Friday, June 22, 2012
Tuesday, June 19, 2012
BESIDES being impossibly gorgeous mothers, what else do Christy Turlington, Karolina Kurkova and Gisele Bündchen have in common?
Each could probably afford to buy her own private wing at a hospital, but instead of going to a top-notch obstetrician, all chose a midwife to deliver their babies.
"When I met my midwife, her whole approach felt closer to home," said Ms. Turlington, who delivered both her children — Grace, 9, and Finn, 6 — with a midwife at St. Luke's-Roosevelt Hospital in New York, one with the help of an obstetrician because of complications. A former model, she founded Every Mother Counts, a nonprofit organization devoted to maternal health. "I knew I wanted a natural childbirth."
Are midwives becoming trendy, like juice cleanses and Tom's shoes? It seems that way, at least among certain well-dressed pockets of New York society, where midwifery is no longer seen as a weird, fringe practice favored by crunchy types, but as an enlightened, more natural choice for the famous and fashionable. "The perception of midwives has completely shifted," said Dr. Jacques Moritz, director of the gynecology division at St. Luke's-Roosevelt and a consulting obstetrician for three midwife practices. "It used to be just the hippies who wanted to go to midwives. Now it's the women in the red-bottom shoes."
And like any status symbol, a pecking order has emerged. Just as getting your toddler into the right preschool requires social maneuvering, getting into a boutique midwifery clinic has become competitive.
"We constantly have to turn women away," said Sylvie Blaustein, the founder of Midwifery of Manhattan, a practice on West 58th Street that has its share of well-heeled clients. Opened in 2003, the practice now has six midwives on staff. "Because of the quality of care, we can only deliver about 20 babies a month."
"It sounds bizarre," Ms. Blaustein added, "but midwifery has become quote-unquote trendy."
Like obstetricians, midwives are medically trained and licensed to deliver babies. The main practical difference is that only obstetricians can perform surgeries, including Caesarean sections, and oversee high-risk pregnancies. On the other hand, midwives tend to approach childbirth holistically, and more of them provide emotional as well as physical care. This can involve staying by a laboring mother's side for 12 or more hours and making house calls.
Nevertheless, misconceptions remain. "There will always be people who have no idea what we do — they think we're witches who perform séances and burn candles," said Barbara Sellars, who runsCBS Midwifery, a small practice in Manhattan's financial district. "Sure, some women want a hippie-dippy spiritual birth and I can't guarantee that. I can guarantee the quality of care."
Ms. Sellars is considered one of the more respected midwives in New York, and her patients have included opera singers, actresses, bankers and models like Ms. Turlington. (Disclosure: of the more than 1,850 babies that Ms. Sellars has delivered, my daughter was No. 1,727 and my son was No. 1,798.)
It was that high degree of care that led Kate Young, a stylist in New York, to seek out CBS Midwifery when she became pregnant with her son, Stellan, in 2008.
"My friends who had the best birth experiences all went to midwives," said Ms. Young, whose clients have included Natalie Portman and Rachel Weisz. "When you go to a doctor, you're left alone a lot. You don't have someone sitting there, looking you in the eye, getting you through it. When I thought about what I wanted for my child and how I wanted to have my child, every sign pointed to going to a midwife."
The rising popularity of midwifery among cosmopolitan women also coincides with larger cultural shifts toward all things natural, whether it's organic foods, raw diets or homeopathic remedies.
"Pregnancy is not a disease, it's a condition," said Dr. Moritz, whose own children were delivered by midwives. "We need fewer OB's and more midwives."
For other women, midwives offer a sense of control. "This is a time when women are asking more questions, getting healthy, wanting to be more empowered," said Ms. Kurkova, the 28-year-old model, who gave birth to her son, Tobin, in 2009. "I didn't want a hospital to take away my power. I didn't want to risk someone cutting me open and taking the baby out that way."
While midwife deliveries typically take place in the hospital, Ms. Kurkova is among those who have given birth at home.
"A home birth is more relaxed," said Miriam Schwarzschild, a home midwife for 25 years who lives in Brooklyn. "I wash my hands, listen to the baby's heartbeat, take the mother's vital signs and that's it. There are no routines. You step outside the bureaucracy at home."
A big selling point for midwives — both at home and in the hospital — is that, barring medical complications, the baby is not separated from the mother after the birth.
Another at-home advocate is Ms. Bündchen, who gave birth in 2010 to her son, Benjamin, in her Boston penthouse.
"We say Gisele delivered her own baby but I was in attendance," said Deborah Allen, a midwife in Cambridge, Mass., who, along with Mayra Calvette, a Brazilian midwife, was present at the birth. "Obviously, privacy is of the utmost importance. You are completely exposed. You need to be in a place where you feel comfortable to do that. Gisele was extremely prepared."
But not everyone is ready to go that route.
When Esther Haynes, deputy editor at Lucky Magazine, decided to go to a midwife, she quickly rejected an at-home birth. "This is New York, and if there was an emergency, I didn't want my story being, 'I called 911 and the ambulance took 45 minutes because of traffic!' " Ms. Haynes said.
"Also my apartment is kind of cluttered," she added. "I hated the thought of going into labor thinking, I wish I'd thrown out more magazines."
Monday, June 18, 2012
The report, in the Archives of Internal Medicine, is the largest yet to tease out the impact of loneliness on people in their later years. Geriatricians at the University of California, San Francisco, asked 1,604 adults age 60 and older how often they felt isolated or left out, or lacked companionship. The researchers were attempting to quantify the feeling of loneliness — a sense of not having meaningful contact with others, accompanied by painful distress.
Answers were recorded in 2002 and every two years after through 2008. The number of older adults who reported feeling lonely — just over 43 percent — didn't change significantly over that period, according to Dr. Carla Perissinotto, an assistant clinical professor at U.C.S.F. and the study's lead author. About 13 percent of older adults said they were often lonely, while 30 percent said loneliness was sometimes an issue.
What did change over the six-year period was the health status of elderly men and women who felt isolated and unhappy. By 2008, 24.8 percent of seniors in this group reported declines in their ability to perform the so-called activities of daily living — to bathe, dress, eat, toilet and get up from a chair or a bed on their own. Among those free of loneliness, only 12.5 percent reported such declines.
Lonely older adults also were 45 percent more likely to die than seniors who felt meaningfully connected with others, even after results were adjusted for factors like depression, socioeconomic status and existing health conditions.
The emphasis on meaningful connections goes to the heart of what loneliness is and is not. It is not the same thing as being alone: 62.5 percent of older adults who reported being lonely in this new study were married. Nor is it simply a paucity of social contacts. As has been observed many times, people can feel lonely even when surrounded by others if their interactions lack emotional depth and resonance.
Loneliness is about the way people experience relationships subjectively, not the number of relationships they have, expert say.
That isn't to say that the number of relationships, or what's known in the scientific literature as "social supports," isn't important. In fact, a large body of research has demonstrated that social supports are critical to older adults' health and well-being, as well as to their longevity. Instead, both social supports and loneliness are important, each separately, each in its own way, even as these components of older people's lives interact, Dr. Perissinotto said.
Barbara Dane, an 85-year-old jazz and blues singer who lives in Oakland, Calif., has seen this play out in her relationship circles.
"As you get older, you see the world writing you off," she said, adding, "So you tend to become passive and think, 'I don't want to bother anybody.' You lose contact with your own kind, your tribe. And before you know it, you're feeling bad."
"It's kind of life a self-fulfilling prophecy. Your eyes start to fasten on the sunset, and you start walking toward it."
An unanswered question is what explains the physical impact of loneliness on older adults. Andrew Steptoe, director of the Institute of Epidemiology and Health Care at University College, London, has been studying this subject. "There is growing evidence that both loneliness and social isolation are related to biological processes that may increase health risk, including changes in immune and inflammatory processes and disruption of the stress-related hormones," he wrote in an e-mail.
"Practical aspects of human contact may also be important," Mr. Steptoe continued. "Someone who lives alone may not have anyone around to call for help if they suddenly experience acute symptoms, while a lonely older person may not have others about them to remind or encourage them to take their medications or follow the doctor's advice."
A small study published last year in Psychology and Aging offers another clue. In that report, Anthony Ong, associate professor of human development at Cornell University, showed that the blood pressure of older people rises in reaction to some kinds of stress and that loneliness accentuates this response.
"Loneliness may be something that is particularly salient in later life, and we should design interventions that help screen for it," Mr. Ong said.
Short of that, reaching out more consistently to elderly friends, neighbors or relatives may help, Dr. Perissinotto said. "Sometimes for older people, just realizing that someone is listening and they're not being ignored makes a difference."