The Misery Of Miscarriage, Ctd

headstone

Many more readers are writing in:

Thanks for your series of posts on miscarriage. I’ve had four miscarriages and have no living children. In clinical terms, I am a “habitual aborter” – it actually says that on my chart! It’s my worst habit and I would quite like to break it.

One of the most baffling parts of miscarriage is the enforced silence around the loss and grief. As you are no doubt discovering, once you write or speak the word miscarriage, people emerge from the woodwork. It seems like everyone has either had one, or has a sister, friend, or mother who has had one. When I had my fourth miscarriage this February, I knew I couldn’t just go back to work again and pretend like everything was normal, as I had for the first three. So, I wrote an email very clearly explaining to my colleagues what I was going through and asking for their understanding. In an instant, I became the person to go to talk about miscarriage. I had a series of coffee dates and after work drinks during which I heard horror stories in hushed tones about babies born in toilets on Christmas Eve, gushing blood before scheduled lectures and during meetings, bosses who demanded a return to work while miscarriage was ongoing, and altogether too many stories of my colleagues’ husbands or mothers who were eager for a quick recovery from the grief over what wasn’t a “real baby anyway”.

It was like I was the un-elected president of a new secret society – the Spontaneous Aborters Club. Seemingly all of my female colleagues had miscarried. It felt so good to finally be talking about it, to be matter of fact about it. The understanding we have as a culture is that miscarriage is not spoken of, which explains the rule that we don’t tell anyone we are expecting until at least 12 weeks. When you crack open this vault to let a bit of light in, stories of darkness come pouring out.

As an aside, I have wondered if our modern reluctance to acknowledge miscarriage has something to do with our struggles over how to think about abortion. I used to worry that if I admitted that my embryo or fetus was a baby that I would have to admit that the embryos and fetuses of women who chose abortion were just as “real”. I’ve come to realize, however, this is actually the crux of what it means to be pro-choice. My husband and I want these babies and so their brief existence and their passing is tangible to me. They are babies because I feel their loss so deeply.  I would never deny someone the choice of whether or not to form this most human of attachments.

Another reader:

I have had three miscarriages and I have had three beautiful healthy children, so I have experienced both the amazing highs and hellish lows of pregnancy. What I discovered through my experiences is that many people just don’t think at all before they let words come out of their mouths. Yes, you could suggest that they mean well, but that doesn’t make up for the stupid and hurtful things they say.

The first miscarriage was also our first pregnancy and we waited until eight weeks to tell our families. Within a week I was having a D&C to remove whatever was left of my pregnancy because my body even failed me when it came to miscarrying.

Whilst waiting for the procedure to begin, a nurse told me it could have been a still birth, which is worse. Though I agree, it wasn’t in any way a comfort to me to consider that my degree of loss could have been higher. Some friends and family members wanted to know what had caused the miscarriage and helpfully suggested things to do or avoid next time. Yes, what we definitely needed to cope with our loss was for people to suggest how we had caused the miscarriage. Believe me when I say that every woman who has had a miscarriage wonders if it was her fault somehow. And the best was my sister-in-law telling me that she knew exactly how I felt because her health issues prevented her from having any more children than the two she already had. Yes, losing a child and not knowing if you will ever be able to have a child at all is the same as not being able to have a third.

Comfort came from those who did actually know how we felt because they had experienced a miscarriage – and often more than one, like us. Miscarriage is a lot more common than one might think and yet still is almost a taboo subject. For a time I felt like the tainted one. Friends who were getting pregnant for the first time didn’t want me around because I was living proof of what can go wrong.  And I never got to experience a pregnancy without fear because every one that ended with a healthy baby was preceded by one that ended with tears.

It has been more than ten years since the last miscarriage and my youngest just turned 9. You would think that I would be over the losses by now and for the most part I am. But sometimes you are reminded such as when you fill out medical forms and it asks how many pregnancies and live births you have had.

Thank you for this thread, because sometimes all you need to help healing is knowing that you aren’t the only one.

Another:

My wife and I have been trying to get pregnant for years and, after multiple rounds of fertility treatment that failed, we were just about ready to give up. Then, in the break between treatments this year, we found out that she had gotten pregnant (the old-fashioned way). We were elated and started planning immediately for the new arrival.

However, after the first scan we were told that there was no baby present (at 7 weeks) and that she had had a miscarriage. This was not a huge surprise given the amount of bleeding that had happened in the few days before the scan, but it was still devastating – even more so because we had told no one and although we could provide some support for each other, we were both in a dark place.

The next week, there was a follow-up scan to see whether a procedure would be needed to remove the products of conception. The nurse turned to my wife and said “and there’s the baby’s heartbeat”. The baby was missed on the first scan. You can imagine how we felt.

Our stress levels have been enormous for the last few months, but as the pregnancy has progressed (showing now with little kicks daily) we have slowly started to relax – that is until I read the New Yorker article and your updates of miscarriage stories. I have warned my wife to stay away from your blog until the baby is born and I am FREAKING OUT. I obviously feel terrible for those women, and the statistical likelihood of something like that happening this late in pregnancy is low, but at this point I won’t be happy until I’m holding my baby in my arms.

(Photo by Flickr user romana klee)

A Literary Appetite

Cara Parks recognizes the 70th anniversary of The Gastronomical Methe landmark work of food writing by M.F.K. Fisher, who “eschewed page after page of recipes in favor of an amalgam of memoir, travelogue [and] essay”:

The collection of essays, which stretches from her childhood to her life in France, the beginning of World War II, the dissolution of her first marriage and the death of her second husband, marked Fisher’s emergence as one of the great voices of her time.

It is telling that Fisher, who wrote so hedonically of food, so often chose to discuss hunger in these pages. The book is not about dumb indulgence but the constant roving of human appetites, be they for love, power, money, or food. She relates a train trip with an uncle while she was still an adolescent, when her teenage habit of blithely ignoring the menu was finally quashed by a stern look. “I looked at the menu, really looked with all my brain, for the first time,” she writes, and then orders her iced consommé and sweetbreads sous cloche with determination and poise. We are all hungry, she tells us, but we must remember to make choices, not drift to whatever is at hand. Our hunger unites us; our choices, in restaurants and in life, make us individuals.

Fisher’s sensual accounts of the connection between food and emotional inner lives severed food writing from kitchen drudgery. She begins another essay with an account of her landlords in France, a family with which she and her first husband boarded. But she interrupts herself from a straightforwardly gastronomic account, describing the “cold meats and salads and chilled fruits in wine and cream …” only to stop herself and realize, “When I think of all that, it is the people I see. My mind is filled with wonderment at them as they were then, and with dread and a deep wish that they are now past hunger. They were so unthinking, so generous, so stupid.” The reader travels with her from a jolly 1930s French kitchen to the desolate aftermath of World War II. For Fisher, food is not just evocative; it is a unique language she wields to explain subtleties glossed over by the written word.

Liberalism Won’t Be Destroyed By Obamacare

extrapolation falicy

Earlier this week, Todd Purdum claimed “that the future of the Democratic Party’s plausible agenda, and of liberalism itself, is on the line.” Nyhan counters Purdum and other journalists engaging in similar hyperbole:

[T]hese journalists are falling victim to the same extrapolation fallacy that pervades so much political coverage. In these sorts of stories, reporters identify a current trend and spin out a story in which it continues to implausible extremes. Consider two recent examples: the decline in President Obama’s standing in the polls after his first debate with Mitt Romney and the surge in Democrats’ standing in the generic House ballot during the government shutdown. In both cases, journalists extrapolated wildly from a short-term trend, hyping Romney’s “momentum”and the damage to the Republican brand and suggesting that the trends would continue in the direction indicated by the arrows in the graphs below.

But as the graphs show, any shifts in public opinion around those events were transitory. … Romney’s standing in the polls stabilized soon after the first debate. Likewise, the GOP quickly shifted from defense to offense after the media’s attention shifted from the shutdown to the healthcare rollout. While it is possible to imagine alternative scenarios (see, e.g., the breathless reporting in the 2012 campaign retrospective Double Down on how Obama narrowly averted a disastrous second debate), the reality is that national politicians and parties rarely self-destruct on the level that these predictions require. Democrats now face a policy challenge that is more difficult than overcoming a poor debate performance, but it is likely that the administration will fix enough problems to maintain party cohesion and prevent repeal, particularly once they can highlight benefits from the law that will become available in January.

Trende makes a version of the same argument:

This isn’t to say that a collapse of Obamacare would be without consequences. It would probably ruin the Democrats’ chances in 2014, perhaps leading to truly significant Republican gains in the Senate. Given that that chamber tends to be a natural Republican gerrymander, it would probably take Democrats some time to recover. But also given the current makeup of the House, further liberal legislation was likely going to have to wait for quite some time anyway.

And even if Obamacare does collapse, the most liberal aspects of the American health care system — Medicare and Medicaid — will still be around. Democrats have already been pretty straightforward about what their “Plan B” will be: Medicare/Medicaid for all. Both programs are still very popular, and the Democratic standard-bearer in 2016 would almost certainly campaign on expanding them, perhaps to those over 55 for Medicare and under 25 for Medicaid. I’m not sure that would be a losing issue, even with an Obamacare collapse. In 10 years, I think it’d be a winner.

I’ve written along these lines dozens of times regarding various attempts by commentators to bury conservatism or the Republican Party. But it is no less true of liberalism and the Democratic Party. The American electorate is not intensely ideological, and is more motivated by things such as the state of the economy, whether there is peace abroad (or whether we’re winning a war), and whether the president is suffering from a major scandal. Obamacare’s collapse wouldn’t be a good thing for liberalism. It wouldn’t even be neutral. But it wouldn’t be the end of the liberal ideology, either.

Killed For Knocking At The Door

Two weeks ago, a drunk teenager, Renisha McBride, got into a car accident in suburban Detroit and sought help at the nearby house. Homeowner Theodore Wafer cracked open his door and shot her in the face with a shotgun – and then called 911. A full news report here. Jelani Cobb examines the state of self-defense in the US:

It is entirely reasonable to be alarmed by an unexpected knock in the middle of the night, and it’s not difficult to imagine someone nervously answering the door with a weapon nearby. But the Rorschach moment is what happens next: Is it possible to look through a cracked-open door and register [Glenda] Moore or [Jonathan] Ferrell or McBride as something other than an amalgam of suspicions? The raging debates over racial profiling forced police departments to confront the question of what constitutes reasonable suspicion, but at a time when the lines between police authority and that of the common civilian are increasingly blurred, those concerns have been partially privatized. Self-defense is now a matter of interpretation, divining the truth of what we see when we look at another person.

But how much blame lies with Michigan’s Stand Your Ground law? Wafer has already been charged with second-degree murder and manslaughter. Bridgette Dunlap argues that SYG – while a “terrible law” – still doesn’t allow people to shoot first and ask questions later:

The right to self-defense allows a person to use deadly force if she reasonably believes it is necessary to prevent an imminent use of deadly force by an aggressor – but she has a duty to retreat rather than use force if it is safe to do so in most states. What Stand Your Ground laws do is remove the duty to retreat when attacked. That’s it. They do not give you a right to attack when you are not in imminent danger.

In the McBride case, the law that would apply is technically not Michigan’s SYG but the state’s “Castle law,” which authorizes the use of force without any duty to retreat at one’s home. (Not having to retreat in one’s home has long been the standard; almost all states have Castle laws.) However, the Castle law will also be to no avail if Wafer did not have a reasonable fear of imminent death, severe bodily injury, or sexual assault. The facts are unclear and may never be known, but it is hard to imagine any jury would believe that a 5’4” woman knocking on a locked door would cause a reasonable fear of imminent death. So it was unreasonable to suggest SYG would apply to those facts.

The Nation has claimed that “due to similar Stand Your Ground laws in Michigan as in Florida, it’s possible [McBride’s killer] may never be charged with any crime.” Actually, we should have expected the shooter would be charged. This demonstrates a misunderstanding of SYG laws generally, and Michigan’s specifically. … Stand Your Ground is relevant here to the extent that it has exacerbated the general gun-carrying culture in the United States and altered the public understanding of self-defense. Multiple studies have shown that states that pass SYG laws experience significant increases in homicide. They do not see significant increases in justifiable homicides. This suggests that the problem is what people think SYG does more than what it actually does, which is provide a defense to homicide.

Healthcare.gov’s Missing Pieces

A government official estimated yesterday that 30 or 40 percent of Healthcare.gov still needs to be built:

Apparently, the accounting systems and payment systems that protect taxpayers against waste, fraud, and abuse—systems that also ensure that insurers get paid, and that premium subsidies are accurately doled out—have not yet been built.

It’s worth noting that, technically, you haven’t enrolled in a health insurance policy until the insurer has collected the first premium from the beneficiary. If the payment systems have not yet been built, it’s not clear how many people, then, have actually enrolled on the exchanges. Last week, the Obama administration claimed that 26,794 people had enrolled on the federal exchange, though HHS did not specify whether or not insurers had been paid.

How is this possible on November 19, when the Obamacare exchange was ostensibly launched on October 1?

Laszewski adds:

Healthcare.gov is not ready for what could come in just two weeks when, between December 1 and December 15, everyone expects massive pressure on the federal Obamacare enrollment and administration site so people can get coverage by January 1. My independent survey of health plans also matches comments by CMS Deputy Chief Information Officer Henry Chao [yesterday] at a House hearing that 30% to 40% of the IT systems needed to support Obamacare still must be built.

Sarah Kliff has more details:

The systems to send subsides to insurers haven’t been built. When someone does shop with a subsidy, the federal government is on the hook to pay part of their premium to the health insurance plan. Medicare deputy chief information officer Henry Chao testified before Congress today – and [Spokeswoman Julie] Bataille confirmed – that the system that will send those subsidies has not yet been created.

“My understanding of the system is we do not need that online until the middle of January, given how the payment schedule works,” she said. “It’s a back end system necessary to process information directly to issuers.”

In other words: Subsidies don’t start going out the door until 2014, so there is no need for the system to exist right now. Whether it exists in January 2014–that’s one area where we’ll have to wait and see.

Our Neglect Of The Mentally Ill

Mental Health Services

Austin Gus Deeds was unable to get the help he needed:

The day before he apparently stabbed his father at the family’s home in rural Bath County, the son of Virginia state Sen. R. Creigh Deeds underwent a psychiatric evaluation but was not admitted to a hospital, because no bed was available. Deeds was listed in fair condition late Tuesday after his son, Austin, stabbed him in the face and chest, then shot himself in what investigators suspect was an attempted murder and suicide.

Suzy Khimm puts this tragedy in context:

Across the country, the number of psychiatric beds has been steadily declining as hospitals moved away from institutionalizing patients and budget cuts have taken hold. The number of hospital beds in freestanding psychiatric hospitals has dropped 13% between 2002 and 2011, according to the American Hospital Association.

But the need hasn’t declined as quickly, and there haven’t been adequate alternatives to pick up the slack. Between April 2010 and March 2011, about 200 Virginia residents were deemed to be “in imminent danger to themselves or others as a result of mental illness or is so seriously mentally ill to care for self and is incapable or unwilling to volunteer for treatment.” But they were nevertheless released from custody because mental facilities didn’t have the capacity to admit them, according to a 2011 report from Virginia’s Inspector General.

In many major US cities, bed shortages have prompted emergency rooms to “warehouse” the mentally ill in holding rooms and hallways, where they languish without treatment. One Seattle woman who tried unsuccessfully to commit her mentally disturbed son in 2011 was told there were no beds available; he killed himself days later.

Tomasky weighs in:

Try this statistic on for a shocker. The per capita state psychiatric bed population in 2010 in the United States was identical to the figure for 1850. Yes, 1850, around when the very idea of caring for mentally ill people first started! Then and now, the number 14.1 beds per 100,000 population.

Between 2009 and 2012, states cut $4.35 billion from mental health services, which eliminated nearly 10 percent of all beds in just those three years. This is while 10 percent more people have been seeking services. I remember when I covered state and local politics in New York, mental health services were always among the first things on the chopping block. No constituency with any political power at all, just a bunch of do-gooders pleading for officials to do the right things. Which in fairness a lot of them want to do, but most don’t end up doing.

Toying With The Nuclear Option

Sargent reports that Reid intends to reform the filibuster:

With Senate Republicans blocking a third Obama nomination to the powerful D.C. Circuit Court of Appeals, a senior Senate Democratic leadership aide tells me Reid is now all but certain to move to change the Senate rules by simple majority — doing away with the filibuster on executive and judicial nominations, with the exception of the Supreme Court – as early as this week.

Kleiman cheers Reid on:

I’m on record as saying that a mid-session change in the filibuster rule made by simple majority vote is a breach of the Senate rules. So be it. Extraordinary abuses demand extraordinary remedies. A asymmetric political process, where one side respects convention and the other systematically abuses whatever power it has, is not sustainable.

Chait assesses the situation:

Ideally, the Senate would find some mechanism that would be strong enough to allow the minority to block unusually extreme judges from the bench, but weak enough to prevent the minority from issuing a total blockade on even qualified judges. That would require the creation of some sort of creative power-sharing arrangement that gives formal definition to the devilishly ill-defined concept of “advice and consent.” But the trend in American government has been that power does not get shared, and instead flows to whichever party has the will to seize it. Senate Republicans have seized new powers by imposing a judicial blockade on the D.C. Circuit, and the only available Democratic response appears to be seizing back more power still.

David Harsanyi suspects Reid is bluffing:

[W]ould Reid really going to blow up the Senate for some D.C. Circuit Court of Appeals judges? It seems improbable. But if he does, the GOP, should they ever return to power, will have the justification it needs to undo Obamacare – or pretty much anything they please – with their own majority. If the filibuster is neither sacred nor a check on power, there is no reason for legislation or cabinet nominees to be immune from the up-or-down vote. It’s going to mean a lot less stability in DC, a lot more seesawing legislation, and more severe partisanship than anyone in the Senate could possibly desire.

Beutler also considers how the GOP would respond:

Republicans know they’ve given Reid practically no choice. And if he goes nuclear it might prove to be an even better outcome for them. It will provide them a plausible rationale for taking things a step further if they win back the Senate in 2014. Getting Democratic fingerprints on the nuclear rule-change precedent, will provide Republicans the cover they’ll need to eliminate the filibuster altogether in January 2015.

They aren’t just testing the limits of Constitutional norms for fun. They’re testing Reid’s faith in the durability of his majority.

The Pity Of War

IRQ: City Of War

A reader writes:

If I read/listen to nothing else on The Dish in the next year, the conversation with Mr. Piro would make my subscription a bargain. Thank you.

Another writes:

As an Iraq vet, I have to say thanks and well done on the Mike Piro interview. These are exactly the kinds of things needed to address the suicide stigma.

If you want a glimpse of the intense conversation, below is Mikey’s account of grappling with the aftermath of a suicide bombing in a marketplace, as Iraq descended into anarchy:


And if you want to understand the challenges of witnessing that kind of horror and then returning to America to take up daily life again, this clip may help:


To listen to the full, wrenching conversation, click here. If you haven’t subscribed yet and want to hear more, [tinypass_offer text=”subscribe”] for full access to everything all the time. It takes a couple of minutes and costs as little as $1.99 a month. Read more about Mikey on the Dish here.

(Photo: A grave of a Sunni who was killed by Shia militiamen, on March 6, 2008 in Adhamiya, Baghdad, Iraq. Locals started burying their killed relatives in a patch of grass behind a mosque two years before, but by March 2008 it contained more than 3000 graves of victims of sectarian violence. By Ghaith Abdul-Ahad/Getty Images.)