.

The secondary lead in the show is Anika Noni Rose, from "Dreamgirls." She is a Tony-award winning actress who is set to become Disney's first black animated princess character later this year. She plays Grace Makutsi, the secretary and aspiring detective at the agency. Her character is more stiff; the actress seems to be playing it for laughs and it doesn't work at first glance. But as the series progresses on, the character begins to "click" and her mannerisms become more quirky and humorous and gives some genuine chuckles later on.

I've read reviews that say that the pilot drags a bit and that the series doesn't really hit its stride until about halfway through. Since that's about when I really started watching, I can't say. All I know is that the last several episodes were really charming and if you start from the beginning of the series, it may behoove you to stick with it for a few episodes if it doesn't "spark" for you at first.

I look forward to catching the rest of the episodes soon and I really hope that HBO will make more in the future. It's certainly a series worth continuing.

*According to the HBO website, it looks like the series is scheduled to repeat next weekend, starting on May 30th and 31st. Be sure to set it to record if you get HBO. Definitely worth catching.