Back Pain = Cesarean Sections

 Australia trials sterile water injections for laboring back pain in an effort to drop 30% c-section rate.

Interesting.  I would not have thought that a woman's experience of back pain in labor is a significant contributor to the high rate of c-sections.  Although of course epidurals increase the likelihood of a c-section, so pain that causes a woman to request/accept an epidural would account for some of that... Well.  We shall see. 

A shoutout for the Science & Sensibility site

Science & Sensibility » The NIH VBAC Consensus Conference: Will It Pave the Road to Hell with Good Intentions?

I recommend this blog post as a brief, yet sensible, look at vaginal birth after cesarean (VBAC).  Thank you for presenting the data in an intelligent (read: non-panicky) way. 

Shackling pregnant women

Ok, I have been trained in security, so I understand some of the concerns, although they were overblown.  But this was an atrocity. 

Arrested woman shackled during labor and postpartum recovery.

Also, Arnold Schwarzenegger's veto.  Really?   

And no, this is still not the controversial post I promised.  Just building the anticipation. 

Getting Away With It

Disclaimer: This is not the controversial post I have promised.  I am still working on that one.  Read this one anyway. 

I have a liking for the quirky, hidden side of science.  I had a ball reading Bill Bryson's A Short History of Nearly Everything.   I snigger far too much at the science in-jokes incorporated in Terry Pratchett's depictions of the institution and the wizards of Unseen University.  I really like Holly Tucker's work.  In that vein, I expected to be thrilled with Jena Pincott's blog.  Pop science, yay!  Good credentials, reviews and a fellow liking for the quirky, hidden side of science.  Unfortunately, I stumbled across a problematic blog post in my very first read.

In my usual spirit of zeal for accuracy, I set about commenting on the post.  I was pleased to see Pincott make corrections to her post.  She removed some problematic material and made the following statement:

"Note: A previous version of this post contained a reference to NFP, the Catholic Church’s form of birth control. NFP techniques such as cervical mucus and basal temperature readings, etc. are much more reliable than the rhythm method. "  

I am very much heartened by the correction and glad my initial positive impression of Pincott hadn't collapsed in ruins.  I do intend to keep reading her blog and have put her science, technology and history books on my buying list.  This incident has given me food for thought, however, at how quick people are to casually mischaracterize or disparage the Catholic Church based on very little or no evidence - in this case, the idea that the Church is promoting the rhythm method despite its hideously poor efficacy seemed based on a misreading of a casual, blog style article in an online Catholic publication.  And I was concerned that an otherwise well-read, science-savvy author could be so incorrect regarding the main characteristics of the rhythm method as opposed to other methods, and the current efficacy rates of NFP methods (as published in reputable secular journals and books).  And that "natural family planning" is not actually a method, but rather a simple descriptor for a range of non-contraceptive family planning methods.  

(Note: I am no longer speaking of Pincott, but in general.)  When these kinds of egregious errors crop up in the work of well-educated, experienced authors, it seems to be symptomatic of the busyness blog writers.  It is, after all, a medium which doesn't call for the careful attention to detail that a journal article or other published work might.  But it is also common to find usually reasonable and careful people fall into accepting whatever negative interpretation of Catholic teaching or idea about the Catholic Church that happens to cross their path.  I have noticed that some of my most intelligent and nicest friends have an unthinking aversion to anything Catholic or demonstrate the kind of discrimination that would appall people if it were associated with religious minority groups.  Usually, if I challenge them, they correct their statements or adjust their views according to the new information or how persuasive my arguments are.  

But the fact that it happens so often leads me to speculate that it's a matter of Getting Away With It.  It is popular to disparage the Catholic Church (and the Lord knows the Church deserves criticism in at least those times and places where it has failed its own mandate).  However, Catholic-Church-bashing is so popular that some of the worst sectarian anti-Catholic propaganda is being published in normally respectable publications.  It's quite possible to get away with an alarming amount of bigotry.  The trigger for this blog is by no means an example of that, but the wider environment does make it easy to adopt a casual attitude when it comes to mention of the Catholic Church.

So, for those interested in the nitty gritty stuff, below is (something very like) the comment I submitted.  This old MacBook is getting glitchy, so I couldn't view my comment on Pincott's blog.  The one below is recreated from memory.

=====

 

Interesting information regarding male hormones/pheromones and their possible influence on the female reproductive cycle. Thanks for linking to the journal articles.

A few thoughts:

What do you mean when you write "early ovulation" - does this mean earlier than might occur if the woman did not have a spouse/sexual partner? I doubt that's what you mean, as it would be quite a strange standard from which to be determining what "early" ovulation may be, since the situation of reproductive women so commonly includes intimate interactions with men. Wouldn't that show in a long run of "early" ovulations, since the woman may well be living intimately with her partner on a daily basis, and which would then be "normal" for her in her situation?

Of course, I don't imagine you mean the release of an egg significantly (weeks!) ahead of normal time, either!

My reading of this post may be flawed, but you seem to suppose that barring the effects of male hormones on a woman's cycle, she will normally experience very predictable, regular cycles - this is cited as the reason the rhythm method doesn't work. However, it is normal for a woman to experience some fluctuation in her cycles - even if she is usually regular, she may experience occasionally some cycles that are "out" with earlier or later ovulation than expected and this can be due to a variety of factors - stress, illness, diet etc... In other words, "life." This is expected in most natural family planning methods of which I'm aware.

None of the major modern natural planning methods (e.g. the Creighton, Billings, Marquette, Sympto-Thermal, Lactational Amenorrhea, Two Day methods) assume a clockwork reproductive system. There is one modern method that began in 2002 that uses a "counting days" system, called the "Standard Days" method. It uses a set formula to determine the start and end of the fertile phase. There is more abstinence with this method, precisely to account for the variability of a woman's cycle, and it can only be used by non-lactating, non-perimenopausal, regularly cycling women whose cycles are not unusually short or long. They track fertility on cycle beads and days of fertility are days 8-19.

You do not seem to know the difference between the "rhythm method" and "natural family planning." The rhythm method has not been renamed. It is simply one of the methods that form a subset of "natural family planning (NFP.)" NFP is really an umbrella term for a variety of methods. You are incorrect in your explanation of NFP - the rhythm method has not simply had mucus and temperature observations added to it. The rhythm method relied on a calendar/counting approach, which is not compatible with the flexibility entailed with the addition of mucus and temperature observations. An algorithm that might be used with some mucus/temps based methods is not properly comparable with the calendar approach of the rhythm method. In fact, as stated in the Catholic article to which you link, the calendar-rhythm method seems to be no longer taught, due to its very poor efficacy rates and the fact there are far more efficacious methods available.

"Despite the rhythm method’s high failure rate, the Roman Catholic Church [sic] continues to promote it."
The Catholic Church promotes NFP as a morally licit way for Catholics to responsibly space or limit births. As an institution it its teaching it does not specifically endorse any one method. It speaks only on moral matters relating to its wider theology. In practice, the Church-affiliated NFP instructors in most dioceses belong to the Couple-to-Couple League (Sympto-Thermal Method) or teach the Marquette, Creighton or (less commonly) Billings methods.
The Catholic Church would be fine with a couple's decision to use the rhythm method, if they so choose, whatever its efficacy. However, the Catholic Church is also fine with a couple's decision to use NFP methods with much higher efficacy.

And on that note, "Contraceptive Technology" (2004) states that the perfect use effectiveness of NFP in preventing pregnancy ranges from 97-99+%.  For a better breakdown of more methods:

Correct Use Typical Use
Chance 85 85
Spermicides 18 29
Withdrawal 4 27
Ovulation Method 3 19 (25)
Condoms 2 15
SDM 5 12
Marquette Method 0.6-2 11-12
Symptothermal 0.4-2 8 -11
Pill 0.3 8
IUD 0.1 0.6

*Adapted from: Trussell J.
Contraceptive failure in the United States.
Contraception. 2004;70:89-96
As posted on the MM website.

As you can see, modern NFP methods' efficacy rates are comparable with many popular contraceptive technologies.

For more information about NFP efficacy compared to contraceptive efficacy, you could see Klaus, H. "Natural Family Planning: A Review. OB-GYN Survey 37 (February 1982):128-150; updated edition 1995, published, NFP Center of Washington, D.C., Bethesda, MD; and Fu, et al. "Contraceptive Failure Rates: New Estimates from the 1995 National Survey of Family Growth," Family Planning Perspectives 31 (March/April 1999): 56-63. For a thorough discussion of the difficulties regarding scientific studies on the effectiveness of NFP see Kambic, R. "The Effectiveness of Natural Family Planning Methods for Birth Spacing: A Comprehensive Review" in Girotto, S. & Bressan, F. (eds.) Human Fertility Regulation: Demographic and Statistical Aspects. Verona, Italy: Edizioni Libreria Cortina Verona, 1999 (pp. 63-90).

For more cutting edge information, the NFP researchers at Marquette University and Georgetown University have been publishing peer reviewed studies on efficacy and related matters in recent years. Creighton University is currently embarking on a large study looking at intentions, use and efficacy and results may be a few years away.

Giving the calendar-rhythm method's efficacy rates and then equating all modern NFP methods with it is a blatant bait-and-switch. I admire your work; I am a fellow lover of the quirky, hidden side of science. I hope your professionalism drives you to make the appropriate corrections to this post.

Prepare Ye

No Godspell revivals, I'm afraid.  Just a pagan papist preparing a return.  Having two very small children inhibits my blogging.  (However do those mommy bloggers do it?) 

However, now I've worked out a time solution that does not involve selling, giving away or otherwise neglecting the little people in the house. 

So gird your girdables in anticipation of my belated next blog post.  Warning:  I shall be controversial.

Pause for thought.

I read this blog post and all the comments following:

Birthfaith on Pitocin 

What struck me most was the comment, "Pitocin use at birth has really been studied relatively little, considering how prevalent it is."

The sad history of some routine birthing procedures in medicine - the lithotomy position and episiotomy are the first that spring to mind - leaves me more disheartened than hopeful.  

Specifically Catholic - a call to charity among the non-contracepting

Many people have claimed to me that the Catholic Church teaches that Catholic married couples can only avoid pregnancy for "grave reason."  

The Church does not teach that “grave reasons” are needed before using NFP to avoid pregnancy.   That is a mistranslation, however commonly repeated it may be.  And it is a line spouted over and over again.   

Humanae Vitae is the most authoritative and arguably most important statement of the Magisterium about this.  In the official Latin it cites seriis causis (“serious causes” or “serious reasons”) as necessary for the intent of a married couple to avoid conception to be licit.  That is, a couple needs something more than a trivial or selfish reason to avoid pregnancy.  This reason does not have to rise to the level of super-serious or life-threatening, which is what most English-speaking people imagine when they hear the word "grave."  

In addition to Humanae Vitae, there is also Pius XII’s October 29, 1951 address to Italian Catholic midwives.  The most relevant paragraph – in the original Italian – first mentions serios motivos – “serious motives.”  The text does also, at the end of the preceding paragraph and later in the relevant one, mention "grave motivo" and "graves razones."  The translation of the Italian grave(s) as “grave” is more excusable than the translation of the Latin seriis or the Italian serios as “grave.”  However, it is still a mistranslation.  The Italian grave (and the Latin gravis) essentially mean “heavy” or “weighty” – as opposed to “light” or “trivial”.   In other words – “serious.”  Furthermore, it is fairly clear from the wording of the paragraph that Pius is using graves as a synonym for serios – i.e., “serious.” In addition, one has to read that address in the context of his November 11, 1951 address to the Congress of the Family Front and of the Association of Large Families.  There he says that the moral limits surrounding the avoiding of pregnancy by natural means are “truly very wide."  Thus, they would encompass all those reasons that would be called “serious” – not merely a small subset of such super-serious reasons that would in English be called “grave.”

The Church calls couples to be generous to life, but also to discern how many children to have based on their relationship with God, spouse, and with children already born, and their obligations to society.  The answer will be different for each couple.  For some, a family of 13 children is both responsible and generous.  For others a family of one child is both responsible and generous.  

What I see displayed in the Catholic blogosphere and discussion boards is a lack of charity amongst the respective smaller or larger sized families.  Those with smaller families sometimes deride their large family counterparts as freakishly irresponsible.  Those with larger families sometimes deride their smaller family counterparts as selfish.  Both sides forget that selfish/generous and responsible/rash will display differently depending on the individuals involved and their personal circumstances, of which most of us have very limited knowledge at best.

Let's play nice, kiddywinks.  

(Thanks and credit go to Professor Kevin Miller of Franciscan University for the translation points.)