"Pushed" to Iatrogenic Prematurity

I am currently reading Jennifer Block's expose on modern maternity care titled "Pushed." It's a nice wrap-up from the midwifery and obstetric literature I have been scouring for truths and perspective over the last two months. It's an eye-opener, but that's mostly by design*. Still, it's a great book because it is bursting out the seams with information, from the history of maternity care to the new fashions and practices. The information is not organized like a boring textbook either; it is presented in a gripping writing style, weaved through stories, and neatly packaged under attention-grabbing subtitles.

Basically, there exists a clash of opinions in American modern maternity care**. The clash is between the obstetricians/gynecologists (representing the organized, insured, medical community as a whole) and the midwives/doulas/women (representing the people who feel that childbirth is a natural process: those who say that most women left to their own devices will be able to deliver their babies and survive without the aid of modern drugs and healthcare). With medical advances have come myriad interventions into American women's childbirth experiences; the perspective held by the midwives is that these advancements and the resulting adopted unnecessary procedures are harmful to women, specifically, and society, as a whole. 

The midwives will have you believe that the hospital is a horrible place to deliver because you will be vulnerable to hospital policies and routine interventions. The doctors will have you believe that you are not safe delivering anywhere else (because, as I have heard now at least three times from my OB, your baby could die).

The more I read, the easier time I have balancing the two perspectives. I am realizing that the true state of modern maternity care is somewhere in the middle: hospital procedures are being reformed to be more "mother-" and "baby-" friendly while American midwives are finding out that they are susceptible to (and influenced by) the same insurance pressures that have made OBs so focused on the active management of labor. 

In order to avoid malpractice suits, OBs are driven to act on, rather than support, the labor and childbirth process. This is one of Block's major points: active management of labor and delivery is defensible in the case of a bad outcome; waiting to see what happens is not. So, at the first sign of trouble, an OB must take action. This starts a cascade of interventions, which too frequently ends with a scalpel to the abdominal cavity. 

How does this relate to my experience? Three weeks ago, my OBs came to the conclusion (based on poor measurements taken by their bad sonographer) that my baby is growing asymmetrically*** and is four weeks smaller in the abdomen than she should be. They immediately referred me to a perinatologist (basically an OB for high-risk pregnancies). After much research and deliberation, I decided to see the perinatologist, if only to remove the categorization of "high-risk" from my pregnancy. At the perinatal care office, I learned that my baby is perfectly symmetrical, but small (measuring three weeks behind her OB calculated gestational age, which is wrong by the way). The perinatologist reviewed the measurements and recommended that we induce labor at 38 weeks. I found this to be quite befuddling. I have a small baby - she clearly needs more time to grow - so my recommended course of action is to take her out early??? 

We asked him why. He looked at me, and then at Kyle, and said "it's very likely that the baby is small because of genetics," however, he continued, with babies that are small for gestational age, sometimes this is due to inadequate nutrition in utero. Since there is no way to know with certainty why a baby is small, we recommend induction for all small babies. Huh.

The doctors have to protect themselves; they simply cannot not recommend induction. Why? Because if my baby is born at a deficit due to insufficient nutrition in utero, then I could sue them for not acting on information indicative of a problem with my pregnancy. I understand that, so I politely decline; it is my decision to make after all.

Iatrogenic prematurity is premature birth caused by the physician, usually via labor induction or scheduled cesarean. The popular belief is that, rather than waiting for labor to start spontaneously at an odd hour, OBs like to induce in the morning, deliver by dinnertime. My OBs have been gritting their teeth to induce me since the first ultrasound measurements came in to suggest that Holly may be growing asymmetrically (see IUGR). Thwarted on that front, now they want to induce me because she is small****. I won't let them.

Opposing the doctors (not taking their "serious" recommendations): that has been challenging, to say the least. They are forceful, persistent, and they have all sorts of nifty diagnostic gadgets on their side. I know that I haven't yet heard the end of the induction talks. Now I am just counting down the days (and appointments) left until my estimated delivery date, hoping that my labor starts spontaneously before the doctors find yet another reason to induce. After that happens, then the medical community and I can move on to battling about something else, like whether I stay strapped to the monitor and/or whether I push in a lithotomy position. 

Bring it on, medical community.

* Block is a journalist, after all. I would not openly call her credibility into question, but I don't think it's unfair to suspect that the information she presents is slightly shaded or exaggerated to heighten its impact on delivery. Furthermore, I trust the data she presents, but also know she may well be withholding data as well in an effort to strengthen her position. As my college suite-mate once remarked, "statistics will tell you anything if you torture them enough"; that is, the analysis of raw data still requires choice (of what's included, what's not, what's meaningful, what's not, etc) and interpretation. By tweaking the variables, thresholds, and analytic methods used, one can significantly alter the outcome of an analysis.

** What follows is a very simple interpretation of the current "issue". It's much more nuanced than what I will deliver here; but I want to make sure to get the basic point across (and I don't want this post to turn into a novel). I am happy to further discuss any aspect of modern maternity care and my findings with any interested readers.

*** At the time, the OBs insisted that it is the asymmetry that worries them, not the size. 

**** At 37 weeks, she weighed 5.5 lbs. That doesn't seem small to me...

Women's Sexual Passages and Orgasmic Birth

I just finished reading Elizabeth Davis and Debra Pascali-Bonaro's book titled "Orgasmic Birth." Davis and Pascali-Bonaro claim that pregnancy and childbirth parallel the experiences of foreplay and orgasm*.

Their perspective is refreshing because it is so different from the one popularly advertised: pregnancy as a medical "condition" ridden with unfortunate and embarrassing physiological changes or "symptoms" and childbirth as a painful, unbearable process (which, thanks to medical advancements, not all of us have to attempt, but which, for those of us who choose to endure it) is made worthwhile only by its result (i.e. the baby).

While I don't quite buy into the orgasmic birth concept** reading this book (and also having recently read Elizabeth Davis' other book titled "Women's Sexual Passages"***) has helped to quiet some of my original fears and anxiety around the task of giving birth. Having never personally witnessed a labor before and being the first among my friends to become pregnant, I had very little information on this topic 9 months ago. In fact, the only information I had on it was that which I had passively received from depictions of labor in the popular media (which, as I already stated, tend to be negative and SCARY).

Now, after having read a healthy collection of natural birth and obstetrics literature and viewed a number of birthing videos, I think I can say (without having personally experienced it) that I know (to some degree) what to expect. And what I expect is neither orgasmic (sorry Davis) nor scary (sorry everyone else); it is a natural, instinct-driven sensory experience that is physically challenging but not unbearable. And I am looking forward to it!

Any day now... :)


* Doing a bit of interpretation here: they never discuss foreplay, per se; however, their description of a woman's experience leading up to the labor and delivery of her baby bears resemblance (in my opinion) to some components of foreplay. For example, the authors suggest that the period of pregnancy is a time during which the woman must take care to become attuned to the sensations of her body and also to her emotions, turn off the analytic part of her brain, relax and open up, and prepare herself physically and emotionally for the experience of labor.

** I'll believe it when I feel it.

*** In this book, Davis claims pregnancy is a sexual "rite" of passage for a woman, in company with other rites such as menarche and menopause. She posits these are meaningful events in every woman's life and they must be celebrated to promote healthy self-esteem in women. Again, interesting stuff. Definitely hyper-feminist (not saying that there is anything wrong with that...), but a good read for its refreshing and different (I might go so far as to say empowering) perspective.

My Un-Professional Medical Opinion

I think that I have a somewhat unique perspective on the progress (and treatment) of my pregnancy for a couple of reasons.

First, I have been educated in research design and interpretation (not medical, but applicable nevertheless). My education helps me to better understand and evaluate (not to mention, to proactively seek out and analyze) credible information regarding test results and the progress of my pregnancy. I've found that doctors don't usually share more information than is necessary to sway their patients toward the medically preferred* course of action. Therefore, if you want to make a wholly informed decision (one that is not biased by your doctor, the current medical fashions, or the pressures placed on the medical community), it's often necessary to seek additional information from outside credible sources to supplement what your doctor is telling you.

The rigid structure of prenatal care can make this difficult: the doctors often expect you to make your decision (read: to take their recommendation) at the same appointment, in which they provide you with the "relevant" (read: supportive of the medically preferred next step, ie shaded, one-sided) information. However, I've found that it's possible to delay just about any medical decision by at least one prenatal appointment and I do so frequently. It's a little frustrating for the doctors, but it gives me time to gather and evaluate all relevant information, thus making me feel more confident in my ultimate informed decision.

Second, I understand and feel comfortable putting my faith in statistics. This comes from both my research education and my many years of experience playing and analyzing poker hands. I understand that when there is a less that 1% chance that my baby will have <this>, the odds are pretty good (in fact, they are excellent) that my baby will not have <this>. In poker, if the odds are in your favor and you know this with a high degree of certainty, you (usually) continue with the hand you're holding. I don't see any reason why medical decisions should be treated differently.

Of course, I am less willing to gamble with my baby's life than with my money. But I find statistics reassuring. In the above example of 1%, I like my chances enough not to pursue further tests or, worse yet, to treat my baby with <choice of drug> in case she happens to be in the 1%. Especially in the latter case, 99% of the time I would be exposing a perfectly healthy baby to drugs where none are needed. This is something that I do not feel comfortable doing, but the doctors prefer it.

My medical team likes to cover all their bases and make even the most favorable odds better. In that interest, they err on the side of preventative care. When the doctors see that I am reluctant to take their recommended treatment because I "feel healthy" and/or I "like my odds" just fine, they don't hesitate to try different strategies for my manipulation. What works really well on a pregnant woman? Appealing to her (likely) emotionality and protective instinct. For example, they think that if they say something like "I've had a baby die because we didn't know to treat for <this>," then I will change my informed decision.  I find this tactic to be under-handed and abusive, not to mention offensive. I imagine this works on a lot of expectant moms. However, thankfully, my rationality and faith in statistics are not easily rattled by proclamations like this.

As I already mentioned, my unique approach to receiving (read: critically analyzing and attempting to have a modicum of control over) my prenatal care somewhat frustrates the doctors responsible for my care. It also sometimes serves to make those around me nervous: how can I refuse treatment, am I being negligent, etc? Rightfully, people will form their own opinions about this. All I can say is this: I love my unborn baby (probably no less than or more than those who take a different perspective and approach to their prenatal care) and I am acting in what I believe to be (from intensive research and careful deliberation) her best interest.

* From my experience, doctors' preferred course of action (at least in pregnancy care) is usually interventionist with a focus on proactive prevention rather than surveillant with a focus (after the fact) on the identification of symptoms and prescription of treatment.

Letter to My Daughter

Dear Holly,

My skinny baby. First, thank you for the Mother's Day card. That was very sweet of you to find a pen and willing body all the way in California to write what you wanted to say to me on paper. I appreciate both your efforts!

Thank you also for directing some nutrients to your legs to grow them nice and long. That effort is going to serve you well one day, when you're running energetically through the daydreams of young boys in our neighborhood.

I understand your hesitation to grow belly fat. I share the sentiment. You're a smart girl, so you're probably thinking it's no use storing lipids now in a place where you won't want them later in life. Of course, it seems like you'd be making extra work for yourself down the line. And, like your parents, you are probably interested in minimizing unnecessary effort. However, I want to assure you that it is okay to get a little pudgy around the mid-section. After all, you're a baby and, among other things, babies are thought to be cuter when they are round. I say that not to suggest that you should care deeply about what people think (you shouldn't), but to help you understand that being aesthetically pleasing is in your best interest: there are lots of studies that show that attractive people tend to have an easier time acquiring positions of power, for example.

Is power important to a baby? Absolutely! Think about it.

Now, the doctors are recommending that I keep you under the (Doppler) microscope so that we can monitor your growth. But, I don't want to do that to you. I have faith in you and trust that you will grow in precisely the way you intend and want to, naturally, and without the need for spectators. So, let's make a deal: I will trust you to spread the nutrients around to all areas of your body (so that you're healthy when you join me and daddy in the world) and you can count on me to keep the doctors out of your sanctuary until you show me that you are ready to come out.

Love,
Mommy

3rd Trimester Sonogram & The (Assumed) Infallibility of Obstetricians and Lab Results

About three weeks ago, we had our third trimester sonogram for Holly. Among other things, the doctors use the third trimester sonogram to confirm their estimated delivery date (EDD) for the baby and to verify that (a) the baby is growing properly (or, as I understand it, according to the pattern that is typically observed in the population), (b) the amniotic fluid volume is sufficient to support further growth, and (c) the placenta appears normal and has not implanted at a place that would preclude natural delivery of the baby.

The results from the sonogram suggested that Holly is 2 weeks smaller than expected from her calculated gestational age. Naturally, the OB (who is trained to see pathologies, even where none exist) took this in one of the worst possible ways and suggested that my placenta may not be working properly. Note: the alternative explanations are that (a) the OB's EDD is wrong (wait - "OB" and "wrong" in the same sentence - but that's blasphemy!), (b) the fetus is perfectly normal but just smaller than typical (but that would imply that a degree of deviation from the norm is perfectly normal... weird!), (c) the ultrasound technician did a poor job with the measurements (perhaps due to being distracted or unmotivated that day; hey, it happens!), (d) the measurements are within the normal range of error and therefore normal (note: the ultrasound error rate for calculating gestational age is 2-4 weeks), or (e) there is a developmental abnormality in the fetus. 

Per our doctor's insistence, we scheduled a follow-up sonogram for Holly, to allow the doctors to confirm and have peace of mind that she is in fact growing at an acceptable rate. They plan to do this by comparing the two sets of measurements. The follow-up sonogram is this afternoon. 

I think that my little girl is already very smart. She heard the re-test was coming and decided to have a nice big growth spurt for the doctors over the weekend. I can tell because my baby bump grew into a baby mountain and I am now feeling her movements much more strongly, which suggests to me that she is crowding out the available space and no longer floating suspended in the middle of the amniotic fluid. 

Attagirl!

If she's anything like her mother, she'll shoot the ultrasound technician a smug look at her re-test. :)

Battle Hymn of the Tiger Mother (Remainder of Book)

I just finished Amy Chua's "Battle Hymn of the Tiger Mother" and have come away from the book with a few general reflections.

First, I respect and admire Amy for her resilience and selflessness as a mother. Some would argue that her aggressive and demanding parenting style is not in fact selfless (Chua even acknowledges this viewpoint in her book), but I see it as such. Much like my own mother (who, like Chua, is not American), Amy forfeited some independence and personal "fun" for the benefit of her daughters' proper (in her opinion) upbringing. I admire that. But what I admire even more is that Chua managed to do all of this while remaining productive in her career, running her household, taking care of two dogs, and planning frequent vacations and special events for her family. I am exhausted just thinking about all that she did, which leads me to my next point:

I can understand how a lot of parents would be reluctant to do what she did. Chua even admits that it wasn't fun for her to supervise piano and violin practices for several hours every day; obviously there were other things the woman could do. Every day she chose to be there for her children rather than to succumb to her personal desires. She chose to (on innumerable occasions) feel hated and resented by her daughters rather than to relent in the interest of feeling loved by them. I think it takes a very secure, self-assured person to do what she did; and certainly one with a solid long-term perspective.

Like any parent, Chua wanted to set her daughters up for future success. She had a coherent strategy for achieving this (which is probably more than most can say) and she had the determination and resilience to execute the strategy against all opposition (which is, again, probably more than most can say). She made mistakes along the way, but she was thoughtful enough to promptly realize those mistakes and re-evaluate her strategy, which leads me to my last point:

Whether or not she would agree with me, I believe that Chua achieved success* with both of her daughters using the "Chinese" parenting style. Here's why:

***SPOILER ALERT***

Although Lulu ultimately gave up the violin against her mother's wishes, she learned and internalized the qualities for success that her mother instilled in her during the violin years: ambition, determination, passion, perseverance, and lots of practice. Toward the end of the book, after she takes up tennis, it becomes clear that Lulu is applying these skills to challenge herself to become a great tennis player. Lulu demonstrates that she is driven to succeed, just not in the activity that her mother had desired for her. The desire to be better (and to eventually be the best) and the knowledge of how to  achieve her goals are qualities that will get Lulu far. I don't believe it's a question of "Western" vs "Chinese" but I do think that it was because of Chua's high expectations of her daughters that they learned to expect so much of themselves.

On the whole, Chua's book was entertaining and inspiring** to read. I enjoyed reading it for its unique perspective, especially because Chua seems to be an intelligent and thoughtful person and proved capable of offering strong arguments in support of her claims***. Her actions are quite radical when evaluated against those typical in "Western" culture, but they are reasonable and never incongruent with her long-term goals****.

* I suspect Chua would disagree because of her inability to control Lulu and Lulu's public defiance, which as she says is uncharacteristic of a well-raised "Chinese" daughter.

** Inspiring not in the sense that it has convinced me to raise my daughter the "Chinese" way, but in the sense that it's gotten me to think about what kind of mother I want to be and how much I want to invest in my children's future success but also in their happiness, in my happiness, etc.

*** Yes, I believe her arguments were strong.

**** At least, this is the depiction I get from the book. I understand the author in writing the book may have provided a biased account for some of the stories.

Note to Readers and Must-Buy Reference Books re: Childbirth and Breastfeeding

When I worked as a business analyst, I tracked my projects, hours, and output weekly. I regularly saw results for my effort and my workload was ever-changing thanks to my (often times) swift resolution of open projects. For 9 hours a day, I maintained a high level of productivity for the company to meet the demands of my job and I found even the most seemingly arduous objectives attainable under the stresses of the work environment.

By design, my life is no longer stressful nor demanding. I am reminded to enjoy it while it lasts.* However, I can't help but actively look for ways in which I can measure my successes and achieve a sense of accomplishment from my daily work. The household tasks are easy and un-interesting to me; and there is, fortunately for my husband and our finances, only so much baby shopping that I can take.

Being output-oriented, I have tied my personal feeling of success somewhat to the publication of these blog posts. Lately, my blogging has become less frequent because of the time I am spending on intellectual pursuits not related to parenting.** However, I find this writing personally valuable as it helps me to organize and crystallize my thoughts; therefore, as a note to readers I'd like to say that, I will soon start to publish posts related to other subjects of interest as well.*** I'll include the topic in the post title for clarity.

I started this blog with a focus on parenting, but now I see that I have put the cart before the horse, so to speak. I took a step back this month and have re-focused myself on breastfeeding and the process of natural childbirth. To that end, I've been reading these books: The Womanly Art of Breastfeeding by Wiessinger, West, and Pitman of La Leche League International (LLLI) and The Birth Partner by Penny Simkin. I have read at least 100 pages of each so far and am very happy with their content and with the perspectives depicted therein.

I try not to buy any books that I can rent from the library, but I saw very much value in personally owning both of these: they are very detailed on their subjects; they are quick to read and easy to understand; and they are organized well to serve as reference books, so that you can read and refer back to parts as they become relevant in your experience.

The Womanly Art of Breastfeeding is written by mothers (members of LLLI) and covers all aspects of breastfeeding (obviously) as well as the benefits of belonging to a network of mothers, such as LLLI. The book is written from the perspective that what's natural is best for both the baby and the mother: LLLI encourages (and provides much evidential support for) breastfeeding (versus formula feeding) and for staying home and personally caring for your infant. However, I should note that they do also offer what appears to me to be useful advice for mothers who must return to work as well (on how to manage the transition, etc).

The Birth Partner is written for expecting dads, doulas, and other labor companions. We bought it for Kyle, but I am finding it very informative (and comforting to read at this time) as well.**** It gives a very detailed description of natural labor at all stages (something that, from my experience and understanding, medical professionals don't care to spend time informing women about). It also gives helpful information related to labor and delivery, such as what to take to the hospital or birthing center, possible labor complications and ways to manage them, the effects of labor medications, and how to get started with breastfeeding. One of the biggest messages throughout the book is that labor is a natural process and that natural, vaginal delivery is easier for a mother that feels supported, calm, and optimistic. Penny Simkin gives the reader a variety of tools with which to ensure the latter.

After reading Simkin's depiction of the natural progression of labor, I can see how a mother and her labor companions can be quickly overwhelmed by the experience if they lack the knowledge of what to expect. I would highly recommend this book to all expecting mothers, fathers, and labor companions (or, really, anyone who wants to be able to understand and empathize with a woman who's going through labor). Those considering an elective C-section for fear of natural delivery would also benefit from reading this book (at least in the sense that the unknown would become demystified and they would be able to make an informed decision about their method of delivery).*****


* Apparently, babies can make life chaotic.

** I constrained this blog only to that subject in the beginning and have been reluctant to change that.

*** Probably a welcome change for most of you. ;-)

**** It is very important to me and Kyle that I deliver our baby naturally. We looked into delivering in the care of a midwifery group versus an obstetrician (in short and among other things, midwives have much lower C-section rates than OBs); but were thwarted from this pursuit by the combined factors that (a) our insurance is not accepted by neighboring midwifery practices and (b) we do not feel that the difference in treatment is worth the significant increase in labor costs. We spent a lot of time on this important decision and I'd like to discuss it at length in a separate post. If you find this intriguing, stay tuned; I'll have that up in a few days.

***** If it's not clear by now, I tend to place a lot of value on informed decision-making.

Unconditional Parenting

As was the case during my undergraduate education, the more I read nowadays, the less satisfied I feel with what I know (and I consider myself fairly well informed and well calibrated in that assessment). This past month, I varied my reading and activities to keep my interest in parenting literature alive. It seems like every writer has a comprehensive system to offer, and everyone who's ever raised a child also has convictions (formed from experience that is not necessarily generalizable, but from which they generalize nevertheless) about what works and doesn't.

I personally look forward to finding out what works and doesn't work with my own child, in my own way. I would like to, and believe that I will benefit from, developing my own parenting style and perspective. I also know that my style will be unique, but also informed by the synthesis of my reading and the personal experiences others have shared with me. I understand the enormity of the responsibility and privilege placed upon me and do not take it lightly. But I also don't intend to approach parenting with a comprehensive system or fully stocked nursery.

Why?

Because I think that a large (and important) part of parenting is responding to your child's needs. In order to do that, you must be attuned to your child, have an open mind, and have the means to acquire what is necessary to satisfy the child's needs. As my husband succinctly put it last night, having a room full of "stuff" and your personal judgment clouded by functional fixedness limits your creativity in responding to your child.

If you are an emotionally intelligent and resilient person, with a solid understanding of human nature, a healthy supply of patience, humility, and love, strong deductive and inductive reasoning powers, and the freedom to concentrate on the new, exciting, and very important task of parenting, then you are capable of being an outstanding parent. If you have deficits*, all the "stuff" in the world will not make up for them (and it is my belief that some of the "stuff" will actually exacerbate the situation). Being introspective with an orientation toward learning is the key toward self-improvement and also toward better parenting (in my opinion).

Alfie Kohn's book Unconditional Parenting had some influence on the views expressed above and, for that, deserves some credit**. Kohn offers a unique perspective on parenting; with strong and plentiful arguments in opposition of traditional parenting practices such as reward and punishment (which he rejects in favor of love and reason). Kohn does not constrain the scope of his instruction to children of a certain age nor does he organize his prescriptions in a manner that clearly communicates the different nuances at various ages; this, I believe, does a disservice to the reader because it requires him or her to identify, logically organize, and recognize those nuances for him- or herself. However, Kohn does explicitly state that the strategy and application changes through the various stages of development and that parents should use the age-appropriate response.

"That's all good and well in practice, but how does it work in theory?" (University of Chicago T-Shirt)

Kohn makes a lot of good arguments against the practices traditionally employed in parenting, due to the fact they are supported by flawed theory and demonstrated to achieve negative or inferior, unintended (and at times opposite from intended) outcomes. In place of the flawed theory of parenting and the mostly effective (at least in the immediate sense, in getting kids to do what you want) practices, he offers a perfect (in his and my opinions) theory of parenting. Sadly the perfect theory (as many perfect theories) is challenging to practice. The challenge posed in this case, I believe, is mostly due to the fact that unconditional parenting requires parents to give up a large amount of control (and who doesn't like control?).

Kohn encourages parents to have humility, respect, patience, and love for their children, so much so that they put the kids' needs and feelings above their own, keeping themselves grounded by asking questions like "How important is my request that they do 'x' right now in the grand scheme of things?" and "Is my request reasonable and aimed at accomplishing my long-term goals for my kids or is it rather a request that is self-centered, aimed merely at controlling the present behavior of the child?"

Kohn asks us to evaluate the message we are sending to our children when, for example, we (their parents / the only people who are biologically programmed to love them) intentionally inflict pain upon them (call it punishment, consequences, time-out, or by any other name...).

"How we feel about our kids isn't as important as how they experience those feelings and how they regard the way we treat them" (Unconditional Parenting, pg. 20).

We may say we love our kids unconditionally, but when we put them on time-out (for example), their experience of that love is that it is conditional: we are withholding our love for the fact that they did something that didn't please us.

I think the strongest arguments Kohn makes against punishment are 1. that it causes negative emotions, 2. that it erodes the parent-child relationship, and 3. that the fear of punishment will make the child self-interested and self-centered in his or her evaluation of whether to perform an action (ie. the child won't do 'x' because he or she fears punishment instead of for the superior reason that 'x' will cause someone else pain or sadness).

There are a few other notable prescriptions made by Kohn that I would be remiss to exclude from this post:
- Talk less, ask more. Avoid offering approval or judgment; describe and invite reflection instead.
- Respect and seek to understand the child's perspective always. Otherwise you may ascribe ill intentions to your child and, because your negative evaluation is likely to be understood by the child, this may result in a self-fulfilling prophecy!
- Help your kids construct solid arguments. Even if their argument will not win, they will benefit from being better at respectfully arguing their position.

I would highly recommend Alfie Kohn's book to any parent. His writing and content shows that he has considered his prescriptions and their opposing arguments from all angles and can talk intelligently on the subjects of parental love and discipline. Even if you don't buy into "unconditional parenting" as a comprehensive system for child-rearing, reading this book you will be moved to consider one intelligent person's informed and worthwhile*** perspective on the subjects of love and punishment. And, I dare say, that consideration will change you for the better.

* I am using "you" and "deficits" in a non-judgmental way here. I do not aim to impose my definition of deficiency on you nor do I care to pass judgment on whether you are deficient. That's for you to decide.
** Obviously, I believe the writer deserves positive credit for his contribution to my views (which I believe are lucid). If you disagree with the views, then for you the credit owed to Mr. Kohn would be negative.
*** In my opinion.

Raising Happiness

Generally, I am suspicious of authors who claim to offer you "x" number of simple steps to achieve something, especially if "x" is a good round number. I think a round number suggests that the author focused on quantity over quality, either diffusing powerful prescriptions with weaker assertions or truncating a longer list of powerful prescriptions to withhold worthwhile insights from the reader (perhaps for a second book?). I would imagine that the author in the first scenario does something like this:

1. He/she selects a topic and generates some prescriptions or steps
2. Based on the generated number of steps, he/she then selects a quantity of total steps as the goal for the book. Unless the generated prescriptions already add up to a nice round number, the goal quantity becomes the closest higher round number.
3. The author tries to fill in the gaps with further research and brain-scratching.

Sometimes the added content is found easily; at other times it is painstakingly generated.  But if the going gets rough yet the goal doesn't change, in my opinion, the overall content quality of the book suffers. Reading a book assembled in this way, you can usually tell when the author is reaching for content by the quality of the author's logic and logical extensions, by the amount of evidentiary support, even by the length of the argument or how well it fits (or rather doesn't fit) with the rest of the book's content.

It appears to me that Christine Carter employed this method to build content for her book "Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents".

While reading the first half of the book, I couldn't have guessed that I would arrive at this conclusion. In fact, I sincerely wanted not to. I liked the opinions and motivations expressed by the author in her introduction. Her language and reasoning depicted there gave me the sense that if I were to write a book on parenting, this would be it.

The first five simple steps were solid:

1. Happy parents are a prerequisite to a happy baby and effective parenting practices.
2. Social support and spending time with good people boosts happiness.
3. Effort and enjoyment should be valued above achievement.
4. Positive pro-social emotions (gratitude, forgiveness, etc) boost happiness.
5. Emotional intelligence and empathy enhances friendships, which are essential to happiness.

Even though all of these were discussed in the other parenting books that I've read, Carter presented them in a fresh, interesting, and genuine manner, offering practical insights informed by her parenting experiments and her mother's intuition.

It seemed that Carter had insights oozing out of her ears. Going into chapter 6, I thought that she might actually be the latter type of author (who truncates her list to achieve a desired round number). Sadly, I was mistaken.

Chapter 6 is titled "Form Happiness Habits". At approach, I thought this chapter would give prescriptions for how to best encourage and facilitate the positive activities, which make kids happy. But that may have seemed too kid-centric for Carter, who instead wanted to discuss how to routinely exert control over the kids' undesired behaviors, one step at a time, so that mommy can be happier. It's about setting "turtle goals" for the kids in changing their bad habits, where the goals are so easy that the kids can't possibly fail and/or become discouraged. It's also about vigilance in goal setting and executing the agreed upon behavior modifications. While I found some of the ideas in this chapter intriguing and potentially useful in parenting, I think that Carter's proposed system for behavior modification is too rigid and cold; the interactions it forces are inauthentic. Moreover, it seems to me that, as a mother, Carter has little patience for her children's bad habits, the formation of which can usually most accurately be blamed on the parent herself.

Chapter 7 also did not live up to my expectations: it was titled "Teaching Self-Discipline," but it offered more content on disciplining your bad kids than on teaching kids, more generally, how to be self-disciplined. What little worthwhile content I found in this chapter was better presented in Po Bronson and Ashley Merryman's "Nurture Shock".

Throughout the book, Carter is not shy about sharing her spiritual beliefs and practices with her audience. I personally don't have a problem with this, so long as her prescriptions are fueled by science rather than her particular form of spirituality. However, by chapter 8, Carter was slapping me in the face with Buddhist teachings and with prescriptions made for little reason besides that, which is understood by the practitioner (ie. meditate for the purpose of learning to be present). She proclaims that children should be taught to meditate, which I find to be a ridiculous statement.

By the end of chapter 8, I was mildly annoyed with the book. I thought about not finishing it, but my curiosity kept me going. I am glad it did because I found some good ideas in chapters 9 and 10. In chapter 10, I appreciated the author's suggestion to eat dinner together, particularly because of her justification: dinnertime allows for all of the happiness steps to be practiced (aids good habit formation/ bad habit deconstruction, etc). I found her examples of how one would go about taking each step at dinner to be illustrative.

Overall, I would say Christine Carter's "Raising Happiness" is okay, with a few novel ideas and a lot of anecdotes depicting her bad parenting practices, to show she is human, after all. Read it if you'd like; I think this blog post just about sums it up tho.

Battle Hymn of the Tiger Mother (Hour 1)

I joined a book club organized for a group of stay at home moms in our neighborhood. The first book on the reading list is Amy Chua's controversial "Battle Hymn of the Tiger Mom." This author and book have received a lot of attention recently, so I figured this reading too deserves a post on my blog. Plus, it's a fascinating topic: East vs. West: who does a better job at raising their kids and why? One woman's lived experience is hardly scientifically credible; nevertheless, Chua offers a unique perspective that I think is worth understanding. 

When I checked the library website, it estimated 250 days of wait time for Chua's book. Wow! The book club meets in a month; I don't have that kind of time! And I don't want to buy the book because I'm cheap. Thankfully, Barnes & Noble grants their nook-owning customers one hour of free access to any book on the nook once per day every day in the store. What a fantastic idea... and a wonderful way to get more of my money than if I were to simply buy this book and bring it home to read at my leisure. :)

I made it into B&N this past weekend for my first free hour, read about 70 pages, spent sixty dollars on other books, and came home with a few insights (and not one of them was about how very little self-control I have in a bookstore - that one I've known for a while). I'll share my reflections here now, and I'll do this after every hour with this book, as long as I find something blog-worthy every time (which I would expect to be the case with such a controversial book).  

Reflections from Hour #1: Amy Chua's Parenting Strategy
Chua had her daughters practicing their musical instruments (piano and violin) for 3 hours per day. Instead of getting a break on lesson days, they practiced extra hours - playing both before and after the lesson. She started them on this routine early, when each of the girls was around 3 years of age. Many of the books I've read so far emphasize the importance of imaginative play and stress the need to avoid exerting performance pressure on kids during these early years. Chua mentions this too, so she's aware of the prescription, yet she's chosen to go against it. Why? For better or for worse, she's decided that creativity and fitness are not important qualities for her kids to possess; but academic performance and musical skills are.

In this regard (as with a lot of other things), I think balance is important. Like Chua, I would want to structure some of my child's time in order to ensure they experience and learn to appreciate the intrinsic rewards that dedication and continued practice bring (while they are also acquiring skills, which will serve to increase their human capital later in life). But, as I've read, imaginative play is associated with higher executive functioning, such as concentration and self-control*, which are skills that aid the learning process as well. Therefore, I would place a bit more importance on play dates than Chua did.

* The research and benefits of imaginative play are discussed by Po Bronson and Ashley Merryman in "Nurture Shock" and John Medina in "Brain Rules for Baby".

Brain Rules for Baby

John Medina is a developmental molecular biologist at the University of Washington School of Medicine. He studies human brain development and occasionally presents lectures on baby brain development. He recently wrote a book titled "Brain Rules for Baby" to answer the common questions and concerns routinely posed to him by parents and guardians during these lectures.

Because Medina's goal is to satisfy his audiences, he delivers simple, easily executable prescriptions for parents to follow. He doesn't attempt to build the reader's specific understanding of brain development so, as the reader, you have to trust his prescriptions without understanding exactly from where the prescriptions stem. This was disappointing for me for the following reason: I wanted to learn from an expert of brain development about the impacts of differing parenting styles and strategies on an infant's brain development and future functioning (disposition, personality, thrill seeking, etc) so that I could gain some understanding on the subject and personally make an informed decision of how to parent my child for my desired results (as my desired results may - and probably do - differ from the general public's).
.
Despite the fact that, at approach, my expectations were misaligned with Medina's intent, I enjoyed reading "Brain Rules for Baby." I think the book is well organized, digestible, and adequately detailed, without seeming long-winded (on any more than a select few occasions).

The biggest prescriptions in the book:

1. A happy marriage makes a happy baby (hostility harms the development of brain and nervous system)
2. A safe environment enables learning (baby can't learn if it fears its surroundings)
3. Pay attention to and respond to your baby's emotions (when you respond, baby feels safe; the display of and encouragement of empathy is integral for your child's future ability to form good friendships)
4. Talk to your baby a lot (when you talk, you are increasing your baby's vocabulary; communication is one of the key ingredients of intelligence, along with the desire to explore and creativity)

Some more specific notables:

5. Breastfeeding is a brain booster for your baby
6. Fit women have to push less in delivery! (work out during pregnancy, but don't overheat the baby)

I like that Medina's advice is baby-centered; he appears to make his prescriptions out of consideration for the baby's healthy brain development rather than as a method to satisfy a parental desire to make the baby "x, y, and z." He explains that baby needs must be met first and foremost and provides the reader with plenty of reasons to want to do this (the strongest being: if you don't do this, then trying to do your "x,y, and z" won't work). I would recommend "Brain Rules for Baby" to anyone looking for some light reading on the fundamentals of pregnancy and early parenting.

Belly Laughs

If you're looking for an entertaining quick read about pregnancy, "Belly Laughs" by Jenny McCarthy is a decent selection.

In "Belly Laughs," the famed Jenny McCarthy shares the embarrassing aspects of pregnancy that most women would prefer to suffer privately. Jenny's account of her first pregnancy is quite amusing, albeit it may lead you to perceive those 9 months as more extreme than they can be (and are from my experience). For example: Jenny gained nearly 40 pounds before the end of her 2nd trimester (nearly 60 overall); I'm in my 6th month and have gained only 2 pounds. I was concerned about the lack of weight gain at first; but, when asked, my OB said this is normal for first pregnancies, especially if the woman keeps to a healthy diet and remains active, with moderate exercise at least a few times a week (all things that I have been doing religiously). Research suggests that an expectant mom who exercises moderately several times per week during pregnancy is less likely to have a child that later struggles with obesity. Jenny's weight gain was not only not an essential part of pregnancy but it also was unhealthy for both her and the baby (she states all she wanted to eat was junk food).

Jenny also seemed to think that it's normal for expectant women to develop split personality during pregnancy, with a "Psycho Bitch" version of themselves looming in the darkness waiting to be provoked in the mildest manner by their husbands and then coming out to throw things and verbally abuse him. My husband has not suffered any of this; some might say he is lucky. I have experienced some extra sensitivity on occasion, with my emotionality tending toward tears over screaming. This likely speaks to the disposition and personality differences between me and Jenny. Pregnant women are hormonal, yes; but it isn't a given that the elevated hormone levels should translate into violence and verbal abuse.

Those are just a few of the notable differences between my pregnancy and Jenny's, based on her narrative in "Belly Laughs". The extreme (possibly slightly exaggerated) account of her pregnancy adds to the comic quality of the book and makes for a more entertaining read. I would recommend the book to any pregnant woman who wants to feel better about her pregnancy experience (Jenny has just about everything a woman could have and she usually has it full blown). Just remember, this is one privileged woman's account of her pregnancy; it's okay if you don't relate with or agree with every aspect of her pregnancy or action during it. In fact, it's probably in your best interest to try not to emulate her in any way.

Great Kids

The books and articles I like to read are those where it is obvious that the author started from a collection of impressive research findings and built on those to gather more material and to be able to develop a general theory explaining the facts. I like these types of books because they offer the most evidentiary support for claims made and, for that reason, they seem to me to be the most convincing and interesting.

Stanley Greenspan's "Great Kids" is very much not this type of book. For starters, the book claims to offer the 10 essential qualities to nurture in a kid for "greatness," but these qualities were proposed and agreed upon by medical and business professionals prompted to think of the qualities possessed by the "great" people that they know. Borderline scientific at best: this method assumes that the qualities people like to see are the qualities which make kids happy and successful. It further implies that we should bring up our kids to possess the qualities that people like to see, even if those aren't necessarily the qualities from which our kids would benefit the most. I personally think our primary focus should be on the latter.

Once the top 10 qualities were selected, it seems that Dr. Greenspan spent the next several months freely associating on the experiences, in which these qualities may be demonstrated and nurtured, threading countless anecdotes with jumbled narrative to achieve the unfortunate more-is-less effect. Granted, Dr. Greenspan is kind of a big deal in the field of child psychoanalysis, so one can presume that a lot of the claims made in the book are derived from research and clinical work discoveries. Unfortunately, the delivery of these ideas conveys no indication of this.

I forced myself to make it through 4 complete chapters (of 10 total) in order to be able to, with some authority, say that you can get the full scope of what he's saying simply by reading each chapter title and then each chapter's last two sections titled "Encouraging" X and "Helping" X or "Steps to" X, where X is the quality discussed in the chapter. I did that for the remainder of the chapters and was a lot less bored with the book (and frankly, wasted a lot less time on it).

I would not recommend this book; there is very little to learn here, mostly because of method in which it is presented.

Nurture Shock

Perusing the baby section in a local bookstore, I noticed one relatively new release on the shelf with a catchy title: "Nurture Shock" by Po Bronson and Ashley Merryman. I read a chapter in the store to evaluate the caliber of the book and was immediately impressed by the authors' clear and concise writing as well as the quality of their descriptions and interpretations of the relevant research.

Each chapter of this book corresponds to a different parenting experience, paradigm, or question. The aim of the authors is to reveal the cases, in which parents' intuitions or the popular beliefs on the subject are not supported, but actually negated, in research.

I read the chapters applicable to children from newborns to preschoolers, as that is my present interest. The structure of the book allows the reader to read each chapter as a stand-alone topic paper, which is nice.

Here are some nuggets of wisdom from the research reviewed and cited by Bronson and Merryman:

1. Praise effort, not intelligence.
A child that is told he or she is intelligent will seek confirmation for this. This has two note-worthy implications: a) the child will tend to shy away from challenges from fear of failure and b) the child will be more likely to cheat from fear of failure. On the flip side, praising effort helps the child rebound from failure and teaches him or her to exert effort for good performance.

2. Don't sacrifice your child's sleep for activities (or anything else). Avoid the weekend shift.
Sleep deprivation in children correlates to lower IQ, lower emotional well being, higher levels of obesity, etc. Also, sleep deprivation messes with your child's memory formation in a sick way: positive experiences tend to be forgotten while negative experiences continue to be easily recalled.
Your child may not be sleep deprived, but you might shift the child's sleeping schedule with your own on weekends. Research shows that this also is not good for your child's brain development: every hour of weekend shift correlates to a drop in 7 points on IQ tests. So, it is in your child's best interest to maintain consistency in waking and bedtime hours across all days of the week.

3. Preserve marital harmony. When your child witnesses a conflict, resolve it in front of him or her.
Children tend to be more aggressive when they witness or detect marital conflict. For their benefit, resolve conflicts, of which they are aware, in their presence. This will do two things: it will a) temper their heightened aggression from the conflict and b) teach them how emotionally mature people who love each other make peace after a disagreement.

4. Socialize your child. Don't be content with other kids doing it.
Being around adults is good for children. A child that spends most of his or her time with peers tends to be more aggressive in order to obtain social standing in the group. Keep a child grounded by socializing him or her with different age groups, and especially with adults. By spending time with your kids, you will be able to exert influence over their learned behaviors, rather than letting their peers socialize them for better or (more likely) for worse.

There are a lot more insights and some very powerful research findings in the book. I highly recommend it.

And Baby Makes Three

Intuition would tell us that the birth of a child brings husband and wife closer together. It appears to me self-evident that this is true in the delivery room as the parents share in the joy of the momentous occasion. Witnessing their baby's birth is perhaps the most precious experience for a husband and wife; but evidently caring for the baby afterward is stressful on the couple. If unchecked, sadly, that stress has the power to dissolve the marriage (and it often does).

Recent research suggests that a majority of marital relationships suffer a significant decline in intimacy and satisfaction after bringing baby home. Acclaimed psychology researcher John Gottman and his wife, clinical psychologist Julie Schwartz Gottman, wrote "And Baby Makes Three" to instruct and equip new parents with the knowledge and tools to prevent - or turn back - the decline of their marriage after the firstborn. By design, the book is accessible and eye-opening; definitely a must-read. But most importantly to me, it is based on solid research: "And Baby Makes Three" is based on years upon years of experimental research, clinical observation, and meticulous analysis.

To provide guidance to new parents, John and Julie draw on lessons and examples from couples who have successfully transitioned into parenthood (that is, couples who managed to preserve their intimacy and high marital satisfaction after bringing baby home). What made these couples successful? For a complete account (as well as exercises on how to prepare your relationship for the transition), read the book.

Here's what I found note-worthy (but a very limited and imperfect account at best):

1. When you select a partner, you select the unresolvable problems of the relationship you will have (as these unresolvable problems are determined by the deep rooted convictions that your partner brings to the table, which contradict your own). Any different partner would come with a different set of unresolvable problems. Assuming you made the right partner decision, accept the unresolvable problems and be willing to communicate about and compromise on those problems for the duration of the relationship. It is important to understand that the unresolvable problems never go away, but you can build understanding around them.

2. Be willing to listen and understand what drives your partner's speech or behavior.

3. Resist the temptation to snap back to a negative remark or action. Cool down your conflicts.

4. Find ways to self-soothe when you're flooding (when your blood is rushing in your veins and you have a strong urge to offend, belittle, yell, abuse, criticize, fight back, etc) during a conflict. Communicate to your partner that you are taking this time so that your action is not viewed as a silent treatment, which will exacerbate the conflict.

As you can see, the prescriptions found in the book also apply more generally to how to behave in a loving relationship. This may lead one to believe that the couples whose relationship suffers after the firstborn are those who were not at this optimal level of interaction in the first place. In this case, the relationship advice John and Julie are providing would have been helpful to these couples before the baby. After the baby, learning these habits of interaction is not only helpful to the couple but necessary for the family's survival.

The reason why it becomes so vital to have good habits of interaction after the baby arrives is because the newborn causes the new parents sleep deprivation and also demands almost constant attention from them. This creates problems such as mood imbalance (irritability, impatience, etc) and neglect for the marital relationship respectively. This has the potential to breed a lot of negative interactions between the parents, especially if they forget how to be loving toward one another.

I am grateful to the Gottmans and the research community for heightening my awareness of the challenges posed to new parents so I can be better prepared to meet them. I hope that this post has made you more aware as well.

If you want to learn more, consider taking one of Gottmans' Bringing Baby Home workshops in your area.

Welcome!

When I first found out that I was pregnant, I was simultaneously thrilled and terrified. I felt excited but unprepared for the pregnancy: I imagined that there was a lot of information I could and should access to learn how to have a healthy pregnancy and to subsequently raise a healthy and happy child and I wanted the time to conduct this research.

A preliminary search of the available content yielded data to suggest that chronic or severe stress on the expectant mother is not good for the growing fetus. When my husband and I came across this finding, I was working as a business analyst in the corporate office of a large retailer, reporting to an aggressive, overly confident, and somewhat socially challenged woman who was not easily impressed nor very understanding. It made my life quite stressful. What I was feeling was not severe stress, but it definitely was not mild either. More, I felt it on a continued basis, since she had joined the company 10 months earlier, which made my stress qualify as chronic. Feeling the weight of my job dissatisfaction and the desire to care for our baby in the best way we know how, Kyle and I decided that I should resign. It was the best career decision I made.

I know that I am fortunate to have the opportunity to stay at home and care for my baby; some people want to but are unable to do the same out of financial considerations and lifestyle preferences. I also feel fortunate to have this period of time before June, in which I can read much of the literature out there and prepare for the transition to motherhood. I wouldn't have been able to do this if I were still working 45+ hours per week.

I know there are people out there who can't do it and those are the people for whose benefit I am writing this blog. My goal is to use this blog to review and share my literature findings on the subject of pregnancy, child development, and early parenting. I intend to analyze and synthesize the literature (so the busy blog reader doesn't have to) and will aim to make my posts succinct and intelligible in this way. I'll do my best to keep citations and direct quotes out of my posts; but you can expect to see book and article references at the bottom of the posts to understand the sources from which any syntheses occurred.

Again, welcome and thanks for reading!