AI midwives are the future

The first official Cranky Dad post.

Dear Reader –

When we last talked, I was pouring my heart out as I held our newborn Anisa Marie Noorani in my arms. It was a magical moment.

Just over twelve weeks later, I am drinking chardonnay like a basketball housewife, holding Anisa in one hand, a vacuum cleaner in another, desperately trying to sooth a screaming baby. After nearly 50 years of no real responsibility, my transition to Cranky Dad has been seamless.

To be clear, I’m not cranky about being a Dad. That part is awesome. The world, writ large? So much to be cranky about.  

Therefore, just in time for the ChatGPT overlords to realize my frontal cortex wasn’t worth their time, I’ve started a Substack so I can share my latest take on fatherhood, life and otherwise. Of course, the fact there is no lack of lukewarm takes for you to waste time reading, let’s just think of this as some next level #ThoughtLeadership.

And an effort to raise money for Anisa’s college fund. Because, in 18 years, that shit is going to be expensive.

So, through this here note, I want to talk about some new topics (and some old ones), share what makes me less cranky and, along the way, continue to irritate you with my bad grammar.

Onward.

Ali

Will He, or Won’t He?

Whether or not Trump is indicted is not the question. By the time you read this, we may already know the answer. My real question is, will Trump incite political violence (again) or won’t he?

Based on his campaign rally in Waco, Texas, social media posts exhorting his followers to, “PROTEST, TAKE OUR NATION BACK!” and claims that “death & destruction” would ensue if he is arrested , the answer is pretty obvious. Trump – and those who echo, or at least tolerate, his message – will have no problem with a violent reaction to the enforcement of the law.

We aren’t paying attention to what this means. Adrienne LaFrance writes in The Atlantic, “Americans tend to underestimate political violence,” because we write off the violence we see – mass shootings, religious attacks, others – as apolitical. When, in fact, they are deeply political. We feel it is violence that happens “over there” between “those people.”  In reality, these acts of violence are products of an ever-deepening polarization in our society where one side hates the other. Agreeing to disagree no longer applies.

Among the factors driving affective polarization in the US are racial and religious identity, accelerated by economic conditions that create massive gaps in wealth. All of which are weaponized by political leaders complicit in the rising tide of violence.

Of course, the tool of choice for these leaders is digital media. In a recent paper, Petter Tornberg writes, “Digital media intensify polarization not as echo chambers but as a sorting machine,” that fuels affective polarization. “This suggests that the attempts of media platforms to reduce polarization by acting against echo chambers—algorithmically increasing exposure to opposing ideas—may backfire, instead resulting in intensified polarization and conflict.”

In other words, the more you see the “other side,” the more you hate them because your ingroup is a self-fulfilling feedback loop of disdain. It takes incredible courage to be a moderate in a room of extremists.

What worries me more is that Tornberg reached his conclusion long before the mainstreaming of ChatGPT -- and all that are the threats and opportunities of AI.

In my current neck of the woods, the prevailing assumption is that AI is a net positive for society. While I am no luddite that wants to unplug the internet (I have a Substack, after all), I have less than zero confidence we have any idea where AI is going to take our economy, much less our politics. In fact, as most of us whistle past the graveyard of our democracy, Gary Marcus points out that, Andrew Torba, the CEO of Gab, recently said “that his company is actively developing AI tools to ‘uphold a Christian worldview’ and fight ‘the censorship tools of the Regime.’” 

Which aligns with a recent report from the Public Religion Research Institute that found supporters of Christian nationalism “tend to support the idea of authoritarian leaders who are willing to break the rules.” And, “Christian nationalism adherents are nearly seven times as likely as Christian nationalism rejecters to support political violence.” Religion is combining with identity, amplified by racial and economic grievances, to harden lines.

There is no “bridge” to those who are ready and willing supporters of political violence and authoritarianism. They are using media, race and religion to grow their ranks. Therefore, we need to provide opportunities for ingroup moderates of conservative communities to break from extremism without losing their own identity.

In my new’ish job at the William and Flora Hewlett Foundation, these are the guideposts we are using to chart this direction.

An Ode to Midwives

The months before and after Anisa’s birth scared the crap out of me.

Not because I was worried about my daughter. Because, look, the entirety of the medical establishment is focused on the health of a baby. Blood tests and scans of said baby were a regular part of life throughout Toya’s pregnancy. And, at this point, all signs continue to point to a healthy baby girl.

So, sure, we were worried about Anisa, but I don’t think I was ever scared. On the other hand, every time I thought about Toya’s health, I was terrified.

Keep in mind we were – Toya was – doing everything by the book. She was eating well. Exercising. On a steady regiment of supplements. Toya went into the process as a healthy woman. And, despite being labeled by the medical community as a “geriatric pregnancy,” (FFS, people, think about the words you use) Toya was maintaining, if not improving, her health.  

For the first few months, I was confident. Given the way the health care system was watching out for our baby, I assumed Toya would receive the same level of attention. Even if women in the U.S. are the most likely to die from complications related to pregnancy or childbirth.

I figured that since we had good health insurance and were fortunate enough to have the wherewithal to seek extra care, Toya would be okay.

I overlooked one important fact: Toya is a Black woman.

Which meant that the CDC’s finding that, “Black women are three times more likely to die from a pregnancy-related cause than White women,” was no longer an abstract statistic.

But, “Again, Ali,” you say, “You are a family of professionals, enjoying a comfortable quality of life, based on a comfortable salary.”

Absolutely true. And every single day, I am deeply grateful for what we have.

Yet, in a study of two million California births, it was found that, “The richest Black mothers and their babies are twice as likely to die as the richest white mothers and their babies.” I found myself listening to Toya’s worries more intently. And, I never told her this, but I got scared.

Making all of this more complicated was the fact that at month five of the pregnancy, we were moving across the country. Leaving Toya’s friends and family, forcing us to figure out a new health care system to find a new set of providers, develop new relationships.

Toya was adamant that her pregnancy, her life, was not going to be left in the hands of a doctor who she probably had not met before wheeling into the delivery room. Through sheer persistence, she secured a spot with the midwife agency of her choice, Collective Birth. A group that included three of the six midwives in the region that had admitting privileges to the hospital of our choice – a facility that delivers more than 6,000 babies a year.

(That last sentence makes me so fucking cranky.)

It really makes no sense. The Commonwealth Fund found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care in terms of:

• Maternal and neonatal outcomes, including lower maternal mortality and morbidity and reduced stillbirths and preterm births.

• More efficient use of health system resources, including lower use of unnecessary and potentially harmful interventions like C-sections for low-risk deliveries, epidurals, and instrument-assisted births.

• Improved patient satisfaction and maternal psychosocial well-being outcomes, including those for postpartum depression.

While the Affordable Care Act requires Medicaid to pay for midwives, reimbursement by private insurers varies. For us, working with Collective Birth cost us just under five figures. As of this writing, our insurance (a generous plan) will reimburse one quarter of our out-of-pocket cost.

One effing quarter.

This type of care for women should be a guarantee, not a privilege.

From day one with Collective Birth, we realized this investment in Toya’s health was worth every single damn penny.

During our first visit, they noticed something fairly significant in Toya’s medical record the providers in DC had not noticed. Much less ever even mentioned. Because of the watchful eye of our midwives, we were able to track the issue throughout the pregnancy.

As reassuring the clinical care was, there was something more important: it was only the midwives who would ask Toya, “How are you doing?” Rarely was it a question that was asked in a clinical setting.

Everyone else treated Toya as a vehicle for the baby. And, as much as I love my daughter, my wife is not just a vehicle.

Somewhere, someplace, I am sure there is some tech-bro designing an AI Midwife. (Seriously, researchers are already asking.) I’ll bet you good money that insurance companies will cover that midwife.

Things That Make Me Less Cranky

We go to their casinos. We get angry professional sports teams have racist names. But, truly, it is amazing how little we understand modern day Native American life.

Then I came across the FX series, Reservation Dogs.

Tracking the lives of four kids growing up on a reservation in Oklahoma, Reservation Dogs, leans hard into every facet of their life. Native American culture, family dynamics, teen suicide. It is a show that honors, celebrates and finds the painful joy of being Native American – something David Treuer does a great job of in capturing the importance of the show in this piece.

It is a brilliant. I can’t wait for the next season.

Meanwhile, I finally got around to reading Heather McGhee’s “The Sum of Us.” Based on the historical fact that a massive number of public pools were filled in just to avoid desegregation, Heather makes the case that racism is bad – economically, socially, politically – for all of us.

Beyond the deep dives into the history of racism and the policy details, I appreciated the journalistic tone of Heather’s work. In fact, in a follow-on interview for the day job, Heather told me she conducted 400 interviews for this project. They are stories that bring the tragedy of racism to life, regardless of your race.

Finally, as some of you know the one thing that consistently makes me less cranky is cooking.

More on this in later posts, but I really dug this recipe for Cod in Sweet and Sour Pepper Sauce. Easy enough to put together quickly, complicated enough to feel like I was doing something.

I served it alongside my favorite potato dish, Pommes Anna.

Everyone was happy. And I was less cranky.