If the mama ain't happy, ain't nobody happy

Or: how I survived colic.

This essay was first published in Chicago Parent, June 2005.

Ten years ago, my daughter, Abigail, was born screaming into this world. My husband and I brought her home on a crisp, clear morning in December, and she continued to cry vigorously hour after hour, day after day.
We called the hospital.

"We can’t get her to stop crying," we shouted to the nurse over Abigail’s screams. We felt helpless and unprepared. Photos from those early weeks show my daughter’s beet-red face and my hand in a splint for skier’s thumb from picking Abigail up so many times every day.
Abigail had colic. And nothing seemed to help.

The word colic comes from the ancient Greek word, kolikos, meaning "pertaining to the intestine." This reflects early theories that gastrointestinal disorders cause colic. Other theories blamed mothers’ anxiety, infants’ difficult temperament or newborn brain immaturity. But none of this holds up in the face of extensive research.

About 20 percent of infants are colicky. It doesn’t matter whether you’re a single mom in Copenhagen, a couple in Chicago or a hunter-gatherer of the !Kung San tribe of southern Africa.

But there is still no universal agreement on what causes colic. Some experts, including pediatrician Dr. Harvey Karp, call colic the "missing fourth trimester" because some signs indicate the baby should still be in utero.

"As odd as it may sound, our babies cry because in some important ways, they are born three months too soon," Karp wrote in the February 2004 issue of Contemporary Pediatrics.

Six reasons
Karp believes colic should be considered the fourth trimester because:

Colicky babies act as though they have tummy troubles, possibly an overreaction of an immature neurologic system to normal intestinal sensations.

Crying peaks in the evening. This "witching hour" may be caused by a day full of stimulation.

Colic’s onset is delayed in premature babies. Preemies are not often alert, and not subject to the stimulation that can cause colic.

Relaxing and shushing mimic the womb and calm colicky babies.

Research suggests a reduction of colic in cultures where parents simulate the womb by wearing babies in a wrap.

Colic ceases after three months—the end of the fourth trimester.

Tracking the cause

Colic is a diagnosis of exclusion, says Dr. Rachel Goodman, a pediatrician at Evanston Northwestern Hospital. So the first step is to rule out other causes, such as reflux. Reflux is characterized by arching of the back and irritability—also colic signs—but is due to milk rising from the stomach into the esophagus. Reflux can be treated medically or by changing feeding positions. But often, reflux is diagnosed as colic, says Dr. Marc Weissbluth, a North Side Chicago pediatrician who studies baby crying and sleeping.

Linda Gilkerson, director of the Erikson Institute's Fussy Baby Network, agrees. She and Dr. Larry Gray studied 12 months of crying baby visits to the University of Chicago Hospitals' emergency room. They found no medical reason for one-third of the crying cases.

So is colic simply unexplained crying? Perhaps. True colic follows the rule of threes: Crying for more than three hours a day, for more than three days or nights per week, for more than three weeks.

That’s it. No medical or gastrointestinal cause, no fault. Once you rule out medical issues and confirm crying follows that pattern, you can call it colic.

Offer relief, not advice

So tell all the neighbors, grandmothers, mothers-in-law and well-intentioned friends—you don’t need their advice. You need a sympathetic person to babysit and give you a break.

Lakeview mom Mimi Wallman’s son, Silas, now 2, had colic. "I would just feel bad for him. I felt powerless," she says. Friends were supportive to a point. "I have a friend to this day who thinks there’s something wrong with him."

Since colic is not a medical problem, most doctors don’t want to deal with it, says Weissbluth. Once medical causes have been ruled out and it is diagnosed as colic, parents may be offered methicone drops or pain relievers, but they aren’t necessary since there is nothing wrong with the digestive tract. Instead, Weissbluth looks for nonmedical strategies that center on the caregivers.

"First-time parents worry what’s wrong with their baby. The physician’s responsibility is to get rid of that feeling of guilt and responsibility, and to coach them through this difficult time," he says. Weissbluth helps parents develop coping strategies and prevent colic from becoming an enduring sleep problem.

Get help

Weissbluth also helps parents prepare before the baby is born. He encourages moms-to-be to read about the first six weeks of a baby’s life. He gets fathers and partners—or a friend—involved early because mom will need support.
Wallman agrees. "The best thing going through this was when family members were not afraid to take the baby off your hands for a while. ... But then you’re gone and you’re thinking, ‘Oh God, poor Grandma.’ You’re still not having fun. You walk out the door, and you’re like, ‘Phew,’ for about five minutes, then you’re worrying if he’s OK. Is Grandma pulling her hair out? And you’re watching the clock."

During my year in North Carolina, my husband and I had little respite. One weekend, my friend Alyce flew in from New Jersey to meet our newborn and give us an evening together. "I promise I won’t let her cry," said Alyce. Her words were kind, but I knew nothing would stop Abigail from crying.

Help for fussy babies

If only I had had access to a program such as the Erikson Institute’s Fussy Baby Network, the only program of its kind in Chicago (see story on page 11). It offers many support services on a sliding-fee scale to families worried about their baby’s crying, feeding or sleeping.

But programs such as Erikson’s are rare, and many parents feel they have nowhere to turn. Worse, some parents or caregivers may snap, leading to violence, such as shaken baby syndrome.

Indeed, every mother of a colicky baby I’ve ever spoken to has said to me, barely joking, "I can now understand child abuse." Weissbluth confirms tragedies can occur when babies cry for "no apparent reason" and parents lose it. He says most infant deaths occur in the first few days of life. The next peak in the U.S. infant mortality rate is at 6 weeks—the height of colic.
While colic happens all over world, caregiving styles may make a difference in the intensity and duration of crying. Which brings us back to the !Kung San tribe of Africa.

In 1991, Dr. Ronald Barr, a professor of pediatrics and psychiatry at McGill University in Montreal and a colic authority, studied crying in !Kung San infants. The study, published in Developmental Medicine and Child Neurology, examined whether infants in less industrialized societies cry less.

The researchers found !Kung San infants cried as often as babies in industrialized countries—but for half as long. In fact, !Kung San caregivers were able to calm their crying babies in as little as 30 seconds. The suggested reason—Africans were more likely to respond immediately and carry their infants continuously. "In contrast, rates of deliberate nonresponse in Western samples approach 40 to 50 percent," the researchers wrote.
In short, the researchers found caregiving styles affect the duration of crying, but not the frequency.

Surviving the colic

While colic does end by the third month, you still have to get through it. Here are some survival strategies:

Less stimulation. I’m certain the constant stimulation I gave Abigail contributed to her colic. Did she really need the flash cards strapped to her car seat? On the other hand, playing the soundtrack to "Priscilla, Queen of the Desert" loudly enough to rock the house seemed to help.

More comforting. Relaxing and shushing actions that mimic the womb can help. Our doctor gave us a prescription for Sleep Tight, a device that attaches to the crib and simulates the motion of a car going 55 mph with the wind rushing past. Insurance denied the claim, so we took to the real wheels. In retrospect, it was probably dangerous for a sleep-deprived mom to be out cruising. And while Weissbluth says there is no evidence that infant massage cures colic, it can help calm them as well.

Wear your baby. My friend Cécile claims her trusty Baby Bjorn carrier got her through colic. Another friend taught me how to swaddle my baby on my back with a cloth, but I was a little nervous about her safety.

Have a plan. Weissbluth says research suggests you don’t have to waste time on gimmicks—what you need is empathy and a plan.

March 15, 1995, three months after Abigail was born, she stopped crying. She woke up with a smile. By no means did she become an "easy" baby. She was still intense and had trouble sleeping.

When my husband and I finally got the courage to plan another pregnancy, we vowed we would be different if we had another colicky baby. We aimed for a spring birth date and got it. Our identical twins were born in April 1999. They were not colicky.

I'm all for a new Prez, but Candidates, we need you in DC to vote!

From the Sierra Club's Pop News:
"As you know, back in June, the House of Representatives passed its FY 2008 Foreign Operations Appropriations Bill (H.R. 2674).The bill included a critical amendment, the "Lowey Amendment", introduced by Chairwomen Nita Lowey (D-NY), to exempt contraceptives from the Global Gag Rule. This would allow foreign NGO's to receive US-donated contraceptives, even if the organizations are ineligible for other US assistance under the rule. The Lowey Amendment passed by a vote of 223-201.
Then in early September, the Senate passed its version of the FY 2008 Foreign Operations Appropriations Bill. The Senate bill already included key provisions identical to the House-passed bill -- exempting contraceptives from the Global Gag Rule.

However, the Senate went a step further and voted to nullify the Gag Rule entirely. The Boxer-Snowe amendment to fully repeal the Gag Rule was adopted by a vote of 53-41.

The House and Senate votes mark the first time since the Global Gag Rule has been in force -- from 1984 to 1993 and again since 2001 -- that both Chambers of Congress have passed legislation to repeal or modify the restriction that has wreaked havoc on family planning efforts!"
Sierrra Club
Click here for Senate Vote.

Hillary and Barack, we need you voting in DC!

A Tragedy Under the Radar

My essay on the burden of global maternal mortality was published in the Perspective Section, Chicago Tribune, Sunday, October 21, 2007. Thanks to the wonderful editors of that section.

Click here for the story.

The Real Reason for this Blog, or Watch this Space

Ok, I'm warmed up now. I've figured out how to get started, thanks to the urban mavens on Urban Baby, and I've told my mom and Miriam about my new blog.

Now I can tell you a little more about me. I'm a multi-talented, spread-too-thin, mother-of-three, public health professional, part-time educator, part-time journalist, member of two (too many) Boards of Directors, doing that work-mom-balancing thang like so many others.

I used to work in public health programs in Africa (I had a farm in Africa...) which allowed me to dovetail my fluency in French with my passion for health, women's health issues, health as a human right.

Yes, a human right. I believe health is a right, not a privilege, not a benefit of working more than part-time. And that's my starting point.

I'm working on an article on maternal mortality now, a tragedy that is so under the radar, most people don't know anything about it. It's become my mission to get an article out on the subject. The Chicago Tribune has accepted my proposal, but only for an 800-900 word article. Well, it's a start. I'll always have blogspot.

Watch this space.

An Anecdote

Fifteen years ago (ok, 16 or 17 years ago), when I was a graduate student at the Johns Hopkins School of Hygiene and Public Health(now the Bloomberg School of Public Health), I was having lunch in the cafeteria with my husband, an intern at the time, and one of his fellow interns/ophthalmology residents, who happened to be from India. I was telling them about a fascinating article I was reading in a magazine called People.
“But not People like Us,” I quickly qualified, referring to the other gossip magazine.
“No,” the intern smiled, “like them.”

David Hume's Take on Darfur?

The sentiment of sympathy, or fellow-feeling, wrote David Hume, must be acknowledged as a “principle in human nature beyond which we cannot hope to find any principle more general.”

It is through this human capacity that “we frequently bestow praise on virtuous actions, performed in very distant ages and remote countries; where the utmost subtilty of imagination would not discover any appearance of self-interest, or find any connection of our present happiness and security with events so widely separated from us."

Maiden Voyage

Greetings, and welcome to my first-ever blog. For a long time, my sister, Miriam, has been telling me I should have a blog. Many friends have been telling me that I should look beyond mainstream (i.e., print) media to get my words out. Why the resistance? I feel sometimes like technology's lost generation. To give some perspective: when I started college, I typed my term papers on a Smith-Corona (albeit electric); by the time I graduated, there were computers in the basement of Canaday Library at Bryn Mawr College.

My father used to compress time for us. "Your grandfather was six years old when Queen Victoria died." This is the leapfrogging of time that Daniel Mendelsohn describes in his book, The Lost: A Search for Six of Six Million.

INTERPRETING THE SILENCES Telling one man's story of torture in Congo

This essay was first published in the Chicago Tribune, Perspective Section, March 4, 2007.

Photo of the Eastern State Penitentiary, Philadelphia, Pennsylvania. Taken by Judith, June 3, 2007.

I first met Paul in the winter of 2005, on my first day volunteering as a French-English interpreter at the Marjorie Kovler Center for the Treatment of Survivors of Torture.
Paul (not his real name) is a survivor of the second war in the Democratic Republic of Congo (formerly Zaire) — the bloodiest conflict since World War II.
It was during his initial evaluation that I heard Paul’s torture history, told to a social worker in the space of a few short meetings. Though I am familiar with African tragedy told in the broadest terms, I had never experienced such a story told by a survivor.
During intake—a process to assess why trauma survivors left their country and how they’ve been feeling since—I would come to learn not only the details of Paul’s torture, but of his life before the war—before the end of the world, as he put it.
Before the war, which began in 1998 and officially ended in 2003, Paul lived happily as a merchant. Then one day rebels came to his house, on a rampage. Paul watched helplessly as his wife and child were taken. He was beaten, then left for dead. He searched for his family for months as he continued to flee the violence. During his last attempt to find his family, he was captured, imprisoned and tortured. He knew then that if he didn’t save himself, there would be no one left in his family.
The story of Paul’s escape had the elements of so many others: a bribe, a serendipitous encounter, a kindhearted stranger, and pure luck. His story ended—and began—in his treacherous passage out of the Congo in the hold of a cargo ship heading to New York. Eventually he made his way to Chicago, and to this North Side center, part of the Heartland Alliance.
Awkward at first
The only reason I now know all of this is that I speak French. At the beginning it certainly felt awkward. What right did I have to be there? I’m not a therapist or a social worker. Yet I also felt a duty to help Paul tell his story.
After the third and last intake session, we said our goodbyes. Paul touched his heart with his hand. "This will stay with me forever," he said. I didn’t expect to see him ever again.
But later that winter, a Kovler caseworker phoned me. Would I be willing to interpret for a Congolese client who has signed up for psychotherapy, one of the treatment options offered to trauma survivors after intake? It was Paul, and I was touched that he had taken this step toward reclaiming his life.
Before we began, I talked with Vienna, his therapist. She had never conducted therapy through an interpreter.
"You must translate everything, even the pauses," she instructed me. "I don’t understand a word of French. I need you to interpret the `ums,’ and the `ers.’. " She wanted me to interpret the spaces as well as the words.
How does one interpret a silence?
I went to greet Paul in the waiting room. He smiled broadly upon seeing me again.
We joined Vienna in a small consultation room. The air was musty and heavy. A broken clock, forever stuck on 1:30, rested on a table. Next to it was a dusty globe with Zaire still on it.
As a key member of this triad, I was there and I was not there. I was part of the treatment team, yet I did not have my own voice. Vienna acknowledged this inherent awkwardness and told Paul that although he would be speaking through me, he should address her directly.
Vienna asked Paul what he would like to talk about that day. "De quoi veux-tu discuter aujourd’hui?" I interpreted, and Paul responded, "C’est elle qui décide." He had said "She is the one who decides," instead of "You are the one who decides." I debated for an instant whether to change the pronoun, then interpreted the sentence literally.
Vienna smiled. "No, you decide what happens here."
Psychotherapy is much more free-form than intake, and I realized I was not quite fluent in its language.
But as I grew more confident, I found myself making suggestions to Vienna, even anticipating her words. I heard myself naturally imitating my two clients, reflecting the lilting phrases of Paul’s French and the quiet monotone of Vienna’s comments and questions—and the silences as well. I paused when Vienna paused, laughed awkwardly when Paul did. I was the ears and mouth for two other people.
Sometimes it was hard to interpret for Paul when his sing-song French was reduced to a muffled mumbling, reflective of his own description of himself as engourdi—numbed—by the events of his life.
One day in the waiting room, I asked Paul what his first language was. Lingala, he told me. But he said he no longer wanted to speak or even think in his mother tongue anymore. I wondered if Lingala would reveal his unspoken thoughts.
Believing in destiny
At our last session, in a break from our usual format, Vienna asked us to share our feelings about each other. Vienna told Paul how honored she had been to be his therapist, and how much she admired his strength. Paul told us he would never forget us and that we would be part of him forever. He believed destiny brought him to us.
In French, in my own voice this time, I told Paul what I had been thinking all along: how much I admired him, how fortunate I felt to have known him, and how I wished him much success. I repeated this to Vienna in English.
What I did not say was how sorry I was about the circumstances that brought us together, and how I never thought that my gift of language would be used in this way. This I would tell Vienna in private.
After we had all shared our thoughts, we sat for a few moments in silence. There was no need for interpretation.

Coming Soon

Helmet Safety: A real no-brainer

Welcome to Public Health Mom

Twenty years ago I fell into a career in public health. I was in my early twenties, had just gotten engaged, and was looking to put my master’s degree in French Studies from New York University to work in international je ne sais quoi, in Washington, DC, or Baltimore, where my fiancé was in medical school. I ended up joining an international maternal and child health training organization, developing training programs in Francophone Africa, and earning a Master of Public Health degree along the way. After moving to Chicago in the mid-1990s, I worked in local and national public health advocacy, evaluation and education, with a focus on women’s health.

I have also spent the last 20 years trying to explain to others outside of the field, just what public health is.

The tag line on my public health alma mater, the Johns Hopkins Bloomberg School of Public Health, Web site reads, “Protecting Health, Saving Lives—Millions at a Time.

A friend of mine asked me, so it’s health care for the poor, right?

No, it’s not. Or, rather, it’s not just that. To borrow the tag line of the department of Health and Human Services, it’s Health for All…by the year 2000, by the year 2010…like Zeno’s paradox, we just never seem to get there.

Sometimes it is harder to explain something that is, in essence, quite straightforward.

As Dr. Al Sommer, my last dean at Hopkins School of Public Health, liked to say, people might understand our field better if we called it the public’s health.

Public health is about all of us-- whether you are a Wall Street bachelor earning a six-figure income or a five-person family living below the poverty line. It requires our government’s commitment to our safety and well-being through enacting laws that are based on policy decisions that (ideally) are derived from research. Some laws are enacted at the state level, others at the federal. Sometimes those distinctions don’t make sense. For example, why should helmets for motorcyclists be mandated in Missouri, but not in Illinois?

Public health focuses on prevention and interventions aimed at populations versus individuals. Some see this as paternalistic. But individuals are not passive in this concept. Individuals must be active players in their own health and in respecting the laws established to protect the public’s health. I prefer to see public health as an interactive contract.
So, I’ll make an effort to brush after every meal, if my government promises to provide me with clean water when I turn on my tap. While we’re at it, let’s make it clean, fluoridated water.

I’ll watch my diet, but please provide me with healthy options for grocery shopping, not just package stores, in my neighborhood.

I’ll try my best not to smoke, but don’t force me to inhale the second-hand smoke of others when I’m in public places.

I’ll work to support myself and contribute to society, but make my workplace safe.

I will stay home when I’m sick and not expose others to my contagions (and vice versa, I hope), but give us all the level playing field of universal vaccinations.

I’ll pick up after my dog, but please make sure the streetlight is working so I can see it!

Medical care is for individuals, but is also a part of the public’s health. A basic package of preventive medical care is necessary to ensure the health of the public. Now, do you consider that a privilege or a right?

I ask that, because this is the fundamental question facing us in these times. Public health folks, by definition, believe that a basic package of health care is necessary, important and, yes, I’ll say it, a basic right to be guaranteed to every person. Note I didn’t write “citizen,” because again, the public health lens doesn’t distinguish between a passport-carrying U.S. citizen and an illegal immigrant. I can catch diseases from either one. It’s their right to have coverage; it’s also my right to have my health safeguarded.

In some countries, all they’ve got is public health. And the way this country is going, we’re going to need a lot more of it. Our high tech, highly specialized, super trained medical system will not make a dent in our infant mortality rate (the second worst among industrialized countries) or our rising maternal mortality (the risk of dying from complications of pregnancy or childbirth), if we don't fix our public health system first.

Public health is an optic through which so many issues—ok, all issues--can be viewed more clearly.

War? Not a good idea for the public’s health. Best to prevent it.

Family planning? A great public health idea. It prevents maternal mortality, reduces abortions, gives mothers, babies, and families a better chance for healthy lives.

If the beginning of my career was a dovetailing of my French skills and my public health education, this chapter represents my desire to weave in my skills and identity as a mother with my training and experience in public health. The essence of motherhood is also about protection, about making wise decisions on behalf of one’s children, in the hopes of developing wise, healthy and, ultimately autonomous people who are good members of society. It is through the combined optics of public health and motherhood that I propose an occasional series of articles to be published under the title, “Public Health Mom.”

Public health is just an esoteric notion if not translated into policy and enacted as law. So I’ll also be looking closely at what our legislators and the presidential candidates have to say about the public’s health.

If we all put on public health glasses, we might find we’re on the same page about even the most divisive of issues. Perhaps we will come to view public health as maternal—and that will be a positive thing.

Upcoming Posts:
Helmet safety
Birth Centers: Now Legal in the State of Illinois
History of Public Health in the United States
Eye on the Presidential Candidates, through the lens of public health
Vaccines and early childhood education: US vs. The French
War is Not Healthy for Children and other living things: a public health view of war
The right to bear arms versus the right to stay alive
Depression: a public health issue
Obesity: the Bloated States of America
Workplace Safety, or Why I’m too old to work at Abercrombie & Fitch
The American Medical Association: It's not your father's AMA anymore.