On grieving timelines

I was reading a theory that European and North American grieving practices transformed from a Victorian model (with elaborate years-long process of commemorating a death) to a post-WWI model where death was expected to be processed more efficiently, perhaps because of the sudden death of a large percentage of the population in the war and the 1918 Spanish flu pandemic.

My mother-in-law died a year and a half ago, and I think our family has benefitted from a pretty spread-out grieving process. Some steps:

  • Family gathered for Suzie’s last days. She died the night after coming home from the hospital, earlier than expected. A few hours for family members to visit her body, lying in her bedroom. Medical school staff came to collect her body later that morning (she wished to donate her body for study).
  • 1 week: neighbor sits shiva for Suzie (week-long memorial time observed in home).
  • Next several months: Suzie’s body is studied by medical students at her daughter’s medical school. At end of semester, memorial ceremony at medical school with students and families of the donors.
  • 2 months out: Memorial service, held at the same hall where Suzie and Rick were married and where the family enjoyed folk dancing over the years. We found that 2 months meant that friends and family could plan to travel, and that we weren’t still in the first shock of grief. (I’ve seen some hard feelings among family members organizing a speedy funeral without everyone being able to make it, and I’m glad we avoided that.) Quaker-style ceremony with attenders gathered in silence, and people rising to speak and share thoughts or memories as they wished. Meal afterward, functioning as a kind of family reunion. Sharing of Suzie’s jewelry with relatives who are visiting.
  • 2 months out: Memorial book produced in paper and digital form. It’s made of pictures from Suzie’s life, writings from family and friends, and her newspaper obituary. Shared with family and friends.
  • 3 months out: Suzie’s birthday. We bought the kind of flowers she always got for her birthday.
  • 4 months out: Rick’s coworkers gave money for the family to do something together. Ferry trip to harbor islands that Suzie loved.
  • 11 months out: first Christmas without her. Sucks. Suzie’s sister makes the annual family photo calendar including pictures of Suzie throughout the years on every page.
  • 1 year out: Spent day of her death with the family visiting a seaside town she liked to visit.
  • 1 year out: family received ashes from medical school.
  • 1.5 years out: Suzie’s daughter has her first baby. Presentation of a baby sweater that Suzie and I planned for two days before her death for Alice’s eventual baby, and I that knit in Suzie’s style.
  • 1.5 years out: family scattered 1/3 ashes at beach with extended family.
  • Still to happen, planned for 2 years out and 2.5 years out: scattering other 2/3 of ashes in two other locations important to Suzie.
  • Still to happen: presenting family with recording of Suzie reading from “The Wind in the Willows” shortly before her death.

I think these ongoing occasions to remember together have been good for the family. I’m particularly glad we didn’t have to spend the first week organizing a funeral. Because Suzie wanted to donate her body, we also didn’t pay any funeral expenses – the only part that cost money was the hall for the memorial service. A typical US funeral costs $7,000 between the funeral home, burial, and headstone, which is not a financial stress a grieving family needs.

I’d like to have a process similar to this for my family when I die.

I particularly like the way Mexico observes the Days of the Dead, with bittersweet celebration of lost loved ones. Families visit graveyards to decorate gravestones, and they make altars with flowers, candles, and the favorite foods and belongings of loved ones. Having a concrete action to take seems helpful, and I imagine it might work particularly well for children.

Planning for altered mental states

On Friday night I helped my sister-in-law while she gave birth. (I had my own baby strapped to my front the whole time, so I wasn’t particularly hands-on, but I helped Skype in the baby’s father who was in England at the time.)

My own labors were unusually easy, and seeing someone go through a more typical labor was eye-opening. This woman is a medical student who’s done her obstetrics rotation, but the pain made a different person out of her. A frightened, exhausted, anguished person.

One childbirth book I read (The Birth Partner, which is my favorite for women giving birth as well as support people) advocates using safe words for pain relief. It gives you the freedom to say “I want morphine” in the heat of the moment when you don’t fully mean it, and if you really mean it you’ll say “eggplant” or whatever and your support people will know to take it seriously. A birth plan is also good for this. In this case, my sister-in-law had asked in advance not to be given an epidural unless she repeatedly asked for one over a period of time, so when she said things like “I want an epidural” and “I want a c-section” her doula and midwife helped her find other ways to cope rather than calling an anesthesiologist.

It felt very strange to watch her in agony, to hear her asking for relief, and to know that the person she had been 6 hours ago and the person she would be in 6 more hours wouldn’t want her to get it. (Women who get epidurals report less pain but no greater satisfaction with their overall experience, probably because the side effects are so annoying.)

For both medical and psychiatric care, some people use some form of Ulysses contract, named for Ulysses who tied himself to a mast to be able to hear the Sirens’ tempting song without following it to his doom. It’s the act of a person who knows they’ll be in an altered state in the future. It’s treating your future self as a different person with different preferences, and forcing them to obey your current preferences.

The last day of her life chronicles Sandra Bem’s plan for her own death after an Altzheimer’s diagnosis, knowing that by the time her mind had deteriorated she would no longer want the death she had planned. My lovely wife in the psych ward is from the viewpoint of the husband of a woman with serious psychiatric problems.

DuBrul introduced me to the concept of mad maps. Like advanced directives for the dying, DuBrul explained, mad maps allow psychiatric patients to outline what they’d like their care to look like in future mental health crises. . . . We started trying to create Giulia’s map by discussing the pills in the medicine cabinet. Under what circumstances would Giulia take them, and how much would she take? I took a hardline approach: No sleep for one night, pills at maximum dosage. Giulia wanted more time before jumping to medication, and favored starting the dose out light.

They’re not failsafe: a birth plan only communicates your preferences, and you should go in with the understanding that you may need an emergency c-section or whatever. A mad map can plot out actions in anticipated situations, but unanticipated situations may throw the old plans out the window.

But I think we’re much better off planning, to the extent that we can, for times when our preferences will be different than they are now. From my coworker who’s set her computer to shut off the internet at 11 so she’ll go to bed on time, to a person planning how they want their death to go, sometimes it’s better for your self-in-the-moment not to have the reins.

Layers of animal advocacy

I’ve been reading a lot about animal advocacy lately and thinking about layers of it. I’ve been vegetarian and nearly-vegan in the past but currently am doing nothing at all to help animals. I’m trying to think about which levels make most sense, and trying not to be too motivated in my reasoning.

Some caveats:
Other people have thought about this way more than I have, and this is my incomplete attempt to grasp the basics.

This focuses on animal suffering, not environmental impact. These sometimes point in the same direction (beans are a low-suffering and low-impact food) and sometimes in opposite directions (beef is better than other meats for animal suffering, because one steer provides so much meat, but worse for carbon emissions). I’m not too bothered about the emissions, because going vegan is estimated to save 1.5 tons of CO2-equivalent greenhouse gasses a year, which costs only a few dollars to offset.) But there are other worries like antibiotic overuse.

This doesn’t get into how to compare animal advocacy with other causes you might work on.

Some stages one might go through:

  • Animals don’t want to die. We shouldn’t kill them. (This was my basic viewpoint during the 10 years I was vegetarian.)
  • Cows and chickens suffer to make milk and eggs, too. In fact, egg production probably causes more suffering than most types of meat. So you should be vegan.
  • If animals have a net positive life, it might be good to raise them even though you then slaughter them. Pastured cattle seem to have pretty good lives (though hens in battery cages seem to have really bad lives), so certain kinds of meat might be okay.
  • Advocating for change matters way more than what you personally eat. Combing the cracker aisle for ones without any whey powder is a ridiculously bad use of time and attention, particularly given that the market for milk is pretty inelastic (meaning it doesn’t change that much based on small consumer decisions.) Whereas advocating for wider changes, like getting your state to ban the cruelest farming practices, is far more effective. Paying more for pasture-raised meat or cage-free eggs is just buying your own purity when you could be doing something more effective with the money, like funding advocacy. Personal diet is basically a distraction.
  • We shouldn’t just advocate for incremental change; we should aim for a world in which animals are treated like they matter. This is like advocating for treating slaves nicely rather than abolishing slavery.[1] You can’t advocate for a constituency while simultaneously eating their corpses. Also, once you start thinking of animals as beings who matter it is seriously horrifying, rather than enjoyable, to eat their bodies.
  • And what about wild animals? Even if we didn’t directly cause their suffering, it’s probably still pretty miserable to always be scared, cold, and hungry and to eventually get eaten by something bigger than you. And there are something like 50 times more wild birds and mammals than farmed animals (not even counting wild fish, reptiles, etc.) Some farming practices might be better or worse; like grass-fed beef might be better because fewer mice and other small critters will live on pasture. But in general a habitat that houses fewer of one kind of wild animal will house more of another, and it seems super difficult to figure out which direction is more helpful.
  • Again, look to the big picture of society rather than personal choices.Things we might do in the future, like terraforming, could affect far more animals than exist today. Getting society to generally care about the welfare of all animals, farmed and wild, is the best goal. If people care, they will bother to do better research on this stuff, and once we know more about the results of our actions we can make more humane choices.
  • You can’t build a coherent movement and get society to think of animals as people rather than commodities without also having the lower layers. So it still matters what you eat.
  • Widespread elimination of animal foods seems really unlikely; the people I’ve met who think vegetarianism or veganism will sweep the planet seem pretty out-of-touch to me. Maybe a movement for animals is better off advocating moderation, like reducetarianism and humane treatment or meat replacements, than abolition.
  • I’ve seen a lot of sketchy logic for both points, but I believe some effectiveness-minded animal advocates have looked at the history of various social movements and have better information here than I’ve found.

[1] Except the New York Manumission Society was formed partly of slaveowners, including the founder. They were successful in phasing out slavery from the state of New York.

Cost comparison of childcare

Now that we have two children, the cheapest form of childcare has changed. Double daycare didn’t sound appealing, so we did the math and decided that an au pair was cheapest (see tables below). Jeff’s family used au pairs and were happy with the arrangement. So we’re planning to go ahead with that this coming year.

Au pairs have a connotation of being something only posh people have, perhaps because having live-in help seems like having servants. But the state department is very clear about them not working extra hours or taking on housework beyond what’s child-related, and they’re supposed to be like a family member (“au pair” literally meaning “on par” or “on equal terms” with the family). Jeff’s sister was an au pair and it was something I considered after college, so it’s not as if it’s a one-way stream either.

Pros:

Cultural exchange. The whole reason au pairs don’t make minimum wage is that they are technically having a cultural experience rather than being employees. If you’d like to expose your children to another language and hang out with someone from another country, this might be a nice way to do it. Caveats: the kids I see with Spanish-speaking au pairs or nannies seem to understand Spanish but don’t speak it themselves (they respond in English). Jeff’s father said they preferred au pairs who spoke English as a first language because it made communication easier. I also think childrearing methods vary quite a bit by culture, and there are some cultures that seem pretty low-interaction, which is not what I would want.

Flexibility: An au pair works up to 45 hours a week, and you can schedule the hours anytime during the week (with a max of 10 hours/day and with at least one weekend a month fully off). Because we both travel for work, the ability to have someone watch our children at odd hours as we’re coming and going from the airport sounds good.

You can also have your au pair travel with you (so if I were at a conference for a week, I could potentially bring the kids and the au pair, which would certainly be nicer than being away from my baby for that long. But the cost of extra airfare and lodging means we’ll probably use this very sparingly).

You also don’t have to cram your child into a daycare’s timeframes: no need to drag them out of bed in time for you to leave for work, or to keep them awake or make them lie down because that’s the group schedule. There’s no panic if they’re not potty trained and won’t be allowed into the three-year-old classroom.

Sick days: An au pair doesn’t work when they’re sick, but they can work when the kids are sick. (With a daycare, the kid can’t be there when they’re sick or for 24 hours afterward.) Since little kids get sick more often than adults, we expect this will mean we miss less work caring for a sick child. Also, snow days, which we have a reasonable number of in Boston.

No commute: having care in our own home is huge for us. When we took Lily to daycare every day, it added about 90 minutes to our days (because you have to manage a child’s commute in addition to your own).

Less stress for children: At home, young children’s level of cortisol (a stress hormone) peaks in the morning and falls throughout the day. At daycare, many children’s levels rise again during the middle of the day. (Caveat: I couldn’t find out whether in-home care with a non-family caregiver matches the home pattern or the daycare pattern, but I’m assuming it’s closer to being home with your family on a weekend.) It’s not clear that this has any long-term effects, but it seems plausible to me that it does.

Cons:

Socialization: It takes extra effort to get socialization for the children because they’re not already in a group setting. For a baby or young toddler, I don’t think this is a problem, but for older kids you could potentially be looking at the cost of preschool on top of an au pair. But I think it’s possible to supplement with visits to library story hours, play groups, etc. Certainly most children throughout humanity have been reared primarily in their own (extended) families rather than in a classroom-type setting.

Privacy: An extra person in your household brings more possibility of conflict and awkwardness.

Inexperience: I know 19-year-olds can be clueless, because I cringe at some of the mistakes I made at that age working in daycares or as a babysitter.

Year-long schedule: If you end up with someone who’s a bad fit for your family, you’re kind of stuck unless you want to pay the fee to re-match. Also if you no longer need childcare (say one parent is unemployed for a few months) you’re still paying for it. But this is true in the better daycares, too.

Unpredictability: The au pair can decide to buy a flight home any time (edit January 2017: ours did this with less than a week’s notice). Young adults who have never lived away from home before are not known for their consistency. There are also factors beyond their control: their visa application could be delayed. They could have a family emergency and need to return home. Trump has mentioned getting rid of the J-1 visa that au pairs use, so who knows whether he’ll follow through on that.
A daycare could also close or lose its license, particularly if it’s a home daycare that relies on a single person, but I’m guessing it’s less likely.

Housing: You need an extra bedroom. If you have the flexibility to rent a larger space this may be fine, but for people who own condos or houses it may not work. In our case, it was possible to build an extra bedroom, which we’re happy to do because we’d like to have a spare room after we’re done having au pairs.

Transportation: If the au pair will need to drive, adding them to your car insurance (and getting another car, as some families do) would add extra cost. In our case, we’re near the subway and don’t own a car, so the transportation cost is just a public transit pass.

Monthly costs in Boston area using public transit:

Au pair

Au pair stipend and agency fees: $1620
Rent: $770 (based on renting a four-bedroom vs. a three-bedroom apartment in my neighborhood)
Utilities (including cell phone): $65
Food: $200
Worker’s comp: $30
Misc spending (museum admissions, public transit pass, etc.): $100
Total $2785

Daycare (this varies a lot but is based on the daycare Lily went to)

Infant in daycare with sibling discount $1794
Toddler in daycare $1885
Total $3679

Nanny 

$20/hour (more if withholding tax and social security), 45 hours/week $3900
Worker’s comp: $30
Food, museum passes, etc. $100
Total $4030

Babywearing around the world

My new daughter, Anna, is one month old. I may have acquired a few too many baby carriers last time (six), but I’m enjoying them now. After babywearing went out of fashion in the western world, I’m glad to be living in a time when it’s back. I can’t imagine getting stuff done without it, particularly when your child is sick and wants to be held all the time.

I love seeing different ways people wear children:

ethiopia

Ethiopia

1940s, Greenland. Inuit women have used an amauti, a parka with a pouch in back for the baby.

Cameroon

Cameroon

hmong vietnam

Children can wear babies, too. Hmong siblings, Vietnam.

hockey

Jack Wembly of the Wembley Monarchs ice hockey team, in 1937 with a very uncomfortable-looking sling he and his wife invented to carry their baby onto the ice.

java

Java

United States

mali

Mali

sacagawea

The US is the only nation to depict babywearing on its currency.

double

Two at once

mexico

Mexico – she can feed her baby on the go!

Wales, c. 1905.

Wales, c. 1905.

rabbit

Lily using a ring sling for rabbitwearing.

Misc. thoughts on birth

I’m 9 months and six days pregnant, and oxytocin is on my mind a lot.

Oxytocin causes and is caused by an awful lot of things. It’s been billed as the “cuddle hormone,” but it’s basically involved with every step of baby-making. Skin-to-skin contact, and eye contact, increase oxytocin in adults (perhaps helping them bond). As the body prepares to give birth, it produces more oxytocin that stimulates contractions. After birth, the baby’s suckling stimulates the production of more oxytocin which causes the uterus to contract again and stop bleeding—very useful! First aid for after an emergency delivery is basically “keep the baby warm and stimulate the nipples so you don’t bleed out.” Skin-to-skin contact stimulates lactation and helps mother and baby bond after birth. (Not sure if this one is related, but skin-to-skin contact is also considered effective for pain relief in newborns during things like injections.)

Because oxytocin stimulates contractions, synthetic oxytocin (pitocin) is given to start or speed up labor. The natural birth people are concerned with the side effects, which are contractions that are so strong as to be more painful for mother and possibly dangerous to baby. Pitocin is also used after birth to stop bleeding.

Of all the home remedies to stimulate labor, nipple stimulation and castor oil are the only ones that work.  (For the record, castor oil is not considered worth it because the ensuing nausea and diarrhea dehydates mother and stresses baby.) Sex should help, in theory, because of both prostaglandins from semen and oxytocin from orgasm. But in practice it doesn’t seem to.

Here’s where the idea that “natural” is safe and “medical interventions” are dangerous really breaks down. Too much nipple stimulation basically gives you a large and unknown dose of oxytocin, maybe much more than the dose a doctor would give you. A few studies on high-risk women doing three hours(!) of nipple stimulation each day for three days concluded it was unsafe, because it was more likely than synthethic oxytocin to bring on dangerously strong or quick contractions. Cochrane seems to think it’s ok if you’re not high-risk, though (and presumably it’s safer if you don’t do three hours a day).

…………

Another thing on my mind is what tradeoffs to make around pain relief. Last time I planned to labor in the tub and get out for the actual birth because I was concerned about risk to the baby, but when they offered me the chance to stay in the water I was not eager to get out. Lily was born in the tub at the birth center.

There aren’t many sources that strike any middle ground between rabidly pro-water-birth pieces by midwives and rabidly anti-water-birth pieces by obstetricians, but this is one. Cool fact about babies: they practice breathing in utero, breathing small amounts of amniotic fluid. Shortly before birth they stop doing this. Upon moving from a warm fluid environment to the cooler air of the outside world (maybe also because the chest goes from being compressed to suddenly having space), the baby’s life support system suddenly changes, and it switches from getting oxygen through the umbilical cord to taking its first breaths of air.

The reason water birth normally works fine is that the baby is moving from one warm fluid environment to another, and they don’t start breathing until they hit the air. One danger of water birth is if your baby is compromised and takes a gasp earlier than it normally would, in which case it can inhale water. The other reported danger is from unsanitary conditions, like the cases of Legionnaire’s disease from pools of water kept at 98 F for days at a time – a perfect breeding ground. And some of the reported problems from “water births” are things like “woman accidentally gives birth while in the bath at home with no medical care.” Another danger is an overanxious attendant pulling the baby out of the water so suddenly that the umbilical cord snaps—this is a reason I would be sure to have an attendant who is experienced with water birth.

So how common are these problems? Not very. The UK recommends that all women with uncomplicated pregnancies have the option of water birth, and 6% of births there occur in water. It’s considered safe there.

Water birth usually results in less tearing for the mother, and I found it helped a lot with pain. So how do I balance the risk of serious harm to my child with the near-certainty of less pain for me? At first I thought it was terrible to consider any chance of a really bad outcome for my baby in exchange for my own relief.

But consider a parent with a headache who puts their child in the car and drives to the store for pain relief medication. There’s some risk they’ll be in a car accident and serious harm will come to the child. But we’re okay with people taking that small risk in exchange for near-certain pain relief. I don’t know how the risks of bad outcomes vary between these two situations, but it does at least seem that we shouldn’t immediately condemn any possible tradeoff between parent and child well-being.

…………

If you do any kind of tidying during late pregnancy, people will exclaim, “You’re nesting!” (Most annoying was from the midwife who pushed the exam-room curtain up against the chair where I was supposed to sit and then said I was “nesting” when I moved it out of my face.)

As far as I can tell, there’s plenty of documentation of nesting behavior in pregnant rats, dogs, cats, hamsters, and rabbits but not humans. My mother still talks about her urge to scrub my changing table with Lysol the night before she gave birth, but that’s is the kind of project that doesn’t sound unusual for her anyway.

Part of me wonders if this is just us medicalizing women’s very sensible wish to get things in order while they still have any time.

Valentine exchange

orange heart

  • If you want to participate, email me at julia.d.wise at gmail by Sunday, Jan 31. Include your mailing address.
  • On Feb 1, I will send you a list of about 5 other people. Please send each of them a valentine by Monday, February 8. They can be storebought, homemade, whatever.
  • If you live outside the US, yours will probably arrive late.
  • Enjoy checking the mail!

Photo credit: emdot via Foter.com / CC BY