Good Enough Mum

Hey, Guess Where Your Freedom To Swing Your Arm Ends? My reply to Peggy O'Mara

The other day I stumbled across this blogpost, which is basically a verbatim post of an article by Peggy O'Mara, editor of Mothering magazine (a woman with whose rhetoric I have been somewhat unimpressed since reading a well-known article of hers in which she interrupted her prolonged diatribe about what we should be doing about our babies' sleep to tell us not to listen to experts who didn't know our babies.  I'm willing to bet that, to this day, she hasn't spotted the contradiction there.)  I couldn't decide which I found more objectionable - her skewing of the facts and figures in the name of 'informing' parents, or her attitude towards freedom of choice - but, either way, I hadn't actually planned to blog about it, purely due to the so-many-blog-topics-so-little-time factor.  However, thanks to my darling husband giving me the much-treasured Mother's Day treat of an hour on my own while he takes the children to the garden centre, I actually had a chance to sit down and write comments on some of the blog posts I've been wanting to comment on; and the comment I wrote for that post got longer, and longer, until before I knew it I realised I had a whole blogpost on my hands and might as well go ahead and post it as such.  So, this is my reply to Peggy O'Mara's article 'The Assault On Freedom Of Conscience'.

......................

I'm all in favour of people having freedom of choice, up to a point. But the point in question is the point at which their freedom of choice impacts significantly upon the lives of others. And, despite Peggy O'Mara's ridiculous claim in her penultimate sentence, parents are *not* the only ones who have to live with the consequences of these particular choices. Their children also have to live – or die – with them.

In the case of choices about vaccines, other people are also affected. No, Peggy O'Mara, no-one is trying to claim that the vaccines are 100% effective – just that they greatly reduce a child's risk of catching a disease, if they come into contact with it. As, indeed, your own figures show. (The vast majority of children are vaccinated, so, if the total number of measles cases is split around evenly between the vaccinated and unvaccinated groups, the rate of measles must be *much* lower in the vaccinated group.) But they don't provide 100% protection (as, again, your own figures show), and some children will be unable to have them for health reasons anyway. So, if you allow measles to start circulating again by providing a pool of unvaccinated children who can pass it around, then some other children *will* be affected.

I don't know an awful lot about the US Constitution, so please stop me if I'm wrong – but I suspect that, while protecting your right to hold and to voice a minority opinion, it does not protect your right to act on that opinion willy-nilly if doing so is going to be harmful to others. If, say, your minority opinion happens to be that small children are perfectly safe being held on an adult's lap in a moving care instead of being restrained in a car seat, you can hold that belief all you like but you'll find that acting on it will bring you both public censure and legal sanction. Not because the big bad government are meanies trying to interfere with your sacred freedom of choice, but because, as the old saying has it, your freedom to choose where to swing your arm ends where someone else's nose begins.

Of course, it's necessary to draw a balance between parents' rights to make their own choices and their children's rights to be free from harm, and I certainly wouldn't want to see a world in which it was acceptable to force all parents to bring their children up exactly in line with State diktat. But freedom of choice does not exist in a vacuum - some choices *are* potentially harmful to other people, and that's not an issue we can simply sweep under the carpet. Choices carry responsibilities. Choices carry potential consequences for people apart from the person making them. We do need to find the best balance we can between allowing parents to parent unhindered, and stepping in where their ways of so doing may have major adverse impacts upon their children.  But Peggy O'Mara is simply ignoring the other half of that dilemma.  She is trying to present this issue as though the choices she discusses were purely individual ones that don't affect anyone beyond the person making them, and that is manifestly untrue.

Adolescent Of Our... no, wait, shouldn't that be *Child* Of Our Time?

Over the past month, I've been watching an episode of 'Child Of Our Time' which looked at gender roles in children.  (As you can gather from the fact that it took me this long to watch a one-hour episode, this was something squeezed into ten-minute slots here and there, around everything else; however, as this particular episode was actually produced by my sister I wanted to get to see all the bits she's been telling me about working on.  Besides, she does some of the interviewing of the children and so every so often while watching the programme I suddenly hear her voice coming from off-camera to ask one of the children something, whereupon I can yell "That's Ruthie!  That's Ruthie!"  Which is pretty cool.)

Anyway, the other day I was squeezing in yet another brief segment of watching and got to the bit where the voice-over told us that one of the girls, Megan, would now have to confront gender roles in a new way because "Megan has a boyfriend."

Er, no, she bloody well doesn't.  She's seven. 

One of Megan's many friends happens to be a boy.  And, yes, she and her friends probably are getting a bit silly and giggly about her 'boyfriend', because that's the sort of thing kids do.  Why on earth are the adults playing into this misnaming?  Megan's mother professed herself unbothered by the whole thing because, after all, he obviously wasn't really a boyfriend and they were just kids having fun.  Which is totally reasonable.  But why not point that out to the children?  The lesson that, just because one of your friends happens to be of the opposite sex it doesn't automatically mean they're your boyfriend or girlfriend, is such an important one to learn.  Why miss the chance to convey it?

If Katie or Jamie, in prepubertal years, tries telling me they have a boyfriend/girlfriend (says she with the confidence of someone who's not yet dealt with this stage of parenting and therefore knows exactly how to deal with it), then I will gently correct them:  No.  You have a friend who happens to be of X gender.  Having a boyfriend or a girlfriend involves more complicated stuff.  There is a difference.  Being friends with a boy, without making them your boyfriend, is perfectly OK, and will continue to be so, no matter what messages anyone else may give you to the contrary.

Naturally, I dissent

I had both my babies by what you might call natural childbirth.  I don't in fact call it that, partly because the term makes it sound as though the naturalness was somehow the goal in and of itself in some sort of Luddite repudiation of technology, and partly because it's yet another example of how overused and meaningless the word 'natural' is.  After all, porcelain tubs filled with hot water are no more likely to grow in the natural setting than epidurals are, but I certainly found a soak in the bath of vital importance to handling the pain in my first labour.  However, I had unassisted low-tech vaginal deliveries for both, pretty much unmedicated (I had two Paracetamol when in labour with Jamie, and a very brief go on the gas and air with Katie, but no Pethidine or epidurals).

This is, apparently, highly objectionable to Dr Crippen.  Part of this, it appears, is because he has much the same semantic objections as I do to the term itself.  Much of it, however, seems to be because he thinks, incorrectly, that natural birth is another term for homebirth.  Dr Crippen is against homebirth, which he believes to be unacceptably dangerous.  The only evidence I've seen him offer to back up this viewpoint is of the Scary Isolated Anecdote variety so beloved by, say, anti-vaccine scaremongerers, but I only read a relatively small proportion of his posts and for all I know I may at some point have missed a more rational discussion of the relative risks of homebirth and hospital birth involving the citing of some actual evidence.  However, it's a moot point, since he's wrong in thinking that natural childbirth automatically means homebirth.  It's a term generally used to refer to birth without intervention or medication, which (theoretically at least) is perfectly possible to do even in the most high-tech of hospitals.

Would Dr Crippen object to a woman having natural childbirth in a hospital?  I doubt it, but it's hard to be sure - some of his criticisms don't seem to have anything to do with the place of birth:

"Right on, trendy “natural” child birth is about jumping into the birthing pool with husb... sorry, “life partner” [Goodness.  And here was me thinking that the days when doctors could make snide comments about pregnant women not being married went out circa 1960], the vicar and the independent madwife, singing ten green bottles whilst the baby struggles to get out and then eating the placenta with a rocket salad."

All of which, of course, a woman could do perfectly well in hospital.  So what's the problem?  Well, his objection to those various potential methods by which a woman might make herself feel comfortable during labour or circumvent the lack of decent hospital food after it's over (placenta-eating isn't an idea I fancy in the slightest, but, thinking back to the quality of the only available meal on the ward the evening I'd given birth to Katie and was starving for some protein after a day of eating nothing but easily-digestible carbohydrates, I can see how it might have its attractions) is apparently that the perinatal and maternal mortality rates are unacceptable.  He does not provide any statistics or details on the impact that any of the things he listed have on intrapartum mortality, but I await with interest his presentation of the randomised controlled trials studying the mortality rates of "Ten Green Bottles" renditions.

I did not, as it happens, have any of the above in either of my births, although the lack of the birthing pool in the second certainly wasn't by my choice.  (In my first labour I used the bath instead, which worked perfectly well; whether or not that would call forth similar levels of derision from Dr Crippen, I don't know.)  For me, natural childbirth - or whatever term you can come up with that describes the choices I made concerning my children's births - wasn't about what I wanted to do during the birth, but what I wanted to avoid. 

I did not want, for example, to have major abdominal surgery on the day when a new helpless person requiring a lot of care and a lot of heavy lifting joined my family.  I did not want cuts made in my genitals.  I did not want my children's first experience of life to be the application to their heads of a suction machine vigorous enough to cause major bruising. If, of course, I found myself in a situation where the consequences of not having one of those interventions were likely to be worse than the consequences of having them, then so be it.  However, I wanted to reduce the chances as much as I could.  From my reading, there seemed to be good reason to think that the stronger forms of analgesia might increase my risk of getting one or other of those interventions, as well as having various other potential and unpleasant side effects.  So I found out as much as I could about alternative ways of dealing with labour pains, and decided to see whether I could get by on those ways if possible.  Which, as it turned out, I could.

You can't get side-effects from a drug you haven't taken or complications from an operation you haven't had.  That's why I wanted to keep intervention to a minimum.  I'd have had any intervention for which there was a genuinely good reason; but I was also aware of how often "This is just the way we do things" is considered a good enough reason on hospital wards, and I didn't consider it a good reason.  So, call it natural childbirth if you like - it's what the term means, after all - or call it by a better name if you have one.  But those were the choices I made about my labours; and those are the reasons why I made them.

Maybe I'll just boycott the yams

Before getting pregnant this time around, I spent a lot of time thinking about the pros and cons of having twins.  As time-wasting pastimes go, I had to admit that this one was somewhere up there just below watching paint dry.  In the first place, since I wasn't planning on fertility treatment, it was an utterly moot point; whatever conclusion I reached, I wasn't going to be offered a choice in the matter.  (Well, except that I did, while Googling on the subject, discover that apparently there is a type of yam that can increase your chances of popping out more than one egg at a time.)  And in the second place, I already knew perfectly well what I thought on the subject.  The idea of twins used to fascinate me right up until I had one baby, and then I realised that the whole 'Wow!' factor of having two babies at a time would not actually make up for the practical realities.  Barry was quite in favour of the idea (although that was mainly because he wanted to have identical twin girls so that he could teach them to enact the "Come and play with us, Danny!" scene from The Shining), but I much prefer the idea of having babies one at a time.

It's not that having a third child would be so terrible, for me at least; it's that having two at once would, in all sorts of ways both minor and major, impact on my ability to be the mother I wanted to be to either of them, and that's something that I would find endlessly frustrating and saddening.  On top of that, the question of how we'd have coped financially with the extra time I'd almost certainly have had to take off work is one that I'm sure we could have answered if need be, but am glad we didn't have to.  I made sure I steered clear of those yams.

Still, having twins wouldn't have been a disaster.  I wouldn't have wanted it that way, but if that's what had happened, I'd have sucked it up, dealt with it, got on with things, and done my best to focus on the benefits - which might not have outweighed the downside in an ideal world, but would nonetheless have been considerable.  But if I'd had twins due not to the vagaries of Fate but due to someone's stupid, careless screw-up?  Then I think I'd have been rather less philosophical about the whole thing.

This is the situation faced by a couple in Australia.  One of the women (it was a lesbian couple) was undergoing IVF.  Having initially signed a form to the effect that the doctor could replace 'one or two' embryos on the day of transfer, she then changed her mind and made it explicitly clear just prior to the transfer that she only wanted one replaced.  She did not want twins.  No, sirree, don't even joke about it.  Only replace one, Doctor.  The doctor then failed to pass this rather crucial piece of information on to the embryologist whose job it was to place the appropriate number of embryos into the tube used to introduce them into the womb, and... well, you can guess the rest.  Three years after the birth of the consequent twins, their parents are suing the doctor for the extra financial costs involved - medical bills, time off work, and, most of all, the cost of raising an extra child.

I encountered this story via Julie's post on it.  Despite her fears, her post didn't offend me - in fact, I agreed with quite a bit of it, though not all.  Julie's take on the matter, and one dittoed by many of her commentators, is that she sympathises with the lawsuit but not with the couple's attitudes as described in the media.  This immediately rang alarm bells with me - if there's one thing I've learned, it's that judging people solely on the picture the media gives us of them is not always such a great idea.  This seemed, when I clicked on the links in Julie's post, to be a typical example.  These women seem to have said a couple of things along the way which indeed don't show them in the best possible light, but which are getting splashed all over the papers devoid of any context or any first-hand information from the women themselves about how they see or are dealing with the whole situation, and that is waaaaay open to potential misinterpretation.  Heaven help me if someone ever chooses to do the same with whatever of my comments on life they can get their hands on, because I don't weigh every word I say before saying it and I don't like to think about how many statements I may have made along my road in life that really wouldn't paint me in the best of lights if they were the only information someone had about me.

In this case, the problem appears to have been exacerbated by a case of Chinese whispers.  Julie reported one of the women as having claimed that she was 'traumatised' by buying a double stroller.  Now, I do have to agree that, despite everything I said in the above paragraph, there are some statements that aren't really excused by any context, and if this woman actually had claimed to have been traumatised by buying baby equipment of whatever variety then I would currently be rolling my eyes and muttering "Get a grip!".  However, when I clicked on the link given, I found that the word 'traumatised' seems to have been introduced into the discussion by Julie - what the woman is actually quoted as saying is "It was like the last frontier of acceptance to spend hundreds of dollars on a pram".  While this is a rather weird way of putting things, I'm guessing that it means something like "last straw", and, if so, then I get that.  I can well imagine that if my brain was already swimming with "Oh, no!  How long am I going to have to spend on bed rest?  How will we make ends meet if I have to take all that time off work?  How will I ever manage two babies at once?  What's going to happen when they're both crying and I can't deal with both their needs at the same time?  Am I ever going to get any sleep again?  Oh, bugger that doctor!", then the discovery that I was going to have to spend a few hundred more on a pram than originally budgeted for might be temporarily magnified from a minor and easily shrugged-off setback on life's bumpy road to a disaster that would reduce me to a sobbing wreck.

I'm a bit baffled, too, as to why it's supposed to be so terrible that the other mother described her partner as having 'lost her ability to love' following the birth of the twins.  I do think that post-natal depression - or even stress, burnout, and exhaustion short of depression - can temporarily rob you of your ability to empathise and to respond emotionally to others, and that that's probably what this woman was describing.  And of course that's all part of what you sign on for when you become a parent, but that doesn't change the fact that being a parent to twins is that much harder and could well contribute to that result in someone who might have coped perfectly well with only one at a time.

Julie raises the pertinent question of how this lawsuit will someday be perceived by the children in question, given that it revolves around the desirability of the nonexistence of one of them.  I agree that this is a big potential issue; I'm not sure I agree that it's bound to be an actual issue, although everyone else seems to think so.  These women are not, after all, going to be saving these press cuttings for the children's baby book.  The twins are three years old right now.  By the time they're old enough to take an interest in such things, the court case will be ancient history.  Maybe I'm over-optimistic, but I do think that children can  generally grasp the idea that their parents love them very much now even if they didn't want them initially.  I don't think children look to a years-old court case to draw conclusions about their parents' attitude towards them; I think that they look to the way their parents have acted towards them day after day after day in those years.  (I also wonder if perhaps this couple just didn't think about the way the media would turn a supposedly anonymous court case into a three-ring circus.  If so, then I'll certainly buy that they're naive, but not necessarily that they're terrible parents, or terrible people.)

As I said, Julie's opinions on these points didn't offend me - I thought they were quite reasonably expressed.  What did offend me, to the point of eventually driving me to write this post despite already having added some lengthy comments to the discussion on Julie's blog, was the attitude of a lot of her commentators.  Partly because I disagreed vehemently with many of the things said, and also partly because of the way so many of those things were being said.  ("Money-grubbing assholes" would be a fair summary of much of the commentary.)

For starters, there was the insistence that suffering a particular consequence because of someone's carelessness can't possibly raise any moral issues over and beyond suffering that same consequence through sheer bad luck.  By that argument, I can stop checking results and prescriptions so carefully - after all, people die of cancer or suffer medication side-effects every day, so what does it matter if a few extra bite the dust because I couldn't be bothered to pick up warning signs in their results or notice that they've been put on medication that's contraindicated for them?  While I'm at it, I'll stop looking out for pedestrians when I drive.  They knew there were risks when they decided to cross that road, so the hell with 'em - they've no right to whine and bitch when I run 'em down.

It's only fair to argue that carelessness is also not the same as malice and that there should probably be limits on the amount that someone should have to pay for a genuine mistake, however stupid.  (One could, for example, quite reasonably question whether the doctor really needs to pay the extra child's way through private school.)  But the number of people who seemed to think that the couple should treat medical carelessness as just another part of the risk they accepted when they decided to undergo IVF astonished me.  I suppose it at least makes a change from the reverse attitude that crops up so commonly these days - the idea that if anything has gone wrong with your life it must be due to someone's carelessness and that Someone, Somewhere, had therefore better pay.  Heaven knows I don't have much patience with that attitude, either.  But this was a genuine case of someone screwing up.  One of the commenters accused the women of having a 'sense of entitlement', as though there was something wrong with this under the circumstances.  Having a doctor who's willing to listen to your wishes regarding your treatment and make reasonable efforts to carry them out strikes me as one of the things to which people certainly should be entitled.

Then, there was the attitude that the couple had no right to complain because all they had to do was opt for one of the other options available to them once they discovered the twin pregnancy - you know, one of those many alternatives easy and insignificant enough to be appropriately prefaced by 'just'.  Just selectively reduce!  Just have one of the babies adopted!  Just get on with it and love them both anyway!  With such a range of options available, why would anyone be whiny enough to complain?

Which is a pretty ironic attitude to find on an infertility blog - the place of all places where advice to "Just adopt!" is recognised as being utterly inappropriate in its simplistic dismissal of the very real emotional and practical difficulties that hang on such a decision.  Advice to just have a baby adopted really doesn't strike me as any more OK.  Nor is advice to just undergo a procedure that almost everyone would see as having at least some moral implications and that would present the risk of miscarrying the fetus that wasn't aborted as well as the one that was.  And as for just loving them both anyway - you know what?  I'll bet they do, lawsuit or no lawsuit.

Which brings me to the other thing that really bothered me - the assumption that, because they didn't want two babies, this must mean that they've designated a Wanted Twin and an Unwanted Reject and made certain both know exactly what their role in the family is.  To read a lot of the comments, you'd think the parents had already had the T-shirts made up to differentiate the two.  (One commenter even stated her belief that the judge should make any financial reimbursement to the couple conditional on them doing so.  Huh?!?)  Once again - I don't believe that loving both your children and wishing you had never been put in the position of having to deal with two at once are mutually exclusive emotions.  It's nice, sometimes, to act as though life were really that simple, but it just isn't.

None of this is to say that I believe there are no questions to be asked about how the pair are acting and whether these actions are justified.  It's to say that, since none of us knows the couple, their parenting skills, or their side(s) of the story, I don't believe we are in a position to assume we have answers to those questions.  Especially not answers as dismissive and simplistic as many people seemed to be rushing to provide.

How the Supreme Court got it wrong

This post contains both controversy and potentially icky medical details.  Don't say you weren't warned.

(EDITED TO ADD: If you tried to comment earlier and couldn't, I do apologise; I had no idea the comments weren't working until my mother told me yesterday.  THEY SHOULD NOW BE FIXED, so please do try again if there's anything you wanted to say.  As long as it's polite.)

The final year timetable at my medical school included a one-week refresher course in obstetrics and gynaecology.  On my first day there, a woman was admitted for a late abortion.  Well into the pregnancy, prenatal scanning had come up with a rare and tragic diagnosis - fetal anencephaly. 

Anencephaly is a terrible congenital disorder where the cerebrum - the part of the brain responsible for thought, emotion, consciousness, everything above the most basic and rudimentary brainstem functions - simply does not develop.  The majority of affected fetuses die before birth; survival beyond a few days is rare, and the disability in those who do survive is profound and total.  Rather than carry a doomed pregnancy to term only to deliver a dead or dying baby, this woman had been admitted for abortion.

Although this next paragraph is a diversion from what this post is actually going to be about, there's a point I'd like to make up front here, because it is so often missed in this sort of discussion.  There is a very understandable tendency to react to this sort of situation by saying that of course a woman in this situation should have the option of aborting.  Of course she should abort.  And, in our rush to say these things, we can miss the subtle and absolutely crucial distinction between those two statements.  It is all too easy to take it for granted that abortion is the appropriate decision in this situation.  And, of course, for many women it is; there is no doubt in my mind that parents faced with this tragedy should have the option of ending the pregnancy there and then if they feel that would be less difficult to deal with than what is, after all, only prolonging the inevitable.  But one thing I have come to understand is that this should be an option and not an assumption, on anyone's part, and that we must never forget that, as counter-intuitive as it may at first seem, a woman may actually want to continue the pregnancy. When the only time you will have with your child is those few months before birth, you may find that more, not less, of a reason for savouring every minute of those that you can.

I hope this woman's choice was the right one for her and not one that she had been pressured into; I have learned not to take it for granted that this was the case.  I do know that whichever choice a woman might make about such a horrible situation, I'd back her all the way.  And I believe that whether or not she wishes to take the option up, abortion should be available.  Which, theoretically at least, it was.  The practicalities proved more difficult.

I forget the exact gestation, but it would have been the second half of pregnancy, after the routine scans, and abortion at this stage is a lot more technically difficult than in the first trimester.  This woman faced the prospect of going through labour.  Difficult enough to get through when you have the hope and joy of a live baby at the end of it to sustain you; heartbreaking in this circumstance.  What was more, the labour would have to be induced with prostaglandin pessaries. Prostaglandin can be tricky stuff.  It can have unpleasant side-effects - vomiting, diarrhoea.  It can bring on precipitate labour, with horribly violent contractions. 

Or, at the other extreme, it can fail to work at all.

When I left the wards on Friday, at the end of the week's attachment, the woman was still there.  Still not in labour despite repeated prostaglandin insertions.  A five-day abortion that wasn't even over yet - not even started.  The gynaecologist sent her home to rest over the weekend and try again the following week.  As we walked away from the bedside, one of us asked what the options were for her if the pessaries still failed to trigger labour.  "Hysterotomy," he replied.

Hysterotomy is a particularly risky type of Caesarean section, done only when section has to be done several months before term.  Caesarean section is normally done through the lower part of the uterus - I am unsure of the precise technicalities involved, but, as I understand it, this is the part that heals best.  However, because the lower part of the uterus is the last part to start stretching out as the pregnant uterus expands, prior to a certain gestation there just isn't enough lower part of the uterus there to cut into - it's all still scrunched down on itself in the bottom of the pelvis like a balloon not yet inflated.  So the only way in is a longitudinal cut through the main part of the uterus.  Any Caesarean is major abdominal surgery with the prospect of a prolonged recovery and possible complications (something we tend to forget in this day and age as they get more common), but a hysterotomy is particularly likely to cause problems.  Hysterotomy means a woman is going to be less likely to be able to conceive again, more likely to develop pregnancy complications, and practically guaranteed to need Caesarean section for any subsequent birth.  If that woman didn't go into labour and didn't change her mind about not wanting to continue this pregnancy, that was the only option left open to her.

So what happened?  I have no idea.  That was the end of my attachment.  I've never known what happened to that woman.  I wouldn't know her if she walked into my surgery now.  But I've never forgotten that horrible, horrible range of options.

If that happened today, that woman would have one more option open to her.  Intact dilatation and extraction.

The problem with later abortions (the technical problem, that is, before anyone accuses me of trying to dismiss the ethical problems) is that it is only possible to dilate a woman's cervix so far without her going through labour, and a fetus of the sort of size we're talking about here just won't fit through a cervix that's only part way dilated.  Up to a certain point, it is possible to cut the fetus into several pieces and get it out that way, but, by the time the pregnancy reaches around 20 weeks, this is just getting too difficult to do because of the size of the fetus.  (It's also a pretty unpleasant method for a woman aborting a wanted pregnancy for health reasons, because this means she loses the chance of the one sight she could have had of her baby).  Hence, for this woman, the only abortion methods available to her at that stage of pregnancy were induced labour or having her uterus sliced open.

However, some years ago, a gynaecologist by the name of Martin Haskell came up with another alternative.  It is possible, just about, to dilate a woman's cervix far enough by instrumental means to get the body of a 20-week-plus fetus out through it.  The problem is with getting the largest part - the head - out.  And, hence, Haskell worked out the method known as intact dilatation and extraction, or IDE.  The gynaecologist dilates the cervix as far as surgically possible, turns the fetus around so that the body can be pulled out feet first as far as the neck, and makes an incision in the back of the head in order to remove the brain and collapse the skull.  At this point in development the skull bones are soft, not fused, and can slide over each other - it's possible to compress the skull enough to remove it through the partially dilated cervix while still leaving it in a state that can be restored afterwards so that if a woman wants the chance to hold her child and say goodbye, the body is in a fit state for her to do so.

This procedure is technically difficult, and, needless to say, has risks.  However, so do other late abortion methods, and there is evidence that IDE is the least risky of the available procedures at this stage of pregnancy.  This may be particularly true in some specific circumstances - Cecily, for example, developed such devastating pre-eclampsia in her first pregnancy that it was not safe for her either to continue the pregnancy or to go through labour or hysterotomy. Women like Cecily, women like the one I saw on my gynaecology attachment, women who may need an abortion in the later stages of pregnancy for whatever reason and who might not want or be able to go through labour, now have IDE available as an alternative.

Except in the USA.  Because, on April 18th, the Supreme Court outlawed this particular method of performing abortions.

And I do mean precisely that.  As the above link actually specifies, other methods of performing abortions at this stage of pregnancy are still available.  If you're against abortion, or against late abortions, or believe that the grounds on which abortions are currently available should be limited, then I don't agree with you, but I can still understand and sympathise with your viewpoint.  But this judgement is not about any of those things.  It is not about saving the lives of fetuses regardless of the cost to women, because it will not save the lives of any fetuses.  It will not prevent a single abortion (well, after reading Cecily's story, I have to amend that to say that I suppose it'll prevent abortions in those rare, tragic cases where a woman's condition is so serious that she'll die before she can get an abortion by another method). Under this law, abortions after 20 weeks can still be done, if the fetus is not yet viable or if severe disability is discovered post-viability.  What this law prevents - all that it prevents - is the use of this particular method to perform those abortions.

Which does, of course, raise the question of why in hell this particular detail was thought to be any of the Supreme Court's business.

Several years back, I used to read and post to an Internet abortion debate group.  After about a year of all the same arguments going round and round with nobody actually caring that much what anybody else had to say because they'd already made up their mind and were too busy trying to yell their viewpoint even louder in the mistaken belief that this would convince anybody, I finally got fed up and left, but not before I had seen this particular topic, like every other abortion-related topic, come up a lot.  I read dozens of pro-life essays and opinions on why this technique was so awful and why it should supposedly be banned.  All of which has left me firmly convinced of one thing: The war on this particular type of abortion is a matter of propaganda.  It is about trying to shore up the Five Minutes Before Birth myth.

The Five Minutes Before Birth myth is a staple of pro-life arguments.  A classic example of the slippery slope genre, it runs something like this: There is no difference between a child Five Minutes Before Birth and a child Five Minutes After Birth.  Therefore, if abortion is legal, the logical and inevitable next step will be the legalisation of infanticide for any mother who decides on a whim (you know, as women do) that her child is an inconvenience.  And since we clearly don't want that to happen, we have to guard against it by making abortion illegal.  QED.

As a teenager encountering the abortion debate, I believed all this passionately - clearly abortion had to be banned, since that was the only way to hold back the encroaching tide of people wanting to move the time limits later and later until it became legal to kill off anyone of any age group purely because their existence didn't suit somebody else!  Until, of course, the one teensy flaw in this logic struck me - no such encroaching tide actually appeared to exist. Nobody was calling for abortion to be performed Five Minutes Before Birth or for wholesale infanticide Five Minutes After.  In fact, although abortion had by then been legal in the UK for twenty years, the time limits hadn't budged.  Maybe the collective psyche of society actually drew a much clearer distinction between abortion and infanticide than the pro-lifers wanted to make out?

The Five Minutes Before Birth myth was trotted out regularly on the aforementioned debate group, and just as regularly shot down by pro-choicers calling for any examples of any cases, ever, where any woman actually had foregone the opportunity to get an earlier abortion in order to go through the whole of an unwanted pregnancy and practically all of labour and then change her mind in the final few contractions.  The only 'example' anyone ever managed to come up with in response was that of a case where a woman whose fetus was found to have fatal defects was induced at eight months and a Do Not Resuscitate order placed on the baby once born.  As the late Molly Ivins so beautifully put it, no woman seven months pregnant ever waddled past an abortion clinic and said "Oh, darn!  I knew there was something I'd been meaning to get around to!"

And then, along came IDE.  And pro-life propagandists seized upon the opportunity to breathe new life into the Five Minutes Before Birth myth.  Stretch the definition of 'birth' some way past what's commonly understood by the term in order to rename IDE 'partial birth abortion'; spin a bunch of misleading propaganda around it; and, behold - you can make it look as though the scare stories were all true and women are having abortions Five Minutes Before Birth after all!

I don't mean to imply that the majority of pro-lifers are manipulating the facts that cynically.  I think that while some of the people writing this propaganda must know exactly what they're talking about, they are the very small minority.  Most of the people who are against IDE have simply fallen for the spin.  They genuinely believe that it has something to do with full-term abortion. On reading the Supreme Court's definition of IDE as a procedure in which a doctor 'deliberately and intentionally vaginally delivers a living fetus until, in the case of a headfirst presentation, the entire fetal head is outside the body of the mother, or, in the case of a breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act (usually the puncturing of the back of the child's skull and removing the baby's brains) that the person knows will kill the partially delivered living fetus', I can imagine exactly what I'd have been thinking if I knew nothing about the procedure - if a doctor's already delivered the fetus part way, why on earth not just deliver it the rest of the way instead of killing it? And I'd be easy prey for pro-lifers who wanted to convince me that it was all a loophole to allow the killing of viable fetuses during birth, a loophole that desperately needed closing.

But if the Supreme Court justices did some research into what they were talking about before passing judgement, then they must have known that this wasn't so.  They must have known that it isn't any sort of 'loophole', but a simple result of the mechanics of the procedure - the head is bigger than the body, and so just because a fetus has been partly delivered by this method does not mean that all you have to do to deliver it the rest of the way is pull a little further.  A head of this size will not come out through a partly dilated cervix without being collapsed first, and a woman's cervix will not dilate fully without labour. 

They must have known that although labour induction and hysterotomy might be perfectly viable alternatives on paper, the extra risks, problems, and potential unpleasantness associated with them mean that they aren't simply an oh-well-just-do-things-this-way-instead substitute. 

They must have known that IDE has nothing to do with "full-term abortion" or "abortion up to birth" - not just because of the absence of women actually wanting to go through an entire pregnancy only to request an abortion at the very end, but because it is not physically possible to use this method that late in pregnancy.  You can't get a full-term fetus out through a partly dilated cervix like that - it's just too big.

They must have known that just because a fetus is capable of surviving for a minute while it's pulled out of the womb does not mean it's viable in any meaningful sense of the term. They must have known that the choice in a late second-trimester abortion, or in an abortion where the fetus has been found to have the kind of birth defect I described above, isn't between killing a baby and inconveniencing a mother.  It's between giving a non-viable fetus a possible few minutes of gasping for breath outside the womb and sparing a mother a procedure likely to be worse and riskier for her than the alternative. 

They must have known, for that matter, that their description of an abortion method in which the fetal head is delivered first only for the doctor to puncture the skull refers to no abortion procedure known, and doesn't exist outside the more hopelessly lurid and inaccurate forms of pro-life propaganda. (For crying out loud, where did they get this stuff?)

So - did they not know these things? Did they really not bother to do the research, hear from the other side, find out the answers to the natural questions before passing this law?  Because that's the only way they could possibly not have known. Or did they know and not care?  After all, this new law only affects women.  Worse than that, it only affects That Sort Of Woman - you know, the sort who wants a late abortion.  And, gee, who cares about them, the unnatural unmaternal bitches.

I know that if anyone actually finds and reads this post, the chances are high that somebody will use the comments section to tell me all the reasons why I should be against abortion.  And I repeat one more time, in case anybody missed it before: This is not about being for or against abortion.  It is not about saving fetuses, because it won't save any fetuses.  It is not about preventing abortions up to birth, because they weren't happening anyway.  It is not about preventing abortions after 20 weeks, because they are going to continue to happen anyway.  It is about stupid, petty, pathetic political point-scoring, carried all the way to the highest level, regardless of the cost for women.   And for some women, that cost is going to be very high indeed.

So... what's wrong with this conversation?

When Jamie reached the age of two with a spoken vocabulary of four words and the occasional letter, Barry took him along to the health visitor for advice.  She agreed with us that he was probably just a normal late developer, but referred him to the local nurse who assesses children with speech problems.  There was then quite a delay since the person he needed to see was off sick, but she finally rang us yesterday afternoon.  Barry answered the phone.

She said "Hello.  Can I speak to Mrs V__, please?"

He said "Yes.  Who is that, please?"

She introduced herself as "the nursery nurse".  Barry, a little bemused and wondering whether I'd booked Jamie into a nursery and omitted to tell him, passed the phone over to me, and I worked out straight away who it must be and made the appointment.

Which is fine by me, and I'm happy to have had the chance to speak to her, but... excuse me?  Why not discuss the child's problems with the parent who answered the phone, regardless of gender?

I know that in the majority of cases it's going to be the mother who brings the child to appointments, but that's not true of all families by any means, and I don't think it's vanishingly rare for it to be the father.  Surely the appropriate thing to do would have been to check that she actually was speaking to a parent of the child in question and then explain who she was and let Barry decide whether or not this was something for which he wanted to pass the phone to me?  Why assume that just because it's a child-related matter, it's the mother's job?

(Incidentally, one other advantage of this approach would be that it would avoid the errors that are inevitable when you try to guess someone's correct form of address purely from knowing the name of their child.  She had no way of knowing that I'm actually Dr V. and not Mrs V., so I won't hold that against her; but she also didn't have any way of knowing that my surname is the same as my child's, which is certainly not something you can take for granted in this day and age.  For this reason, when I'm making phone calls to parents whom I know only through having their child as my patient, my normal greeting format for any adult who answers the phone is "Hello, is that Freddy's dad/mum?" rather than any attempts at guessing at a name.)

Anyway, that's my stereotyping-in-a-biased-society mini-rant for the day.

Storm in a bottle

I've been asked for my views on an incident in which Cynthia Mosher, the discussion board administrator for the Mothering site, banned a woman from selling her formula bottles second-hand on the trading forum.  This decision was, Mosher stated, in accordance with the WHO code of practice on promotion and advertising of breastmilk alternatives (which, for those who don't know, was set up in response to some decidedly shady practices on the part of formula manufacturers aimed at trying to get mothers who would be perfectly willing and able to breastfeed to use formula instead).  The code also, I have now learned, covers containers designed for getting said breastmilk substitutes into babies. (Incidentally, it does not - despite what Mosher states - mention pacifiers.  Not that I could find, anyway.  That seems to be a rather liberal interpretation of 'teats' on the part of Mothering.com.)

This particular interpretation of the code was, apart from any other considerations, a touch ironic.  The bottles in question had in fact been used not to provide a breastmilk substitute but to provide breastmilk itself.  The blogger in question, faced with breastfeeding difficulties that would have had the majority of women reaching for the formula in a heartbeat, had instead become an EP-er - an exclusive pumper.  EP-ing is a near-heroic solution to the problem of wanting to breastfeed but having a baby who, for one reason or another, can't physically nurse - these mothers actually pump the breastmilk for every feed and then feed it by bottle.  It's a hell of a job and I am in awe of any woman who manages it, and I can easily see why, after going to these lengths to keep her baby on breastmilk, Estella felt Mosher's decision to be a slap in the face.

In fairness, I do have to point out that Cynthia Mosher presumably didn't know the precise history of these particular bottles and was unaware of Estella's whole EP-ing history, and, thus, her response probably wasn't intended to be the two-fingers-up-at-EP-ing that it effectively came out as.  I can also see where she's coming from - we live in a society where, unfortunately, formula-feeding is seen very much as the norm rather than the exception, and this in itself, in a vicious circle, has an unstated but powerful influence on mothers' decisions over breastfeeding.  I can see the importance of actively trying to counteract this, to change the messages and images permeating the culture.  Within this context, I can see why Mosher might want to keep the Mothering site as a place where breastfeeding is so much the norm that bottles just don't even put in an appearance.

Having given due and careful thought to these points, I have reached the conclusion that she's being a narrow-minded jobsworth.

After reading Estella's post, I read the full Code and some explanatory comments, trying to clarify for myself as much as possible what the Code actually said.  While I recognise that precise interpretation of words like 'advertising' and 'promotion' in this context is up for debate, it does seem to me that the Code was intended to apply to circumstances where baby product companies are writing advertisements designed to imply that bottles have some sort of non-breastfeeding-related advantage for babies, disregarding possible consequences in the pursuit of their goal of maximising their own profits.  I could be wrong, but I don't think it was intended to apply to simply making parents aware of a source from which bottles can be purchased.  I don't think the World Health Organisation or the International Baby Food Action Network actually intended baby bottles to become a controlled substance only purchasable in shady backroom deals between buyers and sellers permitted to communicate with each other solely by exchanging furtive whispers on street corners.

And there's also another point here that I find quite ironic - namely, the extent to which they're preaching to the choir.  Mothering.com is a powerfully AP-oriented site that bills itself as 'a magazine of natural family living'.  In other words, it's pro-breastfeeding in the way that Germaine Greer is pro-women's-rights.  So what sort of readership can we expect such a magazine to have?  The sort of women who are passionately pro-breastfeeding, highly informed both about the disadvantages of formula and about the pitfalls that lie in wait to trap the unwary would-be-breastfeeder, and determined to continue breastfeeding even in the face of difficulties, that's what sort of readership.  Precisely the sort of women, in short, whose resolve is not going to crumble purely because a passing advert reminds them of the existence of bottles.

It's possible, of course, that Mosher seriously thinks that her readers are so incapable of making their own informed choices on the subject that they do indeed need to be shielded from any mention of Those Objects Not To Be Named, and that going along with this sort of nannying is ultimately in everyone's best interests.  It's a lot more likely that her thinking didn't go much beyond a quick "formula Bad, WHO code Good" that left no room for the possibility that a code worked out in response to interactions between large professional companies and poorly-educated, vulnerable women living in poverty might possibly be somewhat less appropriate or applicable in different situations. 

But I also have to wonder how much of it was about snobbery.  Bottles?  Well, we don't have any of those nasty artificial things here.  Not on our nice forum.  We are Not That Sort Of Mother.  Mosher may or may not have intended her caveat as an insult to EP-ers and to other women who've used bottles for any reason, but I agree with Estella on this one - that's sure as hell the end result.

A brief rant (of My Own)

Karen has been writing about her experiences with society's widespread belief that adoption is a sort of Child Lending Library whereby you get the child on some sort of extended loan, or maybe extended rental - I'm not clear.  The assumption Karen, and other adoptive parents, have to deal with is that a child who arrives in a family via the mother's uterus is thereby her Own Child, whereas a child who arrives via an incredibly tiresome amount of paperwork isn't.  Plus, the mother in the first scenario is that child's Real Mother, whereas the mother in the second scenario is - presumably - a cleverly constructed wooden puppet, or something of the sort.

This isn't coming from people like the vehemently anti-adoption Tricia Smith Vaughan, who is absolutely up front about her conviction that adoptive parenthood is an oxymoron, but about people who are expressing what they genuinely believe to be pro-adoption sentiments - people who don't even notice the 'but' attached because it's so ingrained in their thinking.  The 'but' that isn't spoken, but implied in the protesting-too-much of "You love your child as if...."  'As if' she were Your Own.  "As if" you were her Real Mother.

The extremely real Karen, who feels no 'as if' whatsoever about her love for her daughter, is expected to put up with this, since, after all, she Knows What They Mean.  "You know what I mean," a family friend brushed her protests aside, after she'd objected to his use of 'real' to describe an adopted man's first father.  Well, that's all right, then. Thing is, sunshine, Karen knows exactly what you mean.  That's the problem.  What you mean is that, at some deep-down level, you think that adoptive parenthood is just that little bit less real than parenthood by birth.  Oh, not that Karen isn't a Real Mother - no, no, no, you'd never think that.  All parents are Real.  It's just that some are less Real than others.  It's the fact that you think that - and see no need to apologise for it or rethink - that bothers Karen.

While the main purpose of this post was my irresistible desire to indulge in that particular rant, I do just have to add this, while I'm on the subject:  What's with this whole "own child" thing, anyway? 

I don't just mean the tactlessness of using the phrase to imply that children who entered the family by adoption don't really belong in it to the extent that birth children do; I mean that it's a bit of an odd phrase to describe any parent-child relationship.  Sure, I - as the saying goes - Know What They Mean.  But... my own?  As though I had title rights over him?  The phrase crumbles into meaninglessness when up against the reality of Jamie.  He's his own, and has been from the start - his very own little person.  Is he supposed to be somehow my possession just because some of his DNA matches mine?

Suckiness

I have posted less in recent days than I meant to, because some of my time and energy has been spent on trying to think up some sort of vaguely articulate response to this.

It's bad enough that this woman had to put up with the kind of attitudes she describes in the article.  It's bad enough that the breastfeeding experts she saw were also of so little practical help to her.  (I thought I had a hard time finding someone who could solve the mystery of why breastfeeding was so excruciatingly painful, but I only had to devote three or four days to consulting with three or four different midwives before finding someone who realised that the problem was Jamie's tongue tie.  Exactly how is it possible that both a La Leche League leader and Jack Newman's clinic both somehow missed thinking of that - or other oral problems in the baby - as a possible diagnosis??)  But the bit that angers me the most - to the point of reducing me to spluttering incoherence, barely able to summon up a thought as to how to respond - is the fact that, when she wrote about these experiences, people responded by getting angry with her.

Why, how dare she have the temerity to say anything negative about breastfeeding supporters?  The nerve!  Doesn't she realise that all breastfeeding supporters are saints?  She can't possibly have had a different experience!

Anyway.  This is the e-mail I eventually strung together to send to INFACT about their article.  And if Hathor wants to give me a Y Award, I'll wear it with pride.

************************************************************************************************************************

I am writing in response to an article which I found on the webpage of Hathor the CowGoddess, about the recent Chatelaine article “Breastfeeding Sucks”. Hathor's webpage identified the article as coming from your organisation, so I hope I am correct in thinking that this is the correct place to send my response to it.  I am copying this letter to Chatelaine, as requested.

Firstly, to clear up a detail: I believe it is fairly common practice for editors, rather than authors, to choose the titles of pieces written for magazines.  I dislike the title as well, but suspect that the author may well not have been the one to blame.

Secondly, with regard to your dismissal of the main body of the article, I fear you may be the ones missing the point.

I entirely agree that the health care system should be doing far, far more to support and encourage breastfeeding.  However, their failure to do so was not what caused this author's problems.  From the article, it seems that she is one of the few women articulate and determined enough to get access to the kind of expert advice that should by rights be available to all women.    Her problem – regardless of how 'unacceptable' you find it that she dares to voice it – was that when she did speak to breastfeeding supporters, they treated her with criticism and judgement rather than with sympathy and support.

I am at a loss as to why you would feel it 'misdirected' for a woman to be angry with people who have treated her that way.  Surely, no matter how glaring the faults of the government when it comes to encouraging breastfeeding, we still retain responsibility for our own actions? This author was clear about what she most needed and wanted from the pro-breastfeeding camp – she wanted breastfeeding supporters to acknowledge her problems, to sympathise with what she was going through, to respond to her pain with encouragement rather than blame. That simple change in attitudes could have made a major difference to her breastfeeding experiences; and the fact that this did not happen is not something we can blame on the government, no matter how tempting it is to avoid looking at our own flaws.

Yes, this woman did continue breastfeeding – an achievement in the face of the odds for which she should be resoundingly applauded.  The majority of women are not going to be so determined.  Surely we should be trying to learn from this woman's experience in order to make sure that we, as individuals, are doing all we can to provide women attempting to breastfeed with genuine support, rather than putting them off?  Are we going to have the courage to do this - or are we going to brush this author's experiences aside, hiding behind excuses about what the government should or shouldn't be doing, using their flaws as a handy excuse to ignore our own?

Did you hear the one about Tricia Smith Vaughan and La Leche League?

Tricia Smith Vaughan, self-styled Comic Mom, of whose controversial views on adoption I have previously written, has now been the subject of further 'Net furore due to La Leche League picking her as the guest speaker for their 50th anniversary meal.  (Side note: is that my all-time record for number of links in one sentence?)  I meant to write a post about this at the time, but, thanks to my darned perfectionism dedication to spending hours carefully and lovingly crafting my posts word by word, I was nowhere near finished at the time it became a moot point - LLL, faced with further information about Tricia and her views, reversed their decision and cancelled the booking.

What I was going to write about this time was not, in fact, Tricia's views on adoption - as much as I disagree with them, I don't think I'd have favoured barring her from speaking purely on those grounds.  The way in which she expresses said views is a different matter, but I won't go into that right now.  I actually want to focus on something rather more specific, which I meant to write about a long time ago and didn't; I want to write about Tricia's views on post-natal depression.

In the midst of the storm, this was something that was almost overlooked by the protesters, and, accordingly, by Tricia - in her defence of herself, her views on PND get only a passing parenthetical mention ("did I say it didn't exist? NO! But it is way overrated!")  (Incidentally, I'm guessing she means 'overhyped' - I don't think I've ever heard anyone talking about how wonderful PND is.)  It's also something that I haven't written about before, despite meaning to; and I think her article on the subject bears looking at.

Tricia starts out the article in question by commenting on how our attitude to mental illness differs from our attitude to physical illness.  Would the teacher who referred to a mother's post-natal depression as "a little, well, post-partum" have talked about a brain tumour in the same way?  I don't know whether she would or not, because I can't tell, from Tricia's report of the incident, whether the teacher's phrasing comes from a belief that post-partum depression is so minor that it can be dismissed, or a belief that it's so horrific that even the full name can't be mentioned aloud - the Voldemort of the medical world.  But I do agree with the general point that Tricia's trying to make here: we do, indeed, view and discuss mental illness differently from physical illness.  And I think it's extremely instructive to apply Tricia's own comparison to the rest of her essay.  If Brooke Shields had been suffering from a brain tumour instead of post-partum depression, would Tricia have talked about her illness in the same way?

If Brooke Shields had had a brain tumour, would Tricia have referred to it as Brooke Shields' "supposed" brain tumour?

If Brooke Shields had had a brain tumour, would Tricia have felt that the most appropriate way to start out her discussion of the matter was with a disparaging mention of the money that Brooke had been making from being interviewed about her illness?

Would Tricia have dismissed the problems caused by a brain tumour as "common yet vague symptoms... hello, anybody not feel this way?"

Would she have considered it appropriate to say "I don't have a lot of time for brain tumours, as Brooke apparently does"?

If Brooke was giving interviews about how she survived her battle with a brain tumour, would Tricia have dismissed this as 'whining'?

Would she have implied that the brain tumour was somehow, in fact, Brooke's own fault?  (Actually, we probably would have been spared that at least - I don't think there is a brain tumour-related analogy to the line "trying to get pregnant so that I could have postpartum depression".)

Would she have taken the opportunity to be bitchy about some of Brooke's personal lifestyle choices?  (The nadir of the whole dreadful article is the point at which Tricia implies that Brooke chose to do IVF instead of getting pregnant the natural way because the artificiality appealed to her.)

Would she have questioned the existence of brain tumours on an Internet message board and then referred to the people who disagreed with her as 'lemmings'?

Would she have derided the idea of medical treatment and advised a person with a brain tumour to eschew medical advice and listen, instead, to a popular actor's advice on exercise and vitamins?

If she had talked about brain tumours in this way, would she have been surprised when people who had suffered from brain tumours found her tone smug, mocking, dismissive, and deeply offensive?  Would she have waved aside their objections with a hey-what's-your-problem folks statement that, after all, she hadn't actually said brain tumours didn't exist?

Tricia, I suppose we could split hairs on this one.  I suppose that it's true that you did not, in so many words, come out and say that you didn't think PPD existed.  I suppose that writing about the time you publically "questioned the existence" of PPD isn't technically the same as saying it doesn't.  I suppose that the statement that you "don't have a lot of time for depression, as Brooke evidently does" only implies that you think she had a choice in the matter, unlike, say, a person suffering from an actual illness - you didn't specifically say that.  I suppose that dismissing a woman's description of her suicidal thoughts by telling her to get out and take a walk, in the tone you did (with a bitchy aside about the cost of her apartment, as though that were relevant, for crying out loud) isn't an actual statement that you think she's making a fuss over nothing.

But I look at what you do say, as well as what you don't; and I look at how you say it, something that you don't seem to recognise is often just as important.  What I see is someone who thinks it quite OK to make fun of a woman for suffering from post-partum depression.  What I see is someone who does not appear to see anything to retract or apologise for in that article. 

I've got to agree with your comment that maybe you're really just jealous of Brooke - yes, I do think that that's the likely subtext here, and I think it's a shame you couldn't have dealt with it in a more adult way.  But regardless of whether or not I'm right about that being the reason, the result is the same.  You dismissed a debilitating and potentially serious illness, and you made fun of a woman for coming out and admitting that she'd suffered from it. 

So, no, I do not think that it would have been appropriate for you to speak at LLL's anniversary dinner.  I don't know whether they cancelled because of genuine concern about your views, as other people think; or whether it actually was, as you think, because they caved to popular pressure (though I have to say that the latter strikes me as unlikely in a group who, after all, are about to celebrate fifty years of standing up against society's mores to do what they feel is right).  But, whatever their reason, I agree with their conclusions.  LLL is there, among other things, to provide new mothers with support and help that may be desperately needed, and their dinner celebrates fifty years of so doing; and the fact that you think it appropriate to sneer at someone for suffering from PPD means that you were not the right woman to be speaking at that dinner.