i’m not making this up.

A few months ago I was at dinner with friends, one of whom is pregnant. The topic of drinking in pregnancy came up and someone said to me “you just tell people not to drink because you have to, not because it’s really harmful right?” Um…I made that face. That face.  You know. The one where  you couldn’t possibly believe what you heard but, then again, you heard it.  The one where your eyes are big and your mouth is open.  After a pregnant pause I explained that national and now international guidelines recommend against any alcohol consumption in pregnancy.

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We all know that you are never going to get more unsolicited advice than when you are pregnant.  What you can and can’t do including raising your hands above your head or eating peanut butter in the bathtub along with what your baby should eat, how it should sleep, what it should wear and where it should go to college.  Whether or not you should consume alcohol in pregnancy is among that advice.  However, drinking during pregnancy is the most common cause of birth defects in the United States. And while these birth defects are most common among women who drink heavily, there is no safe amount of alcohol consumption for a pregnant woman.  Alcohol use in pregnancy is associated with low birth weight, preterm birth, birth defects and developmental disabilities.  Health care providers are encouraged to discuss discontinuation of alcohol for women who are pregnant and those actively trying to get pregnant.

April is alcohol awareness month. It was established to reduce the stigma associated with alcoholism and increase awareness about alcohol abuse, treatment and recovery.  Excess alcohol use costs the United States about 250 billion dollars per year.  About 5 billion of that is related to alcohol use in pregnancy.  So no, as gynecologists we don’t just say these things because “we have to.”  We say them because we truly want the best outcome for you and your baby.  So if you should find yourself with two lines on that pregnancy test, congrats!  It’s time to take a break from alcohol.  If you are already pregnant and haven’t stopped drinking I would urge you to do so now.  You can tell your grandmother, your best friend, the lady at the grocery store and the dude at the gas station that you are doing everything you can to take care of yourself and your baby.  Really.  We’re not making this up.

women on lockdown.

In 2013 the Center for American Progress rated Oklahoma as one of the worst places to live for women. Why?  Well, in addition to our above average gender pay gap, ranking near the bottom for women in poverty, and the huge number of uninsured women, Oklahoma has more women in prison than any other state in America.

As a background, the United States imprisons more of its population than any other nation in the world.  In the last 20 years, the percent growth of female inmates was twice as much as male inmates.  So, as a country we have a trend.  When you look at my own state, Oklahoma, we have experienced exponential growth in female incarceration not screen-shot-2016-12-26-at-9-09-16-pmseen in any other state.  As of 2015, Oklahoma puts 127 of every 100,000 women behind bars.  Compare that to 63 of 100,000 as the national average.  From 2015 to 2016, the number of incarcerated women in Oklahoma increased by 9.5% while the number of incarcerated men decreased by 1%. This begs two questions from me: Why do we have so many women in prison? And then, are we any safer or better off with all these women behind bars?

First, at least 2/3 of the women in Oklahoma who are in prison have committed non-violent crimes. Many are incarcerated due to drug offenses, which up until recently carried serious jail or prison time due to Oklahoma laws.  There is no compelling evidence that we are any safer with a high female incarceration rate.  According to the our state Bureau of Investigation, violent crime in Oklahoma was up about 3.5% from 2013 to 2015, and non-violent crime was down by about 4.5% in that same time frame.  The overall violent crime rate in Oklahoma has decreased 7.3% in the last 10 years, while the rate of female incarceration doubled in the same time frame.

For the last couple of years I have given a lecture to our second year medical students on the state of women’s health in Oklahoma.  The good, the bad, the ugly.  I always touch on our incarceration rate.   Why?  Because our other state health indicators are major reasons why we incarcerate so many women.  1 in 25 women enters prison pregnant.  Over 2/3 of incarcerated women have a minor child. The consequences for these children are devastating.  Also, more than half of incarcerated women in our state have experienced domestic violence in adulthood and/or abuse in the home as a child. About 70% have been diagnosed with a mental health disorder.  Why does this matter? Because in 2013, our state ranked 46th (where 1st is best) in mental health expenditures per capita that were state funded.  picture1Most women in our state who enter prison live in poverty and have a lack of education. Again, we rate 40th out of 50 for number of women in poverty.  When women in Oklahoma are marginalized in health and economics, they are disproportionately more likely to end up in prison.  But is the news all bad? Fortunately, no.  In 2015, our state passed 2 bills that allowed reduced sentences for drug offenses and judges to deviate from mandatory minimum sentences.  Then, in 2016, the people of Oklahoma passed a state question that made certain drug and theft related offenses misdemeanors instead of felonies.  The money saved from the reclassification of these crimes will be used for rehabilitation programs, thanks to another state question supported by the voters in my state.  Tulsa County, along with the George Kaiser Family Foundation, have established a Women in Recovery program.  Since 2009, they have helped 475 women and over 1,000 children.  But we still have a long way to go.

Why should you care?  What can you do?  I think, no matter what state you live in, the rate and growth of female incarceration in our country should alarm you.  As a gynecologist I’m probably biased but I think we can measure the success of our nation by the success of its women.  If we can keep women out of prison their children are more likely to succeed in school and avoid drug abuse and addiction.  We should be advocating for increased mental health services in our states and in our nation; for reduction in the gender pay gap and other measures to reduce the number of women and families in poverty.  We should find ways to reduce domestic violence in our nation.  We should support efforts like the Women in Recovery program, and drug and mental health courts that focus on rehabilitation services.  No one knows this better than my sister-in-law, who also happens to be editor-in-chief of this blog.  She works in the drug court system.  She sees women as offenders every day in her home state of Missouri.  She knows it takes, sometimes, half a dozen times or more for offenders to find recovery.  She will be the first to tell you there are no easy fixes and no simple answers.  But I believe if we begin to change the idea that prison is the solution, then we can begin to create a culture where we focus on restoration and rehabilitation for our women.  I think we will all benefit. We have a shared brokenness.  We should share in the efforts of recovery.

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the original birth story.

Today is the day we’ve been waiting for.  Or at least I’ve been waiting for.  We light the Christ candle.  It is now Christmas. I don’t know about you but I’ve been anxious for the last 4 weeks.  Anxious to sing the songs and hear the stories and remember the day we celebrate the birth of Jesus.  It is difficult for me to comprehend that God’s people waited through 400 years of silence for the birth of Christ.  I would bet that every time a new king img_2375was crowned, a new country invaded, a new period of famine or drought came they imagined that they were on the cusp of a conquering savior’s presence.  And then they got a baby.

It is easy for us to look at the coming of Christ as a baby and make that sound we do when we see a newborn.  You know it.  You’re probably making it right now. It is the sound of seeing something that makes us feel warm and fuzzy inside.  This is my usual response to Christmas.  The warm and fuzzy feeling of  watching the Nativity.  But today I am keenly reminded of the frailty of Christ’s birth.  In a striking move unanticipated by anyone looking for it, God chose to manifest himself on our planet as the most vulnerable citizen.  We don’t have record of the maternal and infant mortality rate at the time of Jesus’ birth but we can extrapolate based on the earliest data we have available.  Based on early European data and other modeling statistical methods the best estimate is that 300 out of every 1000 infants born did not live to celebrate their first birthday.  That’s 30% of babies.  And their mothers.  Infection and hemorrhage were common.  As many as 25 of every 1000 women died as a result of childbirth during the time that Mary was pregnant.  Compare that to giving birth in the US today where, on average, the infant mortality rate is 6 per 1000 and the maternal mortality rate is about 10 per 100,000 women.  When Mary accepted the call of God to be the mother of Christ not only did she accept the shame that comes with being an unwed mother in her culture but I’m sure she knew the reality that many mothers and children did not survive childbirth in her community.

It begs the question: why would God choose to become incarnate in the form of a baby? Why choose the most vulnerable way to represent himself?  Maybe it’s because God enjoys being subversive.  Maybe it’s because no one would have suspected to look in a crib for a savior.  I suspect it is because He is in the business of demonstrating to us that power
is made perfect in weakness; that He is best found amongst those who cannot raise arms to protect themselves.  Dare I say that if you find yourself looking for a savior who will increase your power, fill your pockets and take down your enemies…don’t look inside the manger.  Don’t look in the manger for a savior who will use violence and destruction and despair to bring about his kingdom.

This Saimg_0059-jpgvior, the one found in the manger, will be “God with you” always.  He will be with you despite your words, despite your actions, despite your selfishness. This Savior will stay close to you in your suffering, He will walk with you in your grief and He will rejoice with you when life is gracious and good.  He will ask you to forgive your enemies, to lay down your weapons, to love someone who believes differently than you.  He is the Light that breaks through all darkness.  If you dare to look for the savior born long ago out in the cold this is what you will find.

May your life be filled with the light of Christ as today we light the Christ candle.  May every baby you see today and this week remind you of the vulnerable God who sends a baby in order to bring peace healing and hope to your life.  Merry Christmas friends!

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photo credits: Pastor Jason, yours truly, shiftworship.com, and the internets.

 

modern feminism.

I grew up in a household where I didn’t know that I might be disadvantaged in life because I was a girl.  I don’t remember being told “you can do that even though you are a girl.”  I don’t remember being told “you can do anything your brother can do.”  I remember feeling that I could do and be anything I set my mind to.  Period.  I remember being the only girl at a basketball camp I attended in the 5th grade.  I remember being the youngest and the smallest.  I remember shooting a hundred three-pointers and not making any of them.  I absolutely remember that this was the first time that I wasn’t sure I belonged because I was a girl.

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Not long ago I told one of the church girls that I am a modern feminist.  It was in the midst of me telling a story where I was in a meeting and presented an idea.  A gentlemen across the table from me repeated my idea about 2 minutes later as if it was his own.  I wish you could have seen my face.  The craziest part was that everyone just moved on like it didn’t happen.  Why?  First, I think because it’s a sad but common occurrence.  Secondly, I don’t think anyone feels empowered to say anything.  I read a recent article where women at the White House repeat each other’s ideas and give the author of that idea credit to ensure it is heard.  It’s a genius and embarrassingly necessary idea.  I attended a town hall meeting of sorts with two women in local politics.  They both said they were “recruited” into running by their community.  I couldn’t help but think that maybe these women needed a group of people to lift their voices before they could be accepted into the political arena.

And don’t think that men in our culture are the only ones who limit the ability for women’s voices to be heard.  Many women still believe a wife “allows” her husband to commit infidelity by not engaging in enough sexual activity or being too busy at work or caring for children.  Many women and men believe that a large amount of alcohol or a small amount of clothing “allows” women to be the victim of sexual assault.  These men and women have bought into the lie that women must change in order for the culture to change.  I just don’t buy it.  It’s not a woman problem.  It’s a world problem.  I shouldn’t have to dress or talk or walk or do anything differently to not be treated like I matter less. Our culture says “Women, just be different and the world will then recognize your worth. Stop screwing things up for yourselves by some of you wanting to work and some wanting to be stay at home moms; some wanting to be single and some desperately wanting to be married.”  These statements aren’t blatant of course.  They are inherently biased in so many of the arenas we live and work in.  The subtle and subversive notion that if only my voice was less loud and not so high pitched then maybe I would be “heard” more often.  Screen Shot 2016-10-09 at 8.29.01 AM.pngThe creeping feeling that my outfit or my hair is noticed more often than my skill as a surgeon or my innovation as a researcher.   The indignant  feeling I get when the men in the room during a delivery seem surprised to see me take excellent care of their wives and partners.  We all have inherent biases and until we are brave enough to admit them we will never move forward.

Why do I believe I am a modern feminist?  Because when I read the Bible I am drawn to the women who were incredibly faithful and brave in a culture that did little to acknowledge their existence or worth.  A young Mary who bravely accepted the calling of being the mother of Jesus.  The women who faithfully stood by Him during his trial and execution.  Who took him down to be buried and showed up to tend to his grave.  Who knew He could change the world because the poor, the widow and the orphan were just as valuable to Him as the priest, the tax collector and even the king.  Because I want my Christian community to take up for the most vulnerable and recognize that women in the modern church can and will do the praying, the preaching, the spiritual disciplines and the heavy lifting required to move us toward the Kingdom of God.  Because the church girls, my patients, my sister in law and my coworkers deserve better.

I have two daughters.  God bless the pastor.  When Pastor Jason is at a golf tournament with our oldest there is no “you can beat those boys” talk.  Instead, he reminds her that she has the best golf swing he has seen in a 9 year old.  Better than her dads.  And that she can beat anyone.  Why?  Because it’s the truth.  And the pastor knows that she is more valuable than to be compared to a reference group of men.  My 4 year old believes she can do anything.  And from the short time she has been on this planet I’m not convinced she isn’t correct.  Our world will closely reflect how we treat its women and its most vulnerable.  I want my daughters to live in a culture where no one has to repeat their ideas for them to be valid.  My greatest hope is that my daughters will have a voice at the table.  A voice in the classroom, the boardroom, the operating room.  This modern feminist believes women have the ability to change the world.

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(photo credit: smart physician moms plus the internet plus the tribute to the holocaust victims and survivors in Boston)

to be merciful.

Wow.  What a week it has been.  I had been prepping to write something on Zika virus, which, as you can imagine, is hard to put a theologic spin to…but I feel overwhelmingly obligated to discuss the newsworthy yet tragic events of the last few days and weeks.  Unless you don’t do the internet…which means you wouldn’t be reading this blog, you know that former Stanford student and swimmer Brock Turner was convicted of sexually assaulting a woman and then only sentenced to 6 months in jail, of which it seems he will likely serve 3.  If you haven’t read the victims 12 page letter, please do.  Your eyes will well with tears, your insides will hurt, your ears will sting and you will have some tiny insight in what it means to be victimized and humiliated.  If you haven’t a clue about the prevalence of sexual assault, you can read this blog post and get just a bit of insight.  The outcry against this young man’s sentence has been appropriately broad and loud.

There won’t be much medicine in this post.  Instead, my mind has been brewing over the question…what does it mean to be merciful?  When I read about tragedy or see it lived out before my own eyes the word that comes to the forefront of my mind is mercy.  A word that conjures many emotions but I find difficult to define.  So, like any gal in this decade, I texted my church girls and asked what they though it mean to be merciful.  Here’s what they said.

“Good ole’ Webster: compassion or forgiveness shown toward someone whom it is within one’s power to punish or harm.” (of course from an educator).  The other answers were some variation on this.  Interestingly this followed a lengthy “discussion” (via text) on power previously in the day.  So I asked myself, what does it mean to be merciful in the Stanford assault case?  Where does compassion lie when someone has no remorse, no awareness of what they have done and what they have destroyed?  What does it mean to be merciful to the victim?  To her sister?

And then today 50 people were murdered and another 50 plus were injured in Orlando by a man with an agenda of hate.  We can all speculate on who and what that hate was about but I think it would be hard to argue that this wasn’t motivated by hate.  Is there a place for mercy in this situation?

You see, we all hold positions of power at some point in our lives.  We might have authority at our job, with our children, or something as simple as being waited on in a place of service such as a restaurant.  I think how we hold that power is key.  We can clutch it tightly and find the best way to punish our enemies and fuel fear and hatred or we can hold it gently in our outstretched palm and exercise a judgement that is fueled by compassion and forgiveness.  Sounds easy, right? (kidding.)  I believe we can be merciful without sacrificing justice for the victims around us.  DISCLAIMER: I don’t excel at mercy.  I’m pretty good at judgement.  Professionally, I try hard each day to ensure I give power back to people.  That patients feel like they have a voice and that what they say matters and I see them as an individual who matters.  I’m certainly not perfect at it.  Personally, I find it much easier to judge the people in my social circles than to extend mercy.  I want to be confessional so you’ll understand I find this as difficult as you.

So what does that look like?  For the Stanford assault case, I think mercy for the victim is a prayer that says she will forgive herself each time she has a passing thought that maybe she deserves some blame.  For the young man I think a place of mercy is much more difficult to find.  Maybe it’s a prayer that instead of absolving him of responsibility and judgement, his eyes will be open to the breadth of damage he has caused with the crime he has committed.  Where is mercy in Orlando?  I believe it’s compassion for groups of people who have been victimized over and over again and often have no power in our culture.  In both circumstances I think mercy is finding a way to ensure that we know and understand how best to gently handle a position of power and to teach those around us that same meaning.

The truth is I really don’t know in these tragic situations and others like it how to find myself on the side of mercy.  The quote at the top of this blog from Pope Francis is overwhelming to me.  But it is the truth.  May we learn to extend mercy to our enemies.  Maybe then they will do the same and the world will have a smidgen less hate in it.  May we teach our sons (and our daughters) about mercy so that they will know how gently power is to be held.  Maybe then when a young man sees a vulnerable young lady he will think protection instead of victimization.  I don’t think mercy is about protecting ourselves, I think mercy is about protecting others from the harm we and others around us might do to them.  Not with raised fists and weapons but with love and forgiveness for others.  To strive to understand the other, our enemy, our opposite and to teach those around us to do the same.  To give the nameless and faceless victim a voice.  Screen Shot 2016-06-12 at 10.37.46 PM

I know it’s a long shot, but I am convinced that if we experienced mercy and showed it to others then maybe we would understand what it means to lay down power.  We might see less guns and more reading programs.  We might see safer college campuses.  We might lower our voices during the political season to listen and learn.  You see, extending mercy means you understand the person standing across from, whom you have power over, not as object but as subject.  Someone who deserves to be extended compassion and forgiveness.  I wonder if Brock Turner understood mercy he would have seen his victim as a person instead of an object to be owned and used.  Finally, may we be merciful with ourselves when we find no capacity to think of forgiveness when confronted with hate-filled crimes and injustices that we see in the world around us.  May we ask for mercy from those who we have exercised power against wrongly.  We should exercise forgiveness continually and may it spur us to practice a prayer my dear friend sent to me today. “Jesus Christ son of God have mercy on me.”

 

(top photo credit to catholic.org who has an entire website dedicated to memes…who knew?  The other two images are from the Instagram account of the official Nazarene church)