family tools
choose a tool resource directory
find a practitioner parenting toolbox product safety media reviews family fun guide send an e-card family astrology

community features choose a feature birth stories find a Mothering friend live chat mothers' writing group teen voices

	a quiet place by peggy o'mara

Is Anyone Listening to Parents?
Issue 124

I know you are all busy with your families, up to your ears in daily problem solving, and that the last thing you need is bad news. In fact, it’s important to me as an editor to provide broad, positive perspectives on the events of our daily lives, even when these events are negative. I’m always looking for solutions to problems, for ways to say yes to life.

I find that there are new obstacles in the paths of parents who want to say yes to life, and past ones returning for another round. I have come to think of these obstacles in terms of rights. What are our rights as parents? Do we have the right to expect and receive health care that is based on scientific evidence? Do we have the right to recourse and redress if medical procedures legally mandated for our children have adverse effects? Do infants have the right to be breastfed? Do we have the right to protect our children from influences that can undermine a healthy life?

These seem like basic human rights to me, things that most parents would fight for...not things that should have to be negotiated by every new generation. And yet I am willing to renegotiate them, to fight for them over and over again, because the fight for justice is never won; it is inherently ongoing. We have, however, been hit with too much bad news lately.

The CDC released the highest rates ever for surgical birth in the US this past summer. At 26.1 percent, that number is rising as elective cesareans gain popularity and birth options decline. A growing number of hospitals no longer "offer" vaginal births after cesareans, and several birth centers in New York City have closed down. On March 15, the New York Times declared birth centers and midwives to be "fading" phenomena.

Hospitals and birth centers cite increased malpractice insurance premiums for their actions. The now-defunct Elizabeth Seton Childbearing Center in Greenwich Village said its premiums increased 400 percent. Insurance companies claim that these exorbitant rates stem from increasing malpractice suits and claims. However, last year Public Citizen News reported that premiums have increased because insurance companies need to recoup lost earnings from the stock market as well as pay increased premiums to their own reinsurers.

In this litigious climate, tragically, cesarean birth has become the standard of care legally. While vaginal birth remains the standard of care medically, we increasingly see medicine being practiced experimentally so that intervention can be documented legally. We have the right to expect that the care we receive during pregnancy and birth be evidence-based. When it is not, we have the right to seek out evidence-based care wherever it is. We have a responsibility to find communities of normal birth and to do everything we can to grow and sustain them.

Unfortunately, this isn’t the first time natural childbirth and midwives have been declared irrelevant. In fact, many of the most significant moments in the history of childbirth reform have followed closely after discouragement and despair. In 1979, when only 1.7 percent of births took place out of hospital, the American Academy of Pediatrics and the American Medical Association approved an anti-homebirth resolution. That same year, however, the American Public Health Association concluded that "births to healthy mothers can occur safely outside the setting of an acute-care hospital." The next year, the Institute of Medicine of the National Academy of Sciences, the Office of Technology Assessment of the US Congress, and the National Commission to Prevent Infant Mortality all officially supported the development of midwifery.

The Taskforce on Midwifery reiterated this support for the development of midwifery in 1999 in The Future of Midwifery, a joint report of the Pew Health Professions Commission and the University of San Francisco Center for Health Professionals. The report’s "Executive Summary" stated, "It is the finding and the vision of the Taskforce that the midwifery model of care is an essential element of comprehensive health care for women and their families that should be embraced by, and incorporated into, the health care system and made available to all women."

The loss of birth centers and threats to midwifery are part of a larger picture. We are in a time of dynamic change regarding how health care is delivered and managed. The practitioners and practices supported by evidence will endure because they are safer and therefore ultimately more cost-effective. For those of us who receive care, it is important that we understand the implications of submitting to treatment that is not evidence-based. We have a right to ethical care.

It is our job as parents to seek out this ethical base in our pediatric care providers as well. We want to work with someone whose recommendations are based on scientific evidence and who is open-minded toward our personal expertise and parenting philosophy. The area of vaccinations has been one in which many argue the science on both sides of the issue. Mothering has covered vaccinations historically as an issue of informed consent, and more recently we have kept you up to date, both here in the magazine and on www.mothering.com, about thimerosal, the mercury preservative in vaccines. Many assume that the case is closed on thimerosal, that it is out of vaccines and not a danger. Shockingly, we can’t be sure if this is so.

Recent testimony at the February Institute of Medicine’s (IOM) meeting on vaccines and autism raised serious questions again about thimerosal and vaccines. Independent researchers Mark and David Geier testified that their analysis of the CDC’s own database showed a 27 times greater incidence of autism among children who had been vaccinated with thimerosal-containing vaccines than among those who had not. The Geiers have since been denied access to the CDC database, despite the fact that the CDC is under congressional order to make it available to independent researchers.

Like Andrew Wakefield and other independent vaccine researchers, the Geiers are being demonized for their research. At the IOM meeting, they testified that thimerosal-containing vaccines remain on the shelves. In July 1999, the American Academy of Pediatrics and federal health officials announced that thimerosal would be phased out of childhood vaccines. Five years later, it still hasn’t been. In July 2001, at the first IOM meeting on vaccines and thimerosal, the Immunization Safety Review Committee of the IOM called for the "removal of thimerosal from vaccines as a precautionary step in the effort to minimize children’s exposure to mercury." No action has been taken to heed the committee’s recommendations. No ban has been enacted.

Thimerosal-free vaccines are available only for vaccinations included in the regular childhood immunization schedule. But childhood vaccines given less commonly, for example the children’s flu vaccine, contain thimerosal. Because vaccines are manufactured and distributed in advance, thimerosal-containing vaccines may still be on shelves until 2005. In addition, vaccines are never completely thimerosal free, as thimerosal must be "washed" from the vaccine to remove it, and a trace amount always remains. And because thimerosal is added in the manufacturing process, its presence may not even have to be disclosed on the labeling.

According to an article by Andrea Rock in the March/April issue of Mother Jones, "If vaccine manufacturers and government agencies are found liable for neurological damage to millions of infants, thimerosal-containing vaccine litigation could rival that of tobacco or asbestos." The case of 3,400 families with autistic children who are suing the government is scheduled to be heard in federal court in Washington, DC, this fall.

Mercury is now the number-one environmental pollutant in the US. Most of us don’t know what our exposure has been to mercury or where it comes from in the environment. But regardless of our philosophy regarding vaccines, mercury does not belong in them. We do not want to be patronized when we petition our government for compensation for children who are neurologically impaired due to mercury. We have the right as parents to have redress and recourse if our children are injured by federally mandated medical procedures. And if they have not been, we have the right to ask the government to figure out what other sources of mercury in the environment could be hurting our kids.

It also seems to me that babies have a right to be breastfed. Breastmilk is, after all, a food uniquely designed for them. I reported in these pages last issue on the American Academy of Pediatrics and the formula companies’ actions with respect to the National Breastfeeding Awareness Campaign of the Department of Health and Human Services (DHHS). On January 22, Assistant Secretary for Public Affairs Kevin Keane reported that the Breastfeeding Awareness Campaign would be launched in the spring. In a report to the US Breastfeeding Committee on January 23, 2004, a senior agency official from the DHHS Office on Women’s Health described the campaign changes as minimal. The risk-focused campaign strategy remains intact and communicates the increased risk of diarrhea, ear infections, and respiratory illness and the possible increased risk of childhood obesity when children are not breastfed. The campaign also stresses the importance of exclusive breastfeeding for six months.

While ads targeting childhood leukemia and diabetes have been removed for now, DHHS has authorized further research into these diseases and their relationship to breastfeeding. Specific risk ratios were also removed from the ads. By the time you read this editorial, the campaign should have begun. If it has not, call DHHS Assistant Secretary Keane at 202-690-7850.

Breastfeeding protects against childhood obesity. But even when we get our children off to a good start through breastfeeding, we can’t protect them from the influence of junk-food marketing. On February 27, Commercial Alert launched a campaign for a worldwide ban on the marketing of junk food to children under 12. The campaign hopes to save lives through curbing the worldwide obesity epidemic.

A statement, endorsed by 135 organizations, 79 health experts and child advocates, and 22 elected officials from 18 different countries, calls on the World Health Organization (WHO) to incorporate the marketing ban into its global anti-obesity initiative, or to enact the ban through international health regulation. The US opposes the ban and is pressuring its foreign-aid recipients also to oppose it. National health ministers from all over the world will meet this month to decide whether or not to enact the marketing ban.

It is hard to enact bans such as this one because of the influence of industry on government. Just as Congress acted to protect Eli Lilly from liability from thimerosal damage in 2003, well before the public fully appreciated thimerosal’s health implications, so has Congress been pushing for laws protecting industry from liability from obesity claims, even as industry denies any responsibility. Once again, I wonder who is listening to the voices of parents. It’s obvious that our legislators are not; they are more beholden to industry than to us parents.

I feel bullied into having a surgical birth just in case I might sue the doctor later. I feel bullied into having the mandatory vaccines for my children, even though I’m not sure they’re safe. I feel pressured to breastfeed but feel unsupported in public. And I can’t keep my kids away from the bad influences of junk food and junk toys without dropping out of society. I expect society to help me protect my children’s innocence and health, not work against me. And I know I’ll be the only one blamed if my children go astray.

Ours are the voices of parents crying in the wilderness. We have to know our rights. We have to claim our rights. We will not be experimented on during childbirth. Our children will not be given unsafe ingredients. They will not be fodder for the junk-food industry. We will keep them healthy by our own measures. We will make our voices heard.