Monday, March 30, 2009

Pray 5 times a day

Let us pray five times a day

In Spanglish
And in Frerabic,
Let us pray five times a day:
To the God who is running things,
God Almighty, Yahweh, Allah,
Jesus and Mohammed and Buddha,
And the Holy Spirit,
The God who is letting things flow,
Evolve, bloom, grow,
Alpha and Omega,
Brahma/ Vishnu/ Shiva,
And any other of the million holy names,
Whether you believe or not,
In a higher power—and saving grace,
Pray five times a day;
In solidarity
With the known and the unknown,
The great mystery,
Let it be, let it be, let it be, let it be…
With acceptance and actions,
Bliss/ Consciousness/ Energy
Green grass daily rising,
Breath on breath,
Galaxy beyond galaxy,
Singing Psalms, or Om,
With all our alphabets,
Our metaphors and murmurings,
Quintessential praise and thanksgiving;
Five fingers touching,
Five toes dancing,
Five senses playing together,
Five Benedictine and Islamic prayers—
The rhythm moving through life for
At least five centuries,
Five decades of a life,
Five times a day

Monday, March 23, 2009


I am a member of the Women's International League of Peace and Freedom. This month the newsletter has a great article on how Linus Pauling, and his wife, Ava Helen Pauling, made such a difference, and helped get the Atmospheric Test Ban treaty of 1963 signed. But also, women all over the country helped by bringing up the issue, having local parties to educate other women about the potential harmful effects of radioactive fallout on children and other humans, and putting together a Women's Strike for Peace. There is also a great article about childrens' books which get the Jane Addams award for violence prevention. This is a deeply conscious way of making people realize that the prevention of violence demands that we keep teaching ways to promote conflict resolution skills, and ways to work toward constructing peace by reducing prejudice and other sources of potential conflict. You can access the toolkit for these books by going to Click on "about children's book awards" and then click on "building Wilpf". I firmly believe that only when mothers across the country and the world begin to demand peace and safety and better diplomatic solutions will we finally make headway against the culture of perpetuating violence and weapons.
I also deplore the news that the Iraq war has obliterated what was previously one of the best health care systems in the middle east. Besides the loss of clean water and electricity, and all hospital equipment, and medical personnel who fled the country as their lives were endangered, the escalation of PTSD has made increasing demands; and 70% of the victims of violence die because of inadequate resources at the hospitals.
We can do better in helping the world to become a better place. We need to continue to push our government to help build infrastructural support, and peace-making activities.
There is also an article about Rwanda. I am very interested in Rwanda, because Paul Farmer MD and his organization, Partners in Health, have made a commitment to try to build a whole national infrastructure of health care with them, following the model he used in Haiti. One of the crucial issues in any poor country is water, Getting a safe water supply for drinking, and making sure the waste is safely disposed of are the first basic and very important issues of public health. It will be very interesting to see how Rwanda does, with the NGO support; and WILPF is very interested in helping secure local and safe water supply.
I encourage you to join WILPF!

Sunday, March 22, 2009

Mysteries in my world

Yesterday there was a loss of a 21 week fetus, in a family who really wanted the baby and were grief-stricken by the loss. It is always a sad and hard thing, when these miscarriages happen, in the time before a baby is actually big enough to be helped by care in the intensive care unit. This little person, a boy, was so small, and so fragile, that we could not blow air into his lungs sufficiently to help him be able to exist outside the womb. My colleague, the perinatal specialist, had told the parents that we sometimes do not know why babies come too soon, that it may be that they get confused, their timing is off, and they are born too early. Maybe it is about the immune system, but we just don't always have a good answer to that heartbreaking question "why?"
Still, the fact that it happens, as in this family, sometimes makes a couple have a stronger love and devotion to each other, as they have lived through this suffering together, and have comforted and supported each other. So it sometimes happens that I believe I can see an outcome which is a good thing, from such a sad event. For a young couple with their whole life ahead of them, something like this is often the first truly hard thing they have ever had to bear. Still, it is a deep mystery.
Today I had a 16 year old mom, who did a magnificent job of pushing her baby out. She re-confirmed my opinion that being young is just such a big help for the muscle-tone and work of labor. Who knows how her life will go, and I am sure it will not be easy to have had this child so young. But my experience has often been that these young mothers are devoted and good moms, and get their lives "on track" precisely in order to help meet their children's needs. Again, it is a deep mystery, and sometimes very much against the beliefs and the conventional wisdom of our time.
Asking for help, being humble, and just trying to do what is required, one day at a time, are a big part of finding one's way in the world. Spilling blood is part of the work of having babies. Sometimes it seems so beyond-comprehension, and other times as easy as "falling off a log". I just keep hoping that the spilling of blood will not be in vain.

Thursday, March 5, 2009

Santa Clara University

Anyone who knows me knows that I loved being at Santa Clara, and am very proud to be an alumna of this great Jesuit school. I loved studying philosophy, and liberal arts, and especially Humanities, as taught by Christiaan Lievestro. Dr. Lievestro was the first person besides my own father who tried to help me learn to align the history, art, music and literature of a period, and to recognize cross-currents from one author to another, across different languages and cultures. I first fell in love with philosophy by learning from Austin Fagothey SJ, who was by then an SCU institution of higher learning, and awesome self-discipline and clarity. I was graced that the university allowed me to take a course about Teilhard de Chardin taught by Fr. Fagothey in the spring of my sophomore year-- they let me take it because I was going to be away in Vienna for Junior Year, and he would not teach it again till the year after I graduated. Fr. Fagothey had a bit of the old man's falling in love again with God, as he read Teilhard with us. It was a priceless thing, to be in his seminar. I also loved studying under Fr. Timothy Fallon SJ, who taught me metaphysics. In those days, we had to go to the professor and ask to be admitted to their class. So when I asked, I already knew that I would be leaving for the Peace Corps in South America two weeks after graduation in June. And this class was for the last quarter of my time at SCU, in the spring of my senior year. So I asked Fr. Fallon if Metaphysics would be helpful to me in Paraguay. And he answered graciously, with the full force of his leprechaunish humor, "My dear, it's the only thing that will!"
I am very grateful for being taught about Bernard Lonergan, and the metaphysics of Lonergan's "Insight". I took the book with me to Paraguay, and I still think of the basic premise, once in awhile, that "being is the objective of the pure desire to know." And I think of how he presented the way there is a heuristic structure of knowing, and that increased knowledge is pushing back the frontier of the unknown little-by-little, as the data and knowledge pour in.
Today I got the Santa Clara Magazine, and the goodbye note from Fr. Locatelli. He is going to Rome, to be the secretary of higher education for the Jesuits, which is the only organization which currently has a worldwide system of schools and universities. He will begin to coordinate a global structural network. In the weeks ahead, there is going to be a summit among Jesuit educators, addressing some of the themes for faith and justice from within education. The themes Fr. Locatelli says they will address are pretty instructive:
1) migration and refugees
2) faith, understanding and interreligious dialogue
3) religion, science, secularism and the new atheism
4) ethical capitalism and the realities of poverty and inequality
5) eco-justice and sustainability
6) youth and social networking

I am excited to hear about this work, and how those dynamic Jesuits move world education forward. In the same issue of the magazine, there is an article about Leon Panetta, another SCU graduate, and taking on the CIA, and the hope to make the interface with Congress and the world the best possible fit. It pleases me that they also published my letter lauding Sharon Kugler, who is the head chaplain at Yale, for her excellent ministry, and for being a good woman who models "the change we wish to see in the world". The note from Patrick Finley, about Professor William Sheehan was also wonderful.
God bless Santa Clara, God bless America, and God bless the whole world!

Wednesday, March 4, 2009

Pregnancy and ripeness

Dear friends,
I have been thinking about what to write, that is not already written, on this vast subject. I am posting this review of cervical ripening and induction, WITH MANY THANKS to Dr. Aaron Caughey, MD, MPP, MPH, PhD, at UCSF, for the expert review of the data and nuances of this topic.

One of the things I have wanted to say is that there is now sufficient data about how long the cookies should stay in the oven, so they will come out golden brown, not underdone or overdone. And the answer is 39-40 weeks. There is the lowest chance of morbidity at that time. So now we are trying to get as many babies as possible to deliver within that window of opportunity.
After the edge of "term" there is more risk of the baby being surrounded by inadequate water, so the cord can become squeezed in labor, as the contractions intensify. The cord brings oxygen to the baby, and if it is too "vulnerable" it will not deliver enough, so that the baby gets stressed, and then distressed". This makes it important to try to get through labor when there is still enough fluid around the baby so that the cord can float freely, and pass oxygen in and carbon dioxide out. The placenta is "breathing" for the baby, until delivery.
Also, the baby can go poop in the water, which is called meconium. If the baby takes deep gasping movements, the fluid in the baby's lungs can be so noxious, covering the insides of the lung surface, that the baby can not breathe air when it comes out. The baby has to make a transition from being in a watery world, to being in air, and learning to breathe, rather than get all its oxygen from the placenta, through the umbilical cord. So it is very important for the baby not to gasp and inhale deeply the meconium. We now know that babies gasp as a reflex, when they are inside and there is not enough oxygen. So we want them not to have long or deep fetal heart beat decelerations, which cause them to feel less oxygen, and gasp. Babies can tolerate some stress, some low-oxygen, for awhile. But labor can be long and hard, and if it is getting harder and harder to get enough oxygen, the baby will become "distressed"-- and need to be bailed out.
So a big part of the work of doctors, in watching labor, is to gauge how much stress the baby is under, and whether the baby is bearing up under it. In a fast, easy labor the water is abundant, the cord is not compressed with contractions, and mother's pushing allows a natural squeezing which may help the lungs be less full of water, and more ready to take in air when the baby first breathes.
In a long hard labor, there is also the risk of infection, which can rise from bacteria which naturally live in the vagina up into the uterus. So it is really important for the mother to be delivered as promptly as possible, to reduce the risk of infection passing to the baby. The mother also can get a deep infection in the walls of the uterus, which is called "chorioamnionitis" (infection in the bag of waters) and later, "endometritis"(infection in the lining of the uterus)--and this causes the walls of the womb to be less capable of contracting efficiently, both in labor, and afterward, to keep from bleeding from the raw site where the placenta was attached.
When a baby is post-dates, and has meconium, and has infection, it is like 3 strikes against them. For this reason, we want to get them delivered when they are ripe but not at risk.
Some women look askance at us, for trying to talk them into being induced at term. They need to understand that this is the underlying reason. For most moms and babies, it is safer, and there is more chance of a successful vaginal delivery, if we don't wait till two weeks overdue.
In general, I try to "let the river flow, rather than trying to push the river". But sometimes we need to nudge someone into labor to get them to deliver in the best window of opportunity for safety.
What stops us? The last process of pregnancy before labor is cervical ripening. If the cervix is like a green apple, it is much harder to get it to open. It needs to be like a ripe peach. The soft, squishy, mushy tissue will more easily begin to open up. So what we now use, to get the "ripeness" we need, is prostaglandins. The medicine Cytotec, or misoprostol, was invented for ulcers, but it was found to be exactly what is needed to make the cervix ripen. This is what does it naturally, in most women. But some women don't make enough. So we can give them this medicine, vaginally or orally, and the cervix will respond by ripening.
After the cervix is ripened, which may take around 24 hours, the uterus can begin to open up the cervix, by contracting. The contractions are like a castle opening a heavy drawbridge. The drawbridge is drawn up and into the castle walls. We sometimes have to use pitocin, a medicine which is dripped into mom through the iv, to help this process of lifting open the cervix.
Another thing that has to happen is the baby has to come down deeper into the pelvis, and make it through the outlet of the bones. Some babies are just too big for the bones of their moms. Others are lying in a position which makes it harder to get through the pelvis. And some have a tight loop of umbilical cord holding them up. Sometimes we can change the mom's position to help get the baby to turn and come through the pelvis. Sometimes we can actually reach in and turn the baby's head a little, to get it to do this.
When the baby is distressed, or there is thick meconium, or the baby has a body which is too big for the mom's bones, we do a Cesarean Section. This surgery has helped millions of babies to be safely born, with lungs which can breathe, and not having severe infections, and so they can stay with their moms and breastfeed, and not need to go to the nursery in exhaustion and need tubes, iv's and oxygen to help them get out of trouble. A lot of people think doctors are making unnecessary interventions, because they do not understand these facts. All our monitoring is to make sure the baby and the mom are both safe through the process of labor. We want to help babies be born safely, and in optimum health, like golden brown cookies!