Lift Up Your Hearts!

I've noted before some of the problems with epidural pain relief during childbirth, and my latest reading, Lise Eliot's What's Going on in There: How the Brain and Mind Develop in the First Five Years of Life confirms my worries. Here are a few of her concerns:

• Every drug used for epidural anesthesia can diffuse out of the epidural space and enter the baby’s circulation. The good news…is that the total amount of drug reaching the baby is considerably lower than in systemic administration. Nonetheless, whatever dose does enter the mother’s bloodstream crosses quite efficiently to the baby’s circulation.


• Although many studies report no effect…on Apgar scores or cursory neurological exams, few of them have used wholly unmedicated mothers as a control group. Using more sensitive indices of infant behavior, some studies have found that newborns…are less alert, less able to orient toward stimuli, and less mature in their motor abilities than babies of unmedicated mothers. Greater exposure…makes babies jumpy and more irritable. The effects are most pronounced on the first day after birth, but some have been found to persist up to six weeks of life.


• The most common side effect of epidural administration is…a reduction in the mother’s blood pressure. Maternal hypotension is at least partially responsible for the fact that the baby’s heart rate often slows down for a while shortly after an epidural anesthetic is injected. If the mother’s blood pressure falls too low for too long, it can seriously compromise blood flow to the placenta, reducing the fetus’s supply of oxygen. These serious side effects are prevented by giving the woman fluids through an IV….If this countermeasure doesn’t work, another drug may be needed to prevent her blood pressure from falling too low and compromising the baby.


• Many studies have now shown that women who receive epidurals have longer labors, on average, than women receiving systemic analgesia. This is especially the case during the pushing phase…. Women receiving epidurals are more frequently diagnosed with dystocia, the failure of labor to progress, four times likelier to require forceps, and two or three times likelier to end up having a C-section, than women receiving systemic analgesia or no pain relief.


• Although most babies are not significantly affected, epidural anesthesia may compromise the health of the small subset of babies already at risk due to illness, prematurity, or a difficult delivery. Encouraging more women to have unmedicated deliveries would be better for babies, and for the women themselves, who would be exposed to fewer side effects, have shorter labors, and might be in better shape to begin breast-feeding and bonding with their babies right after delivery.

None of these concerns surprised me. What I did find astonishing was her report of the difficulty in getting reliable data on the adverse effects of epidural anesthesia relative to no anesthesia at all, instead of relative to other forms of pain relief: “There are simply too few ‘natural’ deliveries to enroll in a clinical study!” Upon reflection, I believe there are more mothers who chose unmedicated delivery than she implies, though I’m also certain the numbers are far lower than they would be if the public were better educated about the joys of natural childbirth and the dangers of anesthesia. Two additional reasons come to mind for the lower numbers available for study: Those who chose natural childbirth often do so for reasons that would also make them reluctant to have their newborns’ lives disrupted by clinical study. And, sadly, the hostile atmosphere frequently encountered by those seeking to avoid unnecessary medical interventions in the births of their babies often drives them underground, where they avoid observation for good as well as ill.

Nobody's Fool, by Richard Russo (Random House, New York, 1993)

I can't say as I recommend Nobody's Fool, since it's the kind of book that makes me want to wash my brain out with soap afterwards. However, I will admit that his characters are somehow so human (if not humane) that the sleaziness seems essential to their characters and not gratuitous.

The incentive for reading a book that would not otherwise have attracted me was learning that its fictional town of North Bath is based on Ballston Spa, New York, which is not far from where I grew up. It was easy to recognize Schuyler Springs as the real-life Saratoga Springs, and other places that I know (Albany, the Northway, the Adirondacks) are not disguised. Unfortunately, all I know about Ballston Spa itself comprises one family, one home, and one church, none of which is evident in this story, for which they all should be deeply grateful.

My experience reminded me of another time I read a book solely for its setting: Catcher in the Rye is set in Wayne, Pennsylvania, another of my home towns. That book was no better, though probably no worse, than this one. It's been a long time since I read it, and I have no intention of doing so again, setting or no setting, so I can't say for sure.

I'm reading an extraordinarily important and fascinating book: What's Going on in There: How the Brain and Mind Develop in the First Five Years of Life (Lise Eliot, 1999, Bantam Books). I'll probably end up making several blog posts out of quotations from this book, so here's a start. I always wondered why deliberate smiles, such as those manufactured for photographs or in an attempt to look more cheerful than one actually is, usually look so false:

There's purpose and meaning in all aspects of our lives, even the seemingly random incidents. We don't often have the privilege of glimpsing the pattern as well as I did last night.

Our local Target store has a two-layered system of checkout stations, which makes finding the best line a little more complicated than usual. After checking out several in the first tier that turned out to be longer than they looked, I found an almost-empty line in the second tier and headed for it. When I was almost there, a man popped up from another direction, striding determinedly toward my goal. Not wanting to fight him for it, I swerved and settled on the nearest available station.

While I was standing in line, a fellow customer looked at my purchases and asked, "Is that clear contact paper?" It was. "Where did you find it? I've been looking all over for it." She had come up empty at Wal-Mart and found nothing at Target. I was not surprised, as the first time I tried to purchase contact paper at Target I couldn't find it and neither could the clerks I'd asked for help. But I'm a seasoned clear contact paper buyer now, and upon entering the store had headed immediately for the sign that says "Small Electronics" and picked up the last three rolls. At the checkout line I was therefore able to hand one of the three to the very grateful woman and her more grateful daughter, who I'm guessing needed it for a school project.

It was gratifying to know there was a good reason for my comical, pinball-like bouncing around at the checkout stations.

Stargirl, by Jerry Spinelli (Alfred A. Knopf, New York, 2000)

My nephew is going into seventh grade, and this was part of his required summer reading. He didn't have much to say about it, not surprising since it's hardly a title, nor a story, I would expect to appeal to most middle school boys. Or girls, for that matter. At that age, I would have picked up the book, assuming it was a science fiction story, then put it down in disgust when I discovered what it really was.

I'm not sure who the target audience is for this book, since the setting is high school and the themes adolescent, yet the intellectual level seems more geared towards elementary school.

Nonetheless, when I picked up the book recently to check it out, I became intrigued when I discovered that the title character was homeschooled before making her way into public high school—and definitely not fitting in. So when my nephew left for home, taking the book with him, I borrowed it from the library so I could finish reading the story.

I also picked up a few more, similar, books (some by the same author, some not) for comparison. Back when our children were home, I read hundreds of children's books from the library, and was generally dismayed by the genre of modern adolescent school-based stories. Things haven't changed much. As the genre goes, this is among the better, so I almost hesitate to say I found it oftentimes insipid and vulgar. Compared to most of what is out there, Stargirl has much to recommend it.

Back to the homeschooling idea. I don't know if the author actually knows something about homeschooling and is distorting the idea to make his point, or if he is just using the idea as a device to explain why Stargirl is so different. How else to explain someone who is immune to peer pressure, works hard at being kind to everyone, and is unafraid to sing aloud in the school cafeteria? Certainly he gets one thing right: homeschooling allows ordinary parents to raise extraordinary children.

What I really can't understand is why Stargirl would be required reading at the middle school level, unless some teacher wanted an easy way to begin a discussion on peer pressure. For literature, we must stop feeding our students pap! We can no longer hide behind the fiction that they cannot handle more complicated reading. The Harry Potter books are longer and more complex, deal with difficult subjects, and are replete with literary allusions—and Harry Potter and the Half Blood Prince was on the personal summer reading list of countless children much younger than seventh grade.

In my nephew's case, he fit Stargirl in between Harry Potter and Dan Brown's Digital Fortress. Stargirl is okay. It was an interesting diversion. But something is wrong when the books a child reads for school are so much below the books he reads of his own accord. Wrong with the modern American educational system, that is—something is obviously very right with the child!

Janet is currently in Japan, preparing to teach English. Perusing an old diary today, I discovered an inclination toward that profession appearing much earlier in her life than I had supposed. The incident took place in the fall of her third grade year.

I've heard it said that the male human body has enough blood to power the brain or the sexual organs, but not both at the same time. I'm not convinced women are any smarter, but this news report about the Third International AIDS Society Conference on HIV Pathogenesis and Treatment goes far in proving the adage for men.

Anti-circumcision activists will be dismayed by the results of a study of more than 3000 South African men, which suggests that female-to-male HIV transmission may be significantly reduced for circumcised men. There's also plenty in the report to dismay anyone:

For the study, about half of the subjects were circumcised by medical professionals, and the rest remained uncircumcised.

[A]fter 21 months, 51 members of the uncircumcised group had contracted HIV, the AIDS virus, while only 18 members of the circumcised group had gotten the disease.

The scientists conducting the study can't be so stupid as to ignore the obvious: adult circumcision, performed shortly before the study, might have a dampening effect on the subject's sexual activity, thus contributing to the lower disease rates. I find the report meaningless, however, without an explanation of how this factor was taken into consideration.

All of the men received counseling on AIDS prevention.

Since most of "counseling on AIDS prevention" relies heavily on the mantra, "use a condom, use a condom, use a condom," this casually-stated fact should terrify all those who belive condom use to be the best approach to combating AIDS.

[Dr. Charles Gilks, of the World Health Organization] worried that [the results of the study] would lead many men to rush to get circumcised, and said the World Health Organization was racing to set guidelines for safe and hygienic circumcision.

I'm prepared to believe that some men would rather undergo a painful and risky procedure rather than restrict their sexual appetites to a faithful, monogamous relationship. (See above comment about blood and brains.) That they would willingly choose mutilation over condom use is beyond my comprehension, if not beyond that of the WHO.

This cannot be a detailed review, as too many of the people who read this blog have not yet read the book. But I will say that Harry Potter and the Half Blood Prince did not disappoint me. The fifth book, Harry Potter and the Order of the Phoenix, I had found tedious, and I was disappointed in that I thought J. K. Rowling had set herself up for a great ending which never came.

Not so with the sixth book. It held my attention from beginning to end, not easy to do when the competition is an adorable 20-month old grandson, a flock of other wonderful family members and friends, and a lovely converted houseboat on the Connecticut shoreline. It did help that I found Harry's behavior less obnoxious this time. There were a few annoying points—I never did care to read about the tribulations of adolescent love—but they were minor.

Grace, sacrificial love, and persistent hope for the salvation even of one's enemies show more clearly here than in previous books. As always, Rowling's great contribution to children's literature is that she does not sugarcoat evil, nor minimize the cost of the battle, yet still manages to produce a book full of goodness, hope, and fun.

This afternoon, searching for a birthday gift for my nephew, I ventured into long-forgotten territory: a Toys R Us store. Just as a child's growth is more noticeable to one who has been away for a while, so did I find the cultural changes represented by the toys and games to be startling. While there were a few of what I might call generic games, most were branded with characters from television shows and movies. Even the old standby, Candyland, now comes in Dora the Explorer and Winnie the Pooh (Disney version, of course) flavors. Back when I was a more regular visitor of toy stores, there were already a few media-inspired toys, but now the genre has exploded. I did not linger, but left with the impression that I would find more of reality at Weasleys' Wizard Wheezes.

Women who want to get pregnant are now being advised to avoid tofu and other soy products, at least around the peak times for conception. New studies have shown that even small amounts of genistein, which mimics the hormone estrogen and is found in soy products, cause sperm to lose their fertility.

Well, I guess that explains why 20% of the world's population is Chinese!

I've never read Al Franken's Lies and the Lying Liars Who Tell Them:  A Fair and Balanced Look at the Right, and frankly I doubt it will ever rise far enough up on my "must read" list to see the light of day.  For all I know, it's a great book full of interesting and useful information that would do me good to read.  But if so, why does it have a title that sounds like a pre-adolescent playground taunt?  That alone makes it hard to take the content seriously.  Someone needs a ghost title-writer.

Score one more for mothers. When you sang to your baby, rocking and bouncing him, or danced with him around the room, others may have said you were being silly. You may have thought you were just trying to keep your baby from crying. But what you were really doing was giving him his first music lessons. A Canadian study has shown that being moved to music helps babies learn rhythm. Just watching you dance is not good enough, by the way; the baby must dance, too.

This isn't high on the list of important things I have to do at the moment, but Jon challenged me and it looks like fun, so I'll see if I can come up with something reasonably quickly.

Total size of music files in my computer
About 500 songs, I have no idea how many hours, about 2.1 GB.

This is slightly misleading, as most of the music I listen to is not on my computer. What I've counted includes a number of recordings, compositions, and transcriptions of music featuring family and friends.

Last record bought
Prayer for Peace (Orlando Deanery Boychoir and Girls' Choirs), title song by Robert Kerr

Song that I am listening to now
Silence. No, not Simon & Garfunkel's Sounds of Silence, but the real thing, or what passes for it in this busy world. Sometimes silence is my favorite song, especially when I'm trying to concentrate.

Five songs that I listen to a lot or that mean a lot to me
Impossible to choose! But here is a representative sample:

Camille Saint-Saëns, Symphony No. 3 (Organ Symphony)

I Heard the Voice of Jesus Say/Star of the County Down (The link will take you to Horatius Bonar's words, but you'll have to click on the "Kingsfold" MIDI link to hear the right tune.)

St. Patrick's Breastplate (Irish tunes "St. Patrick" and "Deirdre" with Cecil Frances Alexander's translation of an ancient Gaelic poem attributed to St. Patrick. The link doesn't have the complete music, but will give you an idea.)

Kilkelly (Green Fields of America)

Non Nobis, Domine (unpublished arrangement by Linda Clary of Patrick Doyle's version from Kenneth Branagh's production of Shakespeare's Henry V)

5 persons to whom I am passing the baton
I'm not going to name names, but hope some people will add their own information in comments.

Like many Americans, we plan to spend this Memorial Day relaxing with friends. As good and proper an activity as that is, we would be wrong not to recognize the true purpose of this holiday. Those who have given the last full measure of devotion to our country died for more substantial freedoms than a three-day weekend.

Here is some information on Memorial Day by the Department of Veterans' Affairs.

And here is a link to our Veterans' Day tribute to all who have laid their lives on the line for our country, including two family members who died in World War I.

Who wouldn't want to be smarter, think more clearly, and be able to concentrate better? New Scientist has compiled a list of brain-building suggestions for everyone from students to senior citizens.  Some were new to me, some old hat, some intriguing, and some frightening:

• Drugs  This is a scary one.  Modafinil, officially prescribed to treat narcolepsy, keeps healthy people awake and alert on little sleep.  Students wanting an extra edge on exams are taking Ritalin for its concentration-enhancing effects.  No matter how much it's claimed that the drugs are not harmful, I'm extremely skeptical.  But if athletes will sacrifice their future for a little present glory, taking metabolic steroids despite the known risk, can performance-enhanced SAT scores be far behind?
• Food  We've heard most of this before:  Eat a protein-rich breakfast; they suggest beans or Marmite on whole grain toast, but perhaps we could get away with peanut butter.  Throughout the day emphsize fiber (improved cognition), B-vitamins (brain-boosters), eggs and yogurt (for building neurotransmitters),  colorful fruits and vegetables (antioxidants), and fish (brain-enhancing omega-3 fatty acids).  Avoid brain-fouling trans fats.
• Music  The jury is still out on the Mozart Effect, but the brain-boosting benefits of music lessons are clear.
• Mental Workouts  Exercises for improving memory help other parts of the brain as well.
• Physical Workouts  Regular exercise promotes brain growth and reduces brain-damaging stress homones.  Aerobic exercise, sedate walking, and yoga have all shown significant benefit.
  
• Sleep  Just what Mom always said:  If you don't get enough sleep, that extra studying is a waste of time.  Not only does sleep improve attention and concentration, but it gives the brain a chance to work in ways it can't when you're awake.  Sometimes a problem really can be solved by "sleeping on it."
  
• Not for Children Only  Contrary to what we were all told, even adults can grow new brain cells.
• Strange but True?  You might have more brain power than you think.  Volunteers in one study increased the strength of their biceps by 13% after 12 weeks of spending 15 minutes a day just thinking about exercising.  And neurofeedback, related to biofeedback, has enabled some people to use their brains in surprising ways, from improving musical technique, to reducing pain, to treating ADHD.
• Attitude A healthy brain is only one of the benefits of a positive, happy outlook on life.