Category: Pregnancy and parenting

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On opting out

Captain Awkward has a thread on lateness and keeping in contact with people who are constantly late or no-shows. Her answer is worth reading, because she takes both sides seriously: the way being late feeds into anxiety or depression disorders sometimes (and has for her), and the way to structure social engagements with people who are in that place (whether due to mental health issues or not, it doesn’t require disclosure).

She’s specifically asked that people who are good with time and todo lists (I am, relatively) not drop in with “handy hints”, which is fair enough, but now I’m finding some of the”just loosen up, I have rejected our culture’s terrible clock ticking obsession, and I think that makes me a better person” (uh, paraphrased) comments irritating. I’m posting here rather than there because of the relative privilege of being good with my culture’s approach to time, though.

However, opting out is also a pretty privileged thing to do, honestly. Here’s the big clock related things I can’t opt out of, right now: my son’s childcare, who (like most) fine about $1 a minute for late pickups. Moreover, those people also have children to pick up and errands to run, so a significantly late arrival from me would ruin at least three families’ evenings. (Two staff members are required on premises at all times, so one late parent is two late workers.)

Parenting is by no means the only type of problem here too (look at some writings on spoon budgeting some time: what happens when you are an hour late for someone who set aside spoons to see you?) but it’s a pretty typical set of examples. So are people who work in a great number of jobs, especially low pay and insecure jobs.

You can be over-scheduled in a privileged way (racing from piano lessons to dinner parties), but you can be over-scheduled without that (racing from end of shift to the hard childcare deadline to the hospital’s visiting hours to the mechanics for the 6th car repair this season), too. So, I find it difficult to respond to a fairly simple analysis of “I figure that half an hour doesn’t matter that much, or shouldn’t! We all survived before mobile phones [or clocks]! Just say no!” When your needs are dictated by other people armed with clocks and mobile phones, there may not be an exit sign visible.

There are a lot of living cultures with looser time constraints than the one I live in. (People talk about a “polychronic-monochronic” axis of cultures, which Wikipedia tells me is due to the anthropologist Edward Hall.) There are ways to systemically structure things so that half an hour doesn’t matter that much. But, when you don’t live in such a culture or can’t stay in one, it’s just not that easy. But when is “just say no” ever the solution to anything serious?

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Should you give birth privately?

A few people have been researching their options over the last few years about giving birth in Australia, and have asked me what I think about having private health insurance or giving birth in a private hospital.

Background: maybe you shouldn’t ask me! I’m not a health professional, I’m a mother of one, and he was born in a public hospital, in which I was a public patient.

And now, crucial fact about private hospital cover: it pays much of your hospital stay fees and some of your doctor’s in-hospital fees. It does not pay for private consultations with a doctor in an outpatient/private room setting.

You know what obstetricians charge a lot for? The “pregnancy management” fee, to cover your outpatient care in pregnancy. If I recall correctly, the Medicare rebate for this is on the order of $400 to $500. In Sydney, private obstetricians may charge upwards of $4000 for this fee. Who covers the difference? You do. (OK, full disclosure, the Medicare Safety Net may help too, I don’t know the details except that MSN actually cut benefits specifically for obstetricians a few years ago because they’d all upped their fees to incorporate the MSN rebate. So, mostly you do!) Also, anaesthetists in the private hospitals usually end up with a decent gap fee, if you have an epidural or Caesearean.

So, private system birthing is expensive regardless of insurance.

Finally, tests like ultrasounds are usually Medicare plus out-of-pocket too.

Now, birth choices in Australia.

Homebirth. There are some very small number of hospitals in Australia that will allow their midwife staff to attend some homebirths. It’s very easy to get disqualified from such a program. I would be on several grounds (some more legit than the one I’m about to give you), including the simple fact that my son’s birthweight was over 4.0kg.

You might also birth with a privately practicing midwife, or, in theory, with a private midwife collaborating with an obstetrician as backup (there are very few such arrangements so far). Most, although not all, private midwives will also only work with pretty low-risk women (singleton pregnancies, head-down, no high blood pressure or diabetes, that sort of thing, about 80% of pregnancies get a low-risk classification IIRC).

Is private insurance useful? Some private health funds provide some limited cover for this, I believe, on the order of $1k to $2k of the midwife’s fee, which is around $5k last time I looked. In the collaboration setup Medicare contributes too, I think?

Birth centre These are midwife-only maternity units attached to public hospitals. (Sometimes at some physical distance, eg Ryde Hospital only has a birth centre, with transfers to Royal North Shore several suburbs away.) You need to be assessed as low risk and if that assessment changes (and this isn’t uncommon, eg, your baby is breech or you get diabetes or pre-eclampsia) you get summarily transferred to the doctors and your whole care team often is suddenly switched out from under you. (Also they usually don’t do epidurals, I think? So the transfer rate for pain relief is not insubstantial I believe.)

Is private insurance useful? No, this is publicly funded.

Public hospital, midwife’s clinic If you go to a public hospital, and are assessed as low risk, almost all of your pregnancy management will be by midwives. Often they “caseload” now, meaning you see the same one each time. Again, if you become high risk, swish, off to the doctors.

Is private insurance useful? No, this is publicly funded.

Public hospital, doctor’s clinic. If you aren’t low risk, this is you. (This was me.) Chronic health problems or pregnancy complications (like pre-eclampsia) put you here. For your appointments, or at least most of them, you see an OB registrar or staff specialist. On high rotation, often, that is, you won’t usually see the same one many times. If you have a vaginal birth it may still be midwife-only, or largely midwife managed.

Is private insurance useful? No, this is publicly funded.

Public hospital, private doctor’s patient. In this case, you choose your doctor, see them mostly in their own clinic, birth in a public hospital (with you or your private insurer paying for the facilities) with the doctor of your choice attending. This is subject to gap fees for the doctor.

Is private insurance useful? Yes, pays for your accommodation and some of the OB’s and anaethestist’s (if needed) gap.

Public hospital, private midwife’s patient. This depends on a midwife/obstetrician collaborative practice. As I said, rare, but there’s at least one that allows a public hospital birth (private admission) with the midwife of your choice: Melissa Maiman in Sydney.

Is private insurance useful? Yes, pays for your accommodation. Not sure what happens if an OB and/or anaethestist are needed.

Private hospital, private doctor’s patient. There’s no midwife-managed option. If you’re birthing in a private hospital, you need a doctor of your choice attending. Again, pre-birth consultations in their own clinic, and subject to gap fees.

It’s definitely worth noting that while your private doctor will be an obstretrician and can manage higher risk pregnancies, for really serious stuff like prematurity earlier than a certain point, pregnancies with more than 2 babies on board (I think) and similar, they will actually refer you into the public system!

Is private insurance useful? Yes, pays for your accommodation and some of the OB’s and anaethestist’s (if needed) gap.

Public hospital, high risk clinic. I don’t know much about this, I’m told it’s the next level up in risk, and it well might be my next pregnancy. Joy. This is where you end up with OBs with a high risk interest, maternal-fetal medicine specialists (OBs with a formal subspecialty in very high risk pregnancies), renal physicians, endocrinologists, etc. This often involves referral to a tertiary hospital. (Sometimes specialists can consult without you being in one of these, like, an endocrinologist might monitor diabetes or thyroid hormones with you in the regular doctor’s clinic or seeing a private OB.) Birth choices guides don’t talk about this option very much, because you don’t really have a choice at this point (except birthing unattended or with a very risk-tolerant private midwife).

Is private insurance useful? I’m not sure, to be honest. It probably depends on the risk profile of your actual birth, I guess? If your birth is able to be attended by a regular private OB, maybe they let you do this? But you can do this publicly too.

Further reading on birthing choices
My Birth has a lot of information on birth procedures and the outcomes of different birthing providers, from a low intervention advocacy standpoint. One thing of note which gets picked up a lot by low intervention advocates is that despite the private birthing system referring all their hardest cases back to public, and despite the public patient profile being poorer with less good preventative health care and so on, private hospitals have much higher intervention rates.

Conclusion

It really depends on where you want to birth and with who attending. If the idea of the same doctor doing your pregnancy management and attending your birth appeals, that’s tending towards private birthing and thus private health insurance. But it has high out of pocket costs on top of the insurance premiums. (Note also that private health insurance policies are expensive if you include obstetric coverage, and will always have a 12 month waiting period for it, so you must obtain it before pregnancy.)

I was reasonably happy as a doctor’s clinic patient for my first birth. If I was low-risk I’d probably likewise go public, ideally with a birth centre or caseload midwife pregnancy+birth.

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Nannies and flexibility

Liam Hogan tweeted:

Further on rebates for nannies: if they’re a response to family-unfriendly working hours, flexible childcare is solving the wrong problem.

Here’s some systemic problems with childcare as it currently stands that one might hire a nanny as a possible solution to:

availability (strong form) For under 2s in Sydney, you simply might not get a childcare place accessible to you, by your scheduled return to work. Full-stop.

availability (weaker form) You have 2 or 3 children under 5, not uncommon. If you do get childcare places for them all, they (a) start to approach the price of a nanny and (b) are often not at the same daycare centre. So you can add 2 to 3 drop-offs to your commute run, 2 to 3 infection sources to your health problems, and when your children do all end up at the same daycare centre, you can enjoy four to six weeks of emotionally resettling them with the new centre. Or hire a nanny.

commuting in general Family unfriendly work hours are common. Family unfriendly commute hours are even more common: either a really tight schedule where you hope for no breakdowns/signals failures, or just total impossibility of getting to the centre in time. (Or you can have your kids in care near your work, and have them commute with you. Fun for the whole family. Plus you cannot use the centre when you are sick, which is one of the times when you really want to.)

illness I had four bouts of gastro and eight respiratory infections in the four months after my son began daycare. A nanny is an expensive way to avoid this, but that night I considered calling the police because we couldn’t lift him up to feed him? Maybe that’s worth $200 a day to people who can pay to avoid it.

throughout the day contact a privilege of (partial) telecommuters and (partially) at-home business people, and in theory daycare centres allow drop-ins if children are well-settled there and can handle two separations in a day (so, probably not in the first several months of care). For these people, a nanny may be one way of allowing the parent and child to have throughout-the-day contact without the parent needing to be first contact point for the child’s needs.

Now, I fully agree that funding nannies is less good ultimately than, say, free and freely available childcare, predictable work hours, widespread onsite/neighbourhood childcare with liberal allowance for parent drop-in, redesigning work and cities so that 1+ hour commutes aren’t the usual case, or… I don’t even know what you do about the illnesses, because I once saw my 9 month old licking another baby’s face and getting a good licking back. But there’s a raft of reasons why nannies are attractive. We may turn to one after our next child on cost alone. So that’s the context of nannies, for me.

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The practical reality of contraception, Australian edition

Background the first: The practical reality of contraception: A guide for men, by Valerie Aurora, about contraception in the US

Background the second: A layperson’s intro to paying for healthcare in Australia which I wrote as specific background to this post.

Things that are the same in Australia

Contraception works the same way! The side-effect risks are the same:

Let’s start with estrogen-based hormonal birth control and health. I know women who get life-threatening blood clots on estrogen birth control (if the clot gets lodged in a blood vessel, effects range from loss of a limb to death). Others have mood swings so bad that their partners threaten to break up with them and their boss calls them into their office to ask why they’re so mean and bitchy all of a sudden. Don’t laugh – losing your partner or your job is serious shit, and many women decide to risk pregnancy and an abortion rather than the certainty of being abandoned and broke. Another side effect is feeling like you’re going to barf, which usually goes away after a few weeks, but not for everyone. More side effects and health problems abound, but those are the ones I know about offhand.

The mechanism is the same:

Now let’s talk failure rates. You have to take the birth control pill every single day, within a few hours of the same time, to get that 98% or 99% effective rate. Big whoop, you may think. I take my blood pressure medicine every day. Usually. Actually, it’s pretty hard, even with those little day-of-the-week labels on the pills.

Those are specific to the combined pill, but there is no special magical Australian version of contraception. Same risks, same side-effects, same administration, same failure rate.

Valerie’s description of providers withholding prescriptions to force a patient to have a pelvic exams is also true here, although they usually aren’t called pelvic exams: they’re called Pap smears, even though the bimanual exam is often performed too. However, they’re done slightly less often: every 2 years in Australia for low-risk women.

I believe doctors and pharmacists in Australia can refuse the prescription and the supply based on personal moral considerations, and that really sucks. However, it doesn’t seem as common except for the (sometimes publicly-funded!) Catholic hospitals, ew. (See Lauredhel’s “Pro-life” Archbishop Hart’s murderous misogyny and Catholic Church says “Thalidomide-analogue cancer trial? No contraceptive advice for you!”)

Things that are different

Cost

Very important! Many many many brands of the pill are PBS medications, and cost about $30 for 4 months’ supply, so, getting close to Valerie’s mythical $8 a month mark.

Moreover, other contraceptive mechanisms (except condoms, which probably cost about the same) are cheaper too. For example, in the US I understand that I would be out of pocket at least $500 to have a Mirena IUD. In Australia, I had the insertion performed in a public hospital (being elective, I had to wait about 10 weeks), and bought the device from a pharmacy for $35 as it is a PBS medication. Total cost: $35! Length of contraceptive effectiveness: 5 years! (Downside: needs to be shoved into uterus. However, this is easier to do if you’ve shoved a baby the other way.)

Trouble at the doctor

As in Valerie’s entry, scripts for regular hormonal contraception do need to be re-done once a year or so, and given the side-effect profile of the Pill, I can see why. (If your blood pressure is up, you probably won’t notice, but you should be off the Pill.) At least in major metro areas, getting a non-essential appointment to get a script re-issued seems less of a pain though: a few days notice and your clinic will get you in for the required 15 minutes. Also, most doctors will prescribe the Pill to a brand-new patient after a short verbal medical history (at least, if you mention a Pap smear within the last two years) and a blood pressure check, so you can pop into a bulk billing clinic if you have one handy.

In addition, very recent law changes apparently will allow pharmacists to directly supply a small amount of contraceptives (and blood pressure meds) to patients to tide them over to their next doctor’s appointment. (I heard this on the radio, so, sadly, no citation.)

Trouble at the pharmacy

Like other meds in Australia, this just isn’t as much of a pain. The PBS contribution, if any (Nuvaring isn’t covered, say), goes on before you ever go anywhere near the pharmacy, you pay the remainder yourself usually. So the fighting with one’s insurer step is gone. Moreover, while pharmacies do only fill scripts towards the end of the previous supply, the “towards the end” test is more generous: you have two to three weeks at least.

Summary

I think Australia really wins here, especially on cost.

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Sunday Spam: hot banana bread

These are, largely, in reverse order of reading, that is, most recent first. Interesting that that tends to be a thematic ordering too.

Right-wing memes ahoy – “pregnancy is not a disease”

Right wing argument: pregnancy isn’t a disease. Therefore contraception shouldn’t be among funded medical services.
Response: pregnancy is [affiliated with/causes] illness for some women. Therefore contraception should be among funded medical services!

Uh, don’t buy the framing, responders! Says Tiger Beatdown. The end.

7-Year Old Transgender Child Refused Proper Bathroom Visits in School

Child identifies as boy. Parents, doctors and peers recognising child’s gender identity. School superintendent knows better. Unhilarity ensues.

This is what I said a feminist mother looks like:

  • Part One: the questionnaire, demographics, key themes and becoming feminists
  • Part Two: the impact of motherhood on their feminism
  • Part Three: being surprised by motherhood
  • Part Four: defining their feminist parenting
  • Part Five: the difficulties with being a feminist parent

    • This is a summary of a conference presentation Blue Milk gave on her long running 10 questions about your feminist motherhood series. I know that I keep going on about Instapaper, but these were handily divided up into bite-sized blog entries and I was still too lazy to read them before.

    Pink Scare

    A roundup of a series of incidents in which a huge comment storm has been created around a boy dressing as a girl or in girl-marked clothes. Not really novel if you read about this stuff a lot, a good summary either way, particularly the historical context about when and where young children have been expected to be strongly gender-marked.

    What revolution? Why haven’t women pushed harder for caring work to be valued?

    Blue Milk again, on the not-always-perfect marriage of patriarchy and capitalism, summarising Nancy Folbre. Of particular note Higher paid women benefit from their ability to hire low-wage women to provide child care and elder care in the market.
    Film review: “The Help,” a feel-good movie for white people
    The Help has become such a by-word for race fail in my circles that I hadn’t even heard what the basic plot was. Consider this a useful primer: what the plot is, what the problems are. Now you don’t have to see the movie.

    Gaddafi Should Be Tried At The Hague

    Not a surprising opinion for Geoffrey Robertson, but perhaps not everyone has read Crimes Against Humanity. Actually I haven’t read it all the way through either, because I have it in the cheap Penguin edition with teeny tiny writing and a stiff spine, and it’s still too heavy to hold in one hand. Must look into Kindling.

    Anyway, back in to Gaddafi: British Prime Minister David Cameron made a serious mistake this week by insisting that the fate of the Gaddafis should be a matter for the Libyan people. That was the line George Bush took after the capture of Saddam Hussein, as a rhetorical cover so that the death penalty could be imposed on the Iraqi despot by politically manipulated local judges.
    Australians don’t fully understand what is being done in their name

    While we’re in the thematic section marked unsurprising opinions from lawyers active in human rights, Julian Burnside. Why do we do this? What is it about our national character that explains such cruel, illogical behaviour? Simple: the politicians do it for political gain, and most Australians do not fully understand what is being done in their name.

    I’m worried he’s wrong.

    Why Political Coverage is Broken

    Jay Rosen’s keynote address at New News 2011, focussing on the marketing of news to politically interested readers. We’re all insiders, considering how this will play to the voters, as if they aren’t us.

    How the World Failed Haiti

    Well, partly it’s a Wicked Problem (high stakes, one chance to solve it, no good model, no correct solution, no or little ability to fix things after the fact, etc), but one focus of this particular article is that while Bill Clinton himself is potentially a good advocate and ally for Haiti, the people the Clintons tend to hire aren’t so much, perhaps. They tend to be experienced political operatives, not experienced disaster relief workers. (Also, even people specialising in development aren’t the same people who are good at disaster relief.)

    Learning to love my baby

    Jessica Valenti’s daughter was born extremely premature after a traumatic emergency Caesearean following pre-eclampsia and HELLP. She doesn’t think it’s a problem that her feelings towards her daughter were complex and that loving her was scary. She condemns though, factors that made her feel that this made her a terrible person.

    Review: The Red Market by Scott Carney

    The Red Market is the market in bodies, body parts and blood. This is a book review, not the book itself (The Red Market: On the Trail of the World’s Organ Brokers, Bone Thieves, Blood Farmers, and Child Traffickers), which goes on the to-read list.

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    Breastfeeding anti-discrimination changes passed at the Federal level

    This article originally appeared on Hoyden About Town.

    Via the Australian Breastfeeding Association on Twitter, this press release from the Federal Attorney-General:

    A pale skinned woman reads 'Breastfeeding: A Parent's Guide' while nursing a baby

    Attorney-General Robert McClelland and Minister for the Status of Women Kate Ellis today welcomed the passage through Parliament of the Sex and Age Discrimination Legislation Amendment Bill 2010.

    The new law will provide greater protections by… establishing breastfeeding as a separate ground of discrimination, and allowing measures to be taken to accommodate the needs of breastfeeding mothers…

    Here’s the text of a Senate review of the Bill as regards breastfeeding:

    Creating a separate ground of discrimination for breastfeeding

    2.9 Item 17 of Schedule 1 of the Bill would insert a separate ground of discrimination in relation to breastfeeding into the Sex Discrimination Act, to implement Recommendation 12 of the Senate Report. The Senate Report recommended that a separate ground be created because:

    …the intent of the Act is to protect women from discrimination based upon them breastfeeding. This is achieved by providing in subsection 5(1A) that breastfeeding is a characteristic that appertains generally to women. This seems a somewhat circuitous path. It would be desirable for the Act to provide for specific protection against discrimination on the ground of breastfeeding.[17]

    2.10 The separate ground of discrimination, provided for in proposed new section 7AA, only applies to women who are breastfeeding. ‘Breastfeeding’ would be defined as ‘the act of expressing milk’; ‘an act of breastfeeding’; and ‘breastfeeding over a period of time’. The inclusion of a reference to ‘breastfeeding over a period of time’ would ensure that a respondent cannot claim that a discriminatory act was lawful because the complainant was not actually breastfeeding at the time the act occurred.

    2.11 The protections against discrimination on the ground of breastfeeding would be extended to both direct discrimination and indirect discrimination, under proposed subsections 7AA(1) and (2) respectively. Under subsection 7AA(1), direct discrimination would occur if a person treats a woman less favourably than someone else, ‘in circumstances that are the same or not materially different’, by reason of:

    …the woman’s breastfeeding; or

    …a characteristic that appertains generally to women who are breastfeeding; or…that is generally imputed to women who are breastfeeding.

    2.12 The EM also provides an example of both direct and indirect discrimination in relation to breastfeeding:

    • direct discrimination would occur where an employer refuses to hire any woman who is breastfeeding, or a restaurateur declined to serve a breastfeeding patron; and
    • indirect discrimination would occur where an employer imposes a requirement on employees that they ‘must not take any breaks for set periods during the day under any circumstances’, which would have the effect of disadvantaging women who ‘need to express milk’.

    2.13 The Bill provides that discrimination on the grounds of breastfeeding is also prohibited in the following areas of public life (subject to certain exemptions in Division 4 of the Sex Discrimination Act):

    • education;
    • goods, services and facilities;
    • accommodation;
    • land;
    • clubs; and
    • the administration of Commonwealth laws and programs.

    2.14 Item 60 of Schedule 1 would prevent a man from bringing a complaint of unlawful sexual discrimination on the basis that a person grants to a woman rights or privileges related to the fact that they are breastfeeding. This amendment recognises that breastfeeding may ‘give rise to special needs, such as for private areas for breastfeeding, or hygienic areas for storage of expressed milk’, which should not be subject to complaints of discrimination.

    I am assuming that the wording that regards all people lactating and feeding a baby as women is a pretty pervasive problem in this area? Otherwise this seems like very good news on a number of fronts.

    The bill also has provisions about discrimination on the basis of family responsibilities, and increased protection for students who are harassed, including provisions about the harassment of a student by others from a different institution (I’m recalling now the University of Sydney strengthening their internal provisions regarding their residential colleges), and harassment of students under the age of 16.

    Image credit: the image of the woman nursing and reading is Breastfeeding on a park bench by space-man on Flickr, used under Creative Commons Attribution-Sharealike-Non Commercial.

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    Life at 1, 3, 5: general discussion

    This article originally appeared on Hoyden About Town.

    Background: this post is about the Life series that just finished airing on the ABC and which is affiliated with Growing Up in Australia: The Longitudinal Study of Australian Children. Life at 1, Life at 3 and Life at 5 are available on ABC iView for a little while longer for those with Australian IPs and to whom it is accessible.

    Now that I’ve done the specific posts, does anyone have thoughts about the Life series in general? Here’s a few thoughts on individual scenes:

    • In Life at 1 I love the super-serious newborn shot of Shine looking out at the world grouchily.
    • Jara’na was awesome in Life at 3, it was a real shame there was so much focus on his separation anxiety rather than his inventive play and sense of the dramatic.
    • My favourite Life at 5 scenes were both from the Marshmallow Test. One was Anastasia looking directly into the camera and popping the single marshmallow straight in her mouth for immediate gratification, and the other was Shine delicately stepping around the room, not looking at the marshmallow. (Actually, Wyatt was pretty cute too, testing himself by putting his mouth around it but not lifting it from the plate!)

    On the series as a whole:

    • I wish we could see more of the eleven children meeting each other, which they have clearly done several times now, but it’s only been shown for the purposes of very brief cut shots of birthday parties and racing through parks. As the series goes on age-peer relationships will grow in importance, it would make sense, although it wouldn’t be totally representative of their social interactions, to begin to show them interacting with each other.
    • Judging from the birthdates of the children on the website, they’re the six year old cohort this year. It sounded as if there are definitely plans for Life at 7 to film next year and presumably air in 2013, and the print version of the Sydney Morning Herald suggested that the film-makers would like to go through the teenage years, although they don’t have funding yet and perhaps would plan less frequent updates. (Perhaps only one or two during high school.) I think the series would be improved if they could go out to three or four episodes from Life at 7 onwards.

    Speaking of more content, I haven’t gone through the website‘s content, anything good there?

    And a conversation about introversion/extroversion from comments:

    blue milk:

    But there is much to feel concerned about, even in this small segment you have highlighted here, and I found others when I was watching the series too, like the ways in which introverted babies versus extroverted babies were discussed in terms of their performance during some of those classic experiments about attachment and seperation.

    Me:

    But on that subject I was also rather surprised by the interpretation of the separation experiments. I was under the impression that they were usually interpreted the other way around; that a child should show distress at separation from their primary carer, not that a approx 12mo child should be able to cope with that. (Both “shoulds” have their problems!) But Ben’s separation anxiety, and the anxiety Jara’na develops later as a toddler, are both portrayed as extremely worrying.

    We view my own son as moderately extroverted, and his reaction would have been more anxious than any of those shown except Ben’s.

    They said something at some point about all personality types being valuable, and my husband (who is extremely introverted) said something like “just because a personality type exists, doesn’t make it valuable!” The show doesn’t really back up this claim with a discussion of the values of introversion, or for that matter of caution about carer separation or strangers! The only Life at 1 claim about introversion is that it exists, basically.

    There’s also been talk on Twitter at #lifeat5.

    Feel free to use comments here to address any aspect of the series.

    See other Life posts at Hoyden: Life at 1: breastfeeding, Life at 3: obesity, Life at 1, 3, 5: disability

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    Life at 1, 3, 5: disability

    This article originally appeared on Hoyden About Town.

    Background: this post is about the Life series that just finished airing on the ABC and which is affiliated with Growing Up in Australia: The Longitudinal Study of Australian Children. Life at 1, Life at 3 and Life at 5 are available on ABC iView for a little while longer for those with Australian IPs and to whom it is accessible.

    It’s not uniformly positive, but I was a bit more impressed with the handling of disability on Life than I was of breastfeeding or obesity. It’s quite possible I’m not as sensitised though.

    As one would expect statistically, when you select eleven families and follow them for four years, there are several families with members who have illnesses or disability. Sofia’s father Anthony was treated for lymphoma just prior to Life at 1, so that’s only briefly treated and shown in a few still shots of baby Sofia visiting Anthony in hospital. Anthony is shown in hospital again briefly in Life at 5, receiving test results after a false recurrence scare. But the families who have members with disabilities during the series most prominently are Loulou’s and Daniel’s.

    Daniel is the second child of Rodney and Kathryn, and in Life at 1 he is shown visiting his brother Jamie in hospital. Jamie was about three at the time and had a brain injury recently acquired in a near-drowning. He was almost always shown in Life at 1 and Life at 3 seated in a slightly reclined wheelchair, with little or no limb movement shown (in Life at 1 he is also shown in Kathryn’s arms in a couple of scenes, and once in bed with Daniel touching him). In Life at 3 he was described as also experiencing high levels of chronic pain, and at the end of the episode, there is a second segment returning to Daniel’s family for Jamie’s funeral (which was filmed and broadcast), as Jamie had died of pneumonia aged four and a half.

    I was pleased that the circumstances of Jamie’s accident weren’t dwelt on very much (other than the fact that it occurred in a backyard pool, no details of the accident are given), it would have seemed trite to insert a long pool safety lesson. At least to me, the narration seemed generally to portray Jamie as a person in a family as did Jamie’s parents, although Rodney has a piece to camera in Life at 1 in which he discusses avoiding Jamie.

    The main concern in Life at 1 with the treatment of Jamie was, to me, the extent of “what about Daniel?” about the portrayal. There’s quite a bit of “what about [child]?” in the discussion of the families generally. In this case it’s playing into a cultural narrative of concern about a disabled child focussing mainly on their abled sibling. The family themselves express some similar concerns, Rodney and Daniel’s grandmother more than Kathryn.

    Kathryn is herself disabled, with a vision impairment. This is treated fairly neutrally: there are small sequences in Life at 1 showing her dressing Daniel by feel:

    [Kathryn is pulling a red t-shirt over Daniel’s head.]

    Narrator: Daniel will not only have to adapt to life with a disabled brother. His mother is completely blind in one eye.

    Kathryn: Where’s your head?

    Narrator: Over the past two months a cataract has formed on Kathryn’s good eye. Her sight is now extremely limited.

    Kathryn: I can see but most of it is feel. Most of it’s my hands, knowing what to grab.

    In Life at 5 she is shown teaching Daniel to help her with crossing roads and with bus travel. As is shown a little in the segment above, it’s again almost entirely considered in light of Daniel: is it a good challenge for his development, or too stressful?

    Life at 3 Part One also describes disability. Both of Loulou’s parents have had depressive illness between Life at 1 and Life at 3, Louise’s is described as having grief following from miscarriages after Loulou’s birth and then post-natal depression and Shannon’s as an acute episode in a chronic condition related to a motorcycle injury.

    There’s a moment of problematic framing in the discussion of Louise’s depression, in which a decision about medication is framed as the “brave” choice:

    [A close-up of a cake being cut is shown.]

    Narrator: By the time Loulou was one, Louise had been assessed for post-natal depression.

    [Louise is shown in front of the cake, look around at adults attending Loulou’s birthday party.]

    Louise: Everyone for cake? Yes?

    Narrator: She was borderline, and the doctors recommended medication. But Louise bravely tried to soldier on and said no to the drugs.

    Later, after Loulou begins childcare:

    Narrator: The depth of her anxiety made it clear Louise needed help. She took her doctor’s advice and went on to anti-depressants. By the time Loulou turned two, Louise was back on track and emotionally stable.

    Shannon’s acute depression episode occurred shortly after, and the narration leaves that alone more so that Shannon can himself consider the impact of his illness, although again at least the portion shown is largely “what about Loulou?”:

    [Shannon, a pale-skinned man with close-cropped dark hair is shown speaking to camera inside a brick walled building with light coming in through the windows and surrounded by vehicle parts, where earlier he has been working on a motorbike.]

    Shannon: That was a big step for me. “You have a mental illness, a depressive mental illness, that you will need to deal with and be conscious of and shield your daughter and your partner and and anyone else who could be collatoral damage from for the rest of your life.” That was tough. That was really tough.

    What did you think? I think this could have been worse with either a more tragic air or the Fighting Fat episode’s constant refrain of “risk” but that this is still a particularly problematic area for the show to be keeping its tight focus on the particular impact on the abled child when talking about family members with disabilities.

    See other Life posts at Hoyden: Life at 1: breastfeeding, Life at 3: obesity

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    Life at 3: obesity

    This article originally appeared on Hoyden About Town.

    Background: this post is about the Life series currently airing on the ABC and affiliated with Growing Up in Australia: The Longitudinal Study of Australian Children, specifically the episode Life at 3, Part One: Fighting Fat. It is presently available in full on iView for those with Australian IPs and to whom it is accessible.

    Ooo boy. It probably wasn’t ever going to be good, was it?

    Let’s start with the basics:

    Headless fatties. (Recalling that headlessness is a major obesity risk factor!). Headless fatties are shown at:

    • 3:06–3:44: Camera pans horizontally past a blurred very slightly rounded pale-skinned bare abdomen, a blurred shape that might be a pale upper arm outside a black sleeveless top, a second pale abdomen with arms crossed at the top of it, a fatter pale abdomen with (probably male?) breast tissue resting on it, and then cuts to two presumed women’s bodies shown neck to knee and wearing black bra and panties. Both women are pale skinned and one is fatter than the other. They spin around simultaneously from presenting their front to the camera to presenting their back. There is a close-up of them joining hands, some of their upper leg and buttock flesh is in the shot. The camera cuts to a male torso like the fatter one shown previously, and he turns around too, showing his torso from every angle.
    • 32:24–32:50: a brown-skinned fat male torso in black underpants spins to face the camera. It shifts its weight over each leg and spins again. It is joined by a pale slightly rounded woman’s torso in black bra and underpants, a pale fat man’s torso (probably the one from the previous sequence) and a second pale, fatter woman’s torso. They turn simultaneously to have their backs to the camera. The nearest torso, that of the pale man, shows some buttock cleavage.

    Headless fatties. CHECK.

    [Stephen Zubrick, Chair, Advisory Group, Longitudinal Study of Australian Children appears, as he does throughout the series, in a headshot, looking slightly to the left of camera. He is a late middle-age pale-skinned man with short dark hair.]

    Stephen Zubrick: Our data is showing us that one in four toddlers is overweight or obese.

    The Life series doesn’t push back much on the science at any point. For example, in Life at One, saliva cortisol samples were taken from the babies and it was assumed without proof that high cortisol equalled a stressed individual baby. Now, I have no medical/biological background at all, but I do have an experimental background, and I spent the whole time mentally screaming “is that a valid assumption? or does cortisol correlate with stress only across a population?” And in fact they had to back away from the automatic interpretation when Joshua, who they didn’t seem to want to interpret as stressed, had very high cortisol. Perhaps… he was just sick! Likewise, the limits of the psychological tests they run on the children in terms of cultural assumptions, edge cases, controls, error margins are never discussed. Obviously there’s a limit to the extent to which this can be done in a TV episode, but in general I wish the series was less “the experts have worked their magic! this child is fat/stressed/extroverted/determined! The end!”

    And so, it’s no surprise to find out that this is how obesity is treated. How is obesity in toddlers measured? How strong is the link with childhood or adult obesity? How strong is the link between those and adult disease? And, most elementary to me, how many children are supposed to be overweight or obese? Measures of ‘healthy’ weight are often population based, where the top X% of weight, or BMI, or weight-for-height is defined as overweight, but yet, it is by definition expected that X% of people will be found in that top X%. I’d definitely like to be convinced that their measure of “overweight or obese” does not define overweight to be the top 25% of the population somehow.

    There’s fairly standard fatphobic language about food: “good”, “bad”, and some tsking at the parents for using what the show’s writers seem to consider a euphemism, “treat food”. Then there’s this odd little sequence:

    [Visuals of Ben and a sibling eating.]

    Narrator: When we asked parents why they introduced their child to treat food the most common reason given is to reward them for good behaviour.

    [Visuals of Daniel eating from a yoghurt container while his mother Kathryn watches.]

    Kathryn: Finished?

    Daniel: No!

    [Visuals of Wyatt eating a sandwich at a table and looking at his father Glen.]

    Narrator: But for our parents [note, here they seem to mean “the parents featured in the documentary”, not “the parents of the viewers”], unhealthy treat food was hardly ever offered up as a reward.

    [Headshots of individual parents.]

    Kylie [mother of Ben]: Aw crap I can’t even remember what we were given. [Rolls eyes.] Probably Vegemite sandwiches.

    Michelle [mother of Jara’na]: Yeah we didn’t sort of get a lot of rewards when we were kids. There was too many of us.

    Paul [father of Ben]: I don’t think there actually was a lot of time I did actually get a reward for doing anything good or anything like that. I kinda just had to do it.

    Bernadette [mother of Sofia]: I think I got to stay up late and watch TV with my Dad as a reward! [laughs]

    Steffi [mother of Joshua]: Maybe go to the park. Maybe go to the zoo. Or maybe my mother make me a new dress.

    Kathryn [mother of Daniel]: My reward was actual praise. I didn’t get any food or anything like that. So once in a while you’d get, I’d get maybe a treat, but much of it was just mainly praise.

    Narrator: Over one generation we are seeing a massive cultural change in the way we use and view food. Unfortunately, this shift has coincided with a dramatic reduction in how much physical activity our children do.

    The statement about physical activity appears to be driven by the study’s data, but it seems that the “food was never used as a reward in 1975” hypothesis was one the writers came up with themselves based on interviewing parents of three year olds about how they believe they were rewarded as, say, eight year olds (since they mostly won’t remember being three). Aggravating in a series that is supposed to be informed by the study.

    Another problem with this episode is a structural problem with the entire series. There are two episodes for each age group, each loosely focused around a specific issue. Life at 3’s two episodes are Fighting Fat and Bad Behaviour. Each of the children is allocated to an episode and their development and family situation is partly discussed for its own sake and partly discussed with relevance to the topic at hand.

    For Fighting Fat this means that the primary interest in each of the toddlers it focuses on is “will it make them fat?”

    So we have Joshua, who is among other things a toddler, of Chinese ethnicity, a younger brother, the child of an immigrant mother and the child of a father who downsized his career for his family and wants a low-pressure environment for his children. What’s the most interesting thing about Joshua at age three? Apparently that children of recent immigrants might get fat.

    We have Ben, who is among other things a toddler, of unmentioned ethnicity (the cultural identity of most of the pale-skinned children is unremarked on), a survivor of a quintuplet pregnancy and a premature and very low weight birth, a brother to his quintuplet siblings and an older sibling. What’s the most interesting thing about Ben at age three? Apparently that children with low birth weights might get fat.

    We have Shine, who is among other things a toddler, of unmentioned ethnicity (in Life at 5 her father meets his birth family, who are Irish), a child living in poverty, a youngest sibling in a larger family, and the biological child of an adoptee. What’s the most interesting thing about Shine at three? Apparently that children in poorer families might get fat.

    It probably had to happen in some form. Could you get a childhood study funded right now that didn’t have a major obesity focus? But the television treatment is very uncritical, and moreover appropriates several potentially interesting standalone stories.

    See other Life posts at Hoyden: Life at 1: breastfeeding, Life at 1, 3, 5: disability, Life at 1, 3, 5: general discussion.

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    Life at 1: breastfeeding

    This article originally appeared on Hoyden About Town.

    The longitudinal television program Life at 5, following from Life at 1 and Life at 3, is now showing. This is a series of programs following the development of eleven children, returning to them at intervals. It’s associated with Growing Up in Australia: The Longitudinal Study of Australian Children: the parents of the eleven take the survey and the producers of the television program use the survey to inform the documentary, at least loosely, and experts in child development comment on the children.

    If anyone who reach ABC iView (location locked to Australian residents) wants to catch up, and it’s accessible to you, Life at 1 and Life at 3 are currently available, as is part one of Life at 5. Presumably the second part will go up this week after it airs on Tuesday.

    The whole thing has my Hoyden antenna up a bit, so I am going to post a few discussions of some of the aspects of the show I was less impressed by.

    Today: breastfeeding.

    Feeding choices and necessities are not discussed for most children in Life at 1 (in which individual children seem to range in age from birth to about 15 months old, rather than all being 12 months), which would be the only episode where the Australian breastfeeding numbers suggest we’d be likely to meet a breastfeeding dyad in a sample of eleven children.

    The major exception is Loulou, the child resulting from an IVF pregnancy of Louise, a mother in her forties who the narrator says has been trying to have children for ten years. Louise has a negative breastfeeding experience. (Transcript from Life at 1, Part One, this transcript begins at 24 minutes 28 seconds in.)

    [Large black dogs approach a locked screen door from the outside.]

    Woman’s voice: OK.

    [Cut to a close up of a pale skinned newborn with closed eyes and a protruding tongue, rooting. Part of a breast appears in the shot held in a adult hand wearing a ring. The nipple, areola and surrounding area are moved towards the baby.]

    Woman’s voice: Come on. Come on darling.

    [The hand moves the breast around, teasing the newborn. The shot cuts to Louise, a pale skinned woman with light brown hair. Louise is wearing a pink top, and has lifted it up to expose her left breast. Her right hand is supporting the head and neck of Loulou, a pale skinned light haired newborn clothed in green, in the cradle hold near her left breast. Her left hand is holding her breast and squeezing it just above and below the areola. Her posture in general, and her left arm in particular, look tense, and her facial expression is concerned and determined.]

    Narrator: Louise has been told that in the early weeks of life breastfeeding is the most important experience that a mother can give her newborn baby.

    [Louise teases Loulou with the nipple, but Loulou does not latch.]

    Voiceover by Melissa Wake: breast milk is tailored for human babies, it’s tailored for their maximum cognitive growth…

    [Cut to Melissa Wake, a pale-skinned woman with light curly hair, in a studio speaking to the camera calmly and authoriatively. The screen identifies her as “Assoc. Professor Melissa Wake, Paediatric Consultant, Longitudinal Study of Australian Children”.]

    Melissa Wake: … so growing their intelligence, it contains immune substances so it protects against infection, it’s believed to protect against conditions such as asthma…

    [Cut to a high shot of Louise and Loulou. Louise is continuing to tease Loulou with her nipple.]

    Melissa Wake: … so you’re giving your baby the best start to life you can if you can breastfeed them for a substantial time.

    Louise: [sigh, sounding as if she is either exasperated or in pain. She addresses Loulou, who is grunting, in an upset but not angry-seeming way.] We haven’t been having a good time have we?

    [Cut to a close up of Loulou’s face. Her eyes are opening and closing and she is grunting and crying softly. She moves her head from side to side and then seems to be attempting to latch.]

    Louise: I know we’re both learning this thing. It’s so hard.

    Narrator: In the first six months of life the recommendation is that breastmilk is the only food that should be given to a baby and it should be part of a baby’s diet until they’re at least twelve months old.

    [The scene changes. It is a large white walled and floor room filled with colourful children’s toys. Many of all the eleven children are in the room with most or all of the parents. They are largely playing and talking cheerfully. Brief close ups of various faces are mixed with the wide group shot. The sound of chatter is heard indistinctly.]

    But it seems we’re ignoring this advice. When the ten thousand mothers in the study were asked how long they breastfed ten percent said they didn’t breastfeed at all and another twenty percent had stopped before their baby was even three months old. So why are women struggling with the most fundamental task of motherhood?

    [Head shots of individual mothers of some of the other ten children are seen.]

    Kathy [mother of Anastasija]: I wasn’t producing enough and she was still screaming for food.

    Kathryn [mother of Daniel]: I stopped breastfeeding because my milk ran out.

    Steffi [mother of Joshua]: I think it’s… not enough food.

    Kim [mother of Declan]: My milk… virtually dried up at three months.

    Tamara [mother of Wyatt]: I didn’t breastfeed at all because I wouldn’t have time in the day to do it if I went back to school.

    [Louise is shown pushing a pram up to a building. Loulou is asleep in the pram. Louise’s footsteps echo as the narrator speaks.]

    Narrator: Louise knows that breastfeeding will establish the strongest bond between mother and daughter, that it will stimulate growth and intelligence. Her goal is to breastfeed Loulou for at least a year, but after only three weeks she’s on the verge of giving up.

    [Cut back to the original scene with Louise wearing a pink top. She is leaning Loulou over her shoulder.]

    Louise [crying]: I feel a bit like a failure. A sense of failing. With this. [It’s/Is] really big and I really don’t want to.

    [A pale skinned late middle-aged woman approaches a door labelled “Day Stay Clinic” and enters. From here on, this woman, who isn’t introduced by name or given a title, is called Nursing Coach in this transcript. The scene changes to Nursing Coach and Louise in a dim room. Nursing Coach is standing facing Louise, who is seated holding Loulou in a cradle hold. Nursing Coach is moving Loulou with her hands.]

    Nursing Coach: [unclear] Now see what happens there. So her [unclear] is free to move

    Louise [voiceover]: If she got sick or ill in some way I seriously think I would blame myself because I couldn’t breastfeed her and maybe that’s why

    [A third woman is observing Louise and Nursing Coach from about one metre to Louise’s side. She is not introduced and does not speak in any part of this segment. Nursing Coach moves Loulou into position and she latches onto Louise’s breast.]

    Louise: [gasp and grimace of agony]

    Nursing Coach: Now, have you got your toes curled?

    Louise: Yes.

    Nursing Coach: OK, does it still hurt?

    Louise: Yes, yes it does.

    [Nursing Coach begins to touch Loulou and Louise’s breast, seemingly trying to show her how to break the latch.]

    Nursing Coach: OK we need to take her off. So you need to get this thumb…

    Louise: But I can’t, I’m just stuck.

    Nursing Coach: Let her go, let her go, let her go, let her back. OK, finger in there somewhere. Now finger in that somewhere, to push that jaw so she…

    [Loulou’s latch is broken and Louise rolls her eyes.]

    Narrator: Loulou is not attaching properly to the breast. Louise’s nipples are cracked and sore. The pain is excruciating.

    [Nursing Coach again moves Loulou into position, and while it’s not totally clear what is happenin, appears to jerk Loulou forward to encourage a latch.]

    Louise: [yell of pain]

    Nursing Coach: Uh uh uh uh uh. [To Loulou, lifting her up and away from Louise] Up you come.

    [Loulou is crying loudly and frantically. Louise puts her own face in her hands for a moment.]

    [Another latch is shown.]

    Nursing Coach: Good. Now. Just relax your fingers if you can.

    Louise: [gasp of pain] Come on darling.

    [Cut to Louise’s partner and Loulou’s father Shannon, who is driving and speaking to a camera in the front passenger seat. Neither Louise nor Loulou seems to be in the vehicle.]

    Shannon: I think there’s a little bit of post natal depression happening. I think it’s… it’s a whole new adventure that neither of us have ever experienced before. Louise likes to be in in control of things even though she’ll debate that with me. Um, and this is something that she can’t control. A child… I must admit that I was ignorant. I thought here is breast, here is child, put child on breast, job’s done. But I never knew that it’s not all like that for many women.

    Nursing Coach: Want to try the other side?

    [Loulou is shown latching.]

    Louise: [extended cry of pain]

    [The camera pans back. Louise is arching her back with pain.]

    Nursing Coach: [exasperated voice] What do you need to do now Louise?

    Louise: Remove her.

    Nursing Coach: Take her off. Quick sticks! Your fingers! Quick sticks!

    [Loulou cries.]

    Nursing Coach: Enough.

    [Louise stands and cuddles screaming Loulou.]

    Narrator: Louise struggled with breastfeeding for six more days.

    [The scene cuts to Loulou sleeping in a cot.]

    Narrator: The dream for a nurturing and intimate experience with her baby is shattered.

    [The camera pans to a single couch, in which Louise is sleeping under a cotton blanket marked “PROPERTY OF [text hidden]” and the cuts back to Loulou, now awake and calm in the cot]

    Narrator: For Louise, it feels like she’s failed Loulou in the first weeks of life. Time will tell if the enormous expectations that Louise heaps on herself will play a role in shaping the personality of her daughter.

    Watching this was upsetting for me. I had a painful start to breastfeeding that became very upsetting. In my case, my son’s latch was judged good and his weight gain indicated that his consumption was fine, so I was advised to wait out the pain. It disappeared when he was about 14 days old. But there were definitely moments that I did the equivalent of sitting in his room wrapped in a blanket feeling like I sucked as a mother. I reacted very badly to the exasperated “Quick sticks!” sequence in particular. It was hard not to see it as some kind of punishment: if you can’t breastfeed well, you will be trapped in a room with no natural light and a breastfeeding coach who will eventually get pretty sick of your whining.

    There are of course reasons why this portrayal of breastfeeding might have ended up being negative. It’s possible that the intention was that Louise, who seems to have been cast as the late-life IVF mother with high expectations who wants everything perfect for Loulou (a problematic framing in itself) was the mother whose breastfeeding story they’d decided to tell, and it happened to turn out badly.

    I certainly don’t say that Louise’s story shouldn’t be told: it looks terrible and she grieved for the loss of the breastfeeding relationship. It’s one of the ways breastfeeding can turn out. But it wasn’t contextualised with much successful breastfeeding. The only other child mentioned or shown breastfeeding in Life at 1 is Shine, who is seen latching once soon after her birth. (Shine and Loulou are the only babies seen as newborns, other than Ben, who was delivered at 28 weeks with his quintuplet siblings and who is shown as a newborn only in a couple of still shots from his lengthy NICU stay.) Later, in Life at 3 Shine’s parents mention in passing that “boobie” is her favourite word, so it can be presumed she was breastfed as a toddler, but she isn’t shown nursing, and that snippet is in the context of the obesity episode. (We’ll come to it.) That’s not a lot of airtime compared to the “I didn’t have enough milk” sequence above.

    The show as a whole is generally more observational than it is directly educational, so it is not a surprise that they do not offer breastfeeding resources on air (eg, the ABA hotline, or mentions of lactation consultants and how to find them); the series doesn’t, say, talk about how to find help when it addresses poverty either. There’s a very small set of breastfeeding links on the ABC website. But considering the amount of time that is spent having the experts interpret footage of experiments being run on the children (things like how they interact with a new toy, or a stranger), it would have seemed reasonable to have Melissa Wake or another paediatric or lactation expert push back a little bit about why breastfeeding isn’t as common as they recommend. As it stands, the portrayal is of breastfeeding failure being the usual case, and of long term milk supply problems being typical.

    Update: Y points out in comments that there are Life at 2 videos on the website, and if you view Shine’s video you will see some discussion of baby led weaning, breastfeeding on demand and footage of toddler Shine nursing.

    See other Life posts at Hoyden: Life at 3: obesity, Life at 1, 3, 5: disability, Life at 1, 3, 5: general discussion