Birth Of The Clinic Quotes

Death left its old tragic heaven and became the lyrical core of man: his invisible truth, his visible secret.

The first task of the doctor is ... political: the struggle against disease must begin with a war against bad government." Man will be totally and definitively cured only if he is first liberated...

The Director's Role: You are the obstetrician. You are not the parent of this child we call the play. You are present at its birth for clinical reasons, like a doctor or midwife. Your job most of the time is simply to do no harm. When something does go wrong, however, your awareness that something is awry--and your clinical intervention to correct it--can determine whether the child will thrive or suffer, live or die.

(Let’s face it, if men had to give birth, there would probably be only a total of about 47 people living on the face of the earth today as opposed to billions, and abortion clinics would be just another department in Walmart alongside auto parts, golf gear, and firearms.)

Power is lost or won, never created or destroyed. Power is a visitor to, not a possession of, those it empowers. The mad tend to crave it, many of the sane crave it, but the wise worry about its long-term side effects. Power is crack cocaine for your ego and battery acid for your soul. Power’s comings and goings, from host to host, via war, marriage, ballot box, diktat, and accident of birth, are the plot of history. The empowered may serve justice, remodel the Earth, transform lush nations into smoking battlefields, and bring down skyscrapers, but power itself is amoral.” Immaculée Constantin now looks up at me. “Power will notice you. Power is watching you now. Carry on as you are, and power will favor you. But power will also laugh at you, mercilessly, as you lie dying in a private clinic, a few fleeting decades from now. Power mocks all its illustrious favorites as they lie dying. ‘Imperious Caesar, dead and turn’d to clay, might stop a hole to keep the wind away.

Postpartum depression makes you suddenly feel like a stranger to yourself, but knowing the clinical facts are the first step toward wellness.

If birth were to occur this week, your baby’s chances of survival would be at least 85 percent.

The innocuous-sounding term “fertility treatment” enables the wealthy to breed their own kind, buying sperm and eggs at “baby centers” around the country. Abortion and birth control, meanwhile, are for evangelical conservatives a violation of God’s will that all people should be fruitful and multiply, and yet this same fear of unnatural methods of reproduction does not engender opposition to fertility clinics. Antiabortion activists, like eugenicists, think that the state has the right to intervene in the breeding habits of poor single women. Poor

...Power is lost or won, never created or destroyed. Power is a visitor to, not a possession of, those it empowers. The mad tend to crave it, many of the sane crave it, but the wise worry about its long-term effects. Power is crack cocaine for your ego and battery acid for your soul. Power’s comings and goings, from host to host, via war, marriage, ballet box, diktat, and accident of birth, are the plot of history. The empowered may serve justice, remodel the Earth, transform lush nations into smoking battlefields, and bring down skyscrapers, but power itself is amoral.” Immaculée Constantin now looks up at me. “Power will notice you. Power is watching you now. Carry on as you are, and power will favor you. But power will also laugh at you, mercilessly, as you lie dying in a private clinic, a few fleeting decades from now. Power mocks all its illustrious favorites as they lie dying…

I'm struck by the difficulty I had in formulating it. When I think back now, I ask myself what else it was that I was talking about in Madness and Civilization or The Birth of the Clinic, but power? Yet I'm perfectly aware that I scarcely ever used the word and never had such a field of analyses at my disposal. I can say that this was an incapacity linked undoubtedly with the political situation in which we found ourselves. It is hard to see where, either on the Right or the Left, this problem of power could then have been posed. On the Right, it was posed only in terms of constitution, sovereignty, and so on, that is, in juridical terms; on the Marxist side, it was posed only in terms of the state apparatus. The way power was exercised - concretely, and in detail - with its specificity, its techniques and tactics, was something no one attempted to ascertain; they contented themselves with denouncing it in a polemical and global fashion as it existed among the "other," in the adversary camp. Where Soviet socialist power was in question, its opponents called it totalitarianism; power in Western capitalism was denounced by the Marxists as class domination; but the mechanics of power in themselves were never analyzed.

It should come as absolutely no surprise that research has ignored women for so long because the establishment: the journal publishers, the reviewers and the funding agencies has rewarded it. Although the things are changing for the better in the US federal agencies will no longer fund clinical trials involving humans that do not include women... there is still a long way to go [..] Thoughtful, carefully done research on females still takes longer and costs more and is often times harder to interpret than research conducted only on males. So when people's careers depend on their publication rate rather than the need for answers to the questions they are asking, women and the issues they care about most - loose.

Abortion and birth control, meanwhile, are for evangelical conservatives a violation of God’s will that all people should be fruitful and multiply, and yet this same fear of unnatural methods of reproduction does not engender opposition to fertility clinics. Antiabortion activists, like eugenicists, think that the state has the right to intervene in the breeding habits of poor single women. Poor

Speak to me about power. What is it?” I do believe I’m being out-Cambridged. “You want me to discuss power? Right here and now?” Her shapely head tilts. “No time except the present.” “Okay.” Only for a ten. “Power is the ability to make someone do what they otherwise wouldn’t, or deter them from doing what they otherwise would.” Immaculée Constantin is unreadable. “How?” “By coercion and reward. Carrots and sticks, though in bad light one looks much like the other. Coercion is predicated upon the fear of violence or suffering. ‘Obey, or you’ll regret it.’ Tenth-century Danes exacted tribute by it; the cohesion of the Warsaw Pact rested upon it; and playground bullies rule by it. Law and order relies upon it. That’s why we bang up criminals and why even democracies seek to monopolize force.” Immaculée Constantin watches my face as I talk; it’s thrilling and distracting. “Reward works by promising ‘Obey and benefit.’ This dynamic is at work in, let’s say, the positioning of NATO bases in nonmember states, dog training, and putting up with a shitty job for your working life. How am I doing?” Security Goblin’s sneeze booms through the chapel. “You scratch the surface,” says Immaculée Constantin. I feel lust and annoyance. “Scratch deeper, then.” She brushes a tuft of fluff off her glove and appears to address her hand: “Power is lost or won, never created or destroyed. Power is a visitor to, not a possession of, those it empowers. The mad tend to crave it, many of the sane crave it, but the wise worry about its long-term side effects. Power is crack cocaine for your ego and battery acid for your soul. Power’s comings and goings, from host to host, via war, marriage, ballot box, diktat, and accident of birth, are the plot of history. The empowered may serve justice, remodel the Earth, transform lush nations into smoking battlefields, and bring down skyscrapers, but power itself is amoral.” Immaculée Constantin now looks up at me. “Power will notice you. Power is watching you now. Carry on as you are, and power will favor you. But power will also laugh at you, mercilessly, as you lie dying in a private clinic, a few fleeting decades from now. Power mocks all its illustrious favorites as they lie dying. ‘Imperious Caesar, dead and turn’d to clay, might stop a hole to keep the wind away.’ That thought sickens me, Hugo Lamb, like nothing else. Doesn’t it sicken you?

She knows if the test shows another girl growing in her womb, all of the possible outcomes are wrenching. Jasu can demand she have an abortion, right there at the clinic if they had the money. Or he could simply cast her out, forcing her to endure the shame of raising the child alone. She would be shunned, like the other beecharis in the village. But even this, becoming an outcast from her home and community, would not be as bad as the alternative. She cannot face the agony of giving birth, of holding her baby in her arms, only to have it taken away again. Kavita knows in her soul she simply will not survive that.

Even without world wars, revolutions and emigration, siblings growing up in the same home almost never share the same environment. More accurately, brothers and sisters share some environments — usually the less important ones — but they rarely share the one single environment that has the most powerful impact on personality formation. They may live in the same house, eat the same kinds of food, partake in many of the same activities. These are environments of secondary importance. Of all environments, the one that most profoundly shapes the human personality is the invisible one: the emotional atmosphere in which the child lives during the critical early years of brain development. The invisible environment has little to do with parenting philosophies or parenting style. It is a matter of intangibles, foremost among them being the parents’ relationship with each other and their emotional balance as individuals. These, too, can vary significantly from the birth of one child to the arrival of another. Psychological tension in the parents’ lives during the child’s infancy is, I am convinced, a major and universal influence on the subsequent emergence of ADD. A hidden factor of great importance is a parent’s unconscious attitude toward a child: what, or whom, on the deepest level, the child represents for the parents; the degree to which the parents see themselves in the child; the needs parents may have that they subliminally hope the child will meet. For the infant there exists no abstract, “out-there” reality. The emotional milieu with which we surround the child is the world as he experiences it. In the words of the child psychiatrist and researcher Margaret Mahler, for the newborn, the parent is “the principal representative of the world.” To the infant and toddler, the world reveals itself in the image of the parent: in eye contact, intensity of glance, body language, tone of voice and, above all, in the day-today joy or emotional fatigue exhibited in the presence of the child. Whatever a parent’s intention, these are the means by which the child receives his or her most formative communications. Although they will be of paramount importance for development of the child’s personality, these subtle and often unconscious influences will be missed on psychological questionnaires or observations of parents in clinical settings. There is no way to measure a softening or an edge of anxiety in the voice, the warmth of a smile or the depth of furrows on a brow. We have no instruments to gauge the tension in a father’s body as he holds his infant or to record whether a mother’s gaze is clouded by worry or clear with calm anticipation. It may be said that no two children have exactly the same parents, in that the parenting they each receive may vary in highly significant ways. Whatever the hopes, wishes or intentions of the parent, the child does not experience the parent directly: the child experiences the parenting. I have known two siblings to disagree vehemently about their father’s personality during their childhood. Neither has to be wrong if we understand that they did not receive the same fathering, which is what formed their experience of the father. I have even seen subtly but significantly different mothering given to a pair of identical twins.

I think this ‘When does life begin’ argument is kind of cute, but it’s dead end. If we let it go long enough somebody will get punched in the nose, or Brittain will have a coronary incident. No offense, Sally, but most of the right-to-lifers I know—and I know a lot of them because they call at our house pretty regularly to say how much they hate my dad—get all wrapped up with life in the womb, and life after death, for that matter, but they don’t give a rip about life after birth. All you have to do is look around to see we’ve got big trouble in that area. People are starving to death all over the world. Their lives are spent trying to get something into their bellies, which they never get, and then they die. And to tell you the truth, the people who seem willing to fight to the death, or who are at least willing to carry a poster in front of the Deaconess clinic, are politically against giving them anything. The second they’re born, they’re on their own.

Sometimes adoptive parents will go through a virtual pregnancy, using “birth clinics” or accessories called “tummy talkers,” package kits that supply a due date and body modifications, including the choice to make the growing fetus visible or not; as well as play-by-play announcements (“Your baby is doing flips!”) and the simulation of a “realistic delivery,” along with a newborn-baby accessory. For Second Life parents who go through pregnancy after adopting in-world, it’s usually with the understanding that the baby they are having is the child they have already adopted. The process is meant to give both parent and child the bond of a live birth. “Really get morning sickness,” one product promises. “Get aches.” Which means being informed that a body-that-is-not-your-corporeal-body is getting sick. “You have full control over your pregnancy, have it EXACTLY how you want,” this product advertises, which does seem to miss something central to the experience: that it subjects you to a process largely beyond your control.

Power is lost or won, never created or destroyed. Power is a visitor to, not a possession of, those it empowers. The mad tend to crave it, many of the sane crave it, but the wise worry about its long-term side effects. Power is crack cocaine for your ego and battery acid for your soul. Power’s comings and goings, from host to host, via war, marriage, ballot box, diktat, and accident of birth, are the plot of history. The empowered may serve justice, remodel the Earth, transform lush nations into smoking battlefields, and bring down skyscrapers, but power itself is amoral.” Immaculée Constantin now looks up at me. “Power will notice you. Power is watching you now. Carry on as you are, and power will favor you. But power will also laugh at you, mercilessly, as you lie dying in a private clinic, a few fleeting decades from now. Power mocks all its illustrious favorites as they lie dying. ‘Imperious Caesar, dead and turn’d to clay, might stop a hole to keep the wind away.’ That thought sickens me, Hugo Lamb, like nothing else. Doesn’t it sicken you?

She was a new world - a place of endless mysteries and unexpected delights, an enchanting mixture of woman and child. She supervised the domestic routine with deceptive lack of fuss. With her there, suddenly his clothes were clean and had their full complement of buttons; the stew of boots and books and unwashed socks in his wagon vanished. There were fresh bread and fruit preserves on the table; Kandhla's eternal grilled steaks gave way to a variety of dishes. Each day she showed a new accomplishment. She could ride astride, though Sean had to turn his back when she mounted and dismounted. She cut Sean's hair and made as good a job of it as his barber in Johannesburg. She had a medicine chest in her wagon from which she produced remedies for every ailing man or beast in the company. She handled a rifle like a man and could strip and clean Sean's Mannlicher. She helped him load cartridges, measuring the charges with a practised eye. She could discuss birth and procreation with a clinical objectivity and a minute later blush when she looked at him that way. She was as stubborn as a mule, haughty when it suited her, serene and inscrutable at times and at others a little girl. She would push a handful of grass down the back of his shirt and run for him to chase her, giggle for minutes at a secret thought, play long imaginative games in which the dogs were her children and she talked to them and answered for them. Sometimes she was so naive that Sean thought she was joking until he remembered how young she was. She could drive him from happiness to spitting anger and back again within the space of an hour. But, once he had won her confidence and she knew that he would play to the rules, she responded to his caresses with a violence that startled them both. Sean was completely absorbed in her. She was the most wonderful thing he had ever found and, best of all, he could talk to her.

Even as the feminine principle was venerated for its fertile, life-giving properties, there are also many examples of Goddesses who embodied the entire life process: birth, life, death, and regeneration. This is important because it can be tempting to romanticise the Goddess as a sort of angelic Fairy Godmother or abundant Good Mother. The feminine principle is more complex and more powerful than that. There are many stories from mythology that tell of the different faces of the Goddess. One such myth tells of the ancient Sumerian goddess who “outweighed, overshadowed, and outlasted them all . . .Inanna, Queen of Heaven.”[xxvi] This story originated in ancient Mesopotamia, five or six thousand years ago. In the myth, Inanna, who rules as queen over the upper world (birth and life), decides to visit Ereshkigal, queen of the Underworld (death and transformation). As Inanna descends into her sister’s realm, she is stripped of all the symbols of her upper world sovereignty, so that she comes before Ereshkigal naked and bowed low. Her enforced stay in the Underworld and the return after three days predates the Christian story by thousands of years. It is one of the first stories of ritual descent from the realm of life to the realm of death and the return to life after a time of incubation in the Underworld. This is also the theme of most ancient initiation rituals like the Orphic mysteries, the Eleusinian mysteries, and of much of the Egyptian sacred teachings. At the time when the story of Inanna’s journey first appeared, the increasingly male dominated Sumerian culture was separating from earlier matrilineal forms. Before the descent myth, another story tells how Inanna, in order to rule, had to take power from the God, Enki, assuming his symbols of sovereignty as her own. Ereshkigal, queen of the Underworld, represents the archaic feminine, the dark mysteries of the older religion which had been sent underground. The descent story can, therefore, be understood as Inanna balancing her heroic victories in the upper (masculine) world by reconnecting with the rhythms and cycles of the under (feminine) world. Based on clinical experience, one analyst called this a “pattern of a woman’s passage from cultural adaptation to an encounter with her essential nature”.

(Notably, temporary loss of blood or oxygen or excess carbon dioxide in the blood can also cause a disruption in the temporoparietal region and induce out-of-body experiences, which may explain the prevalence of these sensations during accidents, emergencies, heart attacks, etc.) NEAR-DEATH EXPERIENCES But perhaps the most dramatic category of out-of-body experiences are the near-death stories of individuals who have been declared dead but then mysteriously regained consciousness. In fact, 6 to 12 percent of survivors of cardiac arrest report having near-death experiences. It’s as though they have cheated death itself. When interviewed, they have dramatic tales of the same experience: they left their body and drifted toward a bright light at the end of a long tunnel. The media have seized upon this, with numerous best sellers and TV documentaries devoted to these theatrical stories. Many bizarre theories have been proposed to explain near-death experiences. In a poll of two thousand people, fully 42 percent believed that near-death experiences were proof of contact with the spiritual world that lies beyond death. (Some believe that the body releases endorphins—natural narcotics—before death. This may explain the euphoria that people feel, but not the tunnel and the bright lights.) Carl Sagan even speculated that near-death experiences were a reliving of the trauma of birth. The fact that these individuals recount very similar experiences doesn’t necessarily corroborate their glimpses into the afterlife; in fact, it seems to indicate that there is some deep neurological event happening. Neurologists have looked into this phenomenon seriously and suspect that the key may be the decrease of blood flow to the brain that often accompanies near-death cases, and which also occurs in fainting. Dr. Thomas Lempert, a neurologist at the Castle Park Clinic in Berlin, conducted a series of experiments on forty-two healthy individuals, causing them to faint under controlled laboratory conditions. Sixty percent of them had visual hallucinations (e.g., bright lights and colored patches). Forty-seven percent of them felt that they were entering another world. Twenty percent claimed to have encountered a supernatural being. Seventeen percent saw a bright light. Eight percent saw a tunnel. So fainting can mimic all the sensations people have in near-death experiences

By 2004, one in three Americans was considered clinically obese; two in three were overweight. One in ten adult Americans had Type 2 diabetes—one in five over the age of sixty. It is now clear that the roots of this epidemic are evident even in infants and in the birth weights of newborns. Among middle-income families in Massachusetts, for example, as a team of researchers led by Matthew Gillman of Harvard reported last year, the prevalence of excessively fat infants increased dramatically between 1980 and 2001. This increase was most conspicuous among children younger than six months of age.

Every morning I say, “Thank YOU,” and I call a meeting with my committee of Angels. I assign them jobs: Dear Angel … Look after the young single mother in labor. Angel of strength … PLEASE comfort the young father who just found out he is HIV positive. Angels … One of you go to his wife, and make sure she does not get infected. Safety Angel … Please make sure my son wears his helmet on the motorbike. Angel of money … Make sure we can pay the bills for the clinic. Hand-washing Angels, Tooth-brushing Angels, Street-crossing Angels … Look after my grandchildren. Milk Angels … Help the mothers to breastfeed their babies. Angels of Midwives … Look after the birth-keepers. Angels of Peace … Please don’t give up!

When I called Nona Aguilar, author of The New No-Pill, No-Risk Birth Control (Simon & Schuster, 1986), I described my frustration that I was not acceptable to the training program at the Albuquerque clinic. “Well,” she said, respectfully, “I agree with that policy.” I leaned back in my chair. “Okay,” I said. “I don’t understand this. Please explain.” “Properly used,” she began, “sex is about emotional and psychological union. In our culture, artificial birth control—which feminists have strongly advocated—has made sex a recreational activity. Sex certainly can be recreational, but its potential is to be transcendent. Sex is the life-bearing force of humankind. When lovemaking is recreational, it’s a little like being color-blind during sunset over the Grand Canyon. Union becomes harder to experience, and that’s a loss.” With

I always knew I would have to face an occasional tragedy as a physician. This one came early in my career and remains etched forever in my memory. Even the birth of our first child on the same day couldn’t erase it. How many such heartbreaks would I witness during a lifelong career in medicine? Would there be enough Baby Kristin success stories to provide balance?" (page 24)

If Nash attracted Hollywood’s attention, it wasn’t only on account of his mathematical exploits. It was also because of the tragic story of his life. At the age of thirty he succumbed to paranoid schizophrenia. In and out of psychiatric clinics and hospitals for more than ten years, he seemed fated to live out his days as a pitiable phantom haunting the halls of Princeton, his mind an incoherent ruin. But then, after three decades of purgatory, Nash miraculously came back from the far shores of madness. Today, more than eighty years old, he is as normal as you or I. Except that there is an aura about him that neither you nor I have, an aura due to phenomenal accomplishments, strokes of pure genius—and a way of dissecting and scrutinizing problems that makes Nash a model for all modern analysts, myself most humbly among them.

I believe there is no such thing as “termination” in the relationship between children and their birth families. Even if the birth parents die, it’s not “over.” By creating a ritual based on the pretense that the relationship has ended, the child’s internal reality is at odds with the external one. Most of the children we see clinically, especially those who are older at the time of their placement (both domestic and international) are emotionally preoccupied with these dissonances. They may not have words to describe the depth of their confusion or longing or rage, since these experiences most often occurred precognitively and preverbally.

Even though these individuals had seemed perfectly healthy at birth, something that had happened during their development in the womb affected them for decades afterwards. And it wasn’t just the fact that something had happened that mattered, it was when it happened. Events that take place in the first three months of development, a stage when the foetus is really very small, can affect an individual for the rest of their life. This is completely consistent with the model of developmental programming, and the epigenetic basis to this. In the early stages of pregnancy, where different cell types are developing, epigenetic proteins are probably vital for stabilising gene expression patterns. But remember that our cells contain thousands of genes, spread over billions of base-pairs, and we have hundreds of epigenetic proteins. Even in normal development there are likely to be slight variations in the expression of some of these proteins, and the precise effects that they have at specific chromosomal regions. A little bit more DNA methylation here, a little bit less there. The epigenetic machinery reinforces and then maintains particular patterns of modifications, thus creating the levels of gene expression. Consequently, these initial small fluctuations in histone and DNA modifications may eventually become ‘set’ and get transmitted to daughter cells, or be maintained in long-lived cells such as neurons, that can last for decades. Because the epigenome gets ‘stuck’, so too may the patterns of gene expression in certain chromosomal regions. In the short term the consequences of this may be relatively minor. But over decades all these mild abnormalities in gene expression, resulting from a slightly inappropriate set of chromatin modifications, may lead to a gradually increasing functional impairment. Clinically, we don’t recognise this until it passes some invisible threshold and the patient begins to show symptoms.

Runaway costs are crushing the American medical system. Hispanics are the group least likely to have medical insurance, with 30.7 percent uninsured. Ten point eight percent of whites and 19.1 percent of blacks are without insurance. Illegal immigrants rarely have insurance, but hospitals cannot turn them away. In 1985, Congress passed the Emergency Medical Treatment and Active Labor Act, which requires hospitals to treat all emergency patients, without regard to legal status or ability to pay. Anyone who can stagger within 250 yards of a hospital—a distance established through litigation—is entitled to “emergency care,” which is defined so broadly that hospital emergency rooms have become free clinics. Emergency-room care is the most expensive kind. Childbirth is an emergency, and hospitals must keep mother and child until both can be discharged. If the mother is indigent the hospital pays for treatment, even if there are expensive complications. Any child born in the United States is considered a US citizen, so thousands of indigent illegal immigrants make a point of having “anchor babies” at public expense. The new American qualifies for all forms of welfare, and at age 21 can sponsor his parents for American citizenship. In 2006 in California, an estimated 100,000 illegal immigrant mothers had babies at public expense, and accounted for about one in five births. The costs were estimated at $400 million per year, and in the state as a whole, half of all Medi-Cal (state welfare) births were to illegal immigrant mothers. In 2003, 70 percent of the babies born in San Joaquin General Hospital in Stockton were anchor babies. In Los Angeles and other cities with heavy gang activity, hospitals must deal with “dump and run” patients—criminals wounded in shootouts who are rolled out of speeding cars by fellow gang members. Illegal-immigrant patients often show up without papers of any kind, and doctors have no idea whom they are treating. Mexican hospitals routinely turn away uninsured Mexicans, and if the US border is not far, may tell the ambulance driver to head for the nearest American hospital. “It’s a phenomenon we noticed some time ago, one that has expanded very rapidly,” said a federal law enforcement officer.

In assessing any bronchopulmonary malformation in an asymptomatic child, the first chest x-ray should be performed 24–48 hours after birth to allow for resolution of lung fluid.

Jack’s. He’d only been there a minute, waiting for someone to come from the back to serve him, when Mel struggled into the bar, baby against her chest, toddler in hand, diaper bag slung over her shoulder. Right inside the door, the toddler took a tumble down onto his knees and sent up a wail. “Oh, punkin,” she said. She spied Luke and said, “Oh, Luke, here.” She thrust the baby into his hands so she could stoop to lift up the boy. “Oh, you’re okay,” she said, brushing off his knees. “Don’t cry now, you didn’t even break the floor. It’s okay.” She was just about to stand, when she heard her husband’s voice. “Mel,” he said. She looked up from the floor. Jack was behind the bar. He inclined his head toward Luke with a smile on his face. Luke was holding the baby out in front of him at arm’s length, a startled expression on his face while Emma kicked her little legs and squirmed. Mel burst out laughing, then covered her mouth. She rose and went to him, taking the baby. “I’m sorry, Luke,” she said. “It’s been such a long time since I’ve been around a man who didn’t know exactly what to do with a baby.” “Sorry,” he said. “I don’t have much experience with this.” “It’s okay—my mistake.” She couldn’t help but laugh again. “The first day I met Jack, there was a newborn at the clinic and he scooped her up like an old pro.” “Because I was an old pro, Mel,” Jack said, coming around to the front of the bar. “Four sisters, eight nieces and one on the way,” he told Luke. “Prolific family,” Luke observed. “I don’t know much about babies.” “If you’re looking to learn babies, this is the place,” Mel said. “I don’t think there are any virgins left in Virgin River. The birth rate around here is on the rise.” “Me and babies—incompatible. And I like it that way.” Jack

My eyes about popped from their sockets; I couldn’t believe what I was seeing. I immediately lost all of my professionalism as Bea and I both exclaimed simultaneously, 'HOLY #@*!' The metal vaginal speculum fell from my hands and clanked onto the tile floor. The top of an infant’s head was clearly visible with a nice crop of dark hair on the scalp..... I then had to inform her of the reality that, not only was she pregnant, she was about ready to deliver a baby and the birth would probably occur within the next few minutes." (Page 223)

Then the machine started to reel off infant-mortality rates and life-expectancy figures, sex ratios, types of diseases and their prevalence in the various strata of society, average incomes, the incidence of unemployment, per capita income as a ratio of total population in given areas, birth-tax and death-tax and the penalties for abortion and illegitimate birth; it talked about laws governing types of sexual congress, about charitable payments and religious organizations running soup kitchens and night shelters and firstaid clinics; about numbers and figures and statistics and ratios all the time, and Gurgeh didn’t think he picked up a word of it.

The full story of Osama Bin Laden’s long fugitive exile in Pakistan may never be known. He appears to have lived in about four different houses in towns in the northwest of the country before moving to Abbottabad in August 2005, where he remained until his death. Kayani had been I.S.I. director for less than a year when Bin Laden set up in Abbottabad. The Al Qaeda emir and his family enjoyed support from a sizable, complex network inside Pakistan—document manufacturers, fund-raisers, bankers, couriers, and guards. His youngest wife, Amal, gave birth to four children in Pakistani hospitals or clinics after 2002.

Trained Obstetrician and Gynaecologist in Dubai Dr Elsa de Menezes Fernandes is a UK trained Obstetrician and Gynaecologist. She completed her basic training in Goa, India, graduating from Goa University in 1993. After Residency, she moved to the UK, where she worked as a Senior House Officer in London at the Homerton, Southend General, Royal London and St. Bartholomew’s Hospitals in Obstetrics and Gynaecology. She completed five years of Registrar and Senior Registrar training in Obstetrics and Gynaecology in London at The Whittington, University College, Hammersmith, Ealing and Lister Hospitals and Gynaecological Oncology at the Hammersmith and The Royal Marsden Hospitals. During her post-graduate training in London she completed Membership from the Royal College of Obstetricians and Gynaecologists. In 2008 Dr Elsa moved to Dubai where she worked as a Consultant Obstetrician and Gynaecologist at Mediclinic City Hospital until establishing her own clinic in Dubai Healthcare City in March 2015. She has over 20 years specialist experience. Dr Elsa has focused her clinical work on maternal medicine and successfully achieved the RCOG Maternal Medicine Special Skills Module. She has acquired a vast amount of experience working with high risk obstetric patients and has worked jointly with other specialists to treat patients who have complex medical problems during pregnancy. During her training she gained experience in Gynaecological Oncology from her time working at St Bartholomew’s, Hammersmith and The Royal Marsden Hospitals in London. Dr Elsa is experienced in both open and laparoscopic surgery and has considerable clinical and operative experience in performing abdominal and vaginal hysterectomies and myomectomies. She is also proficient in the technique of hysteroscopy, both diagnostic and operative for resection of fibroids and the endometrium. The birth of your baby, whether it is your first or a happy addition to your family, is always a very personal experience and Dr Elsa has built a reputation on providing an experience that is positive and warmly remembered. She supports women’s choices surrounding birth and defines her role in the management of labour and delivery as the clinician who endeavours to achieve safe motherhood. She is a great supporter of vaginal delivery. Dr Elsa’s work has been published in medical journals and she is a member of the British Maternal and Fetal Medicine Society. She was awarded CCT (on the Specialist Register) in the UK. Dr Elsa strives to continue her professional development and has participated in a wide variety of courses in specialist areas, including renal diseases in pregnancy and medical complications in pregnancy.

With a break in the mother-child bond among siblings, each child might express his or her disconnection with the mother differently. One child might become a people pleaser, fearing that if he’s not good, or he makes waves, he’ll lose connection with people. Another child, believing that connection is never hers to have in the first place, might become argumentative and create conflict to push away the people close to her. Another child might isolate and have little contact with people at all. I’ve noticed that if several siblings have breaks in the mother-child bond, they’ll often express anger or jealousy, or feel disconnected from one another. For example, an older child might resent the child born later, perceiving that the younger child received the love that he or she did not get. Because the hippocampus—that part of the brain involved in creating memories—isn’t fully operational until after the age of two, the older child may not consciously remember being held, fed, or cuddled by the mother, but remembers the younger child receiving their mother’s love. In response, the older child, feeling slighted, can unconsciously blame the younger child for getting what he or she did not. And then, of course, there are some children who don’t seem to carry any family trauma at all. For these children, it’s quite possible that a successful bond was established with the mother and/or father, and this connection helped to immunize the child from carrying entanglements from the past. Perhaps a window of time opened in which the mother was able to give more to one particular child and not the others. Perhaps the parents’ relationship improved. Perhaps the mother experienced a special connection with one child, but couldn’t connect deeply with the others. Younger children often, though not always, seem to do a bit better than first children, or only children, who seem to carry a bigger portion of unfinished business from the family history. When it comes to siblings and inherited family trauma, there are no hard and fast rules governing how each child is affected. Many variables, in addition to birth order and gender, can influence the choices siblings make and the lives they lead. Even though it may appear from the outside that one sibling is unscathed by trauma, while another is encumbered, my clinical experience gives me a different perspective: Most of us carry at least some residue from our family history. However, many intangibles also enter into the equation and can influence how deeply entrenched family traumas remain. These intangibles include self-awareness, the ability to self-soothe, and having a powerful internal healing experience.

SKIN PIGMENTATION. Pigmentation refers to skin coloring, which depends on specialized cells that produce melanin. Melanin is the pigment that imparts different shades and colors to the hair, skin, mucous membranes, and retina of the eye. Individuals with too little melanin production have fair skin, whereas those with high deposition have a darker complexion. Skin pigmentation problems arise when there is an excess of melanin production, resulting in dark spots, patches, or discoloration of the skin. It can change the color of the skin over time, resulting in an uneven skin tone. Whilst hyperpigmentation is not a dangerous illness, it may be a sign of another medical condition. As a result, a dermatologist should be consulted to determine the exact cause of the pigmentation. CAUSES OF SKIN PIGMENTATION. • Skin inflammation (post-inflammatory hyperpigmentation) • Drugs (such as minocycline, certain cancer chemotherapies, and birth control pills) • The disease of hormones. • Hemochromatosis (iron overload) • Sun exposure. • Pregnancy (melasma, or mask of pregnancy) • Certain birthmarks. or contact 0331 1117546

TREATMENTS FOR REMOVING A BIRTHMARK Birthmark removal is one of our most challenging, but also satisfying, treatments. Not all birthmarks are the same, regardless of how they appear, which means that technology and expertise are critical to the success of a birthmark removal procedure. A port-wine stain is one sort of red birthmark, while there are several brown birthmarks and other types of birthmarks. Many of these conditions can be successfully treated using laser technology and by using other treatments for removing birthmarks. Birthmarks are skin signs that a baby may develop before or shortly after birth. Birthmarks can be flat or raised, have regular or irregular borders, and vary in color from brown, tan, black, or pale blue to pink, red, or purple. Though most birthmarks are nontoxic and do not require medical treatment, it is important to keep note of any changes in their appearance. Some birthmarks are large and significant enough to interfere with other biological functions. Birthmarks are often produced by the unusual development of cellular components in the skin. The two most common causes of birthmarks are as follows: (i) Irregular development of blood vessels beneath the skin. (ii) An increase in the number of pigments (i.e. melanin) generating cells that gather together under the skin. There are several old wives’ stories and superstitions concerning birthmark causes in various cultures across the world. For more information kindly visit or contact 0331 1117546

he was so astounded by the beauty and complexity of the universe itself, that he saw no need to go seeking gods or goddesses to explain it. His philosophy was that no concept of a creator or overseer could possibly match the awe-inspiring grandeur of nature itself. This is the way the Pagan atheist views the world, and the universe at large. It’s not some dry, clinical and bitter philosophy. It’s a vibrant, dynamic view of life and the environment that births and sustains it. In fact, many Pagans view the universe as a sort of living organism—either metaphorically or in actual terms. The parallels are, indeed, fascinating. And, in fact, many Pagans believe that the distinction between natural and supernatural is a false one—that nature is the totality of all there is, and that it’s meaningless to speak of anything being somehow outside of nature.

It is indeed ironic that one of the most conservative of professions should be called upon to engage in activities that require the very obverse of conservative mental traits. It is rather like expecting the Pope to run an efficient birth-control clinic. And, when it is considered that the

She, like other whites in the birth control movement, saw the role of Black leaders and health professionals as facilitating their organizations’ efforts among the Black population. They incorporated Blacks in their advocacy to help raise funds and to give legitimacy to the movement’s projects in Black communities. But Black members of advisory councils were not invited to participate in national planning, nor were they allowed to manage the clinics that served Black patients.

to live until she was big enough to undergo extensive open-heart surgery. She had been followed since birth in our Pediatric Cardiology Clinic at the New York Hospital, and many of the pediatricians knew her and her family. Despite her physical difficulties she took full possession of all the hearts around her, including mine. When the time for her surgery finally came, her parents were deeply anxious. These were early days for many cardiac surgery techniques, and the risks were considerable, but without surgery, she would not survive childhood. As the senior pediatric resident, I met with Immy’s parents before the surgery to do an intake interview and summarize Immy’s long story. They were committed and ready and very pale. As we spoke, they sat close together holding hands. Afterward I took them

I never could have done that last one without you." Her voice was both shy and lovely. "You know ... my birth sire? He never did anything like that for me. He never ... he didn't even want me to go to the clinic. You know, even though I was hurt..." She cleared her throat. "So thank you. You're the best father ever.

Actually, we do have our Mengele, and his name is Kermit Gosnell. Since 1979, Gosnell ran an abortion clinic called the Women’s Medical Society in West Philadelphia. There he performed late-term abortions and partial-birth abortions, mostly on poor women. If by some mistake children were born alive, Gosnell killed them in a process he termed “ensuring fetal demise.” Gosnell’s preferred technique for abortion was to heavily drug the premature infants and then stick scissors into their necks and cut the spinal cord. Over a period of three decades, Gosnell killed hundreds if not thousands of children in this way, far more than Mengele killed during his two-year stint at Auschwitz.4 If Gosnell is our Mengele, we also have our Kaiser Wilhelm Institute, and its name is Planned Parenthood.

This was the first use of her hands, her first manual act, in sixty years, and it marked her birth as a ‘motor individual’ (Sherrington’s term for the person who emerges through acts).

The clinical outcome of these rapprochement crises will be determined by: (1) the development toward libidinal object constancy; (2) the quantity and quality of later disappointments (stress traumata); (3) possible shock traumata; (4) the degree of castration anxiety; (5) the fate of the oedipus complex; and (6) the developmental crises of adolescence—all of which function within the context of the individual’s constitutional endowment.

Further evidence of the repressive climate these attacks produced can be found in the reluctance of Lathrop and Abbott to ally themselves with Margaret Sanger and use the clinics established by Sheppard-Towner to promote birth control education. Fear of incurring further attacks by the AM A lay at the heart of this decision (Rosenberg, 1992). On a broader scale, the repressive political climate and a slew of reactionary lawsuits combined with the promotion of a consumer culture and sexual freedom by mass advertising to channel the energies of many women away from social justice issues toward self-liberation and sexual freedom, a trend with remarkable similarities to contemporary events (Addams, 1935; Faludi, 1991; Ryan, 1979).

Heart Disease Starts in Childhood In 1953, a study published in the Journal of the American Medical Association radically changed our understanding of the development of heart disease. Researchers conducted a series of three hundred autopsies on American casualties of the Korean War, with an average age of around twenty-two. Shockingly, 77 percent of soldiers already had visible evidence of coronary atherosclerosis. Some even had arteries that were blocked off 90 percent or more.20 The study “dramatically showed that atherosclerotic changes appear in the coronary arteries years and decades before the age at which coronary heart disease (CHD) becomes a clinically recognized problem.”21 Later studies of accidental death victims between the ages of three and twenty-six found that fatty streaks—the first stage of atherosclerosis—were found in nearly all American children by age ten.22 By the time we reach our twenties and thirties, these fatty streaks can turn into full-blown plaques like those seen in the young American GIs of the Korean War. And by the time we’re forty or fifty, they can start killing us off. If there’s anyone reading this over the age of ten, the question isn’t whether or not you want to eat healthier to prevent heart disease but whether or not you want to reverse the heart disease you very likely already have. Just how early do these fatty streaks start to appear? Atherosclerosis may start even before birth. Italian researchers looked inside arteries taken from miscarriages and premature newborns who died shortly after birth. It turns out that the arteries of fetuses whose mothers had high LDL cholesterol levels were more likely to contain arterial lesions.23 This finding suggests that atherosclerosis may not just start as a nutritional disease of childhood but one during pregnancy. It’s become commonplace for pregnant women to avoid smoking and drinking alcohol. It’s also never too early to start eating healthier for the next generation.

In the age of evidence-based medicine, it is becoming strange to refer to daily clinical lessons. However, I find it useful to summarize what I learned from decades of practice. We need this perspective because the results of the current randomized controlled trials are of limited use among those who have acquired a good understanding of birth physiology. In these trials, conducted in large conventional departments of obstetrics, the physiological processes are highly disturbed, both in the study groups and in the control groups (Prendiville et al. 1988; Rogers et al. 1998).

Schmoller said that those who would send every hungry person to a restaurant, every pregnant woman to a clinic, every child from birth to adulthood to a succession of educational institutions, will simply succeed in changing society into an aggregation of self-seeking, egotistical vagabonds, whose neuroses and tensions will provide a surplus of candidates for mental hospitals.

After a rainstorm on a brilliant Sunday morning, 17 January 1960, at Lucerne’s Municipal Maternity Clinic, Audrey gave birth to a sturdy, well-made son. He weighed nine and a half pounds, and they called him Sean. The Christian name was chosen because it was the Irish version of Audrey’s half-brother’s name, Ian, and because it meant ‘Gift of God’, the significance of which was not lost on all who knew the baby’s mother.

Actually, we do have our Mengele, and his name is Kermit Gosnell. Since 1979, Gosnell ran an abortion clinic called the Women’s Medical Society in West Philadelphia. There he performed late-term abortions and partial-birth abortions, mostly on poor women. If by some mistake children were born alive, Gosnell killed them in a process he termed “ensuring fetal demise.” Gosnell’s preferred technique for abortion was to heavily drug the premature infants and then stick scissors into their necks and cut the spinal cord. Over a period of three decades, Gosnell killed hundreds if not thousands of children in this way, far more than Mengele killed during his two-year stint at Auschwitz.4

I could refer you to a colleague who specialises in such things – or, as it happens, a clinic has just opened in Holloway to advise on birth control and dispense devices. You might find that more anonymous. Have you heard of Marie Stopes?’ ‘Didn’t she write a book? I seem to remember something – didn’t she say that women and men should be equal in marriage? It sounded rather sensible to me.’ ‘She believes that a woman cannot be free unless she has control over her own body, which must include contraception. No-one would publish the book before the war, but since it came out – what is it? Two years ago – there has been no action against her or the publisher, so I think we can take it that she has opened this clinic with some confidence.