Child Protection
August 25, 2011
Civil society such as the one in the US, where I live, takes a custodial interest in children.
It is not unerring, but then what is? The goal, however, is to recognize that while parents are responsible for their own children, sometimes this goes wrong. Parents can be bad parents and therefore society has a mechanism for intervention on the side of the child’s welfare.
We also force parents to put their children in carseats which may* provide only marginally improved protection in rare case scenarios.
These, and many other societal steps assert that at some point the child has independent rights that must come into consideration. Alongside, or perhaps even before, those of the parent.
I am a fairly staunch supporter of abortion being the decision of the mother into a fairly late stage. And I am a big believer in the slippery slope argument that you can’t give the right wing wackaloons a micron on this issue. I do not by any means think this custodial obligation of a civil society starts at conception. Not by a long shot.
But FFS, the day of birth is one place I’m full willing to let the slippery slope in support of right wing wackaloonery start.
How about you?
__
*see those freakonomics guy’s claim.
DrugMonkey 
August 25, 2011 at 11:35 am
Uggh, I really have a hard time supporting any right wing wackaloonery. My honest hope is that in the case of homebirthing movement common sense will prevail. But, I’m probably asking for too much. Again.
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August 25, 2011 at 12:01 pm
I realize that this is some serious FWDAOTI, but how exactly would this work? Pregnant women who expressed an interest in home birth would be locked up? CPS would take away children who were born at home? They could join this child, who was taken away from his mother for refusing a c-section (and lo and behold, was born healthy then dragged into foster care).
I am all for telling people they should give birth at a hospital/birthing center attached to a hospital. I am all for not licensing people to deliver babies outside of those settings (and thus giving tacit approval to non-hospital births). There is a big difference between making recommendations, and enforcing them with the hammer of the law. There already are pregnant women who are forced against their will on best rest. I suspect with the “justification” of protecting babies on their birth day, it won’t be long before other doctor’s recommendations to pregnant women get enforced as well.
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August 25, 2011 at 12:31 pm
Prodigal,
Failing to use a carseat only entails a financial penalty…and you have to get caught first. Many CPS interventions fall well short of removal of the child. There are also society-sponsored educational efforts devoted to changing parental behavior that likewise fall short of “locked up”.
So no, I am not by any means advocating criminalizing home birth. Unlike the antivaccaloons, for example, the scope of the act is pretty circumscribed (although drisis has reminded me that for the up to 37% of homebirths that require emergency medical services, those services are not available to another individual in need at the time).
I do think we should discourage it, however.
OTOH, if I were to become aware of more cases like this outrage, perhaps I’d revisit that.
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August 25, 2011 at 12:46 pm
Or this criminal nutjob murderer
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August 25, 2011 at 12:56 pm
I think, because the government is SO heavily into stomping all over mothers (they really are, especially poorer and non white mothers) I wouldn’t encourage a choice to homebirth to be an automatic visit by CPS. But in any complaint as to neglect, I would like to see such general trends as “refusal to vaccinate”, “refusal to send to public school”, “refusal to give medical care” (which would include UC and homebirth with anything besides at least a CNM) as red flags that weigh into their decision. Right now there’s a little too much touchy feely hands off on those particular issues because they align so closely with a certain subsection of very religious people.
Now I do homeschool, so I’m not saying any one of these things alone, because there can be a reason for any of these things that make sense, but the combo effect of them all rarely takes place outside of a family that is putting their ideology over their children’s well-being, and child neglect or even abuse generally follows.
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August 25, 2011 at 2:08 pm
I have little idea of what you seem to associate with “homebirth” in the USA, except that the quite a few writers seem to regard it as fringe and dangerous behaviour. As a non-American, I find your whole discussion of homebirth therefore rather bizarre and apparently based on a set of facts and within a social and economic milieu that is difficult to discern.
In at least some other countries, such as NZ, planned homebirths require midwives who have tertiary training as such, who are a professional group, and have severe consequences if their standard of care falls below certain standards (as do doctors). Generally as a rule of thumb, a woman who wants a homebirth should pick her midwife carefully based on the midwifes experience and word of mouth etc, as one might also pick one’s obstetrician or doctor carefully.
In NZ, many thousands of births take place at low technology birthing centres every year (ie pain relief available, but no surgical facilities), and some have home births. Some women have hospital births, usually because those women or their babies might require high level of care and possible intervention, or because birthing centres are unavailable (eg to some rural women). the norm is that most women give birth within a very short distance of hospital services, the exception being rural women, who generally have many difficulties getting adequate medical care for all medical issues.
In all cases, the expectation is that if there are any concerns about the birth, the woman is moved to a hospital (for free, as are all birthing services here). Of course, not everything always goes well at birth, and quite rightly there should be an investigation when things go wrong (whether at hospital, in a birthing centre or at home) to ensure preventable injury or death to either mother or child are avoided. I suggest that a high level of training is important amongst both midwives and doctors to achieve this goal. We have had many debates around standard of care provided by both midwives and doctors, and I think such debates are important in ensuring best practice by all clinicians, as ultimately we all want the same thing: a healthy mother and a healthy child.
I do not see the American model of birth or health services as one to aspire to. I find the severe reprobation of women who give birth at home strange and judgemental (and I include Dr Isis here) to say the very least.
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August 25, 2011 at 3:05 pm
The fines for not using a car seat are a fig leaf ($10 to $150, but mostly $25 or $50 depending on the state, taxis in NYC for one are exempt). If you believe the Freakonomics guy, or don’t care about your kids’ safety, it is probably cheaper (in cash anyway) to risk the fine then buy a carseat. I really don’t think the fine is what gets people to use car seats. I can’t imagine homebirth would be any different.
There already is social pressure against homebirth for the vast majority of Americans. You ask if I am willing to risk a slippery slope on my rights as an independent person to combat the very tiny problem of women intentionally giving birth at home. My answer is no. “FFS the day of birth is one place I’m full willing to let the slippery slope in support of right wing wackaloonery start” certainly doesn’t imply a public health campaign.
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August 25, 2011 at 3:27 pm
So your “rights as an independent person” trump death or permanent brain injury of another person, eh?
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August 25, 2011 at 4:43 pm
Should we encourage sensible birthing practices? Of course.
That rather overlooks the question of what “sensible birthing practices” are — since this is the subject of $DAUGHTER’s research, I have learned humility on that subject.
However, if anyone is remotely thinking about some sort of enforcement, I anticipate a host of obstacles. Not least of them it’s pretty freaking insane to sanction the impoverished mother-by-rape who can’t afford the obstetric care you insist she purchase (to pick one extreme example.)
Then there’s the “we really meant to go to the hospital, but by then it was too late” gambit. Given that one of my brothers was born in the backseat of a car on the way to the hospital, I know damn well that this one happens. Hell, I know a couple whose OB after her first insisted that they learn how to do it at home, because the first was less than two hours from first contraction to “here’s you son” and the next was almost certain to be too quick for any other approach.
No easy answers.
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August 25, 2011 at 4:53 pm
Yep–I already exist. If I were to get pregnant again, any fetus I carried would not exist as an independent entity until birth. I’ve already said that I am totally fine with encouraging hospital births and trying to convince women to have all the recommended medical care before and during the birth. I am not willing to risk that laws about choices in childbirth won’t become a slippery slope sliding backwards into during the gestational period. And I don’t think doctors know everything. Women in labor should have the right to refuse treatments, especially when we don’t actually know if the intervention is necessary or beneficial (ie continuous fetal heart rate monitoring in a low risk, normally progressing labor).
I have 2 kids that I wanted and loved from the moment I knew I was pregnant. But the truth is that if it came down to me or one of them while I was pregnant, I would have chosen me (and luckily, I didn’t have to make that choice). It frightens me that the choice may some day no longer be my pregnant child’s (or their partner’s). Ignoring the whole abortion debate, for some unlucky pregnant women in the US who WANT the child they are carrying, the time when someone else chooses what health care they themselves must accept is now. My preference is that this remain a rare aberrant event, but giving in right-wing wackaloonery on childbirth could make this more common (women who smoke should go to jail! women who have preterm contractions should do whatever their doctor says regardless of whether there is proof it works! drinking coffee while pregnant should be illegal! laboring women don’t want c-sections for frivolous reasons–they should just submit!)
For example, were I to be unlucky enough to have a 24 week preemie, I would like the option to choose palliative care rather than full resuscitation, since even the best NICU care for such undeveloped babies is unfortunately torture, and the odds of survival (let alone an independent existence) are small. Thanks to the religious right, this is no longer an option in at least one state (and probably more–not sure if the law on this is state by state).
In Isis’s blog post, she says increasing the neonatal death rate from 0.3% (in hospitals) to 0.6% (homebirth) would lead to 12,948 dead babies. But that assumes everyone chooses homebirths. According to the CDC, there are less than 50,000 homebirths per year in the US vs 4.2 million total births. How large a problem is this really that it requires legislation that has much broader implications for pregnant women?
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August 25, 2011 at 4:53 pm
PS Yes, I am procrastinating!
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August 25, 2011 at 4:55 pm
As crazy as I believe home birth is, I’m not willing to take away this choice from a competent woman.
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August 25, 2011 at 5:08 pm
I didn’t know the back story until I clicked over to the freakanomics site. I thought you were going to refer to circumcision– and assert that the choice should belong to the individual, not the parents. I know that’s a whole ‘nother can of worms in the US.
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August 25, 2011 at 6:05 pm
funny, right wing wackaloonery tends in the opposite direction. from conception, that’s some sacred shit. but as of the day of birth, they don’t give a flying fuck what you do or what happens to the kid.
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August 26, 2011 at 4:45 am
Actually Ali, the back story is http://isisthescientist.com/2011/08/23/your-home-birth-is-not-a-feminist-statement
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August 26, 2011 at 6:40 am
“So your “rights as an independent person” trump death or permanent brain injury of another person, eh?”
First, yes. As a legal principle, you cannot require one person to die for another. You cannot even ask them to risk death or have their ‘quality of life’ infringed- if I need a kidney, you are not legally obligated to give one to me. Even if you simply need a blood donation, if no one donates, you die.
This is the society we live in, and it’s largely because of slippery slope issues with utilitarianism. How do we decide who needs a heart more?
You cannot legally force a pregnant woman to endure any manner of medical treatment to save her fetus. And it’s not about where you draw the line of life- you also cannot force a father to donate part of his liver to save his newborn.
Second, we’re not even talking about death or permanent brain injury, but a (significantly) elevated (although still small) *chance* thereof. There is a *chance* of death or permanent brain injury in older women getting pregnant. The rate of downs syndrome (100% mental retardation) goes from 0.2% (mother age 30) to 3.6% (mother age 45). Should all older mothers therefore have CPS come investigate and/or fine them?
There is a *chance* of death or permanent brain injury in any number of pregnancies where a doctor, ideally, would want bed rest. Does that mean that women who are unwilling to do the bed rest thing for 6 months of their lives should have their kids taken away, or should be blamed if something goes medically wrong?
@prodigal academic- yeah, and Isis made an uncorrected typo- the figure should 1,295. She was an order of magnitude off.
An order of magnitude that is IMPORTANT, particularly since there are scientists out there claiming that if only we got 90% of women to breast feed exclusively to 6 months, we would see 911 fewer dead babies a year! (http://www.ncbi.nlm.nih.gov/pubmed/20368314 NB: I consider this science a kinda sketchy, but for the sake of this argument, I consider it a lot less sketchy than assuming ALL births in the US would ever be homebirths)
So the slippery slope could easily go in the other direction- with mandated breastfeeding.
Or with CPS taking parents to family court (where the burden is “what is in the best interests of the child” not “you are innocent until proven guilty beyond a reasonable doubt”), for leaving your kid with an “unrelated adult” (http://perezhilton.com/2011-08-24-a-judge-says-a-gay-mans-kids-cant-stay-with-his-husband) or for allowing your kid to ride in cars, swim in a pool or a lake, climb a tree, play sports (especially football!), enter a building that has a second story…
Parents decide what’s best for their kids all the time. Up to and including things with some risk of permanent brain injury and death.
Our society is, collectively, completely irrational about risk. We accept some comparatively extremely risky things because the benefits (even if they are rarely lifesaving) are HUGE (e.g. car travel). We accept other things that have no unique benefits (e.g. football) because of tradition.
I think what’s really going on here is that the perception that women just wanna have a beautiful, spiritual happy unicorns MF carebear teaparty birth is not a “right” that anyone can take very seriously.
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August 27, 2011 at 10:52 am
No, that is the number after the typo is corrected. It’s based on the last census numbers and 4,316,000 births in 2007. Assuming all were born at home, and that delivering at home elevates risk 0.3%, that 12,948 more dead babies than if they were born in hospital. The original error occured because I multiplied by 0.3 instead of 0.003.
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August 27, 2011 at 2:07 pm
The only thing useful about your tl;dr becca is the last sentence. That’s all the interesting questions ever are. Is x worth y? Where y is something of a cost, hindrance, transgression, etc. The rest of your examples conveniently overlook the many cases where parents are very much coerced or forced to do something against their preferences. The principle is established.
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August 27, 2011 at 2:45 pm
My bad. If we accept the Wax et al meta analysis, if all babies in the US were delivered at home, that would kill more children than lack of breastfeeding, drowning, motor vehicle accidents, and cancer combined.
So if as a parent, you breastfeed, feed your kids organic food to keep them away from carcinogenic pesticides, put them in a car seat, and teach them to swim, all to protect them from death, it would be totally inappropriate to think of homebirth as safe.
Of course, if you’re like me and your kid ate formula from week 3, regularly eats supermarket strawberries in the store, got carted around this week in the backseat of a pickup in a modified bikeseat… then maybe you a different frame of reference (NB- I am teaching my kid to swim, but not to keep him from death-indeed, the illusion of swimming mastery is probably a pretty bad risk factor for drowning- but just because swimming is awesome)…
ZOMG! I hear you say, HOW CAN ANY FRAME OF REFERENCE MAKE 12,943 DEAD BABIEZ SEEM OK?!!!!
So it might be worth factoring in that 12,948 is still ~16x fewer than the number of infant malaria deaths (just those due to infection of a pregnant woman; not counting the more common childhood malarial deaths). Infants in the US are just pretty much spectacularly safe.
*insert standard obligatory comments about which babies matter*
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August 27, 2011 at 4:46 pm
Why, Becca. Is that baby made of straw?
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August 28, 2011 at 10:08 am
Isis- It’s incredibly privileged to care about these levels of risk. I mean, I think even you get that.
And whether or not she sings along with the scarecrow in the Wizard of Oz, I did not construct Tuteur out of straw. She described homebirthers as “Western, white women of privileged classes, they believe that they speak for all women because all women have the same needs and desires.”
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August 28, 2011 at 12:29 pm
regularly eats supermarket strawberries in the store
This strikes me as totally obnoxious. First, it’s unhealthy for anyone to eat unwashed produce in the grocery store. It’s not just an issue of pesticides; you don’t know which stray animal or dumbass prankster decided to take a piss on the crates before the tired grocery store employees hurriedly hauled them inside and hefted them onto the shelves. Second, I don’t understand why you can’t wait until you’ve purchased the berries and returned home. Finally, as long as you’ve broached the subject of “privilege”: my mother would have never allowed me to do such a thing, baby or no. Just as a bright white lad cracking jokes or questioning the teacher in class is said to be “feisty”, “inquisitive” and “assertive” while a bright brown lass attempting to do the exact same thing is described as “aggressive”, “uncomprehending” and “impertinent”, a white baby gnawing on unpaid-for strawberries in the grocery store is “cute” while a brown baby doing the same thing is a welfare-queen-and-shoplifter-in-training. I really like you, becca, but sometimes your comments irritate me to no end.
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August 28, 2011 at 3:19 pm
“Second, I don’t understand why you can’t wait until you’ve purchased the berries and returned home. ”
Sorry it irritates. Truthfully, I’m not best pleased with it.
I could wait to get home from the store (actually, I tend to wait until the privacy of my car for raspberries. I might be a little insane for raspberries). However, my two year old? Not so much. Believe me, he’s more obnoxious to the other shoppers when he doesn’t get the berries.
For what it’s worth, my baby isn’t white, and his dada (african and korean) was the one to initiate the precedent. It has been interesting to note the different areas in which his dada and I are sensitive to public mortification. I am generally radically more sensitive than he is.
My point was that I consider the odds of my kid dying from the behavior were acceptable to me, not that the behavior was ideal (or even particularly defensible).
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August 28, 2011 at 4:05 pm
becca — Forgive me for trying to understand the logic of your post (@2:45pm), but are you suggesting that it is OK to ignore risks of home-birthing etc, because children are dying in Africa? Or that it is even morally superior to ignore these risks, because caring about them is a sign of “privilege,” which is to be eschewed?
Additionally, you seem to be suggesting that if a particular parent’s frame of reference involves exposing their children to a wide variety of risks, then it is OK for that parent to ignore the risk of home-birthing etc. Thus, we are to define deviancy down for increasingly neglectful parents? Shouldn’t it work the other way around?
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August 29, 2011 at 6:38 am
My point is, *from an individual’s perspective*, risks of birth are very, very low in this country, “compared to the vast majority of humanity’s experiences with birth historically, and in many places even today”. It’s an exercise in perspective. We can care about small risks and big risks at the same time- I am not making the argument that we can’t try to cure malaria and worry about why the US has such a high perinatal mortality rate for a developed nation. At the same time, it is helpful to realize that you can have the risk of something *doubled* and it’s still a small risk, from an individual’s perspective.
As a parent, it’s easy to worry about pesticides on strawberries and getting to an accident driving from one campus building to another while your kid is in a bikeseat. I do advocate a model of parenting where parents are not held up as terrible people for making high risk decisions. It’s ok to tell them their decisions are high risk, it’s not ok to call CPS over strawberries. Or even home birth.
In addition, while it’s ok to tell people their decisions are risky, it may be more ultimately effective to ask them what the emotional drive behind those decisions are. If you find a way to come up with shopping carts that actually entertain my kid, or want to enforce a rule that car repair places actually have to return my car in a timely fashion, I will not feed my kid unwashed strawberries or drive in the pickup where I have no carseat.
From a population perspective, I understand why public health advocates are extremely unhappy that homebirth seems to be increasing. At the same time, I think that 1% of births in the US are a relatively inefficient thing for public health advocates to campaign against.
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August 29, 2011 at 11:43 am
Becca– You did say that your partner was African and Korean on DuWayne’s eugenics post. That was back in 2009. This whole time, I thought you were teasing me. I am, after all, one of two or three black and Korean people in the entire country. 🙂
Believe me, he’s more obnoxious to the other shoppers when he doesn’t get the berries.
I cannot refrain from replying that my mother would have dealt with this by spanking the wind out of me instead. I am not suggesting that you do this. Rather, I am mentioning it because my parents’ sternness had a lot to do with the very real existence of what some people call “privilege”. However, I am the one who had the misfortune of being born in the 1980’s. Plus, I am guessing that your child doesn’t live in a predominantly white military community.
On topic: You have made clear your point that only 1% of births in the US will take place at home. I also get that many women have unpleasant or nightmarish experiences with their obstetricians. (My mom vehemently disliked the physician who attended the birth of my sister, with good reason.) However, that shouldn’t stop public health advocates from campaigning against a fantastically pseudoscientific effort to coax women to give birth on bath towels or in inflatable pools with naught but barely credentialed midwives or glorified psychics in attendance– as home birth was gleefully, uncritically presented in my undergraduate Female Sexuality De-Cal class. There isn’t anything inherently wrong with the desire to give birth outside of a hospital– after all, today’s US hospitals are in organization legacies of the Black Plague of 14th century Europe, and they may become de-centralized with 21st-century population growth and technological and medical advancements– but that New Age, pseudo-science, anti-science, “natural is sacred”, “women are designed to give birth effortlessly”, “MD’s only wanna chop you up” shit gets people killed.
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August 29, 2011 at 3:59 pm
Holy moly, do I love Juniper!!!
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August 29, 2011 at 5:10 pm
Yeah, Carebear was born in Korea and adopted by a black US family (who, incidentally, apparently spanked the wind out of him for just about everything). I used to think it was weird, until NPR did a story on adoptions by black families. The Korean war left a lot of unwanted kids, as racism in Korea was somewhat overt at the time. He’s not the only one in that category.
You may very well be one of of two or three of that racial background that was born in the US in the ’80s, though (at least I don’t know anyone to contradict it!).
And yes… I’ve gotta admit… “that New Age, pseudo-science, anti-science, “natural is sacred”, “women are designed to give birth effortlessly”, “MD’s only wanna chop you up” shit gets people killed.” is well put. Also, hilarious to me right now. That is pretty much the attitude that dominates the homebirth movement I’m familiar with on the internets.
There’s a lot about that I can’t really defend. Though I’m still stubbornly convinced that it’s simpler to use ‘nudge’ approaches (i.e. make it cheaper to deliver at a hospital) and work toward getting doctors respectful of all patients, then it is to try to talk sense into the granolafied. I mean really, after a certain amount of tofu, you can’t expect the human brain to function properly.
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August 30, 2011 at 1:24 am
That is what I have been thinking–1% of births means homebirthing is still a fringe phenomenon. I am all for public health campaigns to keep it that way. It was the
“there outta be a law” thing in the post that I object to.
The fact that homebirth is somewhat of a fringe thing (and that hospital births can be RIDICULOUSLY expensive) means that the usual figleaf fine thing (see seatbelt laws) is unlikely to lead to any significant changes in the number of deaths due to homebirthing, at a cost of encouraging <a href="http://www.guardian.co.uk/world/2011/jun/24/america-pregnant-women-murder-charges"this stuff. In a country where women have been arrested on murder charges for having a miscarriage, I find right wing wackaloonery much more of a problem than the woo nut jobs who think natural = safe (yes childbirth is natural, but so is hemlock).
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September 1, 2011 at 5:19 pm
So, I got HPV from one or another of my college-era acquaintances. The HPV turned precancerous, and a doctor removed a chunk of my cervix to make sure it didn’t spread. This type of surgery carries an increased risk of preterm labor, due to the shortening of the cervix, and associated increased risks to the fetus if preterm labor occurs. It is not a BIG increase, but it’s an increase. You know, sort of like from 0.3% to 0.6%.
Should I be fined, or legally barred from having children, because of the fact that my sexual choices in college led to an increased risk for any fetus I carry?
I’m sure some right wingers would think that I ought to be disallowed kids as a form of slut-shaming, but I am guessing that most of you would answer No. So, why is home birth different?
Fundamentally I am saddened that people who consider themselves feminists don’t see it as their job to respect the needs and choices of other women. If home birth isn’t as safe as it could be, to me that is a great argument for….improving the safety of home birth. Enough women have made it clear that they prefer that route, that to me the feminist response is to say, “How can we as a society help you achieve that goal safely and comfortably?”, not to scorn them for wanting something different than what you (or I) want.
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September 1, 2011 at 5:23 pm
Ps, becca, we may be raising the same child.
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September 1, 2011 at 6:31 pm
I am so delighted that you have returned from the land o the missing that I won’t answer that question. How’s it going??!!?
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September 2, 2011 at 4:38 am
Oh, pretty awesome, except for the part where we ended up on a late-night flight thanks to Irene, and then the airline lost our luggage, so we were waiting endlessly in the airport at midnight, and Small fell over and cut his eye open. Other than that, pretty good.
I wouldn’t want a home birth, but I think it’s somewhat akin to wanting a swimming pool, or a gun in the house, in terms of danger to the child. Not a great idea, but I’d rather people had the freedom to do it, and that doctors had the freedom to ask questions about it*, instead of it all being illegal. Better that we have campaigns so that people know to lock up their guns without ammo around, than to try to prevent it altogether. Better that we have campaigns so that women know to choose a CNM for their home birth, than to try to prevent home births. Better that we have birth control education to reduce unwanted pregnancies, than to try to ban abortions. You know, that line of thinking.
* I’m looking at you, Florida.
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January 29, 2012 at 8:11 am
Eine raue Präsenz gewährt eine bessere Integration rein das Gewebe zumal verhindert ein Verrutschen.
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