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This last Remunerative Project required delving deeply into fertility rates across the U.S., the number of obstetric beds available on a state-to-state basis, labor & delivery reimbursement mechanisms (Medicaid vs. private insurance), and the omnipresent specter of malpractice insurance.

Childbirth has long operated as what you might call the American medical industry’s loss leader: The number one reason why people go into the hospital is to have babies, but hospitals consistently lose money on vaginal births (which I suspect is one of the unspoken reasons behind the ever-accelerating uptick in Caesarian numbers.)

This has led to a rash of labor and delivery unit closures in rural regions across the U.S.

Rural L&D unit closures is a major component of the U.S.’s piss-poor (for a developed nation) infant and post-partum-maternal mortality statistics.

Skyrocketing malpractice rates for OB/GYN docs and midwives play a role here, too. Which you can prove easily enough by the fact that L&D closures are less common in states that have enacted some sort of tort reform.

I find myself wondering what role the closure of L&D units in rural areas plays in the big demographic story of the 21st century and the last half of the 20th century, namely the wholescale exodus from rural America.

I don’t think I’ve ever read an analysis that links the two phenomena.

I’m half-tempted to call up Eleanor B., my Sister-in-Policy-Wonkitude, and suggest we do some sort of maverick economics paper on it.

But then I remind myself: Girlfriend, you write fiction now!!!

###

What else?

It was hideous and grey all day yesterday, so I couldn’t bring myself to go tromping.

Also, I overestimated my ability to metamorphose on the flip of a dime from Little Patty, Girl Economist to Patrizia, Authoress of Brilliant and Dazzling Novels, so I really couldn’t push the action forward on the Work in Progress in any meaningful way.

I did eat one of the milk chocolate turkeys I’d been saving to give to my kids on Thanksgiving.

I felt really guilty about that! So, I didn’t enjoy it.

I also watched the movie The Virgin Suicides, which I’d seen once long ago and hadn’t liked at all. I have no idea why I was moved to re-watch it, but I liked it quite a bit this time. Thought I’d rarely seen a film that captured the closed world of adolescent girls quite so perfectly.

Made me think I should try to reread the novel.

I did try to read Jeffrey Eugenides some time in my 20s. I absolutely hated him.

But I'm a big believer that there are some authors you just can’t read until you mature into them. I'm thinking Eugenides may be one. The film The Virgin Suicides uses voiceovers as a narrative technique and uses it quite successfully. The voiceover narration was lifted word-for-word from the novel, and I quite liked the words.
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