Thursday, September 27, 2007

The Prudent Land of Exhibitionism

One thing I’m having some trouble adjusting to in readapting to the U.S. is the hypocrisy between the commercialization of the body and the lack of acceptance of the body in its natural functions. It’s no surprise that images of barely dressed people fill the media, and sometimes the streets. Recently in Washington, DC I saw a woman walking in a public area with nothing more on than a bikini and a mesh cover-up. As long as the couple of strategic points are covered, it’s OK to bare a lot of skin.

Yet the sensitivity about those strategic points – the nipples and the genitals – is so extreme as to make me wonder what happened to make Americans so ashamed of their bodies. Is it the Puritan tradition, the influence of religion, or just never reaching the point of accepting the body as something other than a sexual symbol?

I recall a European friend in Kyrgyzstan telling me how different it was to get a bikini wax in the U.S., versus in Europe or Muslim Kyrgyzstan.

“In Kyrgyzstan I go in with no underwear on at all. The woman who does the waxing looks at me and talks to me normally, as though there is nothing out of the usual. She looks right at my pubic area and does her work, without making me feel there is anything wrong with me.

“In the US, I asked if I should take my underwear off. The woman said no, and just moved it to the side as she was working. It made me feel so dirty.”

Yesterday I got a prenatal massage. It was a nice, clean, professional place, very careful in making the conditions safe during pregnancy. However, I was so covered up in sheets and pillows I wondered if I was in another country. The masseuse removed only the part of the sheet she was working on while she massaged the back and legs. When she massaged my hips, she did so through the sheet. It made me think of my friend in Kyrgyzstan. Was I too dirty to be touched there?

I’m also concerned about breastfeeding in the U.S. It seems to still be considered something dirty to do in public, with books advising working women to go into bathrooms, to lock the lunchroom, or otherwise hide out in uncomfortable places. I see ads for slings advertising their ability to help with “discreet breastfeeding” and showing pictures of mothers on park benches, their baby completely covered by the fabric so as not to offend anyone.

Is the sight of a partial breast so offensive, or so disturbing that a baby should either be denied sustenance, or be kept in a hot and dark environment? Or is it only offensive to the idea that a woman’s breast is a sexual tool? Seeing it used for practical purposes could break some of the mystique.

Since I’m not too eager to hang out on toilet seats in order to feed my child, I went online to check what the laws are. La Leche League publishes a helpful list of current legislation by state. In most places, including where I live, breastfeeding in public is perfectly legal, and is not an obscene act or indecent exposure, even if the breast is exposed. In most areas, a woman has the right to breastfeed in any public place that she herself has the right to be in. I printed out the law for my state and plan to carry it with me. But I find the fact that such a right needs to be legislated rather sad. And I don’t look forward to having to defend my child’s right to be fed.

Having grown up in the U.S., I went overseas with this same prudery I’m now having trouble understanding. I never went to the public baths in Siberia, ashamed to be naked among my neighbors and co-workers. I was shocked the first time I got a massage and had to lie bare-chested on my back as the masseuse worked. I was mortified when I went to the doctor’s for a chest x-ray and I had to walk across the entire room naked, with no gown or other covering. But with time, as I saw them react to the human form as nothing special, I could accept it that way myself. What’s the big deal? We are over six billion people, with three billion or so of each gender. No individual really has anything that someone hasn’t seen before.

I can understand the countries that take a position on either side. Either they hide the body fully, in public and private. Or they accept and embrace it. Here I find a strange middle ground – where many seem to take pride in showing the maximum permissible outline of their shape and form. But once you pull back the little cover, what’s underneath is something lurid and shameful.

Tuesday, September 25, 2007

Transition to Fall

This week was the official transition from summer to fall. Though practically, it’s still warm and beautiful, like summer. But the hints of change are in the air – the slight yellowing of some leaves, the drying of the forest, the temperature that changes from warm, hot and sunny, to cool within a day.

I’m enjoying living here. We’ve finally gotten unpacked and organized and feel as though we have our first home together. Our street is quiet, with a view of a cemetery and the sounds of church bells and squealing children in the daytime, crickets at night. People seem calm and comfortable. I see a population of immigrants that concentrate in a certain area, and I imagine life is more challenging for them. But even they benefit from the calm and quiet here, the good public services, and the good, neighborly spirit that’s easy to generate when people are living comfortably.

I’m readjusting to having frequent internet access and to the experience of online shopping. I’m impressed by how many of our purchases we can do online. Every few days, a package shows up on the doorstep – anything from a pillow to a swim cap to peanut butter. As long as it’s not needed urgently, I can easily do research on quality online, find a cheap price, and then have it head toward my house – all without taking a step outside. I suppose many Americans have long been accustomed to this. I’ve certainly been using the internet to buy things while away. But in the years of living overseas, I’ve missed out on the transition from using the internet for certain objects (like books, electronics and clothing) to a far wider spectrum that can include toilet paper, milk and furniture.

Yesterday Mark and I had the unique experience of interviewing a doula – a birth attendant. Neither of us had any idea what a doula was as of a couple of weeks ago, but now we are considering hiring one. We felt the need for some personal care even more after visiting the doctor today. The doctor was nice enough, and if we could keep him as our permanent doctor, it would be fine. However, we found out there are six doctors in the practice, not five like I thought. So somehow, by early December, I need to have appointments with the four I haven’t met yet. That will give me about 15-30 minutes of contact with each one before the due date. And then it’s a random lottery as to which of the six will be my attending physician. I have a 16.7% chance of getting any particular one – the one I like the most as well as the one I like least.

A doula would be a person we’d select in advance, who would take the time to get to know us and our wishes. In the course of a couple of meetings, our time spent with her would be a vast multiple of the time spent with any one doctor. She’d then be with us from the very start of labor until the end, and visit us once more post-partum. Her job would be to help make the process more calming, relaxing, comfortable, and safe. She’d also be our advocate with the doctors and nurses, helping to ensure our wishes are carried out as much as possible, at a time in which we might not be a good position to argue. According to doula advocates, by reducing stress and making the experience more personal and comfortable, it can speed up labor and reduce the chance of complications. If nothing else, it seems likely to make the process less impersonal, bureaucratic and uncertain.

We’re entering the phase of active preparation. We bought our first big-ticket item today – a used carseat. Slowly, we’re collecting a pile of stuff for this future being. I don’t want it to enter a world of materialism, and we’re trying to stick to the essentials. But I do want it to be comfortable and well taken care of. And we want to be as comfortable as possible ourselves while adjusting to the changes in our lives.Speaking of materialism, I thought it was amazing to see orange and black aisles full of Halloween candy over a week ago – a good month and a half before Halloween. But even more amazing was that today I received several holiday catalogs in the mail. Holiday meaning Christmas. They were selling things like hot chocolate in red and green tins a full three-months before the holiday! An entire quarter of a year is spent marketing this holiday to people, during which they spend an average of $800.

Mark and I have decided we will not celebrate Christmas as a family holiday. Instead, we’ll follow the example of the Russians and others in making New Years our big annual event. I’m sure we’ll still get drawn into Christmas to a certain extent from the celebrations going on around us. No matter what, we’ll be subject to the ads and the pressures to spend more and do more. But we’ll have the benefit of celebrating once everyone else is already tired out. But really, no need to think about that three months ahead of schedule.

Tuesday, September 18, 2007

U.S. Impressions

In the past two weeks in the US, one of the things that strikes me most is the absence of wrinkles on middle-aged women on television. Geena Davis, Christie Brinkley and Oprah Winfrey are only a few examples of women in their 50s and 60s with unrealistically smooth skin. Some look good, others look scary, with their skin plastered against their skulls. I wonder how the numbers are growing among the general population and sense we are reaching a point at which it’s getting more difficult to age gracefully (aka naturally), that wrinkles will stand out even more among age-mates that attempt to maintain their young adult visage.

I’ve also noticed what seems to be fewer SUVS than before, and that makes me happy. On previous visits, I sometimes felt trapped by giant vehicles surrounding me on the freeway. Now, when I take the time to notice, I usually see at least several other small or mid-size cars. The giants are there, but no longer predominant. I guess it’s the cost of gas that may have driven people away. But whatever it is, I appreciate it. For the environment, for the safety of all drivers, and for lessening congestion on the roadway, I think the European model of mini-cars makes society a more pleasant place.

I’ve noticed the opposite trend in baby strollers. Maybe it’s just where I live, but almost no one walks around with a simple umbrella stroller. Despite good sidewalks and a flat, paved landscape, everyone has what one of my friends calls “a beast” – the stroller version of an all-terrain vehicle. I’ve seen them in magazines for $200-$1000 and it’s hard for me to understand what they can offer to make them worth so much money. A good shade, a convertible seat, a smooth ride, a statement of fashion or income, plenty of storage space for mom and dad’s accessories? Maybe after having a child I’ll coming to appreciate those things as being worth hundreds of dollars. But for now, I appreciate the used beast that my friend gave us. It’s down in the basement awaiting its first use. I didn’t even look at its features or test its roll. At the moment, it doesn’t seem important at all.

Tuesday, September 11, 2007

Searching for Quality Maternal Care

My husband and I had another pre-natal doctor’s appointment today and again, the quality of the visit was disappointing compared to Bolivia. At my last appointment in Bolivia I received quite a bit of information. In addition to 3-D pictures, the doctor spent a good 45 minutes examining the fetus, he provided detailed and helpful responses to my questions and I learned a lot. I was told the fetus was almost one kilo, and was in the top 3% for height-weight at its point in development. He showed me a chart indicated that if that rate of growth continues, I could expect the baby to be between 3.5 and 4 kilos at birth (postnote: he was correct, the baby was born at just under 4 kilos).

The American doctor listened to the heartbeat and measured my abdomen, saying “OK.” That was it. The answers to our questions were extremely terse and I had the feeling we were taking his valuable time. We asked if there were any doulas he’d recommend. He gave us a single first name.

“Any ideas on how we could locate Gloria?” Mark asked.

I asked why he recommended this particular person. “Because she knows my name,” he said. “The other don’t.”

Is that really a reason why we’d hire someone? Because she knows the doctor’s name?

Mark’s impression is that the doctor is flakey and he isn’t impressed with the knowledge levels displayed by the staff we’ve had contact with. Now, when we still don’t have full confidence in our primary doctor, we have to begin to rotate through the other four doctors in the practice, so that we’ll have had at least five minutes of contact with the random person who will deliver our child.

It’s understandable, with such a low level of personalization, with no single individual really paying attention to the needs of the couple throughout the pregnancy process, that demand is growing for non-medical staff like doulas. I almost look back nostalgically to the local country doctor – the person who knew his client well, who was available to come in the middle of the night if necessary. Since doctors have moved so far from this model, people have to look elsewhere to find a person who will listen, provide personalized advice and promise to be available over a period of several months.

Saturday, September 8, 2007

A Hospital Tour

This afternoon Mark and I went to visit the hospital where we’ll most likely give birth. We went as part of a regularly scheduled maternity tour and joined a group of couples and young families. It was a varied group –including Africans, Hispanics, Indians and Caucasians – with the women’s stomachs in various stages of protrusion. All however were couples and it seemed a single woman would probably stick out in such a group.

With three months to go, we’re in the stage of starting to have to plan and prepare more actively. We’re slowly collecting a few baby possessions, we have to decide what kind of classes, books and other education we need, and we need to make decisions as to who will be involved in the process and how.

Given the impersonal nature of medical care in the U.S. (we have a 20% chance of getting our own doctor during delivery, and the nurses rotate according to their shifts), we are seriously considering using a doula, something I’d never even heard of a year ago, much less ever imagined using. But we think it could be helpful to both of us to have someone with us the entire time who knows us and our preferences and can be a continual, supportive presence.

Touring the maternity ward made the process seem more real to both of us – both in an exciting and a scary way. It was helpful to be able to familiarize ourselves with the environment, so we won’t be surprised on the day we show up. The hospital offers the helpful service of pre-registering up to two months in advance, so we can check right in on the day of delivery and not be held up by paperwork.

I suppose it’s a nice place by most standards. I haven’t spent much time on maternity wards anywhere in the U.S. It’s certainly nicer than most of the places I’ve visited overseas. Every patient has a private room with a phone and TV and a pull-out bed for the spouse or partner. A menu is available next to the bedside with a full selection of Indian entrees, as well as other special foods. They hold an ice cream social every afternoon to celebrate the new births. There is a single room available with a Jacuzzi and birthing balls, though I don’t know how patients are supposed to get back from there to their rooms to give birth.

Despite these amenities, it still had an institutional feel. The furniture was rigid. We were told that women who give normal, vaginal births usually stay two nights. Those with c-sections stay 3-4 nights. But this depends, “on you, on your doctor, and of course, on your insurance,” she said. The hospital’s c-section rate is 30%, at the national average, but a number I find quite scary.

Maybe it was a slow day, but things seemed pretty quiet. There were only two babies in the nursery (they seem to push mothers pretty hard to keep the baby in her room at all times) and most of the staff congregated at the desk, eating leftover ice cream from the day’s social in their blue and green uniforms.

I’ve been lucky to live several decades without ever spending a night in a hospital. I suppose it’s quite a privilege to be allowed to take a tour of the facilities before I enter for the first time.