Wednesday, June 24, 2009

My Pregnancy Letter

Dear Friends, Family and Complete Strangers who will Feel Compelled to Accost me on the Street in the Next Nine Months,
  1. Yes, I am pregnant.
  2. No, it was not planned. But it does not follow that it is unwanted.
  3. No, I was not thrilled when I found out. As a point of fact, I was rather pissed off. But it does not follow that I unhappy about it now.
  4. No, I am not getting rid of the cats. End of discussion.
  5. Yes, we are discussing names. No, we are not going to tell you what they are.
  6. No I don't know what the gender of the alien is and I'm not interested in finding out.
  7. And while we are on the subject, I don't care if the alien is a boy or a girl. Really. I. DON'T. CARE.
  8. As a matter of fact, I do think it is funny to refer to the fetus as an alien. It certainly feels like one mentally and emotionally. Thanks for your concern.
  9. No, we are not planning on trying for “another on”. We didn't try for this one. Which is not done yet, so why the rush?
  10. No, I don't think I am being selfish by not giving the alien a sibling. I value my sanity far more than I value breeding a second alien to keep the first one company.
  11. Since you insist on pressing the issue, I'm getting my tubes tied. TMI? TDB!
  12. No, you may not touch me.
  13. Do I know you? Have we been introduced? No? Then take your hands off me, n.o.w.
  14. Yes, I intend to go back to work.
  15. Yes, the alien will be in day care since I am going back to work.
  16. Yes, I intend to bottle feed the alien at some point. Possibly with formula. Yes, I am aware that I am a horrible excuse for a mother and that the alien may turned out stupid, like me. With a Master's degree and a good job. If only all of us were so lucky.
  17. Yes, I am using a nurse midwife instead of an obstetrician. Yes, I do think they are qualified to take care of me. Did you know that my father, mother, younger brother, his wife, her mother, one of my aunts and her daughter (my cousin) are all nurses? Now you do.
  18. Yes, the alien will be vaccinated. Yes, I've heard about the autism study. Did you know that the results of that study have never been replicated and researchers have proven that some of data was manipulated? Manipulated as in falsified?
  19. I'm sorry that my (currently non-existent) birth plan does not meet with your expectations. Perhaps you would like to discuss your concerns with my midwife?
  20. No, I'm not giving up my study for the nursery. Have you seen how small the study is? Most walk-in closets are larger.
  21. What about guests? Couch, air mattress or hotel.
  22. No, I am not repainting the spare bedroom for the alien.
  23. Yes, I agree that I'm a horrible person for not wanting to put a theme to the alien's room.
I'm sure this list will get longer...

Thirteen Weeks and Thirty Six Years

The ultrasound and blood tests are complete. The hospital ignored my request for the quad screen and did the standard first trimester screening and took enough blood to fill seven vials. Naturally the tech had trouble finding the vein and spent several moments after sticking me moving the needle around, while it was in my arm. I closed my eyes, breathed very deeply and slowly and tried not to count the number of vials she will filling.*

I've decided, after a flush of irritation, not to push for the quad screen unless the midwives feel it is warranted. The ultrasound showed a healthy little alien with a fondness for moving it's hands and rolling over and over. The risk of Down's went from 1/150 to 1/1053 with the results of the blood tests. After weeks of saying to J, over and over, that whatever the outcome we will be OK, I have to start believing my own words.

Whatever the outcome, it will be OK. I said this to myself one morning, after dreaming about a labor that had gone wrong and that J and I were fighting over whose responsibility it was to raise the alien.

I'm amazed, maternity leave worries aside, at how supportive my employer and co-workers have been. One regularly asks me how I am feeling and passes on pieces of advice from his wife, a neonatal nurse. Others are planning on rotating out of their parking spots next winter, so I can ditch the bus and drive to work in late pregnancy without having to worry about finding a place to park. My supervisor tells me not to worry too much about work that I am missing for prenatal appointments – he knows I'll make it up.

I read about pregnancy, childbirth and child raising almost obsessively these days. Not about the mechanics, which I understand pretty well. I read about society's expectations of how pregnant women should behave. Irritating articles equating an occasional glass of wine during pregnancy and nursing with alcohol (and child) abuse. A compelling yet horrifying livejournal entry about an unassisted home birth, forwarded to me by a co-worker who was a friend of the writer. Compelling as the writer described the process of late labor vividly and beautifully. Horrifying as she hired an uncertified midwife who:
  • Did next to nothing to assist in the birth
  • Never checked to see if the writer was properly dilated for delivery
  • Told the writer to reach into herself and check if the umbilical cord was wrapped around the baby's neck
  • Mistook the sound of blood flowing through veins as a heartbeat on the doppler and told the writer she was going to deliver a twin
I found it very, very difficult to hold my judgement of the writer's choices. I've already has some backlash from a SIL over my decision to use certified nurse midwives instead of an OB. She had a considerable amount of trouble wrapping her head around the idea that doctors are not the only medical individuals qualified to deliver babies. And the fact that I intend to deliver in a birthing center confused her considerably.

But not knowing to check how far a laboring woman is dilating? An inability to tell the difference between a vein and a heartbeat? Really?

I turned thirty-six on Sunday. As far as birthdays go, it was not the most ideal day. J was sick and spent it sleeping. I spent it catching up on laundry, watching 80's movies on television and alternately feeling sorry for myself and telling myself to suck it up and be a grownup. J was sick, but friends left messages in my inbox and I received phone calls from both siblings, my parents and one friend living in Switzerland. The last was a special, completely unexpected and lovely treat.

*Seven and I have a lovely, streaky bruise on the inside of my right elbow to prove it.

Saturday, June 13, 2009

Welcome Back...

To Pittsburgh


Lord Stanley returns to the Steel City.

Wednesday, June 10, 2009

Ten Weeks

Notes from June 4 Prenatal Exam
  1. I am permitted (and encouraged) to read my chart on every visit. This was really surprising and gratifying.
  2. I spent 50 of the 60 minutes of the exam in my own clothes, just talking to the midwife, KM.
  3. I am permitted to do the following activities: ride my bike, swim, work out the ellipse and treadmill and work out with free weights and the weight machines.
  4. When I told KM about my history or depression, she wrote out a list of names of counselors near my place of work and requested that I develop a relationship with a therapist to aid me with my pregnancy and postpartum depression issues. She does not expect me to go every week or even every other week, but wants me to have the appropriate interventions in place in case I become severely depressed at any point.
  5. She found my friend B's suggestion that I take a prenatal yoga class as a tool for controlling the depression and anxiety “absolutely brilliant” and is almost requiring me to take the class.
  6. I can't say that I had a flood of motherly emotion upon hearing the heartbeat via the Doppler. It just confirmed the “walking science experiment” feeling I have been experiencing the past few weeks.
  7. My GP is the medical director of the center. As such, she will be routinely reviewing my chart. Talk about continuity of care.
  8. I have ideal nipples for nursing. I'm acutely aware of how much information I am giving away with that statement, but I found this to be the most hilarious part of the visit.
  9. I can ditch the foul prenatal vitamins and take one Flinstone's chewable a day instead. I can even ditch the chewable, but that would entail watching my diet more closely then I care to think about.
  10. I have to be very careful about the fish I eat.
  11. I felt 10 pounds lighter walking out of the office. The fact that I have been cleared for regular activity after being told I could not do any other exercise other than walk (by the nurse practitioner at my GP's office) has been a contributing factor to the depression and anxiety I am feeling. More so, I felt like they were caring for me as a person and not just as a vessel.
Genetic counseling, ultrasound and blood work (ugh) scheduled for June 15th. Which leads me into part 2 of this post.

I've been thinking a lot of the murder of Dr. George Tiller in the past ten days. I can't help thinking about it. The further I advance in this pregnancy, the more strenuously pro-choice I find myself coming. Primary because the decisions I am making are no longer in the abstract. I am no longer thinking about abortion as a theory, but as a necessary truth I may be forced to explore.

I find myself thinking in relentlessly, ruthlessly pragmatic tones, separating my emotions from what I might be seeing on the ultrasound and in test results in a couple of weeks. I find myself deeply examining my conscience, trying to parse out a complicated formula that will allow me to base decisions on what is instead of what might be.

On June 15th I will have a blood test called a Quad Screen and an nuchal fold ultrasound. The results of these tests will be used, along with my age and genetic history, to calculate the risk that the alien inside me is carrying markers for Trisomy 18 Syndrome, also known as Edward's Syndrome. Trisomy 18 causes severe developmental complications and 50% of the babies diagnosed carried to term are stillborn. Less than 10% survive past the first year.

These tests will not be able to tell me how specifically the alien will be affected, only the risk.

These tests are done between the 11th and 13th week of pregnancy. If the risk returns as high, I will be forced to make a painful decision.

[A] Wait until between the 15th and 18th week to have an amniocentesis to confirm whether the risk is real and learn the specific genetic abnormalities the alien may be manifesting. Test results take three weeks, which would put me in the 18th to 21st week range, right on the cusp of legality (24 weeks) for terminating a pregnancy. There is only 1 clinic in Pittsburgh who will terminate so late in the second trimester. Late termination is NOT the pleasant experience anti-choice paint it out to be. It takes multiple visits to a clinic and it painful. There are no clinics (to my knowledge) in Pennsylvania that will perform a third trimester termination, I would have to prove medical necessity and travel out of state to have the procedure done.

[B] Terminate early into the second trimester, without waiting to have the amnio done, taking the risk that I am terminating a healthy pregnancy. Still not a pleasant experience, but can be done in most clinics in a single visit. I'm also taking the risk of being disowned/ostracized by some family and friends for this decision.

[C] Do nothing and hope for the best. Risk the possibility of having no control over the medical decisions if the alien is born with defects that are incompatible with life.

The murder of George Tiller, the harassment of doctors, employees and patients at the clinics, all of these things have the cumulative affect of restricting women even further, and, ironically, putting women in the position of choosing [B] in situations where the fetus could be healthy as a way of avoiding making decision [A] further in pregnancy.

I think about these things. I think about how angry I get when I listen to someone who paints themselves as “pro-life” belittle women who have abortions because of mental health issues as women who just don't want to take care of a baby, as if the increased hormonal levels, the sickness, the bewildering sense that you are less than the fetus you are carrying, the fear of loss of job and support systems are a temporary state. Because that is ME they are talking about. That is ME who is trying so hard to get up every morning and get through the day.