Sunday, September 30, 2012

Maternity Reverence Off The Grid

Four times in my life I’ve been pretty damn pregnant.  Counting right now.  Right now, I’m pretty damn pregnant, so I know what is coming next.  Pretty soon, I will be quite pregnant, then incredibly pregnant, followed by so pregnant you can’t believe I’m still walking upright.  But walk upright I will, and work too, until my water breaks.  Then I’ll take a week or so off before I tie an apron back around my freshly sagging belly and I’ll return to work without the comfort of the baby safely nesting inside of it (and without the aesthetic good fortune of the baby filling it out).  

Motherhood is a long, slow process of letting go, one that begins immediately after birth.  

The days and years following a baby’s birth are devoted to fostering that kid’s independence and ability to care for himself.  If you do it right, some day your kid will look you square in the eye while you earnestly dole out some unsolicited gem of wisdom, and he will say Thanks for all the nurturing and guidance.  Thanks for the hot meals and the cookies.  Thanks for the late nights cleaning up my vomit.  But fuck you, I’ve got this.  A friend was telling me last week how happy he feels when his kid needs money.  At least there’s that.  

Varicose veins and sciatica aside, there are some real perks to being pretty damn pregnant.  The first of these is that you get to take your kid everywhere.  It will be several months before I have to leave the baby home with his father while I go to work, and several years before I have to drop him off in front of a large building and walk back home alone, praying the whole way that the people there are kind to him.  

Another benefit to being pretty damn pregnant is that everyone around you - your closest friends and total strangers alike - goes out of their way to transmit a little energy to the forming person in your belly.  Cooks at work make you toast to feed the baby.  Strangers hold doors while you walk through.  There are constant offers to lift, to carry, to ease the burden.  People reach out and touch your stomach, feeling...not you...but the baby inside, lightly pressing their hands against the firm bulge of life protruding there.  And there are the smiles.  Smiles and smiles and smiles.  Because even the most jaded and cynical bastard knows the secret there... that with every life, there is hope.  There is not a culture on the planet earth that does not revere a pregnant mother and newborn children.

Capitalism being what it is, Americans have turned our reverence of newborns into a nearly 7 billion dollar a year industry.  By the time your first baby is born, you will likely have a house full of swings, harnesses, carriers, Boppys, Bumbos, Binkies, Blankies... you’ll look around and wonder to yourself how the fuck we ever made it out of caves if this is what is required for a person’s first year of life.  Don’t worry, by the time you have your fourth baby, you will refuse all offers for a shower, having learned that the only real necessities are a stash of onesies and a way to wash them.

Here’s another area we top the charts in dollars spent on babies: maternity care.  Here, friends, is the height of irony.  Americans spend over $100 billion on maternity care (hospital and provider fees) each year.  That’s much higher than any other developed country in the world.  And you’re probably thinking, well, the US has a far superior medical system in place than most of those countries, right?  So we’re probably getting a hell of a bang for our buck, right?  Surely that money is the measure of an advanced system of care for the mothers and infants we so revere... right?

Let’s check in with the World Health Organization for affirmation.  Currently, the US ranks at the top of mother and infant death in developed countries.  33 countries reported a lower incidence of maternal death last year, and 37 reported a lower incidence of infant mortality.  65 countries reported a lower incidence of low birthweight babies.  That puts us below some countries that don’t even count as “first world.”


Obstacles to care are widespread, even though the USA  spends more on health care than any other country and more on pregnancy and childbirth-related hospital costs, $86 billion (*that doesn’t count your doctor’s fee! -meg) than any other type of hospital care.
Nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance. Minorities account for just under one-third of all women in the USA  (32 percent) but over half (51 percent) of uninsured women.
One in four women do not receive adequate prenatal care, starting in the first trimester. The number rises to about one in three for African American and Native American women.
Burdensome bureaucratic procedures in Medicaid enrollment substantially delay access to vital prenatal care for pregnant women seeking government-funded care.  
A shortage of health care professionals is a serious obstacle to timely and adequate care, especially in rural areas and inner cities. In 2008, 64 million people were living in "shortage areas" for primary care (which includes maternal care).
Many women are not given a say in decisions about their care and the risks of interventions such as inducing labor or cesarean sections. Cesarean sections make up nearly one-third of all deliveries in the USA  – twice as high as recommended by the World Health Organization.
The number of maternal deaths is significantly understated because of a lack of effective data collection in the US A .

***Look at bullet four, where they mention that bureaucratic bullshit hoop jumping to get prenatal care if you’re uninsured.  When I learned I was pregnant in May, I immediately applied for coverage through Medicaid, just in case there’s an emergency and we end up in a hospital.  In September, my application process was complete and I was approved.  That’s five months.  Five fucking months that I might have gone without care if I was younger and poorer and didn’t know how to find care from a midwife.  I have no intention of using those state benefits, but for many women, there is no other option.

Irony.  The US spends more dollars per capita on both medical care and plastic crap to help welcome new life.  Yet each year we are losing an alarming number of mothers and babies to a failing system of care.  Each year women and their babies go months without help that would eradicate most of the health problems associated with inadequate maternity care.  Many of those health issues create a lifetime of repercussions for the child, if he survives the birth.  And we’re not talking about it.

Even on the grid, even for those of us with insurance, what we as mothers have come to consider a normal birth plan often involves scheduled cesarean sections and chemical labor inductions to conform to the churn and burn mentality of our insurance carriers and providers.  Get em in, scoop em out, change those sheets.  Sometimes this is for the health and benefit of the mothers and babies, but more often it is for the convenience of corporations and even doctors.

Here, I’ll show you:

Looking back on my own birth history, I see a pattern of unnecessary and invasive intervention in the hospital, which compromised both my and my childrens’ best interests.  In three births, I have not had one that was allowed to progress naturally.  Failure to progress, they called it in 2000, when I labored gently for two days with my first child without much pain or dilation.  Then came the intervention: I was confined to a bed and dosed with pitocin which produced seismic contractions against a rock hard cervix that was not ready to dilate.  They told me it was best for the baby.  That’s how they get you.  They present an intervention as sort of your choice, but not really a choice at all if you’re a good mother.  If you’re a good mother, you’ll do as we suggest.  I assume this was not pleasant for the baby, either, as he was forced down a birth canal with no exit strategy, a bit like being compressed against a steel wall by a relentless piston, I imagine.  Within a couple hours he was in distress and my ex-husband and I listened to the sound of his heart on the monitor as it slowed, slowed, slowed... then stopped.  Emergency c-section.

With my second baby I found a doctor who would allow me to attempt a vaginal birth despite my cesarean history.  Awesome!  I thought.  A week before my due date, that doc sent me to the hospital for a cervical softening, but again I found myself on the pitocin drip.  This isn’t what I’m here for.  The nurse informed me that pitocin was the order on the chart.  I was duped!  I’m not even technically due yet.  But if it’s what’s best for the baby.  The doctor, after all, is the authority in this situation.  What the hell do I know?  I’m just the mother.  That’s the other way they get you.  By convincing you that you are ignorant in matters of birth and the complexities of the process.  I labored in the bed, once again grounded by an iv and a fetal monitor, while the seismic chemical contractions rocked me for nine hours.  I refused the epidural not once, but three times... they really want you to take that thing.  It’s like being behind the gym of the junior high all over again ...come on, mama... seductive temptation from the nurses... it’ll make you feel good.  All the pain will go away.  The third offer was from the anesthesiologist, who just happened to be next door, and thought he’d pop in to make sure I didn’t want some relief.  But we were close, I could feel it, and I wanted to stay with the baby.  I wanted to feel every move she made, I didn’t want to abandon her with numbness.  I wanted us to do it together.  We did.

My third birth was another intervention - fetal heart monitoring alert at a routine appointment, best for the baby - with some rather suspicious motive on the part of my soon to be vacationing doctor, who had already scheduled an induction that I was seriously considering playing hookie from.  I was something like three weeks prior to due with that emergency cesarean section.  Last year, we finished paying off the nearly $10,000 that my 80/20 insurance plan didn’t cover.  

My birth history, and the expenses associated with it, is echoed in the experiences of women across the country, to the tune of $100 billion a year, and not always with the happy results I’ve had.  

Now, at 38, I’m a little wiser to the game, and living off the grid without health insurance.  When I learned I was pregnant I shopped a bit for a doctor and hospital who would allow me and my baby a natural birth (as is recommended by the American College of Obstetrics and Gynocology for mothers who’ve had one or two c-sections).  That doctor does not exist in this town, nor does a hospital or birth facility who would allow a provider to attend that birth even if he or she was willing.  I’m sure they have their reasons.  Reasons I know nothing about, being just a mother and all.

Instead, I found a midwife who is providing us with wonderful care, and who believes strongly in my body’s ability to grow and deliver this baby at home.  Her reverence for mother and child is absolute.  My trust in her is absolute.  
For the nine months of my pregnancy and for however many hours it takes me to bring this child forward, my connection to him is absolute.  We’ll share a body for a bit, then share a birth.  I’ve found a care provider who won’t ask me to relegate even an ounce of my power, who won’t question my instincts, who won’t rush us.  She’s ready to assist, trained to intervene if necessary.

I don’t have the big-picture answer, nor a plan for massive reform of maternity care in the US.  I only know how to manage my own reform, to avoid the pitfalls and traps that my naivete has snagged myself and my children in before, and to try to create a conversation wherein people address the larger issue: that we are allowing corporate policy and insurance companies to harm mothers and babies, and we are paying them billions of dollars a year to do it.  Billions of dollars that we would probably rather spend on Bumbos and Binkies and Boppys.  Or, shit, a college fund?

I’m pretty damn pregnant.  I am the beneficiary of your reverence.  Okay, no one has carved a statue of Oolitic Limestone in my likeness, but you make me toast. You smile. You touch my belly. You offer to lift, to carry, to ease my burden. So I know you want health for all mothers, for all babies. You get it.  I know you do. For nine months a mother is entitled to adequate care and choices by hospitals and practitioners who keep health at the forefront of the conversation, so that she can deliver a healthy baby and begin the long, slow process of letting him go.

Sunday, September 16, 2012

On Losing...

Tom Petty said even the losers get lucky sometimes.  That may be true, but today I have the feeling that sometimes the luck is in the loss.

I just got home from my kid’s football game with a renewed perspective of him and of myself and, as corny as it sounds, maybe of life.  Is this why we value sports so highly in America?  Are we in it for the analogies?  Probably not, but there’s some poetry there if you look for it.

My kid’s 7th grade football team has 14 players total.  That means even if everyone shows up, most of them will play for almost every down of the game, offense and defense.   About an hour and a half, with an 8 minute timeout in the middle.  In two whole games my kid has only been on the sidelines for one play.

The team they played today had 33 players.  I counted 33 very large 7th graders.  I’m not sure where they found these kids, but I’m not certain that some of them would be asked for ID if they tried to order a beer.  I recognized the head coach (one of the seven coaches on their staff!) from baseball this summer.  His baseball team is stacked pretty much the same way.  Even though it’s a rec league, he somehow has a whole dugout of very large, very talented players who completely dominate the league.  He’s a really high energy, ultra-competitive coach. That's euphemism for he is a super-duper fucking prick.  He screams at his players, screams at the players on the other team, and is certainly there to win... which he does.  A lot.  And by a wide margin.  Like, 27-3 on the baseball field and 44-0 on the football field.  Clearly, this is a man who takes winning, and being a winner, seriously.  Not a person with even a trace of pity for the underdog.  He’s the antagonist from every John Hughes movie rolled into one middle-aged man with a weak chin.  He tries to hide the weak chin with a goatee, but I am not fooled, sir.

So while the opposing team rotated their very large players in and out of the game with each play - before any of them had a chance to even breathe hard - our guys were out there every play, taking crazy-hard hits, some of them quite literally being tossed around like rag dolls, then picking themselves up to take the line for more punishment, and I’m assuming, praying for a forfeit.  It was an absolute slaughter.  You’ve never seen anything this brutal.  

I sat under a big grey Kansas sky, on my quilt in the grass with my shoes off, drinking fizzy water while the new baby kicked me in the bladder.  I listened to the other mothers yelling at their sons to “get mad and hurt someone!”  I watched my oldest kid, my gentlest, most sensitive child for sure, taking hit after hard hit, then standing up, limping in a circle for a moment before he returned to the line to lower his body and head and take another from a kid who outweighed him by twenty pounds.  I felt very far removed from it all.  And I wondered What Does Any Of This Have To Do With Us?  

Toward the end of the second quarter, just before half time, I saw a noticeable droop in his posture as his team began to heave out a collective sigh of degradation and defeat. The score was 30-0.  I’ve seen this happen in him plenty.  I’m his mom.  I know him better than anyone.  I know that once his spirit starts to sag like that, a rebound is hours away.

After halftime, eight minutes later, he was back on the field and I was prepared for what I knew was coming: a long second half of him half-heartedly trying to look like he’s trying, but really just wishing he was anywhere else.

I, his mother, the one who knows him better than anyone, was wrong.  Dead wrong.  He threw himself back on the line like... a man.  When I say like a man, I mean like a mountain man fighting a bear.  He held that line like he was made of stone, fought back the big kids from the other team, took some insane hits that sounded concussive in nature.  He fought and limped and fought and limped and fought.  Down to the last minute, even though winning was a hopeless prospect with a score of 44-0... he fought.  My eyes welled with pride at the beauty and futility of it, and my ex-husband’s voice had a quiver when I asked him whose child that is and he said, that’s our boy.

Outmanned, outgunned, outmatched, with no hope of doing anything more than holding your own... isn’t it nice to know that something in the human condition stops us from caving?

Now I’m thinking about that weak-chinned coach and his furious need to win.  I’m thinking about his poor wife, if he’s managed to hang on to one who doesn’t mind him screaming at 12 year olds.  She might never have the chance to see her kid shining through as a loser.  This is going to sound terrible, but it was an incredible moment for me, as his mother, to watch him getting his ass kicked so severely, and standing back up to do it again.  That’s my loser!  

Through the second half, I listened to the other mothers, still yelling at their kids to “get mad and hurt someone.”  Although this is something that would never even be a thought in my head, let alone something that comes out of my mouth at 180 decibels, I felt a little more connected to them.  Those are their losers, too.  And however we go about it, we are there to support their effort.  Because it’s not futile.  It’s not for nothing, even when the final score pretty much says: well, that was for nothing.  

My son walked off the field drenched in sweat, covered in welts that will be bruises by evening, and wondering if he does, in fact, have a concussion.  He was near tears when he told his dad and me about how hard the hits really were, about how hard it was to brace himself for what he knew was going to hurt like hell.  But he did it.  About fifty times in 90 minutes.  It wasn’t for nothing.  This might be the first time in his life that he sees what a badass he truly is.

And that, my friends, is a lucky loser.  

Monday, September 3, 2012

Search Results: Radish Cake

On my sixth birthday, my mother made me a coconut cake shaped like a bunny.  It’s the only cake from my childhood that I can recall so clearly.  It was perfectly shaped like a rabbit and covered in soft white icing.  The icing was dusted with flaked white coconut to look like fur.  It had licorice whiskers and gumdrop eyes, and the coconut was dyed pink for the ears and nose.  It was a perfect cake.  It was nearly a perfect birthday, except that in the middle of my party my brother threw a daddy longlegs in my hair while I was opening presents.  (I bet he feels pretty rotten now, knowing that he is the only blemish on an otherwise pristine childhood memory.  Isn’t that right, you ass?)

That cake stuck with me.  Rather, what stuck with me was the notion that one day someone might make you a cake that you remember your whole life.  They won’t even know they’re doing it.  Our minds are fragile and unpredictable and it’s so strange which memories we choose to keep and which we disregard as useless information not worth remembering.  Because of the bunny cake, I’ve always had a deal with my kids that they can choose whatever kind of cake they want for their birthdays.  No limits.  I’ll make anything.  I never know which one, if any, might be something that makes them feel loved and special every time they recall it.  

It started the year my oldest was turning three and said he wanted a cake like Uncle Donny’s lawnmower.  A push mower.  Not a picture of a mower on a rectangle cake, but an actual 3-D lawnmower.  A tractor mower wouldn’t have been much trouble, but the handle of a push mower defies gravity when it is made of butter and flour.  Knowing that what he really wanted was a frosting covered tribute to a part of his 3 year old life that he valued beyond measure - time with Uncle Donny - I did my best.  As I recall the result was not pretty.  Since then I’ve gotten much better.  Over the years I’ve made gardens and trains and butterflies and beaches and Millenium Falcons and turtles, all with passable success.  Today I may have met my match.

My youngest (not counting the new kid, who is still in utero) is turning four tomorrow.  She wants a carrot cake in the shape of all things... a radish.  A radish?  “You know, she’ll make you anything you want,” said her 10 year old sister. “Eh-n-y-thing-guh.  She’ll make you a princess cake.  Or a pony!  Or a princess riding a pony!”  Undeterred, the youngest smiled her brightest smile at us both and then rode off on her tricycle singing about radishes.  Okay, well, how hard can this be?  It’s just a bulb with a stringy root on one end and some leaves on the other.  I’m not the first person to try to make a carrot cake look like a radish.  Right?

So I googled “radish cake.”  

Google said I am the first person to try to make a carrot cake look like a radish.

There is a popular dim sum dish called Turnip Cake or Daikon Cake.  If you google “radish cake” you’ll get lots of information on those.  They look delicious!  But not for a 4 year old.  What you won’t find is a single image of a cake that actually looks like a radish, nor any ideas about the best way to shape a cake like a radish.

Now I’m convinced that she knew exactly what she was doing.  That’s what that smile was.  She knows that I won’t be satisfied with a two-dimensional radish out of standard circle cake pans.  She knows that I won’t be happy piping the image of a radish in red frosting onto a regular layer or sheet cake.  She knew that I was going to try to create an actual radish out of cake.  That miscreant little turd... she knew!  Well, I will not be made an ass of by a 4 year old.  This is going to be the most fucking amazing radish shaped carrot cake ever, and I’m going to document the whole thing so that the next time one of you diabolical little pre-school smart asses tries to use a root vegetable to make your mom look like a chump, she’ll have somewhere to turn.

I looked up images of radishes and considered my cake pans.  

Wow.  They are really up high.  And the mister is not around right now for me to borrow his tall.  That kettle is going to fall right on my head if I try to pull those down.  Okay, I see a daisy-shaped pan, a bundt, and then your standard 8 and 9 inch rounds.  Maybe I could use the bundt and tell her a worm ate a hole through the radish.  That happens in nature all the time.  I considered using a ½ sheet pan and layering and sculpting a radish from that, but that would never work with a carrot cake.  Too delicate.  

While I was googling images of radishes, I came upon a festival in Oaxaca called Noche de Rabanos , Night of the Radishes. Every year on December 23, since 1897, artists showcase elaborate carvings and sculptures made entirely of radishes. And I thought to myself Holy Salad Toppings! If someone can do this with a radish...

...or this...

...I can make this damn cake.  Encouraged by the ingenuity of my fellow radish artisans, I kept hunting through my cabinets for inspiration.

In the end, I settled on a medium saucepot for the bulb of the radish and a big, flat skillet to make the stringy roots and leaves.  My first bit of advice when you’re baking with these sorts of pots is to butter and flour the ever-loving shit out of them.  

Seriously, I cannot stress this enough.  Whatever seems like a normal amount of butter and flour, double that.  Maybe triple.

Once the cakes are baked and cooled, you can start to assemble your radish...

At first, your radish might look a little like a one-horned reindeer with a goatee.  Frosting fixes everything.

Or does it?

There comes a time in the life of every one of my cakes where I think there is no possible way to fix all the many things that are going wrong.  I once exploded an entire pastry bag of green frosting all over the ceiling of my kitchen.  I’ve learned to be more patient through the process.  Don’t panic, my radish cake making friend.  When it starts to look bad, just put your cake in the refrigerator for a while to let the frosting set, then pile more on top.  Repeat this step as many times as necessary.  I always make a double batch of frosting for emergencies like this one.  Your family will not complain about the three layers it takes to make things look better.

Meep Meep

I repeat: don’t panic.  Even when your husband points out: that’s not a radish at all and that you have made the Roadrunner.

It's only 1 am. I've got plenty of time to fix the Roadradish. He's chilling in the fridge while I crank off this blog entry real quick, just in case someone out there is googling "radish cake" tonight and hopelessly wading through recipes for dim sum.

You're welcome. And happy birthday to your sweet and strange little troublemaker.