Wednesday 11 February 2015

EPIDURALS


 I have recently read 2 paeans of praise for epidurals on Kveller, one from Jordana Horn , who really has skin in the game, seeing as she is expecting her 6th (kol haKavod, besha’ah tovah, or as someone told her, ‘G-d bless you!... G-d help you.’), and another from Renee Septimus, who gave birth around the time that I did, ie back in the day. So I, as mother of 7, felt I could make a comment or three.

Background: As a medical student in 1977 I did a 10 week obstetrics term in a major teaching hospital (different system in Australia) and I got to see all sorts of births and assist as well. And when I saw that epidural being introduced in (then) the minority of women, this enormous trochar and cannula (Medicalese for whopping big needle), inserted in the laboring woman’s back, I was agog and aghast, and I solemnly swore to myself that I would never have anyone do that to me. I nearly passed out just watching.

I am no good with procedures of any kind, neither doing them nor having them done to me; I wanted to be a psychiatrist after all. (Definition of Psychiatrist: Jewish doctor who hates the sight of blood. Hahaha. I digress.)

My first delivery was of twins at 36+ weeks, 34 years ago. My OB was an older guy, trained in London, who inserted a local anesthetic block (details available on request) and delivered the twins vaginally, the second twin breech, with 2 sets of forceps and the sort of skill that no longer exists. He was masterful; he only did stuff when he had to do it, and when he did, he did it well. I stuck with him for subsequent pregnancies despite the fact that he had the bedside manner of a fish, because I recognized and respected his awesome skill and cool head.

So yes, pain relief; but no epidural.

All my other babies were delivered vaginally with no instrumentation and no epidurals; I did have a shot of Pethidine (Demerol) on two occasions, but my last two, one babe of 11lbs and the last of 10.5lbs, with no pain relief at all, except prenatal yoga and what would now be called hypnobirthing. I’m not saying it was easy; it was hard work! That’s why they call it LABOR after all!

Big deal, good for you, I hear you say. Yes. There is a lot of Mazel (luck) in life, birth no exception. Yes, I was lucky, thank G-d. And I also prepared before each birth, with mental, more than physical, exercises; I had a lot of pelvic pain so all I could do was swim, and do very gentle antenatal yoga. The yoga teacher was more into the mental work than her title suggests and it was amazing.

Giving birth with full mental clarity and untethered to tubes and machines and monitors is incredibly empowering. The feeling of elation and triumph was indescribable. I felt like I had won 5 Olympic Gold medals.

Renee has stated that in 30 years she knows of no complication to mother or child from an epidural. As she knows and as we all know, anecdotes do not really mean anything in determining the safety of a medicine or a procedure. So what I am about to say also might not mean a great deal; but unfortunately, I have known personally 2 women who had dreadful results from routine epidurals. In one case, a 5th pregnancy, the epidural site developed an abscess which nearly resulted in the woman becoming paraplegic; fortunately, she recovered after months in hospital and eventually regained the use of her legs. But because she had been so ill, her baby had to be fed formula, unlike her other children whom she breastfed for 2 years. Thank G-d the child is well, but my friend did mourn the loss of the breastfeeding and the early weeks getting to know her baby.
In the other case, the poor young woman delivering her first child had a lethal allergic reaction to the epidural and could not be saved.  The baby survived emergency C-section.
These are very very very rare outcomes. Far more common are the terrible headaches which prevent a new mother from sitting upright, and may not resolve until a procedure called a ‘blood patch’ is used to stop the leakage of the cerebro-spinal fluid from the epidural site.
And there is some evidence that babies are affected directly or indirectly because there are negative effects on breastfeeding early on.

So although I cannot quote you statistics and figures, I can tell you that no procedure is entirely risk-free, epidurals included, and I believe that they should not be used routinely.

Let’s consider giving birth without drugs and intervention as a sort of Personal Everest: It’s a hard climb, but the view and the pride in achievement are incomparable. There are some people who can summit without oxygen- well, not everyone can do that. Sometimes you need extra oxygen or extra Sherpas; and sometimes you need to be Medevaced from base camp. It doesn’t always go according to plan, even with good preparations. But to labor (sorry) the metaphor, I think it is not good to avoid even trying on the climbing boots because you are afraid that they will hurt your feet.

I have heard Sheila Kitzinger talk of giving birth as one of the last truly wild and natural things that we can do in our civilized lives; she said something like, it is standing on a mountaintop with the wind blowing through your hair, it is magnificent, and it is ours. And at the time I thought, well, that’s a load of tosh; tell that to a woman having a hard time. But there is something in that image of a strong woman, whipped by the elements, screaming in triumph. It does get to me a bit; but it’s not for everyone, I agree.

We live in a time and place where there are marvelous medical procedures available, and that is a good thing. We have choices, and that is also a good thing. But when we choose to make interventions routine and commonplace, we see that the harmful side-effects also become more commonplace. 

And I believe we lose something of ourselves when our fear makes us give ourselves into the hands of detached professionals, when perhaps we didn’t need to.



Sunday 8 February 2015

Einat Wilf and the War of Words against Israel.

Today I heard a Defender of Israel speak about the war on Israel conducted with words, and what we can do about it.
Her name is Dr Einat Wilf, former Labor and Independent MK, and she spoke for AIJAC, and she is speaking tonight at Caulfield Hebrew Congregation. She is worth listening to and I urge anyone reading this to go hear her.
She, by the way, ticks every box. She is intelligent and articulate, well-credentialed with a PhD in Political Science from Cambridge, her English is perfect and her manner engaging. She is also young (44), beautiful, a wife and mother. While my mentioning this may seem rather trivial, the fact is that good looks and presentation count when putting forward persuasive argument; people listen. That's life. But as I say, she is also supremely informed and articulate, and that matters more.
I have excerpted a speech which she made in Dublin Nov 22 2014, because she more or less made similar points this morning and will no doubt make similar points tonight. But I still want you to go and hear her if you can.
We must all be Defenders of Israel in this war of words, in cyberspace and in the real world. Modern Israel is an idea which was willed into existence; today's attitude of delegitimization is attempting to insert false ideas of what Israel is into the psyches of people in an attempt to make Israel vanish. We must fight this every day. We must never let libels sit forever on the Internet, unanswered and unchallenged. We must all be cyber warriors; it is a real war.

Please read Dr Wilf's speech.

"What I want to do this evening is to lift the veil from what is really going on in the fight for Israel. This fight is not about PR, it’s not about criticism, it’s not about Israel’s image and improving it. What we currently experiencing is a war, and it’s not a war waged by means of tanks or airplanes or tunnels or rockets; it is a war waged by means of words and images and ideas. To some, this seems to be a war waged by means that are non-violent, and that is supposedly something we should celebrate, right? We speak so often about non-violent resistance. We think about leaders that lead non-violent resistance. We think about Gandhi, about Martin Luther King Jr. So we think that if the Palestinian means are also non-violent, then so too are their ends. But there’s no relation. You can have a violent struggle for a noble cause, and you can have a non-violent struggle for a very sinister one. And this is precisely what we’re seeing here. The cause is the same that it has always been, even when it is waged by non-violent means. The goal of this non-violent battle is the undoing of Zionism and the undoing of its primary and most important crowning achievement – the establishment of the State of Israel as the national home of the Jewish people.
There have been efforts to achieve this end by military invasions, by terrorism, by economic strangulation. All of them failed. Not only have they failed, Israel has emerged stronger from these challenges. Israel’s need to physically defend itself means that we have developed one of the best fighting forces in the world, and its society is mobilized to its own defense. The Arab boycott, meant to strangle the fledging Israeli economy, meant that we realized that we need to trade with the US and Europe and India and China. So, Israel is the only country in the world that does not trade with the countries that share its borders, and yet we have one of the world’s strongest export economies. We had no choice. Israel has also learned how to beat terrorism – not that it has been vanquished completely, but it has diminished to a point that we can continue to live our lives, enjoy our lives, and even celebrate our lives.
So, due to all our challenges, we have emerged stronger. But, the other side has never given up. Each time we successfully counter the challenges thrown at us, we have become stronger, and the Palestinians merely changed tactics. So, when people now celebrate that the other side uses diplomatic means, means of non-violent resistance, popular boycotts, we must understand that this is no reason for celebration since their end goal has stayed the same. The Palestinians have not given up on violence because they have seen the light and have realized that they are truly pacifists. Instead, they are renouncing violence because violence has failed them. So, they are trying something else. The Palestinians are currently waging a non-violent war for very violent ends. I call it the placard war. I’m sure you’ve seen those placards and demonstrations everywhere. They say “Zionism=…..”. Now you might know that Zionism = the inspirational idea of the liberation movement of the Jewish people, the return of the Jewish people to establish a sovereign state in their homeland. However, on those placards it reads Zionism= racism, colonialism, imperialism, apartheid, and (recently joining the group) genocide. People who know nothing about Israel and Zionism will believe these placards. And I have met these people in high schools and colleges around the world; Students who believe they understand the situation will ask questions like “What do you have to say about that apartheid wall?” I can assure you that many know nothing else. “What do you have to say about Zionism’s colonial practices?” they will ask. But they know nothing more about the situation.
So, this has been a very effective strategy for the Palestinians. Don’t be fooled. this has not been an accidental strategy. It has a clear purpose. The purpose is not criticism of Israel nor a discussion of the issues; the purpose is to paint Israel and Zionism as the ultimate evil. These words are chosen because they have become associated in the global mindset with evil. If Israel and Zionism are the ultimate evil, then shouldn’t people of good will do something to make sure that that evil is erased from the face from of the earth? Even the Nazis were convinced they were doing something good. Their minds had been prepared to such an extent that they believed that by eliminating the Jewish people, they were in fact serving the world; doing something good for the world, ridding it of a disease. So, if you think about it and history, the greatest atrocities have been preceded by the preparation of people’s minds. This is what we’re seeing today. This is the nature of this war.
Don’t think that it’s about independence for Palestine. If it had been about independence, this war would have been waged by other means and, by the way, Palestine would have existed a long time ago. This is a war that is waged to ensure that Zionism is rolled back, that the State of Israel as the national expression of the Jewish people no longer exists. People’s minds are being prepared for this reality. If Israel and Zionism are truly so evil, then something must be done. If you’re a person of good will – and I can assure you that many people who are involved in these campaigns believe that they are persons of goodwill- and you’ve been told day in and day out that Zionism and Israel are evil, then you do whatever you can to make sure that that that evil no longer exists.
This is the nature of this war. It’s amazing the extent to which it has been successful. Recently, a young man in a college in Virginia confronted me to ask what I had to say about the fact that Zionism is colonialism, I had to teach him a few basic historical facts. So, I asked him if he could name one colonial movement in history that was sent by no one to a country with zero natural resources – and I can assure you 150 years ago they didn’t know we would find natural gas. So, the history of modern day Israel is about  people coming of their own volition to a place with no natural resources, purchasing land, having an idea of working the land with their bare hands, and employing no one else to do it for them, and above it all in their minds, believe that they were coming home. I’m not aware of any other such colonial movement in history. I can tell you, this young man had no idea that this was the story of the birth of the State of Israel.
People speak of apartheid. But how many people are aware of the context, of the fact that there is a national struggle in which one side – the Jewish people – have been willing to settle for something (less than everything) and therefore they have something and another side which has refused to settle for anything other than everything, and therefore they have nothing. That is the essence of this national struggle.
Some people would give an excuse that there is an inflammation of passions given the difficult images we saw on television this summer. Let me explain something about these images. While they are harrowing, they are not accidental. They do not tell the story about Hamas militants operating from densely populated areas. Have you wondered why there are no images of fighting between soldiers and Hamas militants – but only “civilians” from Gaza?
Israeli soldiers returning from the battle saying “If this is not war, we don’t know what is.” They were fighting Hamas militants, well-armed by a combination of locally produced arms and Iranian-shipped arms, yet we saw none of that. Hamas had a clear strategy. Hamas knew that with all due respect to the rockets and the tunnels, the real war was taking place on the television screens in millions of homes across the globe. They knew this was the real battleground and they made sure they have a totalitarian control of the Gaza Strip.  They made sure that no image of Hamas militants crossed those screens. Journalists later testified to that. They [Hamas] made sure that no image of rockets being launched from near schools or densely populated areas were aired. So, all that remained on television screens were images of women and children dying. So, what is the story people see? They see that Israel is senselessly killing women and children for no good reason, just because it enjoys it – that Israelis are baby killers.
That is an essentialist argument; it’s not about civilians dying in war, it is about Israelis in their very essence being baby killers. Now, at least in the ancient blood libels, the Jewish people were blamed for killing children in order to use their blood to make matzos for the Passover Seder. I sarcastically say that at least when they made up this story, they also provided us with a use or the action. In this new libel, there is no purpose, just sheer enjoyment when perpetrating genocide. Well, sometimes things are so outrageous you need to use a little bit of humor. I don’t know how effective it is, but one of my favorite articles, albeit a mock article, I saw after the claim of genocide began to appear, was that Israel’s Minister for Genocidal Affairs had to quit over repeated failures. Again, I’m not sure that this is sufficient to explain the claims against us, but it does give you a sense of the frustration of what we’re being charged with because it’s not about inflamed passions, it is purposeful.
There are a lot of uses for blaming Israel for committing genocide. Let’s say that Israel was only accused of colonialism or apartheid. If you blame Israel for apartheid, then all you have to do is bring down the Zionist regime, but the Jews can stay. If you accuse Israel of colonialism, then the Jews need to go “home”, but they can live somewhere other than Israel. If you blame Israel and Zionism for genocide, nothing but total war for their annihilation will do. And then it also serves other purposes because if the Jewish people are committing genocide then the genocide against them was not so bad, even justified – retroactively justified. That’s another great use of this word association. Another completely accepted but wrong idea is that if the Palestinian people are experiencing genocide, then the word will give them a state and be on their side.
There is a phenomenon which I call 'Zionism denial'. We all know what is Holocaust denial. Zionism denial is the story that the State of Israel was given to the Jewish people – the remnants – after Europe realized it had failed in its Final Solution. They were given some random piece of land from its empire (because it felt guilty, of course) and that’s why the Jews have a say and that’s why they pushed out the Palestinians. As such, Europe has a responsibility towards the Palestinians because they are the secondary victims of Europe’s crimes. Well, this explanation is not only utter nonsense, it is the complete denial of the history of Zionism. Before World War II, Israel existed in everything but name.
Israel has come into being not because guilty Europeans gave it to them. Israel exists because the Jewish people willed it into being. This is the history that the Palestinians have yet to understand; that a state is not given, not handed over, you have to will it into being through positive action. This is the story of Zionism. But, if you tell the story of genocide, well, maybe a guilty world will give you a state and, in the process, get rid of the ‘genocidal Jews.’
If you think that these accusations disappeared with the summer, you are wrong. I just came from Belfast where I met a senior member of Sinn Fein who told me that the genocide Israel committed over the summer is a “shame, shame, shame”. I explained that Israel took unparalleled and unprecedented measures to limit civilian casualties, both its own and those of the other side. And then he said “we’ll agree to disagree.”’ And I said no, this is not a minor point of disagreement where we agree to disagree; you will retract what you said. And we were at it for a while until he had to end the meeting. But, this is the essence of how this war is being waged, and these things stick. If we don’t fight, they stick, and in the age of the internet what you don’t fight sticks and spreads.
If a Norwegian politician says that the Mossad was behind the shooting of the young Norwegians on an island and no one says anything because the story is insane, the misinformation will stick. If people say that Israel set up this remarkable field hospital in Haiti in order to harvest organs, that too will stick. So, we need to understand that this is the situation currently going on. Nothing less. And nothing here is accidental. Nothing here is about ‘inflamed passions’; it is with a very sinister purpose.
So what needs to be done? First, we need to recognize what this new war is all about: that the non-violent means say nothing about the fact that the end goal is a violent end. We must recognize the need to mobilize. That’s another reason I speak so highly of Boaz and Nurit [Israel's ambassador to Ireland, Boaz Modai and his wife, Nurit Tinari-Modai]: because they are mobilized. Not enough of our foreign service members are mobilized. We don’t need diplomats anymore, we need warriors, we need people to fight because this is a war. As such, we need your help to mobilize and to enlist. Now, when we have to defend ourselves physically, we established what was called the Israeli Defense Forces. Now, I argue we should create the IIDF, the Israeli Intellectual Defense Forces. This is what we need today. We need intellectual warriors; people who wield words and images and ideas to win this battle. The beauty is that each and every one of you can self-enlist. In fact, you are here because you have already self-enlisted, you have already done something to fight.
This is a long haul battle. While we have emerged stronger from all our challenges, it didn’t happen overnight. It took us 25 years to get the militaries of Arab countries to finally decide not to try to mobilize their militaries against Israel. It took us decades to build Israel’s export-based economy; it took us decades to figure out how to deal with terrorism; and it will take us a while to win this war, but we will win and I will tell you why. I will first tell you what victory will look like because you might wonder what victory looks like in a war of words and images and ideas. Victory will come the day that those who hold anti-Zionist views, that those who hold the placard with views that I discussed, will have the social acceptability of neo-Nazis. That’s my definition of victory because right now they enjoy social acceptability. You have already taken the first step by being here tonight. This is where it starts, and then it becomes bigger and wider. However, right now the other side has the social acceptability. That is the entry into polite society. It’s almost difficult to preserve your place in polite society when you speak for Israel. That has to be reversed. That is the essence of victory.
And we will win, ultimately. After making many mistakes in the process, and after it is going to take us quite a few years, but we will win for the same reason we have won all the other wars and challenges: because we have no choice. Ultimately, I will say that if there is any war that the Jewish people and their friends around the world should be able to win, it is a war of words.
Thank you."


Monday 2 February 2015

WIPED.

When did the 'wipe' take over our lives?

Back in the day there was this thing in a plastic canister called 'Wet Ones' which could be used on the go to clean hands or faces or, if you risked it, babies' bottoms , because they could kind of spark off a decent nappy rash; they were a bit acidic or not acidic enough, or they had some preservative, something. Also the packaging meant that you could easily get tour finger stuck in the dispensing outlet, trying to pull out a recalcitrant sheet, and it wouldn't let go without gouging you, the cross cut pieces of plastic acting as finger trap.

Finally, there was the flat pack interleaved style of wipe, rather than the perforated joined ones which meant that, instead of pulling out an endless festoon of wipes, and then needing a third hand to detach one or two while holding a wriggly baby on the change table, one could just pull out one wipe at a time. Usually. And then the wipes got bigger and thicker and more de luxe, until we have today's offering which can not only gently clean a baby's delicate tushie, it can also spot clean food stains on ties or lapels, clean faces and hands, actually, clean almost anything.

But we don't need to use baby wipes to clean the house with because there are 1001 other kinds of wipes for home and personal use. It's gotten a little out of hand.

For example, in my toilet, there is one drawer with flushable adult tushie wipes for that oh-so-clean finish; and in another drawer, I have flushable toilet cleaning wipes, just to touch up the porcelain between cleans. DO NOT, I repeat DO NOT confuse the two. That's why I keep them in separate drawers; you do not want White King on your delicate areas.

In my bathroom I also have make-up removing wipes, which do speed up the night time facial routine but you're a fool if you think that they really clean your skin, because all they do is take off most of the makeup; if you want clean, toned and moisturised skin, then that takes a bit more effort, ladies. Sorry.

In my laundry are antibacterial wipes, Gd knows what for, as if there isn't enough chemical residue on kitchen surfaces; stainless steel cleaning wipes (they don't work); leather cleaning wipes (ditto) and glass cleaning wipes which claim to be streak-free! (they're not). Clearly this foursome won't be replaced when they run out/dry out from lack of use.

I've seen wipes for little faces, little hands and little eyes. I've certainly used my share of 'moist towelettes' on planes.

And I have also seen the most useless invention ever created: the baby wipes warmer. So babykins doesn't get a chill when you clean her bot-bot. This is up there with knee protectors for crawling infants as a symbol of how clinically anxious parents are creating a generation of namby-pamby kids who will have no tolerance for any level of physical and mental discomfort, and eventually will out-anxious their parents. Not to mention, it's another way to make money off new parents.

I think it's time to reclaim the 'Damp Cloth' aka 'Shmatta'.
Think about it! A cloth, e.g., old torn up T-shirt or flannel nappy (remember those?) dampened with warm water is actually very effective in cleaning little kids' faces and hands! If you keep one end dry, then you can use that to dry said body parts after! Revolution.

And a Shmatta is great for wiping down porcelain, kitchen surfaces, high chairs, you name it. You can use plain water! Or some sort of mild cleaning spray! You don't need 'antibacterial' products because they are actually counter-productive. If you kill '99% of germs' that means that you are leaving 1% of the real tough buggers alive, and they will reproduce, and through a process of selection, over time you will eventually create Super Germ. You are much better off just washing your hands and things with soapy water and rinsing and drying. Bacteria can't grow on dry surfaces.

I will, however, concede as to the vast superiority of the modern baby wipe for cleaning poo-ey baby bums, especially when on the go. I think we will keep those. And the adult tushie wipes. (Although they probably aren't so great for the environment, but that's a whole other topic.) But it's either those, or everyone gets bidets. And that won't happen.

But apart from that, maybe it's time to wipe the wipes?