La parturiente et la marathonienne

La parturiente et la marathonienne

Texte de Rixa Freeze: Labor and Marathons

Traduction: Manon Wallenberger

Manon Wallenberger travaille comme berger et écrivain indépendant pour L'alpe, La revue Z et Zalp. Elle a vécu les joies d'une naissance naturelle il ya quelques mois et elle la faire encore!

Manon Wallenberger works as a shepherd and a free-lance writer for L'alpe, La revue Z and Zalp. She has been through the joys of a natural birth a few month ago and wants more of it!

I want to give a big thank-you to Manon for translating this essay! Je voudrais bien remercier Manon pour la traduction!

"Mike" Michael L. Baird

Avertissement : Si jamais quelqu’un a envie de poster un commentaire indigné pour dire qu’accoucher et courir un marathon ce n’est PAS la même chose, qu’il lise d’abord ceci. Evidemment que ce n’est pas pareil. Evidemment l’analogie ne fonctionne plus passé un certain stade. Je pense que la plus grande différence entre donner la vie et courir un marathon c’est qu’accoucher est quelque chose de que toute femme est capable de faire, alors que courir un marathon est, je l’admets, un sport d’endurance extrême.

Je me suis souvent demandé pourquoi on n’aborde pas la grossesse, l’accouchement et la naissance comme s’il s’agissait de courir un marathon. Les femmes enceintes sont confrontées à tant de peurs et de propos alarmistes : « Votre bébé pourrait être trop gros ou trop petit. Vous pourriez être atteinte d’une toxémie. Vous prenez trop de poids ou pas assez. Vous pourriez mourir d’une hémorragie. Vous avez peut-être le pelvis trop étroit. La tête de votre bébé pourrait rester coincée. Il pourrait être en détresse grave. Vous ne saurez probablement pas gérer la douleur, donc il faudrait envisager la péridurale. On ne vous donnera pas de médaille pour avoir accouché de manière non médicalisée. De toute façon tout ce qui compte c’est d’avoir un bébé en bonne santé. »

Et si nous abordions le marathon avec autant de pessimisme que nous le faisons lorsqu’il s’agit de l’enfantement ? Voici mon scenario imaginaire vécu par Anne, aspirante marathonienne.

Anne était assez en forme et capable de courir plusieurs kilomètres, à un rythme, certes, assez lent. Elle faisait du cross au lycée et aimait ça, même si elle était souvent une des dernières à franchir la ligne d’arrivée. Plusieurs amis qui avaient récemment couru des marathons lui en donnèrent l’idée : elle décida de s’y préparer.

Anne commença par se documenter sur la manière de réussir un marathon. Elle voulait trouver des calendriers d’entraînement, connaître les besoins nutritionnels des coureurs et avoir des conseils sur le choix des chaussures de course. Elle alla à la bibliothèque municipale qui avait une étagère pleine de livres portant tous sur les risques liés au marathon. Les différentes blessures dont les coureurs étaient souvent victimes étaient traitées en détail, alors que les réussites n’étaient abordées que succinctement. Les livres vous prévenaient bien que courir le marathon peut certes vous procurer un sentiment de force mais que la plupart des gens ne sont ni capables de s’astreindre à l’entrainement nécessaire ni de terminer la course. Les livres insistaient également sur l’énorme souffrance physique que les coureurs enduraient. Anne savait que des blessures pouvaient arriver et même si elle trouvait cette information intéressante, elle préférait en savoir plus sur la façon de les éviter en s’entrainant correctement, en faisant des étirements ou en modifiant son régime alimentaire. Elle avait aussi plutôt envie de lire des livres qui la motiveraient en partant du principe qu’on pouvait y arriver, plutôt que l’inverse.

Elle se dit qu’il devait bien y avoir quelque part des informations plus utiles, donc elle prit une chaise et s’installa face à l’ordinateur de la bibliothèque. Elle s’échina sur des pages et des pages de résultats avant de tomber sur une communauté de coureuses, peu nombreuses mais sachant se faire entendre, qui avaient réussi leur course et l’évoquaient avec ravissement. Leurs récits parlaient dans leur ensemble de triomphe, de confiance en soi et d’euphorie. Elles parlaient des heures de préparation mentale et physique, des recherches poussées qu’elles avaient faites pour s’assurer d’être parfaitement en forme, et pour trouver les moyens de prévenir les blessures classiques comme les fissures du tibia, ou les problèmes articulaires. Elles se soutenaient mutuellement lorsque l’une d’entre elles n’avait pas réussi à atteindre le temps qu’elle s’était fixée, ou lorsqu’un problème physique l’obligeait à s’arrêter en route. Elles s’encourageaient à mesure qu’approchait le jour de la course.

Anne accrocha son programme d’entraînement à plusieurs endroits de la maison afin de le voir tous les jours. Elle décida de rester positive, sachant que les meilleurs athlètes considèrent la préparation mentale aussi importante que l’entraînement physique. Chaque jour elle consacra du temps à la méditation et à la visualisation. Elle imaginait ce qu’elle ressentirait sur la ligne de départ, en attendant le coup de pistolet du starter. Elle visualisait son cœur qui cognait dans sa poitrine, son sang qui fournissait de l’oxygène à ses muscles, son souffle mesuré et régulier. Elle se répétait des affirmations positives comme : ce sera intense et parfois difficile, mais je sais que je peux le faire.

Quelques semaines plus tard l’entraînement d’Ann se déroulait bien. Elle avait sauté quelques jours, mais la plupart du temps elle atteignait ses objectifs quotidiens. Même si courir était parfois ennuyeux et pénible elle adorait les sensations que cela lui procurait après coup. Anne raconta à une amie qu’elle s’entraînait pour un marathon et fut surprise lorsque celle-ci lui raconta une foule de récits horribles sur des marathoniens qui souffraient à vie de leurs blessures- et même l’histoire d’un coureur qui avait bu tellement d’eau pendant la course qu’il en était mort. Anne répondit qu’elle s’était renseignée sur les blessures classiques ou plus rares, et qu’elle était sûre qu’elle pourrait soit les prévenir, soit se soigner toute seule, ou demander de l’aide si le cas était grave. Son amie lui dit : « mais comment peux-tu en être sure ? Tu pourrais mourir d’une attaque cardiaque pendant la course- tu n’aurais aucun moyen de le savoir avant que ça n’arrive. Ca ne vaut vraiment pas la peine de courir le risque. »

La famille d’Anne pensait qu’elle était folle. Ne devrait-elle pas employer son temps à une activité plus utile ? Et si quelque chose tournait mal ? Et si pendant la course elle avait trop mal et ne pouvait finir, comment se sentirait-elle ? Anne répondit à sa famille qu’elle s’était renseignée et que c’était une chose importante pour elle. Elle leur demanda soit de lui parler de sa future course de manière positive, soit de se taire.

Anne remarqua que les médias se concentraient toujours sur les récits à sensation de courses qui tournaient au drame. Lorsque des journaux télévisés couvraient un marathon, ils montraient des coureurs qui avançaient en boitillant avec des airs de morts-vivants. La plupart du temps ils n’interviewaient que des coureurs ayant abandonné la course, leur accordant plusieurs minutes à l’antenne pour raconter leurs récits. Puis, comme à regret, ils donnaient 30 secondes à un coureur à la mine ravie, malgré la fatigue et la sueur. Bien sûr, une fois que ce coureur là avait terminé son récit, le présentateur rappelait aux téléspectateurs que la plupart des gens sont incapables de courir un marathon et qu’il valait mieux faire taire ses espoirs. Bon sang, pensa Anne. Je connais pourtant plein de gens qui ont terminé la course sans mourir, se casser une jambe ou finir handicapés à vie.

Sans qu’elle sache trop comment- peut-être lorsqu’elle avait commandé quelques paires de ses baskets préférées- des entreprises qui sponsorisent les marathoniens se procurèrent son adresse. Tous les jours ou presque, elle trouvait dans sa boite aux lettres une nouvelle pub sur papier glacé pour « le marathon sans douleurs et sans efforts ». Le slogan d’une des entreprises était : « Nous faisons le boulot pour vous-il vous suffit d’être là pour la course. » Dans leur brochure Anne apprit que :

C’est un énorme travail de courir un marathon. La douleur est insoutenable. Les risques que représentent tant de kilomètres à parcourir sont nombreux. Pourquoi souffrir si vous pouvez le faire avec Indol™? Pour seulement 12 versements mensuels de 199 dollars vous pouvez terminer votre marathon confortablement et avec élégance dans notre véhicule motorisé breveté Indol™. Notre chauffeur vous récupèrera personnellement dès que vous aurez trop mal. Une fois installé dans le confort luxueux de votre siège-Couralaiz™, vous pourrez savourer le spectacle qu’on vous conduit jusqu’à la ligne d’arrivée. Vous recevrez une photo gratuite vous représentant en train de franchir la ligne d’arrivée à pied. Boissons non inclues. Les coureurs devront s’acquitter d’une somme de 10 dollars par kilomètre parcouru à pied. Vous en êtes dispensé si vous prenez l’option Couralaiz™ dans les 5 premiers km. Pour des raisons de responsabilité civile, l’option Couralaiz™ ne peut être souscrite ni pour les 4 premiers km ni après le 23ème.

Anne empilait ces publicités près de sa cheminée. Après ses longues courses du samedi, elle se faisait couler un bain bien chaud, allumait la cheminée et les jetait dans les flammes en observant les bords qui tournoyaient et se recroquevillaient. Elle imaginait ses peurs en train de fondre et de disparaître avec ces publicités luxueuses.

L’entraînement d’Anne se poursuivait. Elle aimait sentir son corps changer- voir ses cuisses se raffermir, sentir les articulations jouer entre chaque ensemble de muscles. Se préparer pour la course lui permit également de mieux apprécier une nourriture saine et nutritive. Son corps lui réclamait des protéines, des fruits frais, des légumes et des hydrates de carbone complexes. Elle mangeait des sucreries de temps en temps mais ne les appréciait plus autant qu’avant.

Plusieurs mois après avoir commencé son entraînement, Anne entendit parler avec inquiétude d’une nouvelle mode dans le monde du marathon : la fracture choisie (FC). Elle savait que les fractures liées au stress faisaient partie des blessures courantes dans le monde de la course, sans parler des fractures rares mais sévères liés à des chutes accidentelles. Apparemment certaines personnes vantaient un nouveau « traitement préventif » qui consistait à porter des moniteurs de fracture osseuse pendant la course. L’argument publicitaire pour ces moniteurs était qu’ils étaient censés prévenir la fracture avant qu’elle n’arrive. En utilisant les informations transmises par les moniteurs, des chirurgiens pouvaient alors finir de casser l’os avec soin (pour s’assurer d’avoir une fracture nette et franche) et de le réparer dans un environnement sécurisé. Les moniteurs étaient assez lourds, et causaient parfois des chutes chez les coureurs, entraînant des blessures importantes. Pourtant, elles étaient LE nouveau must dans le monde de la course où on les présentait comme « le filet de sécurité du coureur ». Un chirurgien vantait cette technologie qui rendait les os des jambes « plus solides que des neufs ». Le monde est-il devenu fou, se demanda Anne. L’idée que des gens pouvaient choisir de se faire casser des os avant même d’avoir un sérieux problème la dépassait complètement. Des flyers commençaient à arriver dans sa boite aux lettres décrivant la FS. Anne ne put s’empêcher de sourire lorsqu’elle découvrit qu’une de ces entreprises s’appelait FCMQN : fracture choisie, mieux que du neuf.

Alors que le jour de la course approchait, Anne était partagée entre la confiance et l’agitation. Elle savait qu’elle s’était bien préparée, mais elle n’avait encore jamais couru 42 km. Elle décida que si quelque chose tournait mal pendant la course et l’empêchait de finir, elle l’accepterait calmement, sachant qu’elle aurait fait tout ce qui était en son pouvoir pour réussir. Tous les jours, elle continuait à se projeter mentalement, s’imaginant à quel point il serait valorisant de terminer la course. Celle-ci finissait dans une vallée où coulait une rivière. Anne y allait souvent nager et savait qu’elle se sentirait incroyablement bien dans l’eau fraiche après l’effort. Elle garda en tête cette image d’elle-même allongée sur le dos, flottant dans l’eau claire, le corps suspendu entre le ciel et l’eau.

Le jour de la course, Anne fut surprise de la foule qu’il y’avait autour des tentes où s’inscrivaient les coureurs. Il y’avait quasiment autant de sponsors que de coureurs. Elle parla avec un coureur expérimenté qui lui dit que cela ne s’améliorerait pas, même après le départ de la course. Elle verrait des motards rouler à côté des coureurs en leur demandant de dire à quel point ils souffraient, et s’ils voulaient abandonner. Sur le trajet, des spectateurs brandiraient des panneaux où on pourrait lire :

• Il n’est jamais trop tard pour abandonner
• Ce n’est pas parce que tu finiras la course que tu auras une médaille
• Lâche ou crève

Alors qu’elles attendaient dans la file pour s’inscrire, une femme qui prenait aussi le départ et avait couru son premier marathon jusqu’au bout l’année précédente, lui donna un paquet. C’était un t-shirt avec le slogan : Zone de non drogue. « Tu vas en avoir besoin, lui dit-elle, surtout autour du km 35 lorsque les sponsors te tendront des cachets de morphine. Ils savent qu’il vaut mieux laisser tomber ceux qui portent ce t-shirt, ou alors ils vont se faire ramasser et à l’occasion se prendre un coup de poing bien placé ». Anne fit un large sourire.

Tout en faisant ses étirements, elle se concentra, visualisa les différentes étapes de la course et se répéta ses mantras : Je peux le faire. Je suis forte. Je suis prête.

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Home birth news and articles

The blog has been quieter than usual--not from a lack of things to write about, but from an overwhelming number of ideas spinning around in my mind. So it's time to condense. In this post, I'm including links and some brief excerpts from several articles and posts and news about home birth.

Judith Lothian's guest post at Science & Sensibility: “Being Safe”: Making the Decision to Have a Planned Home Birth discusses, among other things, her recent research on women's experiences of home birth in the US. She will present her findings at the 2009 Lamaze Conference in Orlando:

Many of the findings of the research surprised me. Women made their decision to have a planned home birth before becoming pregnant, early in the pregnancy, or sometimes as late as 30 weeks into the pregnancy. I was surprised that all of the women described themselves as “mainstream”. They all wanted a natural birth. All the women came to believe that “intervention intensive” maternity care increased risk for them and their babies. They valued the personal relationship with their midwife and believed that this relationship increased safety. They believed they could manage the work of labor more easily and more safely in their own homes. They all expressed confidence that a hospital and skilled physician care were available if needed. ‘Being Safe’ emerged as the theme that captured the essence of women’s decision to plan a home birth. In stark contrast to the current thinking, that birth is safer in hospitals under the care of an obstetrician, these women believe that giving birth at home is safer for them and their babies.

In a powerful way, the findings suggest that we need to look closely at the meaning of safety for women, and whether women and their babies are indeed safe in the current system.

Her findings are remarkably similar to the ones I and my coauthors found in our article Staying Home to Give Birth: Why Women in the United States Choose Home Birth. From the article's abstract:

The most common reasons given for wanting to birth at home were: 1) safety (n = 38); 2) avoidance of unnecessary medical interventions common in hospital births (n = 38); 3) previous negative hospital experience (n = 37); 4) more control (n = 35); and 5) comfortable, familiar environment (n = 30). Another dominant theme was women's trust in the birth process (n = 25). Women equated medical intervention with reduced safety and trusted their bodies' inherent ability to give birth without interference.

Jennifer Block wrote a fascinating and sometimes quite funny article about The Birth Wars: Who's Really Winning the Homebirth Debate? She argues that beyond the vitriolic insults that each side often hurls at each other (home birth is putting your baby at risk and is a selfish choice the mother makes just for "the experience" coming from one side and doctors and hospitals are evil places that injure mothers and babies just to make money coming from the other). She includes more about Melissa Cheyney's research and an example of birth telephone that Cheyney investigated that turned out to be totally fabricated. Cheyney commented:

What we found is that the animosity is so high between midwives and obstetricians that all kinds of rumors spread that are unsubstantiated. A woman and her midwife would transport for something relatively benign, and three or fourOBs away, the story was that the baby came in half-dead. You know that game Telephone? That's the folklore, that's what becomes the institutional memory.

Jennifer Block dedicated several paragraphs to explaining the Dr. Amy phenomenon. Sorry all you conspiracy theorists out there--Dr. Amy is in fact a real person, not an online avatar paid for by theACOG. Block explains Dr. Amy's mission and talks about her face-to-face meeting with her:

"The most important piece of information that every woman should know about homebirth is that all the existing scientific evidence to date shows that it has an increased risk of preventable neonatal death," she wrote on Slate.com. "Even the studies that claim to show thathomebirth is as safe as hospital birth, actually show the opposite." This is a typical Tuteur declarative. She has read the data and done her own calculations, and she believes a different number than the one that was peer-reviewed. This is usually challenged by several readers or activists, some of whom have been summoned like a volunteer fire department to respond. A "debate" then ensues, in whichTuteur charges that the study's authors are, simply, wrong. Then there's the name-calling. The researchers, which she often names, are "biased," pulling a "bait-and-switch," and women are falling for it. "I have written repeatedly about the fact that whilehomebirth advocates claim to be educated . . . they are easily duped because they lack the most basic knowledge about science, statistics and childbirth itself," she writes.

Then there's the name-calling. So omnipresent has Dr. Amy been on the boards that she began to take on a mythical status among the home birth community. Some activists believed she wasn't real, that her picture and bio were fake, that she was a mere avatar for some sort of undergroundACOG propaganda machine (rumors live on all sides).

But "Dr. Amy" is real. I sat with her, face to face, for nearly three hours at a Starbucks off Route 1 south of Boston a couple years ago. She is not a researcher, not an epidemiologist, and probably not onanyone's payroll; she is an obstetrician-gynecologist who left private practice more than a decade ago because, she told me, she'd had it withHMOs and wanted to spend more time with her four kids (she let her license lapse in 2003, according to the Massachusetts Board of Medicine). And for some reason, which I never quite got to the bottom of, she believes in every cell that Home Birth Kills Babies (that's in fact the title of her most recent post on her new site, The Skeptical OB), and no amount of research evidence will convince her otherwise.

And then there's the problem with the research. Because randomize controlled trials do not, and will not ever, exist for home birth vs. hospital birth, those opposed to home birth will continue to insist that the practice is not safe, despite the many observational studies that indicate it is likely a reasonable choice with many benefits for both mothers and babies:

...if the only research that will satisfy those with authority and power is research that is unfeasible, the controversy will never be resolved. There could be 20 more large, observational studies that come to the same conclusion as those that already exist, but they still wouldn't be randomized controlled trials. The home birth advocates would continue to say "The research proves it's safe!" and the American medical establishment would continue to say "The research isn't good enough!"

Jennifer Block also wrote another article Where's the Birth Plan? for RH Reality Check, arguing that incorporating midwifery care into the proposed national health care scheme would have both financial and health benefits.

Compared to healthy women who get standard obstetric care and deliver on high-tech labor and delivery wards, women with low-risk pregnancies who get care with a midwife and deliver in birth centers or even in their own homes, benefit from a five-fold decrease in the chance of a cesarean delivery, more success with breastfeeding, and less likelihood that their baby will be born too early or end up in intensive care. And all of this for a fraction of the cost of the statusquo.

A new economic analysis forecasts savings of $9.1 billion per year if 10 percent of women planned to deliver out of hospital with midwives. (Right now, just one percent do). If America is serious about reform, midwifery advocates are saying, "Hey, how about us?"

Childbirth has been compared to various other life experiences and situations, from running a marathon to having sex to going to the bathroom. In Restaurant Wars and Birth Wars, Sheridan of Enjoybirth analogizes birth choices, and the ACOG's opposition to home birth specifically, to the choice between eating out or cooking at home. I suspect her post is a response to Jennifer Block's article The Birth Wars. An excerpt:

Imagine the year is 2035. People rarely cook at home anymore for a few different reasons. They have gotten too busy and because of subsidies from the food industry eating at a restaurant is less expensive. They actually pay more out of pocket to eat at home. Many people look back and remember, “People actually prepared meals AT HOME! It is amazing that they were willing to go through all that time and energy and that so many survived.”

There are of course a few “natural” people who still eat at home. There is a renewed interest in examining this practice, when a celebrity makes a movie called The Business of Eating Out, examining the risks of doing so and reminding parents about the option of eating at home.

This next one isn't exactly news, but a Medline/Reuters recap of the recent Dutch home birth study. From Home Births Can Be as Safe as Hospital Births in Low-Risk Women:

Intrapartum death:
Home: 0.03% vs. Hospital: 0.04%
Intrapartum and neonatal death within 24 hours of birth:
Home: 0.05% vs. Hospital: 0.05%
Intrapartum and neonatal death within 7 days:
Home: 0.06% vs. Hospital: 0.07%
Neonatal admission to an intensive care unit:
Home: 0.17% vs. Hospital: 0.20%

Jill of Keyboard Revolutionary argues that we shouldn't have to say no when giving birth:

We have to write out a detailed birth plan, make our doctors read it, and then cross our fingers that they will actually listen to our wishes. We have to bring a "support person" or five to the hospital who are also well-versed in our birth plan to help us fight off the marauding staff....I often hear this in response to women who relate their tales of hospital birth trauma. "You can always say no. You should have said no." YOU SHOULDN'T HAVE TO. If you are in the "care" of someone that you need to threaten with lawsuits in order to make them listen, you need to take a step back and do some serious reevaluating.

Briefly noted:
Read about Cindy Crawford, Christy Turlington And Other Celebrity Homebirths
Sazz argues that outlawing home birth will hurt hospital birthers too and features a comment about losing normal birth skills

State & local home birth news:
Cleveland.com reports about Home delivery: Families opt to have children at home
Fort Wayne Journal Gazette: For some, life begins at home
News OK: Giving birth at home remains popular with many Oklahoma mothers
WCCO: Home Births On The Rise, But Are They Safe?
Colorado's 9News: Woman gives birth in her home - alone

From the UK
For the BBC, Cathy Warwick of the Royal College of Midwives recommends: 'Don't tell women how to give birth'
Also by Cathy Warwick for the Tribune: Seismic shift needed on homebirths
London Financial Times: Baby Talk

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Another marathon analogy

I just read the newest issue of the International Doula (Vol 15, Issue 2) and it had an article comparing laboring to marathon running, complete with a tongue-in-cheek description of race guidelines, including:

• Time limit on the race: if you don't run fast enough, you'll be driven directly to the finish line
• Mandatory IV for all runners; absolutely no eating and drinking
• Pain medications strongly encouraged, beds provided all along the race to rest because the meds make you sleepy (but you still have to keep up the minimum pace!)
• "Synthetic energy" if you're not running fast enough

Paula Holland. "Birth--The 'Marathon' of Life." International Doula 15.2 (2007): 14-17.

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Labor and marathons

Disclaimer: In case anyone feels inclined to post a huffy comment about how childbirth and marathon running are NOT the same in every respect, please read this. Of course they are not identical. Of course the analogy breaks down at a certain point. I think the biggest difference between birth and marathons is that birth is something within every woman's capability, while marathon running is admittedly an extreme endurance sport.

I’ve often wondered why we don’t approach pregnancy, labor, and birth like we do marathon running. Pregnant women encounter so much negativity and fear: your baby might be too big or too small. You might develop toxemia. You are gaining too much or too little weight. You might hemorrhage and die. Your pelvis might be too small. Your baby’s head might become trapped. Your baby might go into distress. You probably won’t be able to handle the pain so you should consider an epidural. You don’t get a medal for having an unmedicated birth. All that matters is a healthy baby anyway.

What if we were as pessimistic about marathon running as we are about childbirth? Here’s my imagined scenario for a hopeful marathon runner, Ann:

Ann was in reasonably good shape and could run several miles, although at a fairly slow pace. She ran cross-country in high school and enjoyed it, even though she was usually one of the last to finish. She was inspired by several friends who had recently run marathons and decided she’d prepare for one.

Ann started researching how to run a successful marathon. She wanted to find training schedules, nutritional requirements for runners, and advice on good running shoes. She went to her local public library, which had a shelf of books that focused on the risks of marathons. Most discussed in great detail the various injuries common to marathon runners and only included short segments about success stories. They warned that although marathons can be empowering, most people cannot successfully train for or complete them. The books also emphasized the tremendous amount of pain that marathon runners experience. Ann knew that certain injuries were possible and although she appreciated the information, she preferred to have more information about how to prevent the injuries in the first place through proper training, stretching, and nutrition. She also wanted to read books that motivated her and assumed success rather than failure.

She knew that there must be more useful information out there, so she pulled up a chair to the library’s computer. She waded through pages of results, but she finally stumbled upon a small but vocal community of marathon runners who had successfully completed the race and who raved about the experience. Their stories were generally ones of triumph, confidence, and exhilaration. They talked about the hours of mental and physical preparation, the extensive research they did into ensuring they were in top physical condition, and the ways to prevent common injuries such as shin splints or knee problems. They supported each other when a runner didn’t reach her desired time, or when physical problems forced her to drop out of the race. They cheered each other on as race day grew nearer.

Ann posted her training schedule around the house so she would see it every day. She decided to maintain a positive outlook, knowing that top athletes considered mental preparation as important as their physical training. She dedicated time every day to meditation and visualization. She imagined what it would feel like to line up, waiting for the gun to signal the beginning of the race. She visualized her heart beating strongly, her blood supplying oxygen to her muscles, her breath even and steady. She repeated positive affirmations to herself, such as “It will be exciting and hard at times but I know I can do it.”

A few weeks later, Ann’s training was going well. She had missed a few days, but usually accomplished her daily goals. While the running itself was sometimes tedious and uncomfortable, she loved how she felt afterwards. Ann mentioned to a friend that she was training for a marathon and was surprised when her friend told several horror stories of marathon runners who suffered lifelong injuries—even one about a runner who drank so much water that he died during the race. Ann replied that she had carefully researched both common and rare injuries and that she was sure that she could either prevent them, treat them herself, or seek help if something serious arose. Her friend said, “But how can you be sure? You might die of a heart attack while you are running—you’d have no way to know it’s going to happen until it is too late. It’s just not worth the risk.”

Ann’s family thought she was crazy. Shouldn’t she be doing something more useful with her time? What if something went wrong? What if during the race she is in too much pain and can’t finish—then how would she feel? Anne told her family that she had done her research and that it was an important goal. She asked that they either speak positively about her upcoming race, or that they refrain from saying anything at all.

Ann noticed that the media always focused on the sensational stories of marathon running turned ugly. When TV crews covered races, they showed runners limping along, looking like death warmed over. They usually interviewed runners who had to drop out, giving them several minutes to tell their stories. Then, almost as an afterthought, they would give 30 seconds to a successful runner who looked exhilarated, if a bit tired and sweaty. Of course, after that runner was done speaking, the TV host would remind the audience that most people cannot complete marathons and that it was best not to get your hopes up. Good grief, Ann thought. I know plenty of people who have completed the race without dying or breaking a leg or permanently injuring themselves.

Somehow—maybe it was when she ordered a few pairs of her favorite running shoes—marathon support companies got hold of Ann’s address. Almost every day her mailbox had a new glossy ad for “pain-free, effortless marathons.” One company’s slogan was: We do all the work—you just come along for the ridetm. Inside the brochure, Ann learned that:

Marathons are a lot of work. The pain is excruciating. The risks of running so many miles are numerous. Why suffer when you can do it the Pain-Fretm way? For only 12 monthly installments of $199 each, you can finish your marathon in comfort and style in our patented Pain-Fre(tm) motorized vehicle. Our chauffeur will personally pick you up as soon as you feel too much pain. Once you are settled in your EZE-Ridetm seat, you will enjoy the view in comfort and luxury as you are driven to the finish line. You will receive a complimentary photo of you crossing the finish line on foot. Beverages not included. Runners will be assessed a $10/mile fee for any miles they run themselves. The fee is waived if you take the EZE-Ridetm in the first 5 miles. Due to liability concerns, rides are not available the first 4 miles or after mile 23.

Ann stacked these fliers beside her fireplace. After her long runs on Saturday, she’d run a hot bath, start a fire, and toss the fliers into the flames, watching the edges curl and twist. She imagined all of her fears melting away with those glossy advertisements.

Ann’s training continued. She enjoyed her changing body—seeing her leg muscles become more toned, noticing the articulations of each muscle group. Preparing for the race also gave Ann a heightened appreciation for good, nutritious food. Her body craved proteins, fresh fruits and vegetables, and complex carbohydrates. She ate sweets every once in a while but no longer enjoyed them.

Several months into her training, Ann heard of a disturbing new trend in marathon running: elective bone breaking or EBB. She knew that stress fractures were a common injury among runners, not to mention the rare but drastic broken bones from accidental falls. Apparently some people were advocating a new “preventive treatment,” which consisted of wearing bone fracture monitors while running. The monitors were touted for being able to predict bone fractures. Using information from the monitors, surgeons could then carefully finish breaking the bone (to ensure a clean, even break) and repair it in a controlled setting. The monitors were quite heavy and occasionally caused runners to fall and suffer extensive injuries. However, they were the hot new thing in running, touted as “every runner’s safety net.” One surgeon promoted the new technology as making the leg bones “better than new.” Has the world gone mad? Ann wondered. Why anyone would choose to have their bones broken before a serious problem even developed was beyond her. Fliers started arriving in her mailbox describing EBB. Ann had to smile when one company named itself EBB—Even Better Bones.

As race day grew near, Ann experienced a mixture of confidence and trepidation. She knew she had prepared thoroughly for the race, but she had never run 26 miles before. She decided that if something “went wrong” during the race and kept her from finishing, she would accept it calmly, knowing that she had done everything to ensure success. She continued her daily visualizations, imagining how empowering it would be to finish. The race would end in a beautiful river valley. Ann often swam in the river and knew that the cool water would feel incredible after the race. She kept this image in her mind: lying on her back floating in the clear water, her body suspended between water and sky.

On race day, Ann was surprised how crowded it was around the registration tents. There were almost as many marathon support companies as there were runners. She talked to a seasoned runner who warned her that it was just as bad even when the running began. Motorcyclists would drive alongside runners, asking them how much pain they were in, if they would like to drop out. Bystanders would hold signs saying “It’s never too late to give up.” “Drop out or drop dead.” “You don’t get a medal for finishing.”

One of Ann’s running partners, who had finished her first marathon a year ago, handed Ann a package while they were standing in line to register. It was a t-shirt with the slogan Drug-Free Zone. “You’ll need it,” her friend said, “especially around mile 22 where the race’s sponsors are handing out morphine pills. They know better to stay away from people with these shirts on, otherwise they’ll get an earful and the occasional well-aimed punch.” Ann grinned.

While she stretched, she turned inward, visualizing the stages of the race and repeating her affirmations. I can do it. I am strong. I am ready.

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