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When Christine MacLellan arrived for her routine prenatal checkup at Saratoga Obstetrics & Gynecology Associates in Saratoga Springs in November 2001, her visit was anything but routine. Then four-and-a-half months pregnant and planning a vaginal birth, which had been encouraged and supported by her doctors after a cesarean five years earlier, MacLellan was told something she did not want to hear.

“I don’t know if you’ve been told yet, but we no longer offer VBACs [vaginal birth after cesarean]—so we’re looking at another cesarean,” said the physician assistant.

“I was shocked—stunned—because in the beginning of my pregnancy I received complete support from my doctors, and now, a 180-degree turn,” MacLellan said. “I just nodded and listened while the PA spoke to me. At that point I almost accepted that I’d have another cesarean—maybe I did accept it.”

MacLellan is one of many women in Saratoga County who are finding out that, if they had cesareans in the past, they will be forced to have major abdominal surgery to deliver their next babies, whether or not they need it. Glens Falls Hospital has stopped providing vaginal birth after cesarean, and Saratoga Hospital does so only on a limited basis: According to Ellen Kerness, manager of marketing and community relations, Saratoga Hospital has fewer VBACs now than before November 2001. So many women in Saratoga County who want vaginal births are forced to have repeat cesareans if they cannot find doctors and hospitals to support VBACs.

“I’d been so pleased up to then,” MacLellan said of Saratoga Obstetrics—especially with Drs. Karen Schick and Katja Bock, who performed her earlier cesarean when her daughter, Katherine, was breech.

In her cloud of shock, MacLellan remembers hearing the PA reveal that the changes in VBAC support had to do with Saratoga Hospital—she was told that the hospital does not have an anesthesiologist on premises at all times in case a patient should need an emergency cesarean, and that it is more of a risk than the hospital wanted to take on.

Late last year, Susan Parrillo also received unwanted news during her regular gynecologist appointment at Saratoga Obstetrics. The mother of two—Katie, 4, born by cesarean, and 1-year-old Drew, born vaginally—was told the practice no longer offered VBACs. If she wanted another baby vaginally, she would have to go to Albany Medical Center.

“I was horrified—in complete disbelief,” Parrillo said. “Having a cesarean was the worst surgery of my life, and I’ve had plenty. I didn’t heal properly, had an infection, and couldn’t lift my child or even breast-feed without pain for weeks.”

In contrast, her son’s vaginal birth, assisted by Dr. Peter Cole of Saratoga Obstetrics, was “very satisfying and positive,” Parrillo said. “Healing was amazingly wonderful. I was again rowing competitively four weeks later, something I couldn’t do for a year after my cesarean.”

MacLellan said that after she returned home from her prenatal appointment, she started thinking about the unpleasantness of the cesarean procedure, the long recovery period, and how she would take care of her daughter along with the new baby.

“The cesarean was nothing like TLC television portrayed it,” MacLellan said. “I wasn’t expecting to have my arms tied down and a curtain blocking my view. I like to see what’s going on. . . . And it was painful when they cleaned out my uterus around my rib cage.

“I didn’t enjoy the cesarean section, and I don’t expect labor to be pleasant either, but I’m looking at the big picture—shorter recovery time,” MacLellan added.

When Parrillo heard again and again that “it’s for your own safety not to have a VBAC,” she probed further; her research, she said, showed that cesareans are more risky to mothers and babies than VBACs. It made her raging mad, she said, that women were not being told the truth.

According to A Guide to Effective Care in Pregnancy and Childbirth, by Marc Keirse, Murray Enkin and others, “The rate of maternal death associated with cesarean section (approximately four per 10,000 births) is four times that associated with all types of vaginal birth (one per 10,000 births). . . . Most forms of maternal morbidity are higher with cesarean section than with vaginal birth.”

“Horrifying,” Parrillo said. “One more example for women—large establishments are taking our rights away. There has to be a way to fight the establishment, find a way to have a say about what happens to us.”

“I started chatting with girlfriends,” MacLellan said, “reading articles about cesareans and VBACs, searching for doctors and hospitals supporting vaginal births.” A girlfriend suggested Mondragon, McGrinder Medical Associates, a group of four doctors, a midwife and nurse practitioner with offices in Clifton Park and Schenectady. She also received good reports for Bellevue Woman’s Hospital near Schenectady; one of her friends gave birth there and loved it.

“The staff—very accommodating, offered to schedule a special VBAC class for my husband and me. They even have sibling classes for my daughter.”

“Statistically speaking, I have an 87-percent chance of having a successful vaginal birth after my cesarean since Katherine was breech,” MacLellan said. “However it goes, I’ve asserted myself and didn’t accept what I was told at face value. I hope this helps other women in my position to look into alternatives. I’m the consumer. If the doctor or the hospital doesn’t provide the service I want, I’m free to go to another provider.”

—Kathryn Mora

Kathryn Mora is a freelance writer living in Saratoga Springs.Big Business Beware—Little Brother Is Watching

Big Business Beware—Little Brother Is Watching

Will Waldron

As the new Corporate Flag of America waved in the wind (complete with corporate logos standing in for the stars representing the 50 states), a group of local activists convened outside of the Business Council of New York State’s Albany headquarters last Friday (April 5) to celebrate Big Business Day. The event, organized by Citizens Work, a new citizens’ group started by Ralph Nader, was part of a nationwide action against corporate abuse and power. Protesters addressed issues such as raising the state minimum wage, the Enron and Arthur Andersen scandals, campaign-finance reform and the increasing corporate ownership of the media.

Funding the Epidemic

Hundreds of advocates gather in Albany to demand more funding for AIDS and HIV programs, especially in minority communities

Will Waldron

Shirika Johnson, an African-American woman from Harlem, was just 31 when she was diagnosed with HIV. At the time, she was homeless, living on the streets of Manhattan.

“My life was not about being healthy,” said Johnson. “I was too worried about where my next meal was coming from and where I was going to sleep. Forget taking medication, forget showing up for doctor’s appointments, eating balanced meals, using protection or sleeping right. Inevitably, more people on the streets with HIV equals more infection rates.”

Johnson said that with the help of Harlem United Community Aids Center, she was slowly able to get her life back on track.

“In just three years, I was provided with affordable housing,” said Johnson. “I was given services that I needed to learn how to live a healthy life with HIV.”

But Johnson is concerned that other people living with HIV and AIDS will not have the same opportunity that she was given unless more funding is provided from the state Legislature for programs like Harlem United.

That’s why Johnson joined hundreds of HIV and AIDS advocates on the steps of the Legislative Office Building on Tuesday (April 9), to demand new state funding to fight AIDS in communities of color.

“It takes money to save lives,” said Soraya Elcock, deputy director for prevention at Harlem United. “People of color are disproportionately affected by HIV and AIDS. Eighty-three percent of all AIDS cases in New York state occur in communities of color, and that number has been on the rise all across the state.”

According to the U.S. Centers for Disease Control and Prevention, AIDS cases in New York state have increased by 58 percent just in the past year.

“More than eight out of 10 people with AIDS are people of color,” said Michael Kink, legislative council for Housing Works, a nonprofit AIDS service organization. “Yet there have not been adequate state resources directed at HIV and AIDS in these communities for the past 10 years.”

Kink said that the protesters gathered at the LOB on Tuesday would like $12.5 million in state funding to fight AIDS in communities of color, as well as full restoration of $17.9 million in funding cuts proposed in Gov. George Pataki’s executive budget.

The protesters came out in support of a $12 million initiative in the state Legislature put forth by the Black, Puerto Rican and Hispanic Legislative Caucus and the Assembly Puerto Rican/Hispanic Task Force. They also support a Minority AIDS Initiative in the Senate, sponsored by Sen. Kemp Hannon (R-C-I-Garden City), chair of the Senate Health Committee. The Senate’s initiative doesn’t yet have a price tag, but last year it pushed a proposal that included $500,000 for AIDS services in minority communities.

Kink said that every year since 1994, Pataki has proposed to cut millions of dollars in funding for AIDS in his executive budget. This year, the cuts include $7.9 million in AIDS Institute funding and $10 million in homeless-housing funds. However, each year, advocacy groups have been able to get that money restored in the budget. Still, advocates say that just keeping pace with last year’s funding will not keep pace with need.

“While there have not been cuts,” said Kink, “there has not been an increase in funding either. Yet the number of people infected with HIV continues to increase. We have nowhere near the resources we need to really fight the epidemic where it is today.”

Pataki spokesman Kevin Quinn told New York Newsday that, overall, the governor’s budget plan, including federal funds, will make $2.3 billion available to fight AIDS, making it, he said, “the highest level of funding in state history.”

But for the hundreds of protesters that gathered in Albany on Tuesday, that is simply not enough.

“I am angry because people are sick and dying and they are being forced to live on the streets because there is no money for affordable housing,” said Stanley Jackson, from Harlem. “The programs that save lives are the ones that are getting hit the hardest. The bottom line is, AIDS cuts kill.”

More than 800 people attended the protest, and 61 activists, including Assemblyman Roger Green (D-Brooklyn), were arrested on Tuesday for blocking the entranceway to the state Capitol.

—Nancy Guerin

I Saw U

FCC gives cell-phone companies until 2005 to equip cellular products with Global Positioning Satellite tracking devicesTracking devices once were a staple of old science- fiction and action movies. One typical scene: The good guy slaps a tracer on the villain’s getaway car and follows him—at a safe distance—to his lair for the final showdown. Or a team of leering, white-coated technicians forces a microchip-sized homing device into the hero’s brain cavity.

These days, such scenarios aren’t so fantastical. For blanketing the United States are 140 million human-tracking devices: cellular phones.

When you place a cellular phone call, your phone seeks out the nearest receiving tower, which serves a discrete area or “cell.” The tower routes the call to its destination. If you leave the cell area before your call ends, the call is bumped over to the corresponding cell tower, thereby tracking your rough location.

“Rough” is the operative word: While urban centers, which contain many cell towers, can relay your location with some accuracy, those odds go down in rural areas, where towers are fewer and cell service is often spotty.

But in the coming months, the tracking ability of cell phones will grow exponentially—not just in its power to monitor users, but also in the way it can be used for commercial gain.

Last year, the Federal Communications Commission ordered cellular companies to equip all new cell phones with Global Positioning Satellite tracking devices that can pinpoint a user’s location to within 300 feet, anywhere on the planet. The agency ordered the move at the behest of law enforcement agencies, who have long wished to be able to tell where 911 calls made on cell phones originate.

To a degree, cellular companies have reacted to the FCC’s order with distaste. The GPS chips will add about $20 to the cost of each phone, which often are given away free with cellular service plans.

But the companies are also rubbing their hands with glee at the potential profits. As regular Internet users know, marketers believe there’s money to be made from information about people’s daily activities and habits. Log on to a typical web site, and it may plant a “cookie”—a piece of code that identifies users—on your hard drive. With that information, web sites can track your surfing habits and tailor the content of advertisements accordingly.

Cell phone companies are aware of the potential backlash from consumers; a Verizon Wireless spokesperson told the technology news website CNET.com that it currently has no plans to release information about customers’ day-to-day whereabouts to commercial third parties. Still, none of the cell companies are saying they won’t try to use the information for their own purposes.

One way cell companies could profit is by selling advertising that would be displayed on cell phone screens. In the near future, your cell phone could turn into a miniature billboard, alerting you, for example, to nearby restaurants at lunchtime or to sales at the local mall.

This won’t happen overnight. Cellular companies have lobbied for and received a temporary stay from the FCC’s order to install the GPS chips, although that reprieve is set to expire later this year. The FCC ruling also allows companies to ease into compliance, giving them until 2005 to make all cell phones GPS-equipped.

But in the meantime, you’re not safe from cell-phone marketing: Some companies, such as marketers PangoNetworks, are already making use of today’s more limited location-tracking technology.

Pango sets up zones called “hot spots” within businesses or shopping malls. Hidden sensors can detect your phone or Palm Pilot, upon which the system hums into life, sending ads for merchandise you might be standing near and compiling data about your shopping habits: What stores have you visited? Did you linger near the wrinkle-free khakis or by the animatronic Hello Kitty display? Boxers or briefs?

On its corporate web site, Pango says users who don’t want to receive these messages will be able to program their phones to remain undetectable by the system.

Of course, at the rate things are going, true anonymity may soon be a thing of the past.

In fact, there’s only one foolproof way to beat the system: Turn off your phone. But how likely is that to happen?

—Chris Kanaracus

Chris Kanaracus can be reached at ckanaracus@newmassmedia.com. This story first appeared in the Valley Advocate (Easthampton, Mass.).

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