Mango and Cash: Giving birth isn't what it used to be. Gone are the days when women were knocked out during labor while their husbands chain-smoked in the waiting room. Today's couples -- especially in hyper-health-conscious places like the East Bay -- want control over their labor and delivery. They download complex birth plans from any of a host of Web sites that have sprung up to service the contemporary culture of childbirth. The printouts that parents hand over to their doctors and nurses upon arrival outline a laundry list of delivery dos and don'ts, from the mundane (music and lighting) to the medical.
While some health practitioners welcome this parental involvement, others recoil at being im-pugned by doulas (birthing coaches) and having their medical expertise questioned at every contraction. Among the roughly eighty standard options listed by BirthPlan.com: "I would prefer to keep the number of vaginal exams to a minimum," "I do not wish to have continuous fetal monitoring unless it is required by the condition of the baby," and "I would like to hold the baby for at least fifteen minutes before [he/she] is photographed, examined."
"Some of the [requests] are kind of comical," says Dr. William Isenberg, an OB-GYN at Alta Bates Summit Medical Center for ten years and vice chair of his department. "They're so detailed: 'At three centimeters, I want mango candles burning and my Johnny Cash CD playing.'"
Others are contrary to good medical practice. "One patient of mine said, 'If by some chance I have a C-section, I want my husband to cut the umbilical cord,'" Isenberg recalls. "I had to say to them, 'You need to understand, unless your husband is a licensed obstetrician he cannot be over your opened abdomen.' And yet that request was downloaded word-for-word from a Web site."
Catering to increasingly demanding parents, hospitals such as Berkeley's Alta Bates have built spacious all-in-one labor, delivery, and recovery rooms equipped with bathtubs, and opened their facilities to private doulas and midwives. Still, says Berkeley-based doula Betsy Appell, a lot of local doctors still resist common maternal demands such as letting the umbilical cord pulse before clamping it, or allowing the woman to deliver in alternative positions (hands and knees, squatting). "Birth plans are only as good as they're supported," she says. "Sometimes they give them to the nurse and it goes into a file and no one pays attention." To ensure someone will, Appell recommends keeping the plan simple. "Don't clutter it up with 'I don't want a C-section.'"
Jeri Zukoski, a Berkeley midwife who's been on staff at Alta Bates for the past ten years, says she understands why some nurses are put off by elaborate birth plans. "People who come in with plans aren't focusing on trust," she says. Zukoski thinks a plan can be helpful, but doesn't encourage her patients to write anything up. "Just chill," she says. "When nurses know you have a midwife, they know you don't want [medical] intervention."
Dr. Isenberg says he understands the desire for noninterventional births, which he has seen increase over the last five years, but he also urges couples to be flexible. "Most of us think we can exert some control when we're the choreographers," he says. "But this is a natural process; you have to relinquish some control." -- Kathleen Richards
Rubber, Meet the Road: Eight years ago this August, employees of Silas Royster were clearing weeds on his 52-acre Tracy property when sparks, apparently from their gardening gear, set off a fire in the dry brush. The blaze was to become one of Northern California's biggest environmental fiascos in recent memory. Royster had been operating a vast illegal dump of between six million and eight million spent tires, which promptly ignited. Fire officials decided against dousing the burning rubber with water, since any runoff would further pollute the groundwater. Instead, they let that baby burn -- and burn. Two weeks, they figured. But the fire burned for nearly two and a half years before the authorities finally squelched the smoldering piles in December 2000. The subsequent cleanup reportedly cost in excess of $16 million. Days after the fire broke out, Royster was indicted on unrelated fraud charges. He then died a week later, fittingly enough, of lung cancer.
The legacy of this cautionary tale was a $1.75-per-new-tire state tax for a fund aimed in part at preventing such horrors in the future. On March 14, Fremont and Pittsburg each scored $175,000 of that cash for road repairs. Misuse of funds? Nah. These cities are where the rubber will become the road. The grants, sixteen of which the state's Integrated Waste Management Board has doled out to local governments, compel the recipients to use rubberized asphalt concrete, made with -- yep -- ground-up tires. The board, a unit of the state EPA, hopes that promoting this nifty mixture will create a final resting place for more of the estimated 34 million tires Californians trash each year -- about 8 million of which end up in illegal dumps.
The goal, board spokesman Lanny Clavecilla said, is to expand markets for scrap rubber and thereby create financial incentives against illegal dumping. "Presently the markets are limited," he said. "We're financing this and additional uses for waste tires -- levee reinforcement, speed bumps, playground surfaces, running tracks, athletic fields; it's a variety."
Highways made with retired tires may even prove cheaper. A two-inch layer of the rubberized asphalt replaces four inches of the conventional stuff at a savings of $47,110 per lane-mile, according to a calculation by the RAC Technology Center (RubberizedAsphalt.org). And each lane-mile of the newer product sucks roughly two thousand old tires out of the waste stream. The resulting road, the EPA reports, lasts longer, gives better traction in wet weather, retains its color, and cuts down on traffic noise. It's also crack-resistant, which should play well in Oakland and Richmond. -- Michael Mechanic
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