Wednesday, July 27, 2011

Natural Childbirth: Under the Skeptical Movement's Radar?

People in the skeptic movement are well acquainted with a great deal of common quackery due to articles in publications such as Skeptic Magazine, Skeptical Inquirer, bloggers such as Harriet Hall, the SkepDoc, and speakers at conferences like James Randi's Amazing Meeting. On topics of how irrational, anti-science thought impacts health, these skeptics-at-large regularly touch on homeopathy, anti-vaccine activists, chiropractic nonsense, acupuncture, detoxing, and even repressed memory.

But one rapidly growing and potentially dangerous trend in alternative medicine has largely been ignored by big name advocates of skepticism and skeptic organizations. In general, it is the natural childbirth movement, and specifically, the increasing popularity of homebirths.

Googling "natural childbirth skepticism" produces some revealing results. At the top is an article which is in fact skeptical of natural childbirth, although not published by any organization focused on the promotion of science and skeptical inquiry. It is Skepticism of the Natural Woman by Amanda Marcotte, published last year in Slate, and is a sassy, feminist counter to the idea that natural childbirth is better for women. The next two links are to articles posted in a blog called The Healthy Skeptic, which is in fact run by an acupuncturist who promotes a good deal of woo.

A search of Skeptic Magazine's archives for "natural childbirth" produced no relevant articles.

A search on of "natural childbirth" produced no entries on the practice and a search of "homebirth" produced only one story about a "homeopathic homebirth" buried under a number of examples of harm done by "occult, paranormal, pseudoscientific, and supernatural beliefs."

Nothing about Natural Childbirth made its way into Dr. Harriet Hall "the SkepDoc"'s 2009 article Top Ten Things You Should Know About Alternative Medicine and a search for "natural childbirth" and "homebirth" produces no entries on her blog.

In eight seasons of Bullshit!, Penn and Teller find room for whole episodes on lawns and cheerleaders, but the closest they ever got to criticizing natural childbirth was when they reached for the low-hanging fruit of dolphin-assisted birth.

I must give credit to Skeptical Inquirer. Searching their archives online, I was able to find one article on this subject: 'Natural' Childbirth by Ben Radford, published in the March/April 2006 issue.

The absence of much attention on the natural childbirth movement and increased advocacy and demand for homebirths in skeptic circles begs the question: is this actually something to be concerned about, or does natural childbirth have a sound basis in science and are homebirths just as safe as hospital births? After all, even the Wikipedia entry on natural childbirth makes no mention of any criticisms. So is there really a problem?

I would answer, skeptics should be concerned.

In 2009 I got pregnant and had a baby. What became an epic journey began at a prestigious but humongous hospital, moved to a small birth center, and ended up back at a large hospital. At the start I had lots of fear and few opinions or knowledge of pregnancy and birth, then decided to attempt a totally natural childbirth (efforts which included 24 hours of active labor with no pain killers), then had an epidural, a pitocin drip, and finally an emergency c-section. Involved were several obstetricians and other doctors, many certified nurse midwives, a couple of doulas, a psychologist, and an army of nurses. The long version of the story isn't necessary. Sufficed to say that I experienced almost every typical aspect of childbirth in America today.

Now I'm pregnant again, and the options are more complicated since I had a previous c-section. This and all that happened in 2009 has motivated me to learn as much as I can about childbirth, and it is during these inquiries that I have become fully aware of what has been dubbed by the media as the birth wars.

The birth wars have often been simplified as doctors verses midwives. In this simplification, obstetricians are painted as scientifically brilliant and competent, but also cold, selfish, and arrogant, and midwives are viewed as experts in transforming one of the most horrible experiences for pregnant women into one of the most wonderful, but also hit-and-miss as far as medical competency goes. Of course the truth is far more complex.

First, many of the criticisms of obstetricians coming from the "other side" of the birth wars are unfounded and incredibly insulting. The contentions include that obstetricians use pitocin to induce labor for the sake of their own convenience, that they discourage or refuse to offer VBAC (vaginal birth after c-section) out of personal fears of being sued and total disregard for what is best for the patient, and generally push for unnecessary c-sections because they like doing surgery and make more money that way. These accusations and more are frequently and casually expressed by advocates on the side of natural childbirth. They were expressed in Ricki Lake's film The Business of Being Born, and they come up over and over again in literature and websites advocating natural childbirth.

Midwives come in a several stripes, and can hardly be aligned as a whole group to one side in the birth wars. Many fall somewhere in the middle of a spectrum between the two sides. There are two basic types of midwife in America. Certified Nurse Midwives (CNMs) are trained and certified as both nurses and midwives. They most typically work in hospitals. They are part of and have a good reputation within the medical establishment. The other type is direct-entry midwives, who gain their experience through self study, apprenticeships, or midwifery programs. They most frequently work in homebirth settings. Some direct-entry are Certified Professional Midwives (CPMs), certified by the North American Registry of Midwives. Others are merely licensed in a particular state, and still others are lay midwives. As one can imagine, direct-entry midwives level of training, experience, and competency can vary widely. Whenever horror stories of homebirths gone wrong appear in the news, the midwife involved is a Direct-entry midwife.

While most midwives tend to advocate natural childbirth to some degree, CNMs tend to be more knowledgeable and concerned with risk factors that might disqualify a woman from attempting totally natural childbirth.

For example, the Birth Center I went through will not accept clients who are VBAC, over a certain age or weight, pregnant with multiples, and many other risk factors. Women in labor had transfer to the hospital across the street if any complications ensued. Roughly 20% of the Birth Center's clients end up giving birth at the hospital, and 10% end up having a c-section. I was in that 10%.

I never had any doubts about the care I received at the Birth Center. All the midwives were experienced CNMs. I was required to have blood tests for various risks such as parvovirus B19. 24 hours after my water broke we promptly packed up and went to the hospital. After many hours of excruciatingly painful contractions, a midwife was the one to strongly recommend an epidural so that I could relax, rest, and have enough strength to push. And when it finally became apparent that a c-section was necessary, a midwife stood side by side with the doctor, explaining the process and paperwork I was required to sign. Clearly this was a competent operation where the health of mother and child are paramount. Right?

In the case of my first pregnancy, yes, the Birth Center's approach was competent, totally appropriate, and ultimately successful. Any pregnancy that ends with a healthy baby and mother is a success. So here's the problem. This time around I'm no longer a totally low-risk candidate. When I found out I was pregnant again, I immediately called the Birth Center. I found out I couldn't have my second baby there, so I asked for recommended options. I was given a short list of CNMs who work at or with hospitals, which was great.

But then the person on the phone said, "I can also give you the names of midwives who do homebirths." What!? If it isn't considered safe enough for me to attempt VBAC at a top notch Birth Center across the street from a hospital, why the hell would it be safe for me to try it in my home that is a 20 minute car ride (not accounting for traffic) from the nearest hospital? If the Birth Center is responsible enough to not take on clients with higher risks, why would they be so irresponsible as to recommend alternatives which are even less safe? This is the influence of natural childbirth, a movement that is more motivated by crackpot theories and warm-and-fuzzy feelings than science and evidence.

Dr. Amy, the Skeptical OB, is a one-woman army at war with natural childbirth pseudoscience. In her article Is Natural Childbirth a Form of Quakery? she explains one characteristic of natural childbirth that might partially explain why it has managed to fly under the larger skeptical movement's radar:

"Unlike traditional pseudosciences (homeopathy, creationism) which have always denigrated scientific research, in the last decade, natural childbirth advocates have based the validity of their philosophy on the claim that it is supported by science while modern obstetrics is not."

Dr. Amy points out that the founder of natural childbirth, Grantly Dick-Read, was a white man whose ideas about childbirth are not rooted in any science, and whose writings and work were motivated by his concern that upper class white women were not having enough children to keep up with poor, black women.

Dr. Amy also writes frequently (and harshly) about "the mother of authentic midwifery", Ina May Gaskin. An article in Salon about Gaskin mentions her total lack of formal medical training, and more startling, the story of how one of her own children died during a natural childbirth that could have been prevented had it happened in a traditional medical setting.

Quotes from both Dick-Read and Gaskin, as well as quotes from other major proponents of natural childbirth are frought with bullshit, identifiable as such to any seasoned skeptic. Consider these:

"It is important to keep in mind that our bodies must work pretty well, or their wouldn't be so many humans on the planet." - Ina May Gaskin (Yeah, let's just ignore the fact that childbirth has always been a leading cause of death for women and babies. There's billions of people on earth, therefore childbirth must be inherently safe!)

"Women's bodies have near-perfect knowledge of childbirth; it's when their brains get involved that things can go wrong." -Peggy Vincent (Silly brains, always getting in the way.)
"I have personally come to believe that childbirth is a blessing to women sent straight from God. I mean, in its purest form, birth is the most fantastic orgasm married with a miracle! What more heavenly gift could there be?" -Laurie Annis Morgan (Yes, those pesky doctors are trying to take away the best orgasm of your life. And a miracle. Those bastards.)
But, hell, if pregnant women at low-risk for complications want to think of childbirth without painkillers as some kind of earth-shattering, mega-spiritual experience, let 'em. So long as the end result is a healthy mom and baby, it's all good. The problem arises when even women with greater risk factors and their midwives are so moved by the power and importance of having a natural childbirth experience that they don't take proper precautions and take necessary actions when complications ensue, putting both the woman and child in harm's way.
Let's get to the real meat of the debate. To put it most bluntly, will more babies die during homebirths than would have had they been delivered in hospitals? Many advocates of natural childbirth mention the United States's high c-section rate and connect it with the USA's realtively high infant mortality rate. Dr. Amy argues that infant mortality is the wrong statistic:

"It is a measure of pediatric care. That's because infant mortality is deaths from birth to one year of age. It includes accidents, sudden infant death syndrome, and childhood diseases.

The correct statistic for measuring obstetric care (according to the World Health Organization) is perinatal mortality. Perinatal mortality is death from 28 weeks of pregnancy to 28 days of life. Therefore it includes late stillbirths and deaths during labor.

The US has one of the lowest rates of perinatal mortality in the world."

She further points out that the Netherlands, which has the highest percentage of homebirths in the world, also has a higher perinatal morality rate than any other European country.

If she's correct, then the rising rate of homebirths in the United States should be as alarming as the anti-vaccine crowd. After all, both put the most vulnerable in our population at risk.

Why is this not an issue regularly raised by skeptics-at-large? Could this be the result of what PZ Myers calls The Woman Problem? Or is it that the natural childbirth movement has managed to convincingly appear "evidence-based"? Whatever the reason, it seems clear to this skeptic that there needs to be more skeptical critics of the pseudoscientific and dangerous aspects of natural childbirth.

Monday, July 25, 2011

Review of Battle Hymn of the Tiger Mother by Amy Chua

Battle Hymn of the Tiger Mother is a memoir about one determined, workaholic mother with a clear and, at least by modern day American standards, controversial method for parenting. Chua is shamelessly boastful about her two daughters' accomplishments and her prominent role in pushing for their success. This should immediately puts Chua in disfavor with many, such as those who put "My kid beat up your honor student" bumper stickers on their cars. (Ah, American anti-intellectualism! I've never seen a bumper sticker lashing out at those who celebrate athletic achievement.) Chua's daughters' successes, and the explanation of how they were achieved through endless hours of rigidly enforced study and practice, undoubtedly make many parents feel inadequate. Right off, Chua aims to prove that hard work produces results.

This is not to say that Chua believes or means to claim that her methods are ultimately superior. She wants to believe that Tiger Mothers are the best mothers, that's for sure. But she cannot help but also share with the reader, in sometimes humiliating detail, the stories of her lost battles, particularly with her younger daughter Lulu. Chua mocks herself with a rather dry wit that I suspect many of her critics do not get, but which seems quite apparent in passages such as this:

"After all those excruciating hours preparing for the Julliard audition, and then the food poisoning and the rejection letter, you'd think that I would have given Lulu a break. I probably should have. But that was two years ago, when I was much younger, and I didn't."

Chua is ruthless in her attacks on many aspects of "Western parenting" (a term she admittedly uses loosely, and which mainly refers to a rather hands-off approach to parenting that concerns itself primarily with maintaining high self-esteem in children.) This hardly means that she is uncritical of "Chinese parenting" (another term she says she uses very loosely, and which refers to an extremely controlling approach focused on measurable achievement such as high grades and prestigious awards.) Chua insists that "Chinese mothers" will settle for nothing less than their children being number one. This is obviously not possible in settings where there is more than one Chinese mother. Much of Chua's hyperbole is shaped by her being a Chinese-American woman, married to a white, Jewish man, living in America. Where she lives, she is alone in her Tiger Mother approach. She had good reason to believe her children could achieve the level of comparative success in school and in music that they did. However, proud she is of how she raises her daughters, she admits:

"The Chinese parenting approach is weakest when it comes to failure; it just doesn't tolerate that possibility. The Chinese model turns on achieving success. That's how the virtuous circle of confidence, hard work, and more success is generated."

Chua may call herself a "Chinese mother", but in reality she is more a product of competing cultural influences. This is no more clearly shown as by the relentless self-consciousness with which she identifies as a "Chinese mother". Real Chinese mothers (in other words, those who are embedded in that particular culture and society) are unlikely to think much about their identity as such. Why would they if they live in a place where they experience no resistance to their traditional way of doing things? Values such as upholding family honor, displaying utmost respect for authorities, emphasizing competition among children, and viewing childhood as a time for rigorous preparation for adulthood are simply taken for granted. Chua takes none of these for granted. Instead, she feels a deep desire to defend these not-very-Western ways of thinking, and even when her methods fail, she remains convinced of the traditional Chinese values behind them. This is likely to at least slightly disturb anyone who does not share Chua's values. I must admit that while I was profoundly moved by some scenes in the book, and at times felt I could relate, there were other times that I felt quite distant and cringed just because I don't think that way. But I refuse to condemn Chua for having different values from my own; that would go against my own value of pluralism. Also, another very Western value (that I happen to hold) is the idea that individuals should be true to themselves. When it comes down to it, that is what Amy Chua has done in her parenting approach.

Perhaps the reason I don't mind (and often even relish) how superior Chua feels about her method of parenting is because it's a refreshing change. I'm tired of how judgmental and self-righteous many modern, American parents can be about their approach to child-rearing, which puts so much emphasis on happiness and socialization, and so little on measurable achievement and the acquisition of knowledge. I have heard many, fellow parents express concern over whether their children will feel "normal" and "like they belong", and none express a concern that their children will be mediocre when they could be extraordinary.

I find it telling that the highly cherished quality of happiness, unlike academic skills, is particularly difficult to measure. Depending on a person's idea of happiness, he or she might give quite a range of answers to the question "How happy are you?"
And while some experts have found evidence of how happy Americans are, others report that we are trending toward unhappiness. Amy Chua ponders the question of it in her book, and comes to the conclusion that Western kids do not grow up any happier than Asian kids, and I tend to agree with her. The old cliche that money can't buy happiness is often repeated, however, some studies correlate greater income with greater overall satisfaction with life. And from my totally subjective point of view, I get an awesome feeling when I'm working hard on something, and I gain a deep sense of satisfaction from hard-won accomplishments. On the other hand, the areas of my life where I feel depressed are often connected with times when I feel I gave up or never tried for fear of failure.

For Chua, failure is never a consideration. You work your ass off and achieve. And when that's not enough to reach the goal, you work even harder until it is. Setbacks comes, but you don't let them destroy your confidence. It is an incredibly empowering mentality. It never occurs to Chua that her daughters do not have enough natural ability to get A's in every subject. Westerners, on the other hand, regularly come to conclusions such as "He/She is just not good at math" despite the fact that math is a subject where anyone can improve a great deal if they put enough time and effort into it. It doesn't mean that anyone can become a Pulitzer Prize winning mathematician, but certainly most children could get A's in public school math classes if they put the necessary effort into it.

I am reminded of my own experiences with math in school. In junior high I struggled with the subject, getting mostly C's on tests, and eventually was sent to "the van" for one-on-one tutoring. It felt humiliating to be sent to the van until I took my next test and earned an A. I felt an incredible surge of confidence and pride. Three years later as a junior in high school, I struggled again, and this time sought additional instruction from my math teacher after school. Again, my C's turned into A's. Having learned this lesson, in college math I put extra time and effort into homework and again saw a tutor outside of class, and again I achieved A's. It saddens me to think that many children probably never learn this lesson - that the secret to academic success is hours of study - because no one ever pushes them (and they never push themselves) hard enough to realize their potential. Instead, many people go around thinking that being smart is something people are born with.

Some have criticized Chua and parents like her have no meaningful appreciation for knowledge, no love of life, and are at their core motivated by a desire for riches. I notice that this criticism always comes from people who are themselves financially stable. While greed for its own sake is certainly a vice, the achievement of sufficient and stable means is what allows people enough freedom for political activism, art appreciation, hobbies, charity, and many other activities that can greatly enrich a person's experience of life. It might sound noble to say, "I don't care about money, I just want to be happy." But I notice that it is mostly middle class teenagers and college students who express such sentiments. People in their 30's or older, particularly those saddled with a mortgage, car payments, rising energy and food costs, health insurance and co-pays, student loans, and kids (or a desire to have kids but not the means to support them) tend to care a lot about money since they realize that not having enough definitely impedes on one's happiness.

There are two more criticisms of Chua's book that I tend to dismiss. The first is that she is exploiting stereotypes in order to sell a book. No doubt, the marketing of Chua's book emphasized the sensational and aimed to stir up controversy. How much of this is Chua's personal marketing strategy and how much is the publisher's is anyone's guess. To those with a more refined sensibility, these tactics and rhetoric come off as crass, even grotesque. However, that sort of marketing works. Those bloggers and columnists who have criticized Chua for such tactics have contributed to that system by giving her book even more exposure, and they have hypocritically benefited from that system by adding their own voice and name to the controversy. Sufficed to say, marketing is a dirty game, but it is one that anyone trying to sell anything must participate in. Are we really going to waste words criticizing Chua for being good at it?

The other criticism I dismiss is that her parenting approach is rooted in selfishness. The idea is that her only real motivation is bragging rights over her daughter's accomplishments. What a mean thing to assume about any parent! Chua herself deals with such accusations in the book, and with sharper wit than I can. To quote her:

"To be honest, I sometimes wonder if the question 'Who are you really doing this for?' should be asked of Western parents too. Sometimes I wake up in the morning dreading what I have to do and thinking how easy it would be to say, 'Sure Lulu, we can skip a day of violin practice.' Unlike my Western friends, I can never say, 'As much as it kills me, I just have to let my kids make their choices and follow their hearts. It's the hardest thing in the world, but I'm doing my best to hold back.' Then they get to have a glass of wine and go to yoga class, whereas I have to stay home and scream and have my kids hate me."

The fact is, there is no right way to parent. Different kids, within the same family, respond better or worse to radically different approaches, and it is impossible to predict what will be successful or disastrous with any given child. No parents, no matter how good their intentions, no matter how willing to sacrifice themselves, can avoid screwing their kids up, at least a little. I think a lot of modern parents agonize over this realization and the pressures of having to choose a single parenting approach. Many decide to take a very hands-off approach. And indeed, this approach works well for many children. But not all. Chua, quite consciously, chose the opposite approach of the total control-freak. It seems clear from her daughter Sophia's blog that her kids both love her and benefited from many aspects of such an upbringing. I'm sure she screwed them up some, but I doubt any more than the average kid.

There are those who view Chua as a hero and who take her book to be a parenting guidebook. I don't think those readers are paying close enough attention. The list on the back cover with the heading "How To Be A Tiger Mother" is a marketing hook. (Duh.) Chua makes it clear both in the book and in more lengthy interviews about the book that the "cruelty" toward her daughters described all took place and was understood within the highly personalized context of her immediate family. Chua trusted that her underlining love and respect would be assumed by her daughters. (Incidentally, she also describes frequently telling them she loves them and is so hard on them because she believes in their abilities. And when they make big achievements, she gives them praise.) Chua describes screaming, vicious arguments with Lulu, and then how minutes later they'd be cuddling and laughingly reenacting their fights to mock their own intensity. Not to give too much away, but when Lulu is in the early stages of adolescence, this pattern of fighting and easily making up starts to break down, and it is here and only here when Chua begins to pull back on her Tiger Mother approach. After getting to know Chua and her family in the earlier parts of the book, I found this narrative climax and its resolution both relieving and heart-breaking. In the end, it is clear that Chua has a strong bond with both of her daughters, and that she is not actually willing to drive them to hate her in any true or long-term sense.

I cringe at the idea of anyone reading this book as a guidebook and trying to superficially implement Chua's parenting methods. I suspect that being a Tiger Mother can only be successful when it is internalized through experience, and of course coupled with obvious feelings of love and respect for one's children.

Forget the controversy. Battle Hymn of the Tiger Mother is a memoir, a personal story, not a manifesto. One more voice in the ever-evolving discussion of how to raise children.

Thursday, July 21, 2011

Recipe: Spinach in Fruit Smoothies

Toddlers are notoriously picky eaters, and health-conscious parents often fret over the difficulty of getting our kids to eat enough fruits and vegetables. Some kids love just about any kind of fresh fruit, but others do not. I must have offered my daughter strawberries two dozen times before she finally tried some, and even now she'll only eat certain fresh, whole fruits, and only when she's in the mood. Vegetables, being more bitter in flavor and usually requiring cooking, are generally the most difficult type of food to get kids to eat enough of on a daily basis. I've found that constantly offering a wide variety of veggies (broccoli, carrots, green beans, sweet potatoes, and potatoes are favorites), steamed and topped with a little butter and salt will usually do the trick. I end up having to eat most of it myself, but I'm satisfied that as long as I keep offering it at lunch and dinner time, at least a couple servings a day end up in my kid's stomach. And it's not like it hurts to get more vegetables into my diet, too.

Smoothies are a super easy way to add whole fruit and some vegetables to a diet. Smoothies are far superior to fruit juice in that they contain less sugar and retain the fiber that helps fill us up, among having other health benefits.

A few years ago a friend of mine passed on a recipe for a smoothie that had been developed specifically to get a child to eat raw spinach. It was a complicated recipe that involved tofu, mango juice, and sweeteners. I tried it for myself, and it did taste fantastic. I have since experimented with simpler smoothie recipes. I've found that raw spinach can be added to just about any fruit smoothie, and it will not ruin the flavor - no sweeteners or exotic juices are necessary. These days I just throw together a smoothie based on whatever I happen to have on hand, but it occurs to me that I should start a collection of the most successful attempts. So here I present a much simpler version of the smoothie that got me started. Again, the taste of the spinach is so mild that it really gets lost, and the only evidence of its presence is the green color, which as you can tell from the photo, my kid doesn't mind one bit:

Mango Banana Spinach Smoothie

Blend together:
3/4 cup frozen mango
1 banana
1 cup loose raw spinach
1 cup water

Wednesday, July 13, 2011

The Samuel Jackson recording of Go The Fuck To Sleep

I finally got around to listening to the recording of Samuel L. Jackson reading Go The Fuck To Sleep:

When I first heard a clip from the recording on the radio, I reacted with simultaneous amusement and slight discomfort. The amusement was, of course, because the recording is hilarious. Jackson is a versatile voice talent, and so can effectively project a soothing tone for lines such as "The tiger reclines in the simmering jungle. The sparrow has silenced her cheep." and then switch to a convincing blend of pissed off and a little desperate daddy for the next lines, "Fuck your stuffed bear, I'm not getting you shit. Close yours eyes. Cut the crap. Sleep."

The slight discomfort comes from seeing yet another portrayal of an angry black man in mainstream media. I know, I know, I sound all "politically correct" even bringing it up, but anyone who questions the excess amount of images on magazine covers, album covers, newspapers, movies and television, billboards, etc. really isn't paying attention. Black men are disproportionately portrayed as violent criminals, womanizers, and bad fathers. So it is a little weird to have a book written by a white man and illustrated with images of a white child being read by an obviously black man. It is almost as if because people expect a black man to be pissed off, we're okay with one cursing out a child, and therefore we feel okay laughing about it. I keep imagining the text being read in other voices: an effeminate white guy, a gruff, slow, Southern drawl, a syrupy-sweet woman's, or maybe instead a sharp, nasally woman's voice. Would any of these be as funny to a general audience as Jackson's deep and sometimes reassuring, sometimes intimidating, and undeniably African American voice? I really don't know, I just wonder.

Similarly, novelist Amy Sohn questions whether a woman could have written Go The Fuck To Sleep and had it be just as successful. Just as people have become accustomed to the image of the angry black man, fathers are not expected to be as patient, attentive, and generous to their children as mothers. And just as I would argue that perhaps a general audience is more comfortable with a black man reading this book, Sohn argues that a general audience is more comfortable with man having written it.

Again, I don't know the answers to these questions. I suspect I'm in a tiny minority of people who tries to cultivate a personal awareness of how different groups of people are presented in media and how that might influence my own prejudices. I'm certainly not arguing that there is any conspiracy out there to get people to think of black men as angry. Stereotypes are usually perpetuated in a much more fluid and unconscious manner. I also don't want to develop an oversensitivity to negative stereotypes, to the point where I can't enjoy such a talented readings as this. Ironically, when I first heard of the book Go To Fuck To Sleep, in my mind I imagined a white, woman author, because I felt I could relate to the concept so well. The text of the story bobs back and forth between gentle and poetic coaxing and I'm-at-the-end-of-my-rope frustration. Boy is that familiar.

It isn't just that young children are often difficult to get to sleep. It is also that at the end of the day, working parents (and most parents work full time these days) are just plain exhausted. And no matter how much we love our little munchkins, everyone eventually runs out of patience. When I read Go The Fuck To Sleep or listen to the recording, I see myself reading The Runaway Bunny or Pajama Time! for the millionth time in a soft, yet expressive tone of voice, while deep in my mind I'm also screaming, "For the love of all that is good and decent in the world, just fucking nod off already so I can clean the kitchen!" In his reading, Jackson's tone conveys not only anger and frustration, but love. After all, if we didn't love them, we'd forgo the 38+ minute bedtime stories altogether and just lock them in their rooms screaming.