Managers ?= cleaners

Our lab is looking to hire a new lab manager, and it turns out that there are differing opinions on what a lab manager's job includes. Some lab members say that it is a lab manager's job to keep the lab clean, including (but not limited to) washing glassware that has been neglected in the sink, wiping down the lunch/conference table daily, tidying the tool bench, and cleaning shared lab benches. Others say that lab members should be responsible for these cleaning duties, and the highest priority in hiring should be administrative excellence.

There's a third way to look at it, which is that if your lab manager is young and inexperienced, cleaning comes with the turf; but if you have an experienced manager, best not to waste his/her valuable time on menial tasks. (Also perhaps an older, wiser lab manager knows how to get trainees to clean up after themselves?)

What say you? There's a poll on the right...

Defending the gates of Journal X

I recently served as a reviewer for a journal. This was the first time I myself had been asked to review, so I was both excited and a bit nervous. Would I have useful things to say? Would it be difficult to assess the paper's suitability for Journal X? After all, it's one thing to aid your advisor with a review, but it's another to be the only person evaluating the work.

The manuscript seemed to me to be a clear reject. And here was the funny thing: I had thought that in the event of a reject, I would feel righteous. Like I was defending the Journal from shoddiness. Like I was a bulwark against the frustrated feeling you have when you read a bad paper in a journal you respect.

Instead, I mostly felt sad for the authors, even though I don't know them. I kept twisting their data around in my head, trying to find a way they could revise the manuscript with just one or two experiments so that it would be publication-worthy. "What if....? Hm, no, that's still not going to cut it. Or perhaps...? No, that would turn it into a totally different manuscript." In place of righteousness, I felt regret that I could not rescue this effort from the reject pile.

I doubt any of this regret came through in my review, though.

-----

ps. Ten bucks says CPP tells me to sack up and quit having emotional responses to fuckwad manuscripts, amirite?

Birth part 2: the bit with the hollering

Into the birth center, where the midwife checks me out. Bad news. Small has a fetal arrhythmia--a hiccup in his heartbeat.

We'd known this was a possibility. He'd had the same hiccup at his last prenatal checkup, and though the midwives were pretty sure it was trivial--the sort of thing that often resolves at birth--we were scheduled for a fetal echocardiogram to make sure. But the echo doctor was out of town and couldn't see us until two days before the due date--and here we were, in labor five days earlier. The midwives had warned us that if the arrhythmia was present during labor, we would have to be in the labor and delivery ward, not the birth center, so I'd willed the hiccup to vanish before then. To no avail.

Ok, we'd known this was a possibility, so down to the L&D. Except, no. L&D had no rooms open. One room was being cleaned up, would be ready in twenty minutes. So, now tethered to the damn external fetal monitor and IV I'd hoped to avoid by being in the birth center, we waited.

Ever waited through a hospital's "twenty minutes"? Two hours passed. The contractions were strong; I was encumbered by the monitor, which slipped if I moved too much, and I felt unable to get up and move around. Sitting across the room, taunting me, was the lovely large hot tub I had been fantasizing about. Full of water, even. Our bathtub at home hadn't been deep enough to submerge my giant belly, and all I wanted in the world was to get into a deep hot tub.

But instead, there I sat with Dr Hyde, the doula, and intermittently the nurse and midwife on duty, waiting. It was like sitting on an airport tarmac. You can't open your laptop because you're not in the air yet. You can't fall asleep because you're anticipating take-off. You are penned into your little seat and aren't supposed to get up. And you wait.

I couldn't settle into labor--my body knew that we would be moving, any time now, and so it sort of went into withdrawal. Not that the contractions stopped! Ha ha, no. But they stopped accomplishing anything. The midwife said my cervix was only 4-5 cm, a crushing bit of news, since it'd been hours since my doula had said the same thing. I dozed a bit more, as did everyone else--I remember waking up for a contraction and being a little affronted that both Dr Hyde's and the doula's heads were lolling back in their chairs. If I am in pain you should be, I don't know, witnessing.

Finally, finally--now about 4 pm--we were moved down to L&D. It was 20 hours into labor, and I was exhausted and cranky. Still only 5 cm. Well if there's one good thing about being in L&D, it's DRUGS. And I wanted some, pronto. If I had to put up with hours of waiting and NO GODDMAN HOT TUB, I was sure as hell taking the one recourse available to me.

Doula D asked, "Do you want an epidural, or do you want a short-acting narcotic?" she asked. "Because if you have the narcotic and you want more, we can always go to the epidural, but once you have the epidural, you can't go back."

So I had a dose of the narcotic Nubain, and then another when the first wore off. It took the edge off the pain and made me quite sleepy--we were back to dozing between contractions. The sleep was good because I was so exhausted (the night before I went into labor I had slept uncharacteristically poorly, and obviously the night of labor hadn't been real restful either). All told, I spent four hours under the influence of Nubain, but alas, the labor made little progress--I was only at 5-6 cm. So that was the end of the Nubain (and you're not really supposed to take it late in labor anyhow due to its effects on the baby).

8:30 pm, 24 hours into this. How to get labor moving again? My midwife had an idea. "We're going to break your water, ok? And everything's going to get more intense--are you ready?"

I peered at her through the haze of pain and fatigue. She couldn't possibly be expecting a hearty assent, could she? I was already miserable, and she wanted me to say, "Yes, please make this worse"?? (Also, was there a choice?) I gave some sort of sullen acknowledgment that she had spoken, the way that as a teenager angry at my parents I knew better than to say "ARE YOU FUCKING KIDDING THAT'S A BAD IDEA" but still had to make clear that I was Not On Board with their plan of going to the farmers' market at 8 am or whatever.

So they broke my water. It felt as though my body was a bathtub and the drain had just been opened. "AAAAAAUUUUURRRRGGGGHHH," I said. In fact, from this point forward you should assume that I was saying something like that nearly nonstop unless otherwise specified.

I couldn't believe the volume of fluid I was disgorging. It felt like I was creating my own personal Slip 'n' Slide, and hurtling down it at Mach 2. Also, pain. The stage of labor from 7 to 10 cm is called "transition," which I now understand as meaning that you will "transition" from a comparatively normal adult in significant amounts of pain to a crazed animal unable to see straight.

The next couple of hours are pretty hazy. I was panting so shallowly that my blood oxygen kept dropping, necessitating yet another damn sensor, this one a finger clamp that monitored blood ox. Periodically someone would tell me that I needed to breathe more deeply to keep my oxygenation up, which never failed to puzzle me because I was breathing LIKE TWENTY TIMES A SECOND LIKE A GODDAMNED MOUSE so how could I be out of oxygen, but I cooperated nonetheless, or at least I think I did.

Time passed. Dr Hyde says that the nurses and midwives changed out the sopping wet bed pads underneath me, but all I remember is the sensation of my toes going squish underneath me whenever I moved. At some point I asked whether it was the pushing phase yet, and someone asked me if I felt like pushing. Instead I felt like dying, which made it difficult to assess much else.

"You're doing great!" the doulas kept telling me. This was so patently false that I was irritated. Pretty CLEARLY, I was hollering at full strength, ergo NOT SO GREAT. But this seemed so obvious that I hesitated to point it out.

10 cm! Only 2-ish hours after they'd broken my water. But a new problem: every time I pushed, the baby's heartrate dropped low. After a few rounds of this, my midwife announced that unless we could get the baby out within 45 minutes, she would have to call in the obstetrician for possible vacuum / forceps / Caesarean.

The doulas helped turn me around so I could hold onto the raised head of the bed for support as I knelt on the (still squishy) lower half, both to accelerate the process and in the hopes that a position shift would fix whatever was causing the rate drop. Still his heartrate decelerated when I pushed. My right leg was pulled up so I was half kneeling, half squatting. Still the heartrate dropped. They decided I should switch to left leg squatting, right leg kneeling. I had had about enough of this, and, in a brief moment of clarity and coherence, much as you might experience during severe drunkenness, said politely, "Actually, I'm ok like this."

They all laughed at me (in my memory, probably not in reality) and said, "It's not for you, it's for the baby!" FUCK THE BABY, I did not say, instead shifting my weight. Still Small's heartrate dropped during contractions.

So now the pressure was on to deliver the baby asap. My hollering had shifted to more of an "OWWWWW" sound. Doula S stood by my head, next to Dr Hyde. "Ouuut," she urged me. "Ouuut."

I could do that. I wasn't hollering OW, I was chanting a fucking mantra! "OWWWWWWWWWWTT," I said, enunciating the final T like I was in goddamn singing class. See? Not a cry of pain. A mantra. A mantra that could be heard two miles away.

I did some pushing. It wasn't apparently doing very much. Doula D uttered the following words of wisdom: "Are you feeling rectal pressure?" (YES OH YES) "Do whatever makes that pressure the strongest and most intense."

This was the clue I needed. What's more, it helped me focus on the sensation of pressure, as distinct from the pain. Delivering a baby I didn't know how to do, but pooping seemed (barely) within my competency. And that was exactly what it felt like--taking a 7 lb poop, with 8 or 10 people cheering me on (Small's arrhythmia and heartrate had brought an entire NICU team into the room on standby).

Within half an hour, Small had emerged, his hollering picking up where mine left off. The cord was wound around his neck and stomach, but not in such a way as to cause harm. And as soon as the doctors could listen to his heart--not a single arrhythmia to be found. He was as healthy as they come.

Oh but there's one last step! The delivery of the placenta. Pushing something else through my vag seemed like the worst idea anyone had ever had, and the midwife's cheery "Don't worry, the placenta has no bones!" was not in fact reassuring. If someone had offered me an epidural right then, with Small over on the warming table, I would have taken it. In fact I was contemplating requesting a Caesarean. But out it somehow went.

And then they brought over Small and he headed right for my breast as though he'd been doing it for years.

Query

Manuscripts sent out for review may state explicitly that the referee should destroy the manuscript after review. Presumably in this day and age, that would mean "delete the PDF." Does anybody actually do this?

Labor lasted 27 hours so you're damn right it's a two-part post

One tends to hear a lot about pregnancy--the morning sickness, the swollen feet, the constant bathroom trips--but much less about labor and birth. In part this is because birth is a private act, while pregnancy is performed publicly, but in part it is because falling birth rates and delayed childbearing reduce the exposure we have to women giving birth.

In academia, with its further fertility delays, these effects are exacerbated. I was in my late twenties before any of my close friends or relatives gave birth. At the time we got pregnant, I had perhaps heard more about the problems of fistula in impoverished African women (thanks, Nick Kristof!) than about the process of giving birth in upper middle class America.

After I gave birth, I discovered that many of my friends really wanted to know details, but they were sometimes reluctant to ask. Commonly, a group of labmates would hover until someone managed to ask the question--"Did you have an epidural?"--and then all heads would swivel, waiting for the answer. I think both the curiosity and the reluctance to ask are symptoms of how little many of us hear about this basic physiological process. Mainstream depictions tend to focus on the pain, often (e.g. Kirstie Alley movies) for comedic effect.

During pregnancy I found women's stories as reported in a few birthing books (Birthing From Within; Ina May's Guide to Childbirth) to be more helpful than the more clinical presentation of, say, What to Expect When You're Expecting, or the (truly awful) Your Week by Week Pregnancy. As Birthing From Within author Pam England puts it: Millions of women have given birth; how can there be only one right way to do it?

So here's my version, for Arlenna, for other pregnant readers, and frankly for anyone who would like a little demystification of this secret act. Consider it the happy finale to the IVF series.

The first surprise was that it was early. Conditioned by friends and relatives that first babies are generally late, I was expecting an early September arrival for our late August due date. (One nice benefit of IVF--you don't waste time speculating about the accuracy of the dating!) One week prior to the due date, I was happily planning an upcoming week of analysis. As I left work, my advisor called out, "It could be any day now!" and I laughed at him as I walked away.

So that night, while eating the zucchini, tomato, and pancetta pasta that Dr Hyde had prepared, I was nonplussed to feel some cramps. Unlike Braxton-Hicks, the painless if sometimes intense contractions that had been constant companions in the third trimester, these cramps were mildly painful, like minor menstrual cramps, and reached all the way around both belly and back. "Just early contractions," I thought, "probably irregular and will go away." Regular contractions spaced five minutes apart is considered the threshold for visiting the hospital, but most women start out with irregular contractions 10-15 minutes apart.

But after dinner, just to see, I started timing them. Six minutes from the start of one to the start of the next. Then six minutes for the next. Six minutes. And, hmm, six minutes. I called my doulas.

A doula is a woman who accompanies you throughout the process of labor and childbirth. Unlike a nurse, midwife, or doctor, she will not leave when the shift changes; nor will she (necessarily) participate in any medical evaluation or treatment. Her role is to support and encourage the laboring woman and her partner. A doula's presence significantly reduces the rate of Caesarean birth, epidural anaesthetic, prolonged infant hospitalization, rate of forceps/vacuum usage, length of labor, etc. etc. [1, 2, 3]. (Also, more breastfeeding [4].) In other words, doulas are good for women and babies.

Our hospital offers volunteer doulas, pending availability.However, I wanted to meet a doula ahead of time and make sure I liked her. How to find one?

There are websites where you can search for local doulas, but I found mine in an unorthodox manner. The woman sitting next to me on the bus one day had a bag with the name of a doulas' organization on it. I asked her about it and it turned out that she was not a doula, but had a friend who was. She put us in contact, and Dr Hyde and I went to interview her.

Doula S and her partner Doula D were so awesome that I decided not to interview anyone else. They were both midwives as well, so if I wanted to labor at home for a while before going to the hospital (which I did), they were qualified to evaluate my progress. Most important, they were clearly committed to helping me have the experience I wanted, and not imposing on me their vision of how labor "ought" to be.

During several prenatal visits they spent an hour or more answering our questions and asking us some too, to establish our preferences. Were we seeing a midwife or an obstetrician? How did I feel about epidurals and other forms of pain relief? What painful experiences had I had, and how had I handled them?

Eventually the plan we settled on was this: I switched from obstetric to midwifery care, once it was clear that the pregnancy was going normally. At our chosen hospital, this meant that I could labor in the midwife-run birth center, which has big tubs and is generally cozier than the standard OB-run labor & delivery ward. If at any point I decided to have an epidural, or if something was not going well with the labor, I would be transferred a couple of floors to the regular L&D. Also, with our doula/midwife help, I would labor at home for as long as I felt comfortable doing so. The idea was to delay an epidural as long as possible, and perhaps even avoid one.

Why this route? Epidurals typically provide pretty good pain relief, but they're not without drawbacks. Epidural anesthesia requires an additional IV line for fluids; in addition to the numbness produced by anesthesia, this keeps the woman tethered and less able to stand or change positions. Epidurals slow down labor and increase the chance of vacuum, forceps, and Caesarean deliveries. The greater risk of infection and fever increases the usage of antibiotics, and therefore the likelihood of thrush. A urinary catheter is also normally required, again with associated risk of infection, antibiotics, and thrush. (Why this emphasis on thrush? A woman in my breastfeeding group had it and said she'd rather go through labor a second time than have thrush, the pain was so bad.)

At the same time, I certainly wasn't ruling out the magic epi. The prospect of being in a lot of pain for 24 hours was daunting, to say the least. My philosophy was that I'd never given birth, nor even seen someone else do it, and that it would be presumptuous for me to declare ahead of time how things would go. The last thing I wanted was to set up an expectation of unmedicated childbirth that would make me feel like a failure if I chose an epidural after all.

So the official position was--default no epidural, try to use the hot tubs to get through it; but easy access to Plan B if and when I changed my mind.

After I let my doulas know that contractions had started, around 9 pm, we sprang into action. That is, Dr Hyde did the dishes and went to bed; I had a beer and went to bed in the guest room. The beer took the edge off and helped me relax, so I was able to doze between and even through the continuing contractions. Around 2 am I got up and took a lovely hot shower, which helped ease the pain a bit. An hour or two later, I decided that misery would like some company, and woke up Dr Hyde.

The next eight hours or so were not terribly unpleasant. I moved around the house, rocking during contractions and groaning or humming as the mood took me. The nice thing about much of labor is that the time between contractions is calm and painless. If you've ever hiked a steep mountainside, contractions are like the switchbacks, while the intervals are like the straightaways where you regain your breath and appreciate the scenery again.

Around 5 am Doula D came over, freeing Dr Hyde to go out for food. Midwives and doulas will usually encourage you to eat and drink in labor, on the theory that you need to keep your energy up over the long haul. Labor & delivery wards, by contrast, often have no-food policies. The concern is that a woman may require emergency Caesarean and that under general anesthesia she is at risk of aspirating her own vomit. Truly emergency Caesareans--the sort where you don't have time to put in an epidural/spinal catheter if there isn't already one in place, necessitating general anesthesia--are fairly rare (Wiki cites as 5% of all C-sections, so perhaps 1.5% of all deliveries in the US?) While it's understandable that the L&D ward wants to err on the safe side, in practice this means that the other 98.5% of laboring women are denied food.

I'm a good eater, and I get cranky fast if I don't eat for ~6 hours. So I knew I would want to eat during labor (another reason to labor at home or in the birth center, which permits this). Accordingly, Dr Hyde picked up some food, including, on my request, raisin bread. I don't know why I was intent on raisin bread. Normally I eat it perhaps twice a year. But raisin bread I demanded! Must have!

So throughout the labor, I snacked on eggs, fruit (cold grapes were a magical godsend--something about the high water content, mild sweetness, and ease of consumption--I ate them nonstop), peanut butter, and of course, raisin bread. This strategy worked well for me. Some women vomit during labor as a physiological reaction, whether to pain or some other aspect, but I noshed like the high-metabolism lady I am and it all stayed down.

Much of the morning (around 8 am - noon, 12-16 hours into labor) was spent in the bathtub. You enjoy a hot compress for muscle cramps? Labor is just like that, times 10. I grew bored in the bath, so Dr Hyde sat in the bathroom and read Harry Potter 7 to me. We were both rereading it at the time because we'd just seen the movie of HP6, and now I will forever associate Harry's peregrinations in search of the Elder Wand with labor. Occasionally I dozed between contractions, then made Dr Hyde reread whatever section I'd slept through.

At some point, my doula checked my cervix and said I was around 5 cm. I was pretty chuffed. "Halfway there," I thought, "and this is totally manageable. I am fantastic! I am champion!" Those of you who have been through labor, feel free to start laughing.

Around noon, I started feeling like I wanted to get to the hospital. Contractions were still livable, but I was starting to feel a shade of panic, an urge to be In The Place. We called the hospital to verify they had an open room in the birth center, packed up, and headed over.

to be continued