How did this major abdominal surgery—which poses significant risks—become mainstream in less than a generation? Many factors, including new obstetric technology, the effect of that technology on malpractice threats and costs, and changes in the way doctors are trained converged to make cesareans seem less risky than vaginal births, changing both obstetricians’ and pregnant women’s notions of what constitutes “normal” and “necessary” medical treatment during childbirth.

To see how quickly pregnant women’s attitudes toward childbirth changed, consider two contrasting stories about a woman’s reaction to her cesarean birth—one in 1971 and the other in 1984. Both women were first-time mothers. Both enjoyed problem-free pregnancies. And both were carrying full-term babies, facing head down, when they gave birth. In other words, they each experienced classically low-risk pregnancies—even though both women had a cesarean.

In 1971, the first woman—let’s call her Carol—checked into a big-city hospital at 2 a.m., shortly after going into labor spontaneously. Although only 20, she was not nervous. Her mother had given birth to nine children vaginally and Carol assumed that her own first birth would be a similarly “natural thing.”

In the labor room, someone came in periodically to check the baby’s heart rate with a fetal stethoscope. By dawn, Carol remembered, “they were having a little more trouble finding his heartbeat.” Nurses and doctors began to complain that Carol’s cervix was only two centimeters dilated. At 10 a.m., doctors decided to perform a cesarean, although they didn’t tell Carol their plan. Rather, they informed her husband, who was consigned to the waiting room—the custom in the early 1970s. Carol did sign a consent form to allow the surgery, but no one explained to her what she was signing and she didn’t ask. She was in labor and in no mood to question anything.

Consequently, when an orderly wheeled Carol into the operating room, she was bewildered despite having just consented to the surgery. “I’m going, like, ‘What’s happening?’” A doctor responded cryptically, “We’re going to operate.” Carol was flabbergasted. “Why?” Everyone ignored her. “It was like I was a non-entity.”

Only after her son’s birth did Carol learn the reason for the surgery. Facing difficulty finding a steady heartbeat, doctors feared fetal distress. But the explanation did not satisfy Carol. Her son’s Apgar score, a numerical rating of a newborn’s condition formulated one minute after birth by assessing five vital signs including heart rate and skin tone, had been first-rate. “There was nothing distressed about this baby! When they pulled him out there was nothing distressed!” Today, she remains certain the cesarean was unnecessary. “I really felt that it was clinic day. The doctors were going to make sure that they didn’t have to come in later.”

Fast forward 13 years. By 1984, when Leanne gave birth to her first child, the surgery had become common, constituting 22 percent of births in the U.S. Unlike in 1971, when Carol had her first baby, by the mid-1980s everyone knew someone who had had the surgery.

Leanne was two weeks past her due date when her obstetrician told her she had to come to the hospital. He ruptured her amniotic sac, hoping to jumpstart labor. By then, the electronic fetal monitor, a device that provides continuous information about the fetal heart rate, had replaced doctors’ intermittent use of the fetal stethoscope. Nurses connected Leanne to the monitor. Her baby’s heart rate began to fluctuate, probably in reaction to the drain of amniotic fluid. The obstetrician told Leanne, “We’ve got to get this baby out of here.” Leanne reacted unhesitatingly. “Just do what you need to do.”

After the birth, she harbored no regrets. She was certain that the surgery had been necessary given what seemed to be the potential risks to her child as indicated by the fetal monitor. “We got him out. We got him healthy. We didn’t lose me. We didn’t lose him. Everything was fine.” Leanne, unlike Carol, was sure her cesarean had been necessary. By the mid-1980s, due to the increasing number of cesareans, the notion that vaginal childbirth was risky had become common. Leanne’s favorable reaction to cesarean surgery had become the norm, Carol’s anger the aberration.

Cesareans can indeed be lifesaving. But the grave conditions that demand the surgery are rare—each occurs in fewer than one percent of births. These conditions include the umbilical cord dropping into the birth canal before the baby does, several different placental complications that include premature detachment and obstruction of the cervical opening, and a full-term fetus lying sideways in the uterus. Yet the electronic fetal monitor helped cement the view that vaginal birth is far riskier than it actually is.

In hindsight, it is clear that physicians and hospitals adopted the monitor too quickly. The monitor had been introduced in 1969 but the first clinical trial of the device was not published until 1976. By then, all but one of the hospitals housing obstetric residency programs in the U.S. had adopted the machine, making its use central to the training of new obstetricians.

The authors of the 1976 article that appeared in the American Journal of Obstetrics and Gynecology found that the monitor—although considered by most obstetricians to be a vital tool—did not change outcomes. Apgar scores; stillbirths; neonatal and perinatal deaths; incidence of cerebral palsy; and admissions to the neonatal intensive care unit were effectively identical whether the fetal heartbeat had been tracked constantly by the electronic monitor or intermittently by a nurse or doctor wielding a fetal stethoscope.

The only difference between the two groups was that the mothers connected to monitors had a cesarean rate of 16.5 percent while those checked intermittently with a fetal stethoscope had a cesarean rate of 6.5 percent. Seven subsequent studies, one of 35,000 births, confirmed these findings. But having been taught that the electronic fetal monitor was vital to their own professional success, as well as their patients’ well-being, obstetricians ignored the studies.

Edward Hon, the Yale University obstetrician who invented the monitor, complained of his colleagues around the country, “They’re dropping the knife with each drop in the fetal heart rate.” Before electronic monitoring, continual observation of the fetal heartbeat was impossible, so no one knew precisely how the fetus responded to the many nuances of labor. “As we started seeing these dips and things all over,” another obstetrician observed of the monitor strip, “it helped increase the section rate a lot.”

The monitor also helped to create the current malpractice climate in obstetrics. Since the mid-1980s, the continual record produced by fetal monitors has become a tool of trial lawyers to “prove” to juries that a timely cesarean would have prevented cerebral palsy, even though the cerebral palsy rate, at one in 500 births, has not decreased even slightly with the advent of the monitor. As one seasoned obstetrician explained, a lawyer can now point to a squiggle on a page and claim, “‘Well, that’s where the baby was damaged.’ How do you disprove that?”

The litigious atmosphere in obstetrics, aided in no small part by the unreliable but tangible data produced by the fetal monitor, has prompted an ever-increasing number of obstetricians to perform a cesarean in the face of even niggling doubt about the course of a birth. In the legal and medical worlds, no matter the outcome of the operation, an obstetrician who has performed the surgery is considered “covered.” And that has increased the cesarean rate further still.

Through the 1980s and ’90s, the surgery became the first resort for younger obstetricians treating virtually any complication of labor. As one obstetric resident at a large, urban hospital said recently of herself and her cohorts, cesarean section is “probably the skill that we get the most experience in.” She joked, “We could do a C-section on a desert island.” Significantly higher reimbursement rates for cesareans versus vaginal births add to the tangle of factors contributing to the rise in cesareans.

Forty years ago, Helen Marieskind, the author of a 1979 U.S. Department of Health, Education, and Welfare report on the increase in cesareans and ways to mitigate it, noted, “The question must be raised as to how much a climate accepting of C-sections in and of itself promotes more Cesareans.” Marieskind’s “question” was clearly prophetic. Carol’s and Leanne’s contrasting stories indicate how quickly mothers came to accept cesarean surgery. The claim of the obstetric resident that she could perform a cesarean on a desert island demonstrates how casually physicians now view this major abdominal surgery.

And yet this dramatic change in obstetric practice has not been good for mothers. Cesareans carry risks, including intractable postpartum infections, that vaginal births seldom do. One of the most frightening downstream effects of a cesarean is placenta accreta, when the placenta grows into the uterine scar left by a previous cesarean. The condition, which causes life-threatening hemorrhage, has increased 55-fold since the 1950s. Accretas almost always require emergency hysterectomies; seven percent prove fatal.

Undoing the medical ethos that led to the epidemic of cesareans will likely take time and will require concerted effort from, and the education of, a number of players: obstetricians; hospitals, particularly hospitals with obstetric residency programs; insurers; and patients. But it can be done.

History demonstrates that changes in society and medical culture, rather than medical need, prompted the surge in the cesarean rate. There is a lesson here. As new treatments and diagnostic tools become available, no matter the field of medicine, it’s important to remember that medicine is not a dispassionate science, but an art continually shaped by changes in culture and society.

The post How Cesarean Births Became a ‘Global Epidemic’ appeared first on Zócalo Public Square.

Now, both my daughter and I understand that genetics determined her sex months earlier, but it’s fun for us to have a story that imagines the universe magically speaking to me. When I found out that she was a girl during an ultrasound, and an amniocentesis confirmed the result, the confirmation wasn’t exciting. And that’s a story she never asks me to repeat.

So I am not surprised at the appeal of gender reveal parties, at which expectant parents deliver the doctor’s pronouncement—no peeking—to a bakery, with instructions to make a pink or blue cake or cupcakes. During the party, they cut the cake or give out the cupcakes, and the color hidden under the frosting reveals to everyone whether the couple is expecting a boy or a girl. The party is suspenseful (revealing a secret), egalitarian (everyone finds out at once), and delicious (cake!)—a perfect afternoon. Unheard of a decade or two ago, gender reveal parties are the latest manifestation of the conflict between modern technological pregnancy and its ancient legacy of mystery. That this all plays out through pink and blue cake speaks to the peculiar anxieties and ironies of our time.

Now that almost every detail about pregnancy can be known, it’s hard to imagine a time when carrying a child was a hidden, and private, affair. Prior to the 19th century, the only way to be sure a woman was pregnant was at the quickening, when she could feel movement in her belly. This moment was the woman’s alone to experience, and she had the power to share her news or not. Women could withhold this information or adjust its timing in order to protect information about who the father was.

Gender reveal parties rely on a confusion over sex and gender. Photo courtesy of Kristin Ausk/Flickr.

In the Middle Ages, piss prophets used a combination of appeals to the divine and examination of a woman’s urine to create a precursor to the pregnancy test. But before there were ultrasounds and genetic testing, the sex of the baby was revealed only at birth. Of course, once people knew they were pregnant, they attempted to predict sex. Even today old wives’ tales endure, focusing on the position of the belly bump (low: boy) or the cravings a woman has (sweet things: girl) or how much morning sickness a woman experiences (more sick: girl).

Mystery accompanied fault-finding. Until recently women had limited legal power or autonomy over their bodies and shouldered blame for their child not meeting social expectations. During the Renaissance, the theory of maternal impressions warned that every thought a woman had affected an unborn baby. If a child was born with abnormalities, those were thought to have been caused by the mother’s thoughts. Some cultures believed that women were able to control the baby’s sex. Even today, women are still blamed for birthing the wrong gender, though we now understand that the baby’s sex is determined by the sperm.

The moment of birth for women often was—and still might be—a frightening reckoning with others’ expectations as well as a moment in which mysteries were solved. Would she produce the required heir? Would she produce the required sex? Would she even survive childbirth?

With scientific advances of the 20th century, the puzzling, worrisome, and solitary experience of pregnancy gave way to a glut of information, advice, images, and a new set of expectations. Some developments gave women control. The history of the pregnancy test shows how this technology allowed women to confirm pregnancy earlier than ever before and privately make decisions about it.

Scientific advances also meant more opportunities to connect with an unborn child. Fetal ultrasounds, originally used only to diagnose problem pregnancies, have become emotional occasions during which parents bond with their fetus and even discover its sex. Some parents pay for private 3D-ultrasound viewings solely so that they can look at their baby.

But the medicalization of pregnancy, which Robbie Davis-Floyd refers to as the technocratic model of birth, led to power shifts. Women actually lost control over their bodies as the people around them became fixated on the growth of their fetus. Machines and tests used by doctors replaced instinct and feedback from mothers to assess the progress of pregnancy.

Furthermore, expectant parents are expected to share ultrasound pictures with the rest of the world, even to upload them to social media sites like Facebook or to post online videos. Television programs use ultrasounds as a form of entertainment. Social pressures on women ask them to examine the air they breathe, monitor what they eat, and measure their levels of stress, all in the name of having a healthier fetus. While some of this research may lead to healthier babies, it also brings increased judgment of, and restrictions on, pregnant women.

The medicalized pregnancy has also become a commoditized one. Outside experts have come to dominate pregnancy advice. Hotels sell baby-making packages, gyms offer pregnancy yoga and massages, and an entire market is devoted to products supposedly educating the fetus in the womb.

Amidst all these pressures there has arisen a greater desire for rituals, like belly-bump photo sessions, belly tattoos, and elaborate baby showers. The months of pregnancy are now divided into smaller and smaller segments, each filled with invented customs.

The gender reveal party has become yet another ritual, and a way to retrieve the mysteries of pregnancy. If, during the age of the mysterious pregnancy, a pregnant woman had little power but much knowledge about her body—knowledge that others depended on her to reveal—gender reveal parties reclaim the privilege of revelation, along with some control. Parents can orchestrate these parties, choose their rituals, and plan for the future with the knowledge that they are likely to survive childbirth. The ritual includes birth partners, allowing them to share in this womb time, just as they expect to be involved in egalitarian parenting after the birth.

But the logic behind gender reveal parties contradicts many of our current sensibilities about gender. First, there’s the name: It should really be called a sex reveal party, since sex is a function of one’s DNA. These parties conflate sex and gender. As the French philosopher Simone de Beauvoir said, “One is not born, but rather becomes, a woman.” A person’s gender identity may not match the sex they were assigned at birth, and gender roles are culturally constructed notions.

Gender reveal parties thus contrast with recent progress in the United States, including more rights for transgender people and those who are gender-nonconforming. Many families today wish for unlimited possibilities for their children, regardless of sex or gender. Some parents intentionally choose names that do not signal male or female. They cheered when McDonald’s announced that it would stop asking children if they wanted a boy or girl toy with their Happy Meal. Some parents buy from fashion lines that market gender-neutral clothing for infants. A ritual that emphasizes the importance of sex or gender seems to go against such progress, especially with oddly anachronistic themes like “Little Man or Little Miss” and “Bows or Bowties.”

Moreover, the new ritual of the gender reveal party might offer women only pseudo-power. When others are brought into pregnancy—not only doctors and friends and relatives but also cake decorators and party planners—women cede control over what’s happening in their bodies. Projecting human attributes onto the fetus makes it easier to imagine that it is a baby at an earlier stage, which also shifts power away from a woman’s control of her own body.

Still, the desire to create new rituals surrounding birth makes sense to me. When we have constant information at our fingertips and share our innermost thoughts with others, the idea of having one aspect of life where we control the mystery and create suspense for others is seductive. The birth story I share with my daughter is special in part because it provides us with an origin story of our own. Humans need stories, myths, and rituals along with our neonatal vitamins and ultrasounds.

Once we’ve cut the cut the cake and publicly declared “It’s a girl” or “It’s a boy”—what do we want that to mean? What’s troubling about the gender reveal party is that it’s a new ritual that doesn’t take us forward. Rituals that recreate the mysteries of the past must remember the history of struggles for the hard-won freedoms and empowerment that came with them. A ritual that sexes and genders a person before they are born places limits rather than offers possibilities on who they may become.

The post What the Gender Reveal Fad Says About Modern Pregnancy appeared first on Zócalo Public Square.

I had been thinking about freezing my eggs for a long time. At 38, happily single with a career just starting to take off and a lot of travel in my immediate future, I knew I wasn’t ready to start a family. But since I want a child of my own some day, I figured now was the time to freeze my eggs.

Once I’d decided on the procedure, I told all of my close friends. At first I felt sheepish, as if the decision signaled that I had “given up” on finding a partner. The traditional model of an American woman’s path to happiness and a family, reinforced in movies and television, does not leave much room for deviation. It feels as if the options are black and white–either you follow the traditional path (love, marriage, baby) or you’re a spinster with cats.

Luckily everyone–my parents, friends, and colleagues–was incredibly supportive. My friend Briita even texted me emoji of hypodermic needles and chicken eggs.

After getting over the exorbitant cost–the biggest barrier to egg freezing–my greatest fear was giving myself the shots. I imagined maneuvering giant horse needles into my butt, jabbing backward into the skin like puncturing a watermelon with a bread knife. Instead, the needle I held in the Vegas hotel bathroom was shorter than my thumbnail, and slid into the skin of my abdomen nearly effortlessly.

When Briita invited me to join her for a weekend in Vegas, I almost didn’t go because it was going to be the first night of my injections. But I figured if I had to do them, Vegas would be as good a place as anywhere.

Briita and I discussed the procedure poolside, lounging in the warm desert sun. Glancing at my watch, I realized the two-hour window for the injection time, which started at 6 p.m., was approaching. Briita gave me the idea to commemorate my first one: a shot for a shot.

A waitress came over, and we considered what kind of liquid encouragement was appropriate for my first stab into motherhood. “A lemon drop shot,” said Briita.

The drink arrived in a plastic mini-Solo cup. The purist in me wanted a real shot glass, but this would do.

“Do you want me to go with you?” Briita asked, her voice dropping, the words coming out more slowly and carefully, as if she wanted to offer her help but wasn’t exactly sure of the protocol.

“No, it’s fine. I got this. I’ll text you if I need help.”

Drink in hand, I went up to our palatial hotel room and retrieved my box of Follistim cartridges from its minibar perch on top of tiny cans of Red Bull and Heineken. I meticulously went through all the prepping steps, watching and re-watching YouTube instructional videos produced by fertility clinics, which usually featured married white couples with the husband administering the shot. They zoomed in on weirdly manicured and disembodied hands dialing back the dosage on the injection pen as if it were a gold watch on QVC.

The unofficial videos on YouTube by regular people were far more relatable. If a woman sitting at her computer could slide a needle into a soft roll of fat while talking to a camera without skipping a beat, then I knew I could do it. These women talked frankly about their fertility, the challenges of IVF, and the unexpected side effects. There were women struggling with infertility wishing each other good luck and “baby dust,” message boards where you could find “cycling partners” who were on the same hormone schedule, and endless tips about how to make the shots easier.

Pumping the music out of my iPhone (I had built an injection playlist that included Bon Jovi’s “You Give Love a Bad Name” and LMFAO’s “Shots”), I laid out some paper towels on a “clean, flat surface,” sang along to the refrains, and giggled at every “shot” reference. Silly puns, it turns out, have great healing value. Aging, single motherhood, infertility, fear of dying alone—these issues are serious enough. When they’re coupled with a syringefest reminiscent of a scene from Pulp Fiction, you don’t need any more fear and trepidation. You need Pat Benatar, cranked up. There is something incredibly rewarding about drawing a deep breath, putting “Hit Me With Your Best Shot” on replay, and just getting it done.

I took a swig of the lemon drop shot with my left hand and steadied the needle with my right. I made two aborted attempts. And then I sank the needle into my belly, released the pinch of skin I was holding, and slowly pushed the medicine into my body. I counted to five, pulled out the needle, and began celebrating.

Las Vegas is such an impossible, unlikely place, a neon metropolis in the middle of the desert. Equally marvelous and unlikely is the technology that allows me to safely retrieve and freeze my eggs for future use, without a single incision. Because egg freezing only recently lost its “experimental” status and the success rates are not as well known as with embryo freezing, I decided to keep my options open and freeze both eggs and embryos. It feels a little bit like I’m living in a science fiction novel.

Now, a few months post-retrieval, I wonder when and how I will decide to use the eggs I’ve just nourished, protected, collected, and frozen. It’s possible I’ll meet someone and have children the traditional way. It’s possible I’ll marry in time for one child, but need to return to my frozen eggs for a second one. It’s possible I’ll decide to be a single mother, the way my mother was for many years. It’s possible I’ll adopt or decide not to have children at all, and be equally happy. But if I do have a daughter or son some day from the eggs I retrieved, I look forward to telling my child about the unexpected summer night in Vegas when it all started.

The post In Vitro in Vegas appeared first on Zócalo Public Square.

But there’s a more disturbing cost that you might be surprised to learn about that’s not even factored into those staggering numbers: fetal alcohol spectrum disorders, the conditions that can result when a mother drinks during pregnancy. (When all of the disorders are present, in their most severe forms, we call it fetal alcohol syndrome.) According to the U.S. Centers for Disease Control and Prevention, almost all of these children will have mental health problems as adults, and 82 percent will not live independently. During adolescence, they also face an increased risk of drug and alcohol addiction. As a result, the lifetime cost of providing services to just one person with fetal alcohol spectrum disorder in 2002 was about $2 million. And 40,000 children are born each year in the U.S. with the disorders.

While both of us will have a beer or glass of wine with friends, neither Mary Jane nor Mark’s wife had a drink of alcohol while pregnant. Our friends and our doctors, along with casual reading on the subject, had impressed on us the serious risks, and we decided it was not worth it. Only about 12.2 percent of pregnant women drink in the United States; however, in low- and middle-income countries, about double that number of women will drink during pregnancy.

The two of us really saw the visceral impact of fetal alcohol spectrum disorders when we started working on improving mothers’ and children’s lives in South Africa. Fetal alcohol spectrum disorder affects as many as one in 10 children entering first grade in South Africa, the highest reported rate in the world.

Up until the 1990s, black South Africans were partially paid for their work in fields with a “dop” or portion of wine. Drinking alcohol continues to be a part of the daily fabric of life in the townships—including brewing (and drinking) beer or spirits at home and visiting local bars known as “shebeens.” Alcohol is directly related to the high unemployment rates, especially for men in the townships–up to half of the young men are un- or under-employed over their lifetime.

The impacts of a mother drinking during pregnancy are not seen immediately. Brain damage slowly shows itself when the baby is small and fails to grow, speech comes late, colors are not learned by kindergarten, and school becomes a daily challenge. As we walked through informal settlements in Cape Town and Worcester–shacks without running water or flush toilets–we saw stunted and malnourished children playing outside all day long, many with the telltale signs of the disorder. Their faces feature foreshortened chins, thin upper lips, a flat midface, short nose, and low nasal bridge. We couldn’t help but think ahead to the problems these children will have in school and their increased likelihood for dropping out. Their futures evaporated before they had a chance to grow, because of what their mothers knowingly or unknowingly drank before they were even born.

About one in four pregnant women in South Africa drinks alcohol before recognizing she is pregnant. Without intervention, these same women drank much more throughout their pregnancy. Even though there has lately been much chatter about how the occasional glass of wine with dinner should be OK, there really is no known “safe” amount of alcohol to drink during pregnancy. There is also no known safe period to drink during pregnancy. Binge drinking is by far the worst thing to do while pregnant–large doses (even if infrequent) are far worse than a small amount of alcohol routinely. Unfortunately, among alcohol drinkers in America, one in four binge drink, typically on weekends. This includes women who knowingly or unknowingly binge drink while pregnant.

The variations in how and when people drink may be the reason we have not been able to eliminate the negative consequences of alcohol during pregnancy. While access to drugs is often limited in many parts of the world, alcohol is almost universally available, especially in low-income countries because it can be manufactured locally. Brief, one-time counseling sessions that focus on the vulnerability of a fetus during pregnancy can help mothers understand the risks and reduce their drinking while pregnant. At sessions we offered to expectant mothers in South Africa, the influence of alcohol on a developing brain is starkly demonstrated by cracking an egg in alcohol at room temperature: the egg poaches. A developing brain is cooked when alcohol is circulating through its body. However, most women worldwide do not have access to these interventions. Compounding the problem: local healers throughout the world often use alcohol-laced remedies to help their clients, including pregnant women, relax.

Here in the U.S., alcohol is embedded in almost all of our social rituals. Mary Jane’s parents in Los Angeles never drank, but they always had liquor to offer friends who came over for dinner. She does not know a male colleague who does not fancy himself a wine connoisseur and has been flabbergasted at the amount of money peers will spend on bottles of wine. Christmas, Passover, football tailgate parties, and practically all developmental milestones (graduations, childbirths, deaths) are marked with alcohol.

Given that alcohol permeates our lives–and every individual responds differently to alcohol–we have a responsibility to support one another and create a culture where “yes” is not the expected answer to the question: “Do you want a drink?” Genetic influence when it comes to alcohol abuse is real and scary. Some people are able to drink and never develop an addiction, while for others alcohol is a daily craving that is difficult to control. Previous attempts at controlling alcohol use that frame it as a question of willpower didn’t work. We need more community-level approaches with policies that augment the ones we already have: the minimum age of drinking, restriction of bars in the proximity of schools, demonstration of a legal I.D. in order to purchase alcohol, and punishment of bar owners who continue to serve intoxicated customers.

National rates of tobacco smoking decreased as a result of structural and policy changes, including higher tobacco taxes, bans on smoking in restaurants and workplaces, and limits on when and where tobacco can be bought. Alcohol use could be similarly regulated–through higher alcohol taxes, continued limits on buying liquor based on the time of day or day of the week, and limiting alcohol at sports events, especially collegiate sports, or at educational events and professional conferences. Changing social rituals–such as bringing alcohol to parties, celebrating major achievements with champagne, marking the end of a workweek by getting drunk–will take much longer to shift. Perhaps we could bring premium fruit juices to dinner parties instead.

In the next year, another 40,000 infants will be born with fetal alcohol spectrum disorders in the U.S. Following on the heels of Fetal Alcohol Spectrum Disorder Awareness Day earlier this month, we encourage you to make a personal pledge to watch out for yourself, your friends, and the people you encounter casually who may be at risk of creating a child with the disorder. The price to our children, our families, and our future is too high.

The post This is Your Child’s Brain on Alcohol appeared first on Zócalo Public Square.

If I were to get pregnant, I would know just where to go for help: the local offices of Women, Infants, and Children, the federally funded food and nutrition program; Planned Parenthood; and the Family Resource Center. All three are places where I stood in line for hours with my siblings as a child growing up in Watts. But finding local resources to pursue higher education is harder. As one of the few community college students living in Watts, I can’t find a place to print out an essay or get college-related advice.

When I ran into a friend who grew up in the same low-income housing development as I did, she said there was an easier way than to struggle through college. “You should get pregnant,” she told me. “Girl, the government will take care of you, trust me.”

I didn’t think much of her idea. But she was right about one thing: In my community, there are many resources for young parents, and barely any for college students. Just on my own block, I recently counted a total of five programs for mothers my age or younger.

This makes some sense. One in five births in Watts are to teen mothers—the highest rate of teen pregnancy in Los Angeles County, according to Luis Rivera, a program officer at First 5 LA, an agency that promotes early childhood education.

Because my friend has children, she qualifies for subsidized rent for a two- or three-bedroom apartment in our complex. You have to have a low income—and you have to have dependents—to live where we do. My friend also qualifies for a Section 8 voucher, under which the government pays up to 70 percent of her rent. To me, that would be like hitting the lottery. I live with my grandmother, who is going through chemotherapy—and if she passes away, I will likely be kicked out of our complex because I don’t have children.

I know these resources are needed for the survival of single-parent families living in poverty. My own mother heavily relied on government assistance to care for my six siblings and me. And when my mother is absent or in trouble, we live with her mother. Unfortunately, my grandmother has arthritis and diabetes (causing her to become blind), so it was difficult for her to get a job that paid enough to support herself and the five of us grandkids who live with her. My whole life has involved income-based housing assistance, food stamps, and donated clothes.

The trouble with assistance programs, as I’ve seen it, is that they reinforce a cycle of poverty without offering a way out for young people like myself who want to pursue higher education and a career—at least without having to get pregnant.

My grandmother has always emphasized the importance of a college education and helped as much as she could with my college search and application process—even though she did not go to college herself. According to census data compiled by the Los Angeles Times, 2.9 percent of residents in Watts age 25 and older have a four-year degree. Growing up, the only person I knew with a college degree in my neighborhood was my auntie, Janice Burns. I wanted to be just like her. She went to the local high school initially but transferred to a school in Carson at the suggestion of a school counselor who told her she would have a better chance of going on to college if she left. After obtaining her master’s degree from UCLA, my aunt reinforced my grandmother’s push for me to attend college. They decided that I would be more likely to reach college if I went to school out of the area. So I enrolled in a small charter school, Frederick Douglass Academy High School, more than 10 miles from our home. Although it took two hours on the bus to get to and from school, I loved attending a school that provided assistance for college-bound students, including a $500 scholarship upon graduation—something I wished my own local school provided.

Getting into Long Beach City College, where I now study sociology, was difficult; staying enrolled in college has been much harder. As a college student today, you need a computer and Internet. I didn’t have a computer, printer, or smartphone for my first year of college, so I had to wake up at 5 a.m. and travel over an hour away by bus to the college computer center to get an assignment finished before class. My neighborhood library, which is a five-minute walk from my house, has free Wi-Fi, which is great if you have a computer, but most community members do not. (I only got my laptop last year.) At the library, there are two outdated computers available to adults, each with a 15-minute time limit—not a lot of time if a person has an essay to type up, or needs to complete her federal student financial aid form, or wants to use the Internet to find places that actually offer assistance to college students.

A few blocks from my apartment, Thomas Riley High School offers one-on-one college and career counseling, and a mentoring program in conjunction with the University of Southern California and Cal State Dominguez Hills. I would take advantage of these resources—but they are not for me. Thomas Riley is “a learning community for pregnant and teen moms.” How are those of us who don’t have children and don’t want to get pregnant supposed to find our way?

I recently talked with a Southwest Community College student, Shanese Diamond, who is one of the few other people my age I know of in Watts who is attending college. Our experiences are similar. She was born to a teenage mother who participated in many government assistance programs—and she too believes that path would be easier. “If I had kids, I would be a qualified applicant for Section 8 and other welfare programs that are beneficial,” Shanese told me.

As I struggle through college, I wonder why there aren’t more resources to help me succeed, especially in an area with such a low rate of college graduates. The problem is obvious: As the Bill & Melinda Gates Foundation has pointed out, low-income students are 28 percent less likely to finish college than those in higher income brackets.

The simplest approach would be to extend existing programs for young mothers to students like me. For example, why couldn’t we provide Section 8 housing vouchers to college students in neighborhoods like mine? Make it so we can rent a decent one-bedroom apartment without having to work 40 hours a week, like I do at my janitorial job for a contractor at Los Angeles International Airport.

I wouldn’t mind if such benefits were tied to my grade-point average or academic progress—I’m for anything that will help me focus on schoolwork rather than on survival. To the same end, why not create a local center in my neighborhood that has computers and guidance counselors and doesn’t require being pregnant or having a kid to enter?

It sends the wrong message for safety-net programs to reward acts that delay college (such as having a baby, dropping out of high school, even committing a crime), rather than providing incentives to promote college enrollment and graduation. I worry that this bias in offerings is one reason why there are so few college graduates in my community. Assistance with housing and support for college goals would create an incentive for kids growing up in poverty to try to do better. And it would help young people like me complete school once we get there.

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A few years later I was pregnant with our second child, our daughter, when the physician’s assistant in my doctor’s office urged me to reconsider an amniocentesis test I’d just declined. “You don’t understand,” I remember her telling me in hushed tones. “You are a high-risk pregnancy for … chromosomal abnormalities. You are old.”

I was nearly 39. This time, my chart referred to my “advanced maternal age.” Fertility specialists had already warned me I’d nearly waited too long to have children. I’d seen that my risk of delivering a baby with Down syndrome, the chromosomal abnormality my PA was referring to, was now about one in 137, a far cry from the one in 1,667 odds I would have faced if I’d had a baby at 20, when my body was most ready.

Funny thing, though, no one, not my doctor, not the fertility specialists, not the worried physician’s assistant, ever mentioned my husband’s age, though he is seven years older. We all assumed he would be able to make healthy babies forever, just like those paragons of virility, Hugh Hefner, Larry King, and the late South Carolina Republican Senator Strom Thurmond, nicknamed by his staff “Sperm” Thurmond, all of whom fathered children well into their 70s.

Turns out, we may have all been wrong. Emerging science suggests that men, like women, have a biological clock: the older the father, the greater the risk of infertility and of passing on genetic mutations like autism, schizophrenia, bipolar disorder, and epilepsy. Which raises a tantalizing prospect: Could this knowledge begin to reverse the trend of people starting families later and later in life, alter the priorities of men and women alike, and reshape the way we all live and work?

In fairness, medical conditions like autism, schizophrenia, and even fertility are complex. The risk of genetic mutation shown by new studies is still relatively small. And social change usually comes in slow drips rather than sweeping revolutions, as a result of a host of factors converging at once. But that’s where this gets interesting. There are a host of factors converging now, from economic and demographic trends and rapid advances in technology to new studies on productivity and shifting social and gender norms. Throwing the pressure of a male biological clock into the mix could be just one more factor tipping the balance toward change.

But first, the science. New studies are finding that men not only experience the same decline in fertility that women do as they hit their mid-30s–a 35 year-old man has half the chance of fathering a child within one year as a 30-year-old–but that as men age, they face increasing risks of passing along genetic mutations that result in neurological disorders.

The latest news from a study of autism published in Nature hit like a bomb. Researchers found that while a 20-year-old father passes on an average of 25 new genetic mutations, a 40-year-old father passes on about 65 mutations.

The researchers linked their finding and the worldwide trend of fathers’ delayed childbearing to the “epidemic” of autism. (The Centers for Disease Control estimates one in 88 children in the United States has an autism spectrum disorder, an astounding 78 percent increase from 2000, when they first began tracking the disorder.)

Reaction to the news has ranged from widespread unease to a certain giddy schadenfreude among some feminist writers. At a neighborhood gathering, a friend who’d had his children later in life agonized about whether his children’s health problems were really all his fault–wracked by the kind of guilt that I’d only seen before in my women friends.

But rather than ask the larger questions about why men are delaying childbearing in the first place and whether that could change, some of the proposed solutions are to simply lean on technology: Bank your sperm for later use, advised an editorial accompanying the Nature study. “Freeze your eggs!” became the clarion call on the web and social media in the days after the report was released.

“That’s just nonsense,” said Dr. Harry Fisch, a fertility specialist in New York whose book, The Male Biological Clock, was largely ignored when it came out a few years ago. “It’s a Band-Aid. What we need is change. Economic change. Social change. Lifestyle change.”

If, as evolutionary biologists have argued, women choose older mates because they are better providers for their children, could the new science, coupled with the rise in education and earning power among young women, throw that old calculus off? What if financially independent women decided that taking fewer risks with their children’s DNA was worth more than a stable provider? Would we begin to see shifts toward more gender equity at home and at work?

“The age difference between a husband and wife is a big predictor of gender inequality,” said Philip Cohen, a sociologist at the University of Maryland, explaining that even a small difference in earnings affects how a family makes decisions like who should stay home with the children or dial back a career. And a man typically being older means he’s had more years in the workforce and higher earnings–not to mention that persistent wage gap. As a result, a majority of couples favor the man’s career, leaving the woman, even if she works outside the home, primarily responsible for organizing and doing the lion’s share of childrearing and housework. The age difference that contributes to this stubborn imbalance is a strong social norm that hasn’t budged, ever, Cohen said. “But if women have more options in the marriage market and don’t put the same emphasis on wealth and income and shift to biological virility … it’s interesting to think what could happen.”

In recent decades, the age of first marriage and the age of first births have been rising for both men and women. But men are delaying childbearing because women are delaying childbearing–as I did–in large part to finish their educations and get launched on careers. The workplace can be a punishing place for someone in her 20s with a lot to prove, and a management structure designed to make you work long and hard to prove it. Add to that a load of student loans to pay off, the desire for financial stability, and a prevailing philosophy that having children is a private responsibility which thus does not require social supports like paid parental leave and affordable childcare, and you have a perfect recipe for delay.

Working as a journalist in my 20s, I knew virtually no one who was taking time out to start families. We feared that once we fell off the steep and narrow career ladder we were climbing–which was harder for a woman to get on in the first place–we’d never be able to get back on. So we worked long hours well into our 30s. Aided by advances in contraception, we put off having kids until we couldn’t any longer without facing what Harvard economist Sylvia Ann Hewlett calls the “creeping non-choice.” And it wasn’t just professional women staring down their biological clocks. From 1970 to 2006, the proportion of first births to women 35 years and older increased nearly eight-fold.

By the time we could wait no longer, many of us needed the help of technology. Though advanced reproductive technology, or ART, has been around for a while, surveys show that most of us don’t realize that it can’t outsmart an aging body. In 2009, for instance, only 36 percent of all ART cycles resulted in a live birth. And most of those were to women under 35.

Delay means fewer babies altogether. The U.S. fertility rate has been dropping in recent years, with the steepest decline among men and women with some college education, to about 1.1, which is lower than the countries with a fertility “crisis” like Japan, Spain, and Italy, far below the 2.5 level for U.S. women with no high school education, and lower than the 2.1 level required to replace the population. Scandinavian countries like Sweden, where parenthood has also been delayed, actually have among the highest birth rates in the developed world, the result, said Indiana University sociologist Linda Haas, not only of supportive family policies, but flexible workplaces and a sweeping commitment to gender equity, which makes it easier for men and women to have both meaningful work and quality time at home.

The American workplace, meanwhile, is still designed to reward the kind of Ideal Worker who doesn’t exist anymore, if he ever did–a single breadwinner with no family responsibilities and no desire for a life, someone who is ready and willing to work 24/7 for 40 years straight.

Could a ticking male biological clock take on the Ideal Worker and reshape the workplace? Perhaps not on its own. Perhaps not anytime soon. But it could be part of a “cresting wave” of change, said Ellen Galinsky, who studies workforce trends and directs the Families and Work Institute. Galinsky has found in recent years that both men and women report they want more time for life and flexible hours, autonomy, and engagement at work. More men are reporting a desire to be involved fathers and feeling just as much or more conflict between work and home as women. Galinsky said some enlightened workplaces are responding to a shifting economy, aware that the most productive, creative, and healthy workers aren’t necessarily the ones with their butts glued to the chair in the office for 10 hours straight.

Younger workers with a less tethered vision of life (less tethered to one career, one office, to a landline phone) may be as powerful a force as any scientific evidence for rethinking how and at what age people balance work and family. Gen Y’s expectations for a more fluid workplace are pushing against old norms. “It’s very clear, if there’s any generational difference I see in our research, it’s that young people want whole lives,” Galinsky said.

Leslie Zaikis, herself a member of Gen Y, left corporate America to become one of the first employees at the start-up Levo League, a Gen Y networking site. She points to surveys that show Gen Y men and women value flexibility over pay, would rather be unemployed than work in a job they hate, expect to change jobs often, are willing to take risks, and expect to work within a more democratic organizational structure, one where giving their regular input to the CEO is not unheard of. They want to be passionate about the work they do, make an impact, Zaikis said, and, most importantly, have a life at the same time. Zaikis herself works flexible hours, taking time to train for half-marathons, and focuses on the quality of her work, not when and where she does it.

“Will there come a time when we do listen to our biological clocks and have children earlier? Yes,” she said. Both men and women in Gen Y are already eschewing “prestige” firms and instead seeking out start-up and tech companies with a “cool factor.” These companies, she said, have already begun emphasizing working smarter instead of valuing face-time and long hours.

In its research on workplace trends around the world, Accenture, the consulting firm, has found that both men and women in Gen Y have no plans to work themselves into the ground and to the nether edge of their fertility, like older generations–like me. Gen Y has “had it all before,” Richard Westphal, Accenture’s North America Talent Strategist wrote me in an email, “so they don’t see why it should be different at work.”

But change is hard. That point hit home when I ran into my friend’s son, 22 and just out of college. Ben hadn’t even heard the news about the male biological clock. And while he, like the rest of Gen Y, plans to have the kind of work that still allows him time to canoe and play the violin, having a child in his biological prime is the last thing on his mind. He has friends with close to $100,000 in student loan debt. They are struggling to find jobs. Once they find one, they don’t expect to stay in a job for long or anticipate a job with benefits like healthcare, much less paid parental leave or on-site childcare. Ben told me he looks at the cost of houses and wonders if he’ll ever be able to afford to buy one. And, a good student, he’d made particular note in a sociology class of the fact that raising a child to age 18 in the average middle-class family costs close to $300,000–with the childcare bill second only to rent or mortgage–not counting college. “I saw that and thought, ‘Oh crap, I’m not having kids any time soon,’” he said. So when could he see himself starting a family? He shrugged. “Before 40.”

In the end, I was lucky. I have two beautiful, healthy children. And I hope, as studies have found, that being an older parent has made me calmer, more patient, and able to spend more time with them. But I’d like to imagine that the future for them will be different, more forgiving, where choices about how to work and when or if to have children and how to share caring for them with their partners are real choices, not dictated by outdated workplace culture or social norms. I’d like to imagine that their career paths could look more like winding trails across a broad field with all sorts of interesting, rewarding, and profitable places to go at different times and at different paces rather than one narrow ladder to be scaled at full speed at any cost. I imagine them in smart workplaces that understand that people who live well, taking time for family or to go canoeing or to play the violin, actually do better work. Will the male biological clock be enough to get them there? We’ll see.

Brigid Schulte is a Schwartz Fellow at the New America Foundation and a Washington Post staff writer currently on leave to write Overwhelmed, a book on time pressure and modern families at work, at home and at play, to be published by Sarah Crichton Books/Farrar Straus and Giroux.

*Photo courtesy of Shutterstock.

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