Birth Story

The birth Jan. 7 of Blue Ivy Carter, daughter of hip-hop stars Beyonce and Jay-Z  (Shawn Carter), had Lenox Hill Hospital in Manhattan in a tailspin this week.

Beyonce

Other new parents complained of disruptions and even security breaches as the celebrity family reportedly took over part of the hospital's sixth floor for a private, customized labor-delivery area for $1 million-plus. (A hospital spokesman said the Carters occupied an "executive suite" and paid the standard rate for it.)

Neil and Rozz Nash-Coulon were upset at being detained in the neonatal intensive care unit after visiting their newborn twins, while Edgar Ramirez reported he was refused entrance to visit his baby in the the NICU unit. Windows were covered, private security guards issued orders, and security cameras were even disabled, families complained.

"The security of our children is at risk when you cover security cameras," Ms. Nash-Coulon told Nina Bernstein of the New York Times.

And, all the secrecy fed rumors. Beyonce's website states that "Baby Blue" was "delivered naturally," while portions of the blogosphere ran with a report that the birth was a C-section. And there's even a contingent that holds that Beyonce's pregnancy was a fake, that a surrogate mom bore Blue.

Tina Fey and Jane Krakowski, stars of the sitcom 30 Rock on NBC, told The Today Show's Matt Lauer that they both had their babies at Lenox Hill Hospital as well. Said Fey, "My celebrity treatment at Lenox Hill involved taking a group breast-feeding class in a closet."

This year it looks as if we are moving beyond shooing moms out onto the street at the crack of dawn on Mother's Day to raise funds to fight cancer. This year we are going after their brunch and posy money as well.

A new organization called the Mother's Day Movement pronounces itself "shocked to learn that $14 billion was spent in the US in 2010 on Mother’s Day celebrations including flowers, cards and meals."

Roses from my daughter Nora

The group's website says that, "given the number of women and children suffering globally, and here at home, it is time for everyone to rethink this holiday and donate a portion of Mother’s Day spending to those less fortunate."

Actually, last year was a low point for mom on her "special day," probably due to the weak economy. This year, the National Retail Federation estimates Americans will spend upwards of $16 billion on mom, even though the NRF opines in its press release that "mom doesn’t expect much for Mother’s Day."

And why is that, do you think? Perhaps because while more three-quarters of all mothers are in the work force, including more than 60 percent of those with very young children,  women still make only 83 percent of their male counterparts' wages?

I am all for supporting needy women and children, for working to bring down maternal mortality and for curing cancer.

But boy, do I hate it when proponents of these projects tie them to Mother's Day.

That nice Nicholas Kristof of the New York Times, who writes so compellingly about victimized women around the world, has suggested "we move the apostrophe so as to celebrate not so much Mother’s Day — honoring a single mother — but Mothers’ Day, to help save mothers’ lives around the world as well."

To which I say, talk to me about these issues on Monday.

Sunday represents one of two days all year — the other is my birthday — when I guiltlessly look my dear family members in the eye and say, "I don't know what's for lunch. I don't want to go to the park. I don't intend to get out of bed until the sun goes down."

Perhaps you think I am being humorous, but I'm not. Why do you think women around the world are in such wretched shape? It's because their needs come in dead last, behind the livestock in some places, and nobody thinks a thing of it.

No one should consider pilfering the small comforts society extends to mothers on this day.

Sure, affluent women will score even more great stuff on Mother's Day than they usually get. (People celebrating the holiday will spend an average of $140.73, the NRF reports.) But plenty of moms whose grown children call them a handful of times a year* might actually get flowers or a gift on Sunday or even — woo-hoo! — a meal they don't have to cook themselves.

On Mother's Day, every individual should look at the woman who gave him life, or think about her, and if she is a kind and decent woman, thank her for all that she was willing and able to do — and by the way, do something to bring her a little pleasure.

Because if we can't even do that, then heaven have mercy on the women of the world.

(*I am lucky enough to have a far more attentive grown daughter.)

As a followup to the post on the debate over the prudence of Major League Baseball's paternity leave list, I thought I would post a portion of Steve Lombardi's April 27, 2009, interview on WasWatching.com with New York Times sportswriter Tyler Kepner, who covers the New York Yankees.

In his recent story on the new paternity leave list, Kepner called it "baseball’s latest common-sense roster rule," in contrast to some other sportswriters who wrote that they thought ball players should show up for games even if it means they miss the birth of one of their children.

In Lombardi's Q & A interview, Kepner talked about his own experience of being a father of four on the one hand, and on the other hand holding down a job that rivals long-distance trucker for time spent away from home.

WW: How do you manage being the father of four young children while also being a beat writer covering the Yankees? What are the biggest challenges on both sides of that fence for you as you try to manage a work-life balance that fits your needs?

Tyler Kepner: That’s been the essential question of my life for the last 10 years. But this much is obvious: it would be impossible to keep any kind of balance without a supportive and patient wife and a fair and understanding boss. I am very lucky to have both.

All of my editors at the Times have treated me wonderfully, allowing me to build some flexibility into my schedule so I don’t miss too many family things.

Over my 10 years on the beat at the Times (2 with the Mets and now 8 with the Yankees), I can remember missing a series in Seattle for a birthday, the All-Star Home Run Derby for another birthday, the last game of a series at Tampa Bay for a school play, a series in Baltimore for a dance recital, a series at Minnesota for a wedding, and so on.

I still end up covering probably 75 road games a year, but having a boss who understands that you have a life outside your job is just so crucial. It takes away the burnout factor, which is a very real risk but has never been an issue.

By knowing the editors respect my personal life, I can give everything I have to the job on the days I work.

And on the days I’m off, I don’t do any work at all. Most of the time, I don’t even watch the game.

I would say Kepner's insights apply to ball players as well, even to the best ones, who might hold a game's outcome in their hands.

People aren't machines, and that includes elite athletes. They need to have balance in their lives just in order to perform well on the job. They, their employers, spouses and families, are the best judges of what that balance requires.

Many thanks to Steve Lombardi for letting me use this part of his blog post. Incidentally, I love, love, love the fact that one male baseball writer asked that question of another male baseball writer and elicited the response Kepner gave.

Where do you stand on this? It probably depends on how seriously you take your sports.

The baseball season was only a few weeks old when a sports blogger lambasted Texas Rangers pitcher Colby Lewis for missing a game in which he was scheduled to pitch, in order to attend the birth of his daughter, Elizabeth Grace.

Colby Lewis

Lewis, 31, was the first player to go on Major League Baseball's new paternity leave list. A player can be on the list, and off the roster, for up to three days for the birth of a child.

"Baseball players are paid millions to play baseball," Richie Whitt wrote in a post for the Dallas Observer sports blog. "If that means 'scheduling' births so they occur in the off-season, then so be it. Of the 365 days in a year, starting pitchers 'work' maybe 40 of them, counting spring training and playoffs.

"If it was a first child, maybe. But a second child causing a player to miss a game? Ludicrous."

Twitter and blogosphere lit up with sputtering rebuttals: Fatherhood trumps baseball any day, buster.

The Rangers' pitching coach, Mike Maddux, said he supports the new list.

But baseball writer Rob Neyer waded in on Whitt's side of the fracas for SB Nation:

"I'm going to be honest here, as I have been since the first time this came up, some years ago (official paternity leave is new, but players taking a game off to attend childbirth is not)," he wrote.

"As a human being, I think this is fantastic. As a baseball fan, though? If my team's in the playoff hunt, I'm sorry, but I don't want one of my starting pitchers taking the night off. We're not talking about some guy who works on the assembly line for the Integrated Widget Corporation. We're talking about one of the most talented pitchers on the planet, not easily replaceable. What if your team finishes one game short of the playoffs? Was it really worth it?

"Or as a sage philosopher once observed, The needs of the many outweigh the needs of the few.

"And last I checked, there were many fans of the Texas Rangers."

Well, it's not just the Texas Rangers anymore. Several other players have already gone on the list, including the Oakland Athletics' catcher Kurt Suzuki, Washington Nationals' shortstop Ian Desmond and New York Mets' left-fielder Jason Bay.

“Teams were basically granting [leave to attend births] anyway, but they ended up playing short, and that really wasn’t the goal,” Peter Woodfork, a senior vice president with Major League Baseball, told the New York Times' Tyler Kepner for a story about the list. “[The paternity leave list] leaves no gray area. Neither side feels like, ‘Well, we really want you to stay.’ There’s no guilt, and it helps both sides.”

Image courtesy of Wikimedia Commons

The Women's Health Initiative, a series of randomized controlled trials begun in 1991, was supposed to be definitive in terms of the role hormone-replacement theory would play in managing the health of post-menopausal women. However, the WHI has yielded unexpected and sometimes apparently inconsistent results.

The medical establishment expected the WHI to show that HRT, which had been popular for years, helped prevent cancer, heart disease and osteoporosis in older women.

Instead, in 2002 researchers announced in the Journal of the American Medical Association that they had stopped the trials, which involved more than 160,000 women, because participants receiving estrogen combined with progesterone were developing invasive breast cancer at substantially higher rates than were women receiving a placebo, and their rates of heart disease were also high.

HRT, which to that point had been prescribed liberally for post-menopausal women, virtually disappeared as a therapy, in spite of the fact that it did seem to be helping women avoid hip fractures and colon cancer.

Just last week, though, again in JAMA, a group of WHI researchers reported that a smaller study of women who have had a hysterectomy, who were treated with estrogen alone for a median of 10.7 years, showed a decreased breast cancer risk with the treatment, with no significant increase in heart disease.

Well, that's disconcerting. Should post-menopausal women be asking their doctors about HRT after all? Probably not most of them.

“Women are different — it’s relevant to almost every medication and almost every intervention,” Joann E. Manson MD told Tara Parker-Pope in a story in last Sunday's New York Times.

“With this study, in many ways, science worked the way it’s supposed to work. It’s a little like watching sausage being made. It may seem on the surface that the study was a real problem and had many, many flaws, but in reality, it ended up giving invaluable information,” said Dr. Manson, a WHI investigator who is also chief of preventive medicine at Brigham and Women’s Hospital in Boston.

Adds Pope, "The most compelling lesson of the research should be that science is always worth the wait. Consumers should insist that doctors make recommendations based on scientific evidence, say investigators, rather than allowing drug companies or marketing hype to dictate patients’ health care choices."

That's true for middle-aged women, pregnant women, men and parents as well.

Image: Vincent Van Gogh's "L'Arlesienne"

Yipes! That was a long hiatus! So sorry. Hope not to do that again.

I am back on Birth Story with huge new respect for teachers, after serving winter quarter as an undergraduate lab instructor at Northwestern University's Medill School of Journalism. What teachers do in the classroom, I discovered, is the tip of the iceberg of the job.

I am back. Yes! So back to our topic, sort of. Well, a tangent, actually.

Nearly every time I Google "birth news" looking for, you know, something to blog about — my topic is birth — I come up with some permutation on the "birther" flap calling for President Obama to produce (on a daily basis, as far as I can tell) his birth certificate. Otherwise, critics will assume he was born in Kenya, his father's country of origin.

Is he? Or isn't he?

Donald Trump and Whoopi Goldberg got into a dustup on "The View" last week about Obama's alleged reluctance to produce his birth certificate. (Just Google "birth news.")

The next day, "The View" ladies showed what they said was a copy of Obama's birth certificate.

Ben Smith at Politico wrote yesterday that the document Trump claimed was his own birth certificate, produced to needle the President, is not in fact Trump's official birth certificate. (But then Trump did come up with the right one.)

All of which just tells you that you can't go wrong, publicity-wise, getting a corner of this issue, or non-issue, as the case may be. Maybe I'll get a lot more hits today than I do ordinarily, writing about boring old childbirth.

The Arizona legislature is considering legislation that would require the state to sign off on proof of U.S. birth from presidential candidates. (They wouldn't let me teach at Medill until I produced proof of U.S. birth. Surely presidential candidates don't get a pass on that.)

The House version of the Arizona bill calls for evidence that that baby dropped onto U.S. soil, while the Senate version of the bill includes a definition of a "natural" U.S. birth as one to individuals who were U.S. citizens at the time.

I think both those elements have to be there, actually. That is, proof of either of those things ought to be enough, and I think maybe we need some laws to clarify that.

Even though some people go to great lengths to manipulate the law to convey U.S. citizenship to their infants like, allegedly, the Chinese women Jennifer Medina writes about in the New York Times today, it is important for anyone born in the United States to be an "automatic" citizen. Anything else is a total repudiation of what the United States has been, and stood for, for more than two centuries.

At the same time, we live in a small world. Pregnant U.S. citizens travel all the time for work and pleasure, and probably some other reasons, too, and they shouldn't be terrified about losing their children's full rights of citizenship if they happen to be abroad when their water breaks.

The Administration and numerous officials of the state of Hawaii, where Obama was by all accounts born on Aug. 4, 1961, have repeatedly confirmed the President's birth to a U.S. citizen on U.S. soil. Two for two. (So that's settled, right?)

And whatever you think of Barack Obama, he is a stellar example of the promise the United States has made to its residents, going even beyond its citizens — that if you work hard, the sky is the limit on what you can achieve.

Well, that's my two cents for today. It's nice to be back, although like teaching, blogging is a whole lot more time-consuming than I thought it would be before I actually tried it.

Happy spring, dear reader!

Annie Murphy Paul's new book, Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, is getting the star treatment. It is the subject of a Time magazine cover story (written by Paul), and an article by the New York Times' Motherlode blogger, Lisa Belkin.

And why not? Paul has written what looks to be a fascinating exploration of the explosion of research on the effects of the environment human beings encounter while developing in their mothers' wombs.

In a guest post for Motherlode (the link is above), Paul writes, "Startling as it may seem, qualities ranging from our intelligence to our temperament to our health, and our susceptibility to diseases as varied as cancer, asthma, obesity, diabetes and mental illness, are affected by our experiences as fetuses decades ago."

We have already considered one aspect of this research here at Birth Story, how a mother's weight gain during pregnancy can influence her infant's lifetime chances of being able to maintain a healthy weight. But Paul covers the waterfront in this "new chapter in the long-running nature-nurture debate," as she calls it.

In her Motherlode guest post, Paul raises and then downplays the likelihood that mothers will be blamed for anything that goes awry with their children, given the new understandings of the importance of what goes on in the womb.

Love Paul's optimism! And, I'm impressed she researched this book while she was pregnant. I'm looking forward to reading it.

My children are 10 years apart in age, and one thing that has struck me since Maeve's birth almost 13 years ago is how much more complicated the world grows as they get older.

When children are small, you can see clearly how their perfect lives will roll out. You can see them graduating from Harvard — or perhaps Yale; you devote serious time to considering which would be better — going into law or medicine, gliding along until they finish up as President of the United States. Along the way, of course, there will be sports trophies, prom dresses, all the trimmings.

Reality sets in gradually. It turns out the kids have learning disabilities, or strange hair, or no interest in sports — whatever, and likely in multiples. Ten years or so after spinning all those perfect dreams, you might find yourself praying they'll finish high school. Or even, please, God, let them stay alive through high school.

When Maeve was in preschool, I remember sitting in a group listening to moms in the Harvard vs. Yale stage, while my mind was on the then-exotic sensation some teen-aged boys in Nora's vast social network had created by sending nude pictures of girls they had probably known since kindergarten out across the Internet. I remember thinking that perhaps I had seen some of those boys, and those girls, on swings in the park or at a library reading hour when they too were small.

What I mean to say is that many of the things that seem critical when children are little get put firmly in perspective as they grow.

Poking around Lisa Belkin's Motherlode blog on the New York Times website this week, I landed on a post called "A Breast-Feeding Guru Who Uses Formula," which attracted me because I have been writing about breast-feeding. Through Belkin, I discovered Katie Allison Granju and her mamapundit blog. (I know, where have I been?)

Granju is a writer and digital-media expert who has become an authority on breast-feeding. Nevertheless, she found with her fifth child, Georgia, now seven weeks old, that she was unable to breast-feed. "I did have colostrum for the first week or two, but I never got the full enchilada," she writes in a post on Babble.com.

She tried "pumping, herbs, supplemental nursing system, plenty of skin to skin with baby, nursing on demand, nipple shields," all to no avail.

She is "resigned" now to the fact that Georgia is a bottle-fed baby, and she does what she can to inject warmth and meaning into an experience she never expected a child of hers to have.

But Granju believes that a horrific recent event in her life has contributed to her inability to breast-feed.

"I suspect that the biggest factor in my inability to produce milk at the moment is that my oldest child died in my arms only a few weeks before G was born. God only knows what the shock of that experience did to my body and its normal functioning," she wrote.

The death of Granju's son Henry from a drug overdose is about as terrible as this world gets. We dream for our children but they live the lives we give them. My heart goes out to the Granjus.

One of Hanna Rosin's grievances against breast-feeding in "The Case Against Breast-Feeding," her article last year in The Atlantic, is that it prevents women from doing work that would be more productive, or at least more lucrative.

"It is a serious time commitment that pretty much guarantees that you will not work in any meaningful way," she wrote.

Hello? This week alone, as the mother of a 12-year-old at the end of summer vacation, I have spent a morning at the beach, an entire day at a water park, and an afternoon turning Gatorade bottles into papier mache fish. Need I say that no one gave me one shiny dime for any of this activity?

To the extent that women do it themselves, motherhood is a career-wrecker. Six months or so of exclusive breast-feeding at the front end seems hardly worth mentioning.

I have not worked more than 30 hours a week (most years much less) since my older daughter, Nora, was born almost 23 years ago. It was my choice, but I paid a price in diminished salary and less prestigious assignments — in opportunities.

Even so, I would do it again if I got a do-over.

Why is that? Because I can't think of anything I would rather have than time and relationships with my husband and my children. That was true when the girls were little, and it's true now.

Nora has moved 2,000 miles away this summer. When she calls me, I drop everything to talk with her. And even though, if I added up our phone/Skype sessions, the total would probably look like a serious time commitment, I don't ever worry about how much valuable time I'm losing.

(For a twist on this perspective, see "Putting a Price on Motherhood" in today's New York Times.)

Last Friday, New York's Gov. David Paterson signed into law A8117b-S5007a, the so-called Midwifery Modernization Act, which removes the requirement for midwives to obtain a written practice agreement from a physician or hospital to practice in New York State. The bill will take effect in three months.

Paterson's signature was by no means a sure thing — the Democratic governor, who is not seeking re-election in the fall, vetoed thousands of bills this summer, and he waited until the very last possible day to sign the midwifery bill.

Not only that, but the American Congress of Obstetricians and Gynecologists, the new political arm of the American College of Obstetricians and Gynecologists, lobbied against the legislation. The group argued that it would make midwife-assisted birth less safe, as midwives who did not have formal relationships with doctors might not be able to access medical care in an emergency. WPAs have been a condition of practice for midwives in New York since 1992.

But old certitudes and worst-case-scenarios fell flat in Albany this summer.

The closing of St. Vincent's Hospital in New York City last spring created a crisis for those relatively few women seeking home birth with midwives, and provided an object lesson in the difficulties the requirement for a written practice agreement could create. By June, seven midwives who had had WPAs with St. Vincent's were still scrambling to find doctors willing and/or able to formally partner with them, and hundreds of mothers who had been planning to deliver at home were in a state of limbo.

Beyond the immediate concerns, though, the ease with which the bills sailed through the New York legislature — the vote was unanimous in the Senate — suggests that midwifery has attained a mature level of acceptance in New York, which has perhaps 900 midwives, more than any other state.

Assemblywoman Amy Paulin, for example, one of the bill's sponsors, had her children with midwives, including two home births.

Groups that represent midwives emerged as effective lobbyists for the bill, mustering thousands of calls, emails and signatures on petitions.

Meanwhile, ACOG's efforts were notable for gaffes like a quote in the New York Times from Donna Montalto,  executive director of ACOG's New York division, who said physicians might balk at providing emergency care without a WPA.

“What obstetrician who has never seen the patient, doesn’t know the midwife, and happens to be at home at their son’s baseball game is going to say, ‘Sure, I’ll come in and take care of your patient,’?” Montalto said.

Perhaps most importantly, the new act affirms the view that birth is a natural event, and not necessarily a medical one. New York legislators have given midwives a vote of confidence, one that could portend a significant shift in attitudes about childbirth.

"Pregnant Graffiti" by Petteri Sulonen