Chaos: at home, at school, around the world

My whole life seems to be a constant state of chaos with only glimmers of sanity thrown in to keep me striving for something more. For me, however, most of my current chaos is self-inflicted and is rooted in a deep seated avoidance for the word “no”. Since I have very few childhood memories, I find it a challenge to recall much from my early years and I can only guess at some things given the circumstances at the time. My parents divorced prior to my birth in which time my mother and two older sisters moved in with my grandparents.  As a toddler my mother remarried and I now had three big brothers added to the scene on a regular but not daily basis. I have photographs of the apartment in Dallas where we lived near my preschool and an increasing number of memories of the house we lived in during my kindergarten and early elementary years. During the summer between second and third grades we moved out to the country where I lived until moving to Arizona to attend college. Like every family we had our challenges and some tragedies so, on some level chaos was just a part of life. I fondly recall, however, the intentionality of my parents to minimize the chaos and provide stability in routines, namely regular family outings and vacations. Still, I remember feeling left out and confused at times and unaware of how to handle even peer conflict without withdrawing – on one occasion hiding under a table and pouting until I fell asleep. In retrospect, perhaps that was the beginnings of my “I’ll do as much as I can to appease and please” attitude. I remember even in kindergarten, retreating to my neighbor and best friend’s house where her mom read stories to her and we played endlessly in the yard, not wanting to go home. I just assumed that that was how every child felt. The older I got, the more secrets there seemed to be and I just lived on a “need to know” basis; a behavior that I, unfortunately, carried into adulthood seeing “trivial” information as a burden on others instead of helpful communication. None the less, I think I had it pretty good and I knew that my parents loved me and I was safe.

On the other hand, I see children in our program more often than I’d like that are experiencing a much more real form of chaos and I realize that for them too this is just a way of life and without the perspective of age this, for them, is what everyone else experiences as well. Children whose parents are in the process of divorce or have split recently so the child is bounced from house to house like a ping pong ball in play between angry adults. While I know that these situations can be navigated relatively successfully by all participants, I also know the opposite to be true when the child has two sets of expectations and the primary goal seems to be to make the other parent as angry as possible. My thought is always, “why can’t these two “adults” see what they are doing to their child?” Children come to school angry or withdrawn and the best we can do sometimes is to provide the stability that he needs during the day and enough love to make it through the next night.  It is heartbreaking to see a four year old express the guilt associated with parental breakups when they cannot be convinced that it isn’t their fault.

On the other side of the globe, the 2007 presidential elections in Kenya brought with it plenty of chaos, particularly to its children who were not only forced from their homes by the violence but were separated from their parents leaving many orphans (AP, 2008).  According to UNICEF and the Kenya Red Cross Society 150,000 children were in need of support after losing their families and experiencing extreme violence first hand.  These children harbor anger, fear and frustration over the attacks, even fearing former classmates who are Kikuyu – the attacking tribe. But, “Pamela Sittoni, a spokeswoman for the UN Children’s Fund, UNICEF, agreed. ‘A comprehensive counseling package has to be developed. [We'll be] looking at how we can follow up with these children and provide the psycho-social support they need. That has to be a priority.’" (IRIN, 2008) Fortunately, most of Kenya’s displaced children now reside in the care of these organizations but still others have been placed in camps or questionable facilities and have been passed out to adults looking for houseboys or worse. Others who were fortunate enough to have been reunited with relatives may not be any better off in the face of severe poverty, who may possibly be being used for manual labor. Consequently, UNICEF is exploring the possibility of expanding their orphan support fund in order to provide more and appropriate care for as many children as possible. Fortunately, many more organizations have sprung up in the years that have followed and continue to support efforts to help children overcome this tragedy and become functional members of society – not just survivors.

The Associated Press (2008, February 21). The lost children of Kenya’s political violence. Retrieved on January 26, 2012 from http://www.msnbc.msn.com/id/23280823/ns/world_news-africa/t/lost-children-kenyas-political-violence/

IRIN humanitarian news and analysis (February 26, 2008).In-depth: Kenya's post election crisis. Retrieved on January 27, 2012 from http://www.irinnews.org/IndepthMain.aspx?InDepthID=68&ReportID=76948

SIDS: Sleep Environment/Breastfeeding

Sudden Infant Death Syndrome is one of the many topics I cover in my high school class. My primary motivation is to gather more relevant information to pass on to my students and to check for current research. My hopes are to not only be able to provide my students with accurate information and statistics, but to encourage them to continue to research the topic and share their findings with the rest of the class through some sort of presentation.

Unfortunately, I am finding it challenging to locate current articles from overseas. My primary concern is that most of the articles that I have found thus far were written in the 1990’s, or before, and so much has changed since then. My question is, “has the Back-to-Sleep and other interventions significantly impacted the incidence of Sudden Infant Death Syndrome?” Nonetheless, I have located one article from Georgetown University that not only provided data collected from around the world, but links to their sources as well. In this article an international comparison conducted in 2006 revealed that the incidence of SIDS has been reduced significantly around the globe from 1990 to 2005 (for some countries more current information is provided as well) after awareness campaigns such as Back-to-Sleep were run nation wide. The following chart illustrates the reduction in SIDS deaths for each country involved in the study.  I find it interesting, though, that according to this chart, the United states still ranks 2^nd in the world for unexplainable infant deaths when we were ranked 8^th just 15 years prior.

Chart 3. International SIDS Rates, Ordered from Lowest to Highest SIDS Rate in 2005

(For more detailed information on this chart go to: http://www.ispid.org/statistics.html)

Another article published by the American Academy of Pediatrics (2009) shares the findings from a study on SIDS and sleep environment conducted in Germany from 1998-2001. Not unexpectedly, risk factors discussed in the article included prone sleeping, infants sleeping in the living room (what other studies have identified as “couch” sleeping) and infants sleeping prone on soft surfaces – namely sheep skins. An earlier article from the AAP (American Academy of Pediatrics, 2009) reports a connection between breastfeeding and the incidence of SIDS. While there is no direct causal proof that breastfeeding reduces the risk of SIDS by 50%, there is a strong correlation. One suggestion may be that babies who are breastfed may be rooming in with Mom or even sleeping in the same bed which may allow for a reduced parental response time if something were amiss with Baby.

International Society for the Study and Prevention of Perinatal and Infant Death. (2011). International Infant Mortality Statistics. Retrieved from http://www.ispid.org/statistics.html

Georgetown University. (2011, August). National SUID/SIDS Resource Center. Retrieved from http://www.sidscenter.org/Statistics.html

Vennemann, M. M., MD, PD, MPH^a, Bajanowski, T., MD, PD^b, Brinkmann, B., MD, PD^a, Jorch, G., MD, PD^c, Sauerland, C.,MSc^d, Mitchell, E.A., FRACP, DSc^e, the GeSID Study Group. (2009, March 1). Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome. PEDIATRICS, 123(3), e406-e410.  Retrieved from http://www.pediatricsdigest.mobi/content/123/3/e406.full (doi: 10.1542/peds.2008-2145)

Vennemann, M. M., MD, PD, MPH^a, Bajanowski, T., MD, PD^b, Brinkmann, B., MD, PD^a, Jorch, G., MD, PD^c, Sauerland, C.,MSc^d, Mitchell, E.A., FRACP, DSc^e, the GeSID Study Group. (2009, April 1). Sleep Environment Risk Factors for Sudden Infant Death Syndrome: The German Sudden Infant Death Syndrome Study. PEDIATRICS, 123(4), 1162 -1170.  Retrieved from http://www.pediatricsdigest.mobi/content/123/4/1162.full (doi: 10.1542/peds.2008-0505)

Birth Story Plus

I hear other birth stories or know of women (like my sister) who labor for a couple of hours and then push a few times and voilà, out pops their bundle of joy and they are ready to go home! Well – I am definitely NOT like those women so I’ll fill you in on how things went for me.

My first delivery was very difficult and had to be induced. I also had an epidural which I was convinced was part of the problem since I couldn’t push effectively without the use of my legs. I vowed that my second pregnancy would be much different – a much “better” experience.  The pregnancy was relatively normal with only a false reading on the AFP at 16 weeks to upset the apple cart, but a normal amniocentesis calmed our fears.  This time I also asked my best friend to be my labor attendant since my husband was less than enthusiastic about the job. She and I spent weeks preparing for the big day by finding just the right music, the right “visuals” and practicing relaxation techniques; I was determined not to have any pain medication this time. Yet again however, I went well past my due date. This time the doctor only waited a week before inducing my labor. So we packed up and headed for the hospital: me, Terri (my coach), my mom and my husband (who pretty much just dropped us off, left and came back later). I was induced and even though the contractions were irregular in strength and frequency they still hurt like a Big Dog!(I don’t’ really know what that means, I just say it a lot.) Not all of the relaxation techniques worked but I was still determined not to have an epidural. After several hours, more pitocine was added to my IV and my contractions became more regulated and much stronger but my daughter was still taking her sweet time showing herself to the world. Eventually, after an eternity (ok probably more like an hour or so) of pushing our beautiful baby girl finally arrived just before midnight. She began nursing with little or no problem. The only other thing I remember at that point was that the doctor had to “fish out” the pieces of placenta that detached during delivery – when I yelped and wiggled he yelled at me and told me to be still or it would hurt worse!

I’m sure I rested well for the hours that followed but, in the morning the pediatrician came in after checking out the baby and told me that she would have to stay another night. Since she was overdue, her bowels had emptied prior to delivery and she had aspirated the meconium. It wasn’t a huge concern, but they wanted to monitor her breathing to be safe. I have never felt a more empty feeling than having to leave the hospital that night without my baby girl in my arms - I don’t know how parents who have to leave their newborns there for days or weeks do it. But we met the doctor bright and early the next morning and he gave the all clear so my mom and I brought her home.

As I began to research how this experience compared to other women’s birthing experiences from around the world, I chanced upon one website, www.bellybelly.com.au , and was struck with the large number of women in Australia whose tales were woefully similar. The next article I found, however, was intriguingly unexpected.  WHEN I HAD MY BABY HERE! relays the birth experiences of Hmong and Viatnamese women living in Australia and how they felt compelled to  compromise or relinquish their traditional practices because of hospital protocol (Rice, 1994).  The women spoke of various cultural norms that are contrary to the practices of Western medicine, from birthing procedures to a month long period of confinement afterwards. One woman explained that in Asia, Hmong women typically gave birth at home, alone or with the assistance of their mother. If the Hmong husband is present his involvement is minimal, he only helps cut the cord and clean the baby, moreover, Vietnamese men are not allowed in the room at all during delivery. So being thrust into a room with a multitude of medical personnel and perhaps even another mother is a very strange and unsettling environment.  I recall at one point counting 8 or 9 people in my room and Lord only knows what parts of me were exposed at the time and I can honestly say that I did not care! I think some of them may have even been medical students, no idea. I just wanted to get that baby out and the stop the pain.

These women are also expected to avoid showering and confine themselves for 30 days postpartum. Their traditions dictate that they either take warm sponge baths or steam baths for the month following the baby’s arrival and that they remain at home, inactive to allow their bodies to regain strength and stay healthy. Western norms insist that women shower before leaving the hospital and walk as soon as possible. Speaking for myself, I was only too happy to allow my mother-in-law the privilege of watching my newborn so that I could go to the grocery store for a few minutes. I still wasn’t moving very quickly, but I just couldn’t sit still.

The most interesting aspect of the article was the parallel of Smidt’s text readings for the week and the consistent reference to Western medical practices and their assumption that their ways of delivery were better and more appropriate. Unfortunately, there was no consideration for the cultures of the Hmong and Vietnamese mothers who, on occasion, had cause to second guess their own traditions and practices under the guidance of hospital staff. Moreover, these particular instances were often followed by expressions of regret from the mother who wished that she had listened to her family instead.  This article echoes the idea that child development research has been criticized for reflecting primarily Western and European cultural norms and traditions (Smidt, 2006, p 3) except that the focus is on prenatal and postnatal care.

Birth Stories and Augmentation (2012). Retrieved on January 7, 2012 from http://www.bellybelly.com.au/birth-stories/induction-and-augmentation-birth-stories

Janelle (2005). Matthew’s Birth (Birth Stories and Augmentation. [Forum Post]. Retrieved on January 7, 2012 from http://www.bellybelly.com.au/general/birth-of-matthew-2005

Katheryn (2004). Lachlan’s Birth (Birth Stories and Augmentation. [Forum Post]. Retrieved on January 7, 2012 from http://www.bellybelly.com.au/general/birth-of-lachlan-2004

Rice, P.L.(1994) When I Had My Baby Here!. Asian Mothers, Australian Birth - Pregnancy, Childbirth and Childrearing: The Asian Experience in an English-Speaking Country. Melbourne: Ausmed Publications, 1994. Retrieved on January 7, 2012 from http://www.hmongnet.org/hmong-au/preg2.htm  

Smidt, S. (2006). The developing child in the 21st century: A global perspective on child development. New York, NY: Routledge.