The first rule of Midwifery is YOU DO NOT ASK QUESTIONS.

The first rule of Midwifery is YOU DO NOT ASK QUESTIONS.

Midwifery Today has had to respond to the #notburiedtwice campaign regarding a preventable infant death.

The editor and owner of Midwifery Today crowdsourced a patient problem on face book- a mom that was past 42 weeks and had no amniotic fluid visible on ultrasound. Both of those things are extremely obvious warning signs of impending fetal mortality, but no one actually did anything and the baby died as a result.

As you can see from the screencap, they blamed a physician (who shall not be named) and are promising to delete any further questions about the matter.

You aren’t allowed to question them. Someone’s child died, and they can’t be bothered to even answer questions about accountability in the matter. Its despicable.

I was willing to believe before that Jan Tritten wasn’t directly involved, but not now. Not after they invented a mystery physician who would have done nothing about a total lack of amniotic fluid on an ultrasound. Midwifery today obviously does not think very highly of their readers to think that they would accept this story as being true.

What I don’t understand is that if a physician was attending to this matter why on earth would the midwife be crowdsourcing the problem in the first place? She already had access to someone with much more training and experience than she did in the matter, who she could (presumably) talk to on the phone or in person to get in depth answers about her concerns. Why would she turn to a bunch of strangers on the internet to get suggestions?

The thing about telling the truth is that all the details fall into place without any effort. Your mind knows the truth and defers to it without trying to. When you lie you have to come up with excuse after excuse to explain the gap in evidence between what really happened and your own story, and thats how everyone finds out. It is a lot easier to fess up to what happened and deal with it than to try and bury the truth under falsehoods. If Midwifery Today thinks they aren’t going to get caught lying, they are mistaken.

EDITED TO ADD: An astute poster on facebook pointed out how nonsensical it would be for a midwife to point out that their state has ‘full autonomy’ for midwives an no transfer mandates past 42 weeks if a physician was attending this patient.

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#notburiedtwice

#notburiedtwice

A recent scandal in the midwifery community has been drawing a lot of public attention. Signal boost the totally needless death of a baby by using hashtag notburiedtwice. Home birth and natural birth advocates try to bury the memory of babies sacrificed at the altar of NCB, but they don’t have to be forgotten. Nothing can bring back that mothers baby, but we can try to make sure that as many people learn from this tragedy as possible. Dr Amy’s blog has links to different social media sites that should be answering for the tragedy. Please contact them ASAP. 

Menstruate the ancient way- without fear!

This is my parody blog. I hope you all enjoy it!

Menstruate Without Fear

Menstruation. The word provokes a lot of imagery for women. There is blood, and pain, and angst. Big Tampon would have you believe you need their products to feel free during your period, but they are ignoring an ancient wisdom that protected women for generations. Fear is what causes pain during menstruation, not uterine contractions.

It sounds hard to believe, I know! I was skeptical until I read the work of Chancely Tick-Feed,  a gynecologist from the turn of the century. He described, in detail, how women could optimally menstruate and avoid the pain usually associated with intense uterine contractions. He wrote a book called “Menstruation Without Fear”,  which I read, and then I tried it myself. I was amazed! Not only was my period no longer painful, it was an empowering experience. Image feeling empowered every single month.

Tampon commercials have us fear our natural bodies. Western ideas…

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A preventable home birth death- Possibly in Utah

Midwives routinely practice outside of their scope, and publicly discuss doing so. I cannot count the number of times I have seen this behavior on facebook alone!

Safer Midwifery in Utah

UDATE 1- Oregon does not require a license, but has strict requirements on unlicensed midwives that warn clients of how unaccountable and untrained they are. Other people have said this was Jan’s client, but her midwifery today profile says she stopped practicing decades ago. I am trying to get some clarity on where this death occurred and if Jan Tritten was attending it or not.

UPDATE 2: Because of the wording of the facebook thread, I am going to assume it was Jan Tritten’s client and edit my post accordingly.

UPDATE 3: Jan Tritten had this to say after deleting the thread on facebook:

“The
questions on this page are messaged privately to me and put up
anonymously. They are not my cases. This is to help mothers, midwives,
doulas and physicians in their work. it is to get opinions from many
different practitioners and parents.”

I found a link…

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Debunking The Business of Being Born: Part 6

This is part 6 in a series on The Business of Being Born. Descriptions of the movie are in bold, my commentary is in normal text. The other parts of the series can be found here.

There is more footage of a woman laboring at home with someone applying counter pressure to her back during a contraction.

Dr Odent says “Today what we have to rediscover is how easy birth can be… when we don’t try to make things too complicated. When ideally there is nobody around but an experienced, motherly, and silent low profile midwife”

There is footage of the same woman as before pushing her baby out in a birthing pool at home. 

I am a bit confused- is birth easy if the conditions are right, or is it so hard that you ‘claim a victory’ when you achieve it?  This is how politicians talk- vaguely, and out of both sides of their mouth. The point is that you will hear whatever you want to hear and get a good feeling listening to the person talking. It isn’t a good way to convey actual information or make testable claims. The doctor had an awful lot of subjective conditions around his claim of easy labors, so if a woman had an unbearable labor he could make use of the no true scotsman fallacy to deny that conditions had been correct.

I should also note how gross it is for a man to be lecturing women on how to make their labors easy. He has no idea because he will never give birth to a baby, and is unlikely to be an authority on the experience. He might as well be explaining how to optimally menstruate.

The woman delivers her baby and holds them. The midwife checks the baby and is very unobtrusive while doing so.

It is a beautiful moment. This is the most emotionally loaded type of scene in the Business of Being Born- scenes of moms having idyllic births in their homes.  What I dislike is how this was combined with audio of a doctor talking about ‘easy’ birth. They have taken the birth of that woman’s baby and used it to sell a point, one she may not agree with. I find this deeply disrespectful of the woman who was kind enough to let them into her home and tape her giving birth. We never get to ask the woman who had the baby if she considered it easy or not, nor are we given any information on how many women doing a home birth would consider it ‘easy’, which would be more useful than anecdotes anyway. The way that the footage is edited makes it look like it was effortless because all we see are glimpses of the process. A documentary can never do justice to something that often takes hours and hours (like childbirth).

A different pregnant woman says “I went online, and I found that new york hospitals had some of the highest cesarean rates in the nation. That actually really surprised me, I guess I expected new york women to be more like, ‘Hey, I’m taking charge.’ So I was surprised.”

Having a c-section does not indicate a lack of “taking charge”.  Having a vaginal birth does not mean you are ‘taking charge’ any more than seeing without glasses is ‘taking charge’ of your sight.  All the insults to women who don’t want (or cannot have) NCB are not stated outright, but they are certainly there.

she continues: “And I was scared. I mean I knew what interventions I was okay with, and they were pretty much zero. You know, I mean, I really understand that things can go wrong during pregnancy, just like with anything else. But I don’t want that to be precipitated, so to speak. I said “David, this isn’t looking good.” And that’s why I started to interview midwives in the city.”

What is the trade off for lower c-section rates though? It seems impossible to me that practicing in a radically different way (the selling point of midwives in TBBB) would produce only a lower rate of c-section and not affect any other outcome. Of course, now it is well established that the trade off for a lower c-section rate is a higher rate of perinatal death and brain damaged infants. That is why no one besides NCB advocates care much about lowering c-section rates.

The name “Mayra” appears on the screen while the same woman as the previous scene continues. “I just feel like I trust my body. I really just kind of want to, and I mean, have a feeling that this is kind of the way you run things anyway, but I just wanted to let my body do what it’s gonna do. 

Cara (the midwife) replies “Oh and it totally does. And the truth is I don’t even run things. Your body runs things, and its respecting that. And then I’m like the gaurdian of safety, and the witness of your process. I really do firmly believe often times the body is smarter than me, and I’m not that dumb.

The matter of ‘trusting your body’ is an interesting question- I am fairly certain that the majority of men trust their bodies, they do not see it as an opposing force or something to overcome. Women are constantly told to see their bodies as adversarial and untrustworthy- too weak, too fat, too this, too that. In need of cosmetic surgeries or products to fix ‘flaws’. The majority of women know the pain of repeated dieting and regaining weight, or not losing much to begin with, and then judging themselves for failing.  Women fight their bodies all the time, so the idea of trusting it can seem very relieving to women. I find it distasteful that they exploit the low self esteem of women for profit.  A much more powerful message would be one of unconditional acceptance of your body. I would say that you can trust that your body is amazing, that you don’t need to prove the value of it to anyone, ever. Your body will carry you through life however it can, and one way isn’t better than another. You don’t have to walk or give birth vaginally or be strong or thin or anything for your body to be trustworthy or valuable.

Hearing the CNM talk about the body being ‘smart’ is a bit troublesome as well- if something goes wrong in labor that necessitates an intervention it is not the body being ‘dumb’. If you don’t need an intervention your body wasn’t “smarter” than someone who did need one. The privileging of one group of bodies for their ability to perform certain tasks that others can not is the essence of abelism. What each of our bodies are capable of isn’t an hierarchy or a moral obligation, its just whatever cards we were dealt. Its only unfortunate to be a c-section mom in a culture that demonizes c-sections and exalts vaginal birth. Natural childbirth advocates and The Business of Being born push that agenda precisely, but fail to investigate or even mention the logical outcome of that world view. The obvious conclusion is that women who do not have vaginal births will feel broken or foolish for it, or like they ‘failed’ at birth. There are a lot of people who feel unnecessarily guilty about having agreed to a c-section. I know I did. I tried to figure out what I did wrong or where things could have possibly turned out differently, and I’ve talked to some old friends online who feel the exact same way after trying to have a natural birth.

There is footage of a midwifery clinic in new york. They discuss their support of choosing NCB style childbirth when patients request them.  They talk about their commitment to patients, and how they believe that it is in contrast to most OBs style of practice. 

That’s fine. These are all hospital births with advanced practice nurses in attendance. I am not really sure what this has to do with home birth or natural birth.

Abbey Epstien and Ricki Lake are in a cab looking at history books about birth and look at creepy photos from the past. There were some awful practices back then. There is more creepy hospital footage.

There are historical examples of abuse of patients in any non-privileged population. This is a very real fear that women, people of color, fat people, gay people, people with mental illnesses, poor people, etc experience when seeking care from physicians or hospitals. It is not an unfounded fear, care disparities exist and are well evidenced, but midwives are equally as capable of being culturally or ethically incompetent in their profession. Even if NCB advocates are right and midwives are the answer to this problem, then it is a woefully inadequate one. Virtually everyone except women of childbearing age, who need specific care that midwives can provide, are not served by using midwives as a solution to historically based oppression. There must be system wide changes put in place to protect all vulnerable people from the inhumane treatment that can exist within hospitals.

An anthropologist says “The drug scopolamine was invented in germany in the early 1900s. And american women found out about it. Remember that, at that time, women were still being told that the pain of childbirth was the curse of eve. And that it was because of eve’s sin in the garden of eden that women had to suffer during childbirth. So you could imagine how the modern, liberated, feminist attitude at the time would be “I certainly do not have to suffer, and if there are drugs around that keep me from having to suffer then I’m going to go find those drugs because I’m a modern woman.” 

The implication here is that women who fought hard to get pain relief during childbirth were misguided, victims of the times, and avoided pain in an attempt to be ‘modern’ or trendy.  This is a very strange way to weasel out of the fact that many women find that childbirth is unbearably painful, and they wanted drugs because pain is unpleasant.  It is a much simpler and believable explanation that what the anthropologist has argued.

Yes, even more creepy hospital footage. This time paired with a twilight sleep re-enactment complete w/writhing, struggling, crying. The anthropologist continues “Women thought that it [scopolomine] took away pain during childbirth, but it doesn’t.

Women who had ‘twilight sleep’ births were usually given scopolomine and opiates, so there was pain relief, just not from the drug being discussed.

It actually just takes away your memory of the experience. So scopolamine spread rapidly across the united states, and by the 1960s almost everyone was having twilight sleep. Now it does take away memory, but it also takes away self control. It takes away self-awareness. ” She continues on about the horrors of twilight sleep and how women were strapped down if they freaked out too much, how they could be left for days laboring and drugged, etc. 

The history of medicine is full of horrifying practices and inequality.  This is essentially an argument from tradition- that group x was wrong in the past, so they are probably wrong today. It is a logical fallacy. If they are wrong today then there will be evidence that demonstrates it.

Marsden Wagner says: If you look at obstetrics for the last 50 years, what do you find? IN the 1930s they were giving x-rays on every pregnant woman to measure her pelvis. And then in the 1940s they discovered that that caused the baby to have cancer, so they had to stop it. And then in the 1950s and 60s, they had another drug called thalidomide, which caused babies to be born without arms and legs. And then they had to stop that. In every case it was after the fact. In the 1990s, They were giving cytotec to induce labor in women who had had a previous cesarean, and they ended up with hundreds and hundreds of ruptured uteruses and many many many dead babies before they found out, finally, in 1999 that they shouldn’t do that. But, you see, theres not a good history in obstetric practice of careful study of the long term effects of all these interventions. This is why, if you really want a humanized birth, the best thing to do is to get the hell out of the hospital. 

You could say something negative about virtually every branch of medicine, or any profession ever, and that is because medicine is practiced by people. People make errors. The best thing you can do is try to fix it when problems arise, and that is exactly what happened according to him. Problems were identified and so practices were changed. Midwives do not change their practices when problems arise. MANA has not changed any policies in light of the fact that they felt that the mortality numbers for out of hospital breech and twin births were unacceptably high. They still decline to define low-risk pregnancy and want homebirth midwives to be able to attend any births that the midwife and client agree upon, even those proven to have extremely high rates of death and disability, all without any insurance in case of an emergency or mistake. Its deplorable.

Something that Dr Wagner failed to mention was all of the exciting successes of OBGYN care over the past 50 years. There are many more successes than failures in terms of technology and outcomes. This is a triumph of science and the work of many hands over many years. Its something worth celebrating, or at a minimum mentioning when discussing the history of OBGYN care over the past 50 years. There isn’t even an attempt to give a balanced account of events here, and its pretty shameful.

Discussion of the themes in this portion of the movie:

Midwives are fond of saying that physicians are scaremongers or bullies, but this portion of the movie is definitely intended to cause fear. You are supposed to be afraid of your doctor, of medical technology, of the hospital, and of c-sections.  It scared me, and midwives profited off my fear of going to the hospital, then they subsequently dumped me on the hospital staff during labor.

The way that this portion of the movie attempted to use feminism to sell midwives upset me. I was reminded of a story from Roseanne Barr, about all the opposition she faced in getting her show on the air at all. She assumed other women in the media would be her allies, because they shared the same struggles:

My breakdown deepened around the fourth episode, when I confronted the wardrobe master about the Sears, Roebuck outfits that made me look like a show pony rather than a working-class mom. I wanted vintage plaid shirts, T-shirts, and jeans, not purple stretch pants with green-and-blue smocks. She bought everything but what I requested, so I wore my own clothes to work, thinking she was just absent-minded. I was still clueless about the extent of the subterfuge.

Eventually she told me that she had been told by one of Matt’s producers—his chief mouthpiece—“not to listen to what Roseanne wants to wear.” This producer was a woman, a type I became acquainted with at the beginning of my stand-up career in Denver. I cared little for them: blondes in high heels who were so anxious to reach the professional level of the men they worshipped, fawned over, served, built up, and flattered that they would stab other women in the back. They are the ultimate weapon used by men against actual feminists who try to work in media, and they are never friends to other women, you can trust me on that.

This is how I feel about midwives now. They will talk the talk to get you to sign a contract, but they don’t really care about any of this stuff once the check clears. They won’t support women who leave NCB or who are mad about the way a midwife has treated them. The men that the NCB movement fawns over are mostly old white men who claim to know how women can have their ‘best’ birth. Real feminists let women lead the movement, or at a minimum question the sex disparity in the leadership. You would think that a movement that is overwhelmingly female would have more women than men as Big Names, but you would be wrong. It doesn’t look anything like the feminism I know, because its not feminism at all.

Next up is the nauseating ina may portion of the film. stay tuned.

Debunking the Business of Being Born: Part 5

This part 5 in a series debunking the Business of Being Born. Descriptions of the movie are in bold, my commentary is in normal text. The other parts of the series can be accessed by clicking here.

A woman says “Its very easy to convince a woman that they need this procedure or that procedure, because there is a huge power disparity.”

There is an inherent power disparity in any situation with patient care. Doctors are trained in how to deal ethically with the disparity, while I have noticed a tendency in midwives to ignore the problem or pretend that it can be overcome by force of will.  There is also the issue of accountability- doctors are not very accountable for unethical behavior that does not result in bodily harm, but they are still much more accountable than midwives. The film makes it seem as though midwives are the solution to patients being given misleading information and coerced/forced treatments, but midwives are equally as capable of doing this to pregnant women. I know because it happened to me, and have since found many stories of women who have been through it, too.

There is footage of a laboring woman in a hospital  asking “What is the risk to the baby?” and a doctor replying “minimal”. 

Combining this footage with the previous statements gives the impression that the doctor is lying to the patient. We are not given enough information about the procedure or the patient to judge if it is true or not.  This scene is emotional for me- I feel for the woman who may be uneasy about what her doctor has told her (or maybe she is feeling fine? We don’t get to speak with her again so we cannot know, her face is blurred so its impossible to know if she was even anxious or not). This movie expertly manipulates feelings of helplessness that women almost universally experience in patriarchal society.

A woman says “So if you’re in labor and the doctor says, ‘wow, I think we need to do x,’  you’re gonna say ‘yeah we need to do x’. The doctor may think he is giving you an option, but you hear the expert advising you to do something. ” The woman making the statement is revealed to be a part of citizens for midwifery, a political group whose aims are to increase the access of women to midwifery. 

I agree that patient consent violations are an enormous problem in medicine. It isn’t just a problem for pregnant women, and so using homebirth midwives as a solution leaves out a wealth of people who could benefit from a more universal solution. Almost dying in an accident, or surviving cancer, or any other situation that causes a person to face their mortality is a major life event and transformative in the same way that giving birth can be. People who actually care about solving a problem are always looking for possibilities to better deal with the problem, they ask meaningful questions about what strategy is best. They do not push a single solution and fail to discuss any others. That is a sign of pushing an ideology or a belief system instead of practical solutions for practical problems.

(more footage from monty python)

Ricki Lake and Abbey Epstein are on the phone with an indiana midwife talking about her interest in their project. They discuss that Ricki Lake is the driving force behind the movie because she had 2 babies, the 2nd one at home. Ricki discusses how it was important for her to experience everything, to feel everything, to have the memory of pregnancy and birth. She notes how a lot of women she knows don’t care about any of it, they just care about a healthy baby. She wanted to explore it because she feels that so many women are missing out on an amazing life altering experience of natural child birth. The midwife agrees that it is hugely transformative. 

(footage of a happy unmedicated birth)

Something I really resent now is that someone like Ricki Lake can use her class privilege to push whatever agenda she wants, simply because it was important to her personally.  I would personally love to make a documentary about the dark side of midwifery in america, but I am not rich or connected in the entertainment industry so its unlikely that I would ever get the opportunity. My message isn’t less important than Ricki’s, but only one of us will be heard on a national scale. People who wield that kind of privilege have a duty to others to act with integrity and avoid misleading others. This movie is grating in its emotional appeals and telling omissions. Shame on you, ricki lake.

Several other women discuss how powerful having a baby was for them and the reverence the occasion deserves. There is more footage of a different woman during her home birth labor.

“A woman doesn’t really need to be rescued. Its not a place for a knight in shining armor. Its the place for her to face her darkest moment and lay claim to her victory.” Says Cara Muhlhahn

At the time that I fell for this movie this line of thinking seemed empowering. In reality, none of us have any real control over if an unmedicated vaginal birth is possible for any individual woman. When I was in a doula training I remember the instructor saying “the baby will come out if she is in a coma. The uterus pushes the baby out.” I felt a little confused- how was it an achievement (or a ‘victory’) if it can just happen while you are unconscious? I ignored the cognitive dissonance involved with that. I admired how amazing our bodies are instead of questioning the premise of NCB- that you can control how your birth ends up. You can’t. All you can do is make a bet based on statistics and hope you are in the majority.

There is footage of cara assisting a laboring mom at home in a birth pool. 

Another midwife talks about how birth can be empowering and wonderful or traumatic and scarring. They show footage of a woman being wheeled off to an emergency c-section who is obviously in a lot of pain. 

The implication is that her birth by c-section was traumatic. We can’t know because we cannot speak to her. We are made to feel sad for her when really, the reality for women without access to c-sections is much more grim.

“We are completely lost. And we have even forgotten to raise the most simple questions. What are the basic needs of women in labor? And the fact that midwives have disappeared is a symptom of the lack of understanding of the basic needs of women in labor.” says dr michael odent. 

He continues “Like a traveler who suddenly can realize that, he took a wrong way. The best thing to do in this case, is to go back to square one. The point of departure. And to take another direction. 

This isn’t necessarily true. The best course of action may be to find out what is working and what isn’t, and make revisions to the things that are obviously not working. He doesn’t ever get specific about the ‘basic needs of women in labor’, but makes it the basis for his entire argument to return to home birth using midwives. Another claim that is impossible to actually examine for validity. Its boring at this point to type that out.

There is footage of Cara looking at a map and planning a route to a patient, and discussing her credentials as a CNM. She says that her reasons for preferring home births is that the client gets to have their baby at home. Her secord reason is that she would prefer to be on their turf instead of the other way around. She discusses the philosophical underpinnings of “giving the power back to the woman.”

This mindset isn’t restricted to midwives, there are OBGYNs who believe in giving power back to female patients. There are midwives who believe that they know better than patients. It is so easy to exploit the human tendency to stereotype groups of people, and this movie is absolutely shameless about it. They never ask if there are abusive midwives or feminist leaning physicians. Its an obvious question that the film makers failed to examine.

(footage of cara during prenatal visits. She is very nice to the patients and their families)

“I do believe that women who choose homebirth, they do share something. It could be just a feeling that she knows how she wants to do things. And then I think when she’s in labor, she can interact with her labor in a different way than if everyone is doing things to her and making decisions about her.” 

Examination of the themes so far:

I think women who choose home birth may or may not share things. I do know that most of them are white, middle or upper class, and college educated.  Something women of that demographic share more often than other groups is anorexia or bulimia. Until there is research about this I can only offer my opinion, but I do believe there is a connection. Natural Child Birth has a lot in common with the twisted thinking of an eating disorder. There is a lot of perfectionism, judgment, black and white thinking, and the belief that your body will perform a certain way if you are Good Enough. Your body will be proof that you are Good Enough. Your body, its pain, its resistance, is a thing to overcome to prove to yourself, and others, that you are acceptable. If you accomplish it you will finally feel amazing, whole, at peace. There is only one ideal birth to chase, just like there is only one ideal body.  Craving an unhealthy level of control over yourself or your life is a feature common to many women with eating disorders, it may be because there is such a large proportion of eating disordered women who have survived sexual abuse. Midwives are not helping these women, they are preying on them for income. This is such a horrible, dangerous idea to give women who cannot control if they need a c-section, or if natural child birth is a meritless agony to them in retrospect.

The movie deceptively pairs footage of doctors with negative statements and midwifery footage with positive ones. Where are the women like me, like so many others, who had awful midwives? Where are the vignettes of births that women considered ideal that were not NCB?  I have a hard time believing that the film makers could not access anyone with a contradictory opinion, they simply chose not to show anything damaging to the image of midwives.

Something that really made me dig in my heels and adhere more strictly to NCB ideology was the way that anti-home birth advocates ridiculed the idea that women highly value the experience of giving birth. It was extremely personal to me. I identified with this movie a lot because of the value it placed on women and their experiences.  I was at a positive place in my life after overcoming a lot of adversity, and after seeing this movie I thought “Hey, why not me? Maybe I can have the best experience and a healthy baby. Why not aim for the best life can offer?” When other women ridiculed chasing the ‘ideal’ experience of child birth I felt very sensitive about it. Who were they to tell me what I should or should not want?  They always framed it as an experience vs safety, but it seemed like a false dichotomy to me. Why not both? I had to fight for so long to feel like I was worth anything, or that things might turn out well for me in the next chapter of my life.  It also made me think that anti home birth advocates were sexist. The ridicule of a woman who wants ‘too much’ from life is rampant, and it seemed to me that this was yet another example. The worst thing a woman can be is someone who takes more than their share- of food, sex partners, of a conversation, of attention, of decision making, of authority. We are constantly told to be happy with our lot, even when it is woefully inadequate. It is unfortunate that anti-NCB groups are not sensitive to the hopes of women in NCB. I empathize completely with those wishes and do not see them as selfish or narcissistic.  I am hoping that this blog will be a place to show sensitivity to the valid concerns raised by NCB advocates while also being critical of their message about the proper solution to these problems. Stay tuned for more.