Tuesday, November 30, 2010

No BPA ban for baby bottles

My friend and political informant Adriane sent this along a couple weeks ago, and I let work and Thanksgiving get in the way of e-mail. So this news is now a couple weeks old, but still important:

Sen. Dianne Feinstein blames the chemical industry for killing her effort to secure, in the food safety bill, a ban on BPA in baby bottles and sippy cups. She said late Wednesday that a last-minute deal with Sen. Enzi to ban BPA in such items six months after the bill passed was scuttled by the chemical industry, which was able to get the support of some Republicans – she named Sen. Richard Burr in particular. Feinstein hoped to get Leader Reid’s approval to offer an amendment, but she told PULSE late Wednesday that her understanding was that he wouldn’t allow them.

“It’s very, very frustrating,” she said. “I cannot understand how a chemistry group would oppose taking out a chemical which at the very least may well impact the endocrine systems of infants because they want to make money.”

Original link here.

Thursday, November 18, 2010

A breastfeeding support home visit

The last Centering Pregnancy group I co-facilitated, the other co-fac was an experienced LC. Between the two of us, we told the midwife that she should let us know when the moms in the group deliver and we would help them with breastfeeding if they need it. Unfortunately, they deliver at a different hospital in town (not the one where I work) where lactation support is extremely minimal. That hospital also tells moms things like "Just let her cry, she'll figure it out eventually" and "Don't feed your baby more often than every 3 hours" and "Don't let them nurse more than 30 minutes". As you can imagine, a lot of breastfeeding problems result... not to mention jaundice readmits.

One of our Centering moms had help from the midwife at the hospital (including her jaundice readmit), and from the LC once at home. Baby would not latch consistently, and the LC e-mailed me today to say that she thought things had been going better but she had just found out they weren't. She was booked. Could I see this mom today?

It was good timing - I didn't work last night - so I called the mom and headed over. Pulling in to the apartment complex and going into her apartment was a total flashback to my AmeriCorps days* - three immigrant families packed into a single apartment, each with one bedroom of their own. The bedroom was even just like I remembered, cramped with a big TV in the corner.**

We spent a long time working on feeding, pumping, and talking about our plan. She has two problems - getting her baby to latch and maintaining a supply with just a hand pump (which wasn't getting used often enough). This mom told me her goal is "puro pecho" which if you've read my "los dos" post, you know isn't always the case with Hispanic moms! I am so determined to help her reach her goal - she is a committed mom who has been persistent where other people would have given up.

Still, it made me discouraged. A more privileged mom would hopefully have the education and resources to quickly identify breastfeeding problems and feel entitled to help; she would be able to hire a private lactation consultant to make multiple home visits; she would be able to rent a hospital-grade pump to maximize her supply.

This mom happened to do Centering and happened to have for facilitators two LCs with extra time on their hands. What about all the dozens and hundreds of other moms in her situation, who we don't know and can't see? In many other counties, I could refer her to a WIC peer counselor; her county's WIC has none and doesn't seem interested in getting any. At best she might be able to get a better pump from WIC (which she didn't realize - I knew to call and ask.) If not for the very rare happenstance of hands-on support, she'd just be left to struggle on her own, offering a screaming baby the breast 8 times a day and using the hand pump she got in the hospital to get what she can.

This is breastfeeding support in our country, to the most vulnerable moms who need help the most. This is why we need to talk about the public health risks of seeing formula as a perfectly good fall-back. This is totally unfair to mothers who WANT to breastfeed, who are working hard to breastfeed, and who do not have the resources to get the help they deserve.

*Bonus AmeriCorps story: Our supervisor did not love us doing home visits - you wouldn't either, if you were an experienced midwife with strong maternal instincts, in charge of a group of naive but enthusiastic young women. She approved home visits only in very specific circumstances and with lots of warnings. We also had to call when we got there and call when we left safely. Like I said, strong maternal instincts. So one of my teammates and I went to do a home visit one day after lots of dire warnings and promising to call. We are primed to be cautious. We get there and it's just mom and baby home. We start helping her... and her boyfriend walks in just home from work - with a six-pack of beer. Immediately we both get a little anxious. This is what our supervisor was most concerned about - boyfriends/husbands/other men around who would give us a hard time or see us as a target. We're having trouble getting the baby latched (all the while keeping one eye on the guy doing stuff in the kitchen) and we suggest to mom that she pump a little to get the milk flowing. Her boyfriend leaps into action, assembling the breastpump, bringing it to her, and then sits beside her, asking us a lot of concerned questions about how the baby is feeding. So much for our paranoid fantasies!

**For a long time I wondered about that - how could people only have enough money for one bedroom, but still enough to have a huge expensive TV? - until one of my AmeriCorps teammates explained to me that buying expensive electronics was how many people in South American countries keep liquid assets. Think about it - if you don't or can't get a bank account, how can you make sure you can get cash if you need it, without actually keeping all that cash on hand? One way is to buy something that will be easy to re-sell quickly. It's not a great investment, because it will depreciate instead of appreciate, but people only have so many options. I really appreciate the work that community-based organizations and credit unions do to help teach people about banking and make those options more accessible.

Sunday, November 14, 2010

Balancing the budget and thinking about health care

One of our MPH courses, we had to do an exercise in which we figured out how to balance the federal budget. We had to do it through making spending cuts alone, and it was unbelievably difficult. It's a good reality check to have to weigh what you want to have happen with the realities of what else would have to be sacrificed to get it. It's a reality check I think more people should engage in when talking about social and health-related programs, taxes, and what cuts and increases really mean when we stop playing year-to-year budget shell games.

The New York Times has a new interactive feature up letting you try that exercise, both by cutting programs and increasing various taxes, with an article explaining how they made their calculations and what the long-term implications of the deficit fight will be:

It [the long-term deficit] comes from the projected growth of Medicare, Medicaid and, to a lesser extent, Social Security. It is the result of baby boomers’ having paid far less in taxes than they will draw in benefits. “The reason we find ourselves in this situation,” said Mr. Bowles, the former chief of staff for President Bill Clinton, “is that we’ve made promises we can’t keep.”

The deficit puzzle focuses on the year 2030 because it is far enough away that the boomers’ retirement will weigh heavily on the budget but near enough that reasonable budget estimates exist. By 2030, the needed deficit cut will equal about 5.5 percent of annual economic output.

By comparison, domestic discretionary spending — all of it, including Head Start, college financial aid, the F.B.I., medical research and airline safety — will add up to about 3 percent of economic output, according to Congressional Budget Office projections. Military spending will equal about 4 percent.

So the solution will have to revolve around tax increases and changes to health care and Social Security. And the country cannot wait until 2030 to implement most of the changes, notes Alan Auerbach, an economics professor at the University of California at Berkeley. If it did, the interest on the national debt could become crushingly large. Deficit cutting will probably be a regular part of politics for the next couple of decades.

It's very popular to talk about cuts in discretionary spending - "let's cut Head Start", "let's stop spending on military technology and spend it on education" but the truth is, entitlement spending is by far our biggest budget item and health care makes up a big chunk of that. Thinking about how to contain health care costs and yes, how to ration health care (not whether to ration health care, since it is already rationed, but how) are going to be a big part of this debate.

Thursday, November 11, 2010

Choosing and getting into MPH programs: Part 4: Getting in

This is Part 4 in my series about choosing, getting into, and getting funded by MPH programs.
(Part 1 is here, Part 2 is here, and Part 3 is here.) Sorry this is taking me a gazillion years to get through. I was planning to finish the last piece in one installment. But in the interests of forward motion, I decided to go ahead and post what I have written at the moment (the "getting in" section) and then work on finishing the last bit ("getting funded") soon (soon, I promise!)

Getting in
I promise this will seem relevant in a minute: When I was an undergraduate, I worked for three years as a tour guide and general admissions office helper. I also sometimes assessed students' writing or art submissions and wrote up summaries for their admissions files. My senior year, I also got to start doing interviews of prospective students - those interviews also went into their admissions files. I had friends who worked at the admissions office as admissions counselors, and I had friends who read files as alumni readers. I knew a fair amount about what went into the admissions process.

I also belonged to an online forum for students, and every year prospective students would post asking for advice about how to get into the school. And all the current students would confidently post back information that was just plain wrong, or at best misguided. They would say things like "Your grades don't matter as long as you're passionate about something!" when in fact, the admissions office was busy turning away passionate kids who had transcripts full of Cs. Because the current students had gotten in themselves, they thought they understood why and how the admissions office made the decisions it did and how it would view other people...but really, a lot of them had no clue.

I tell you all this in order to say that as much as I want to give you advice about getting into graduate school based on my own experience and the experiences of the people I see around me, I won't. Because I've never been part of a public health graduate admissions process, and I might be wasting your time and telling you the wrong things.

Instead the advice I will give you is exactly what I used to post on that message board when I saw misinformation: Admissions officers are not shy. The admissions process may not be easily discernible, but it is not a secret either. They are not trying to hide their process from you. While they probably won't be willing to give you percentage odds on your personal chances, they can tell you what they're looking for and whether or not you fit it.

Informed by my undergraduate experience, when it came time for me to apply to grad school I sat down with multiple grad school admissions officers, as well as professors and/or other people from the departments I was applying to who participated in the admissions process. I said, "Here is my resume, here is my transcript, here are my interests. Is there anything I can do to strengthen my application to your school?" This is a nicer way of saying "Do I have a chance?" and also a way that enables you to, in fact, find ways to strengthen your application before you apply.

It's easy to make assumptions about what a program might want - they'll want their applicants to have classes in biology, or to have volunteered at a clinic, or to have worked abroad for at least a year, or to have X score on the GRE, etc. etc. But you don't actually know until you ask, and if you don't ask you could be setting yourself up for a lot of stress and effort wasted on one set of things, when you should have been focusing on others.

For example, I was stressing about how my (somewhat diverse) work/volunteer experiences would add up in the minds of admissions committees. When more than one told me "Yes, we consider that the work you've done fulfills our experience requirement", that put my mind at ease that I didn't need to try to shove anything more onto my resume before I applied. On the other hand, one of my top choice schools told me that because I had no undergraduate math courses (save one statistics course), they would want to see a good GRE math score - so I studied the crap out of that section.

And when I finally applied, I could feel confident that I had done absolutely everything I could to put together strong applications - because I had talked to the people who would be reading them.

So once again: don't assume what programs want, and don't take my advice, or any other random person's advice, about getting in. Go to the source(s), and ask*. Just call, find out who reads applications/coordinates the admissions process, and make an appointment (phone or in-person). It really is that simple. (P.S. As far as I'm concerned, this applies to all schools, all admissions processes, everywhere. Ask!!)

*Tip: One easy-access way to do this, and to scope out programs in general, is to get a student pass for the American Public Health Association annual conference's Public Health Expo. They have a whole section of schools/programs of public health exhibiting there. For the past few years, on one day of the conference, they've been offering students/prospective students free admission to the Expo room. So if you're in the vicinity of the APHA conference then check it out. I do NOT encourage you to buy a conference registration just to go to this, unless you are independently wealthy.

Questions to ask when you talk to them:

  • This is my educational background and my transcript. This is my work/volunteer background and my resume. What can I do to strengthen my application?

  • What are average/minimum GRE scores that you look for? How important are standardized test scores in the admissions process?

  • Do you have minimum work/experience requirements? Does what I've done so far fulfill them?

  • What do you look for the personal statement to cover?

  • Does it help to speak with professors? (Usually the answer is yes!) How would you suggest I find faculty in my interest areas/make contact with them?

  • What percentage of applicants did you admit last year? The year before?

  • What is a mistake you see applicants make frequently, and what could I do to avoid it?

The only other thing I'll say about getting in: I find that people applying to public health school are often anxious. They are anxious about getting in. I remember being pretty anxious too. I met with admissions staff, with professors, studied for the GRE, revised my personal statement a thousand times, not to mention my resume, and re-read my transcript with a critical eye (not that there was much I could do about it). And in the end, I got in at plenty enough places to boost my ego, and to have a good range of choices.

I wish the world was beating down the doors of public health. The truth is, it isn't a lucrative career and (given that nobody knows what it is!) it's not incredibly prestigious either. There are certainly competitive programs out there, but the insanity does not reach the level that most people accustom themselves to for undergraduate applications.

I say this not to make you feel overconfident (and then write me angry e-mails when you don't get admitted) because yes, people are rejected from MPH programs every year (I was also one of them - it's not like I got accepted everywhere). By all means, work very hard on your applications, but I will say that I think I spent too much time worrying about getting in, and not enough time worrying about how to get funding and where I should actually go. Then, once I was admitted, I kind of had to scramble to figure things out. A little bit of confidence that you will have options can help you prepare for what you'll do once you find out exactly what those options are. Again, just because you can get into a particular program doesn't mean you should do it!

Tuesday, November 2, 2010

Breastfeeding links

To get some links out of the way that have been piling up, and to celebrate my new IBCLC certification, a breastfeeding link party:

Normal Newborn Behavior, and Why Breastmilk Isn't Just Food" from the Lakeshore Medical Clinic

The Academy of Breastfeeding Medicine conference was last week - you can read conference updates and winners of their "clinical pearl" contest at their blog. (One of my favorites: "Give baby until 4 days past his due date to get the hang of breastfeeding." Not that you should give up on a baby after 4 days, but that with moms who are easily discouraged and with our epidemic of slightly early babies, this is a good target date to keep people moving forward until everyone catches on.)

Elita at Blacktating on whether her birth experience set her up to fail at breastfeeding. (Check out the comments for a lot of personal stories from others with the same question.)

The Motherwear Breastfeeding blog posts an ad to educate women in India about the importance of colostrum. (I love all the women going from store to store asking to buy colostrum!)

Public Health Doula, IBCLC!

Thursday night I got a text from one of my LC classmates that the IBCLC exam results were already up. I was standing in a suburban CVS, on a late-night pantyhose-and-makeup run to prep for a wedding. I grabbed my friend's iPhone and started trying to both find the results website and find where I'd e-mailed myself the code to see my results (while babbling "They weren't supposed to be up till tomorrow! Why are they already up! I was going to check tomorrow!") With my iPhone inexperience this took way longer than necessary, and my friends had to herd me to the front of the store to check out (my eyes never leaving the screen). There, standing in the CVS check-out line, I found out that I had passed and am, indeed, a real honest-to-goodness IBCLC.

Wow! I'm relieved, excited, and a little disbelieving. I've wanted to be an LC for so long, and there was a stretch of years where I couldn't imagine when and how it would be possible (a post on this may be forthcoming). That I really am an IBCLC now is kind of hard to believe - it doesn't feel quite real yet. Maybe because I've already been doing LC work at the hospital pending my results, so on the day-to-day level nothing will change (except my paycheck - all right!) But I think also because I recognize how far I still have to go. Back when I did tae kwon do, they used to tell us that becoming a black belt wasn't the end of your training - instead, it was starting all over with a whole new set of things to learn, knowing that you'll be learning them and refining them for the rest of your life. And that's where I feel like I'm at now - ready to step up to the next level with the recognition of how much I still can learn and practice.

Thanks to everyone for your good wishes and support! I have loved having this blog and the breastfeeding blogging community as part of my education throughout this journey.

(P.S. Wedding was great, I'm back from my trip, and hopefully there will be more posts soon!)