The "ick" factor

Last night, our Bradley instructor showed us a video of several births, some of which included episiotomies. A. had to turn away, while I could mostly watch it. I found that interesting, since I am extremely sensitive to gore and therefore refuse to watch many movies that A. would like to see. Afterwards he said he distinguishes clearly in his mind between real and fictional gore, and is only sensitive to the real. I guess I didn't learn that skill.

Thinking about it, I've decided that the Bradley instructor showing us a graphic episiotomy, blood and all, is not qualitatively different from the forced-birthers waving their bloody fetus pictures. Surgery is gross. I wouldn't want to watch an appendectomy, but that doesn't mean I would decline one if it were indicated.

I will still be doing what I can to avoid an episiotomy. On the basis of its merits, not its ick factor.

Fetuses as victims of violence

I didn't used to think much of Antonia Zerbisias. She started out as the Toronto Star's television reviewer. I'm not usually a television fan, so much of her work was uninteresting to me. And frankly, I thought of her as a bit of a lightweight. Then she started writing about weight loss, and women's relationships with their bodies. She was still relegated to what might be considered "fluffy" topics, but her analysis was good and often insightful. Now she's doing some serious opinion writing: Killings reopen debate on rights of fetuses. It's still, for some odd reason, in the Living section (if it were Rosie DiManno it would be in Opinion). The Star has been missing a strong feminist voice since the departure of Michele Landsberg (a product of her era, that is, great on everything except transgender issues). I hope they continue to give Zerbisias more weighty assignments.

Yesterday's topic was proposed legislation in Canada to make the killing of a fetus during a violent attack on a woman a separate crime. Zerbisias gets it right:

To me it's clear: When a pregnant woman is killed by her partner, that's murder. Isn't that enough to lock up a killer for life? No separate charges should be laid. Our uteruses are not public property.

As someone who is currently 7 months pregnant, the same gestation as Aysun Sesen, the woman whose murder triggered this debate, you might expect my feelings about this issue to be more complex. They're not. If I were to be violently attacked and my fetus killed, that would be assault. On me. If I were to be killed, along with my fetus, that would be murder. One murder, of me. This creature may be keeping me up at night by increasing my appetite, it may be kicking me hard and hiccuping at all hours, but neither on an emotional nor a rational level do I consider my seventh-month-gestation fetus a separate person. It feels like a part of me, though a rather strange and uncontrollable part.

Another argument for providing a separate penalty for the "murder" of a fetus is that pregnant women are exceptionally vulnerable. While it's true that domestic violence tends to be initiated or increased during a woman's pregnancy, and that homicide is the number one killer of pregnant women, I'm not sure what the effect of extra criminal penalties are. That is, a woman is valuable, and doesn't deserve to be battered, whether she is pregnant or not. I don't deserve to be hit, now, at seven months pregnant, but I don't see how it's any worse than if I were hit a year ago, or a few months from now. Much more effective would be the consistent enforcement of existing domestic violence laws, more resources to help victims of domestic violence, etc.

Creating a special class of pregnant victims won't help anybody. Madonna=protected, whore=deserves to be beaten? And it comes from the same place that led my labmate to tell me today that I can't move furniture into my new office (with windows!). I'm in a "delicate condition." So delicate, I'm worth more than other women?

Viable

I'm at 29 weeks, five days. This is exactly the gestational age at which Charlie, of a Little Pregnant fame, was born. This comforts me. The data I've read say that 30-weekers have about a 95% chance of survival, with about a 2% chance of major disability. Statistics are helpful (especially to a math geek and research-addict like me) but knowing of an adorable little boy who loves Friendly's milkshakes, silver dollar pancakes, and imitating the cat, is reassuring. Even if I only know him through the computer.

Being beyond the "limit of viability" range relieves me beyond measure. Premature birth freaks the hell out of me. After reading The Preemie Experiment, other blogs, and tons of medical literature, A. and I had a long talk about our wishes if we were to have a "micro-preemie." We decided that at less than 25 weeks, we would want to the medical team to provide comfort care only. Between 25 and 26 weeks, we would look at the individual situation, talk with a neonatologist, and make a decision based on individual factors and the neo's expert opinion. Past 26 weeks, we would "allow" aggressive resuscitation measures. But then I found out that it's not that simple; it's apparently not really up to us. The Baby Doe Law and the Born-Alive Infants Protection Act tie the hands of parents and healthcare providers, and require them to give care, even if it is painful, near futile, and likely to result in a severely degraded quality of life. The former law is designed to protect the rights of the disabled, and the latter is an anti-choice stunt law that has ramifications beyond the reproductive fascism envisioned by its writers.

But now that we're getting to 30 weeks, there's really no question about the provision of medical care. Nobody will ask my opinion, and everyone will agree on the right course of treatment.

The next big milestone is 34 weeks, after which a birth would result in a "near-term infant." Not a big change, just terminology, but I think it corresponds to needing the NICU significantly less, or maybe not at all.

I'm finally starting to show. The Dunkin' Donuts guy let us in 15 minutes after the store closed, and gave us four doughnuts (we asked for 2) for the price of 1. I think it might have been because he noticed my belly.

And since I'm not allowed to announce it to anyone who actually knows him, I will say it here. My beloved A. has been a non-smoker for two and a half weeks now, after a 20-year habit. I'm very proud of him. And he's barely been an asshole at all during that time. (Thank you Zyban!)

Call for help from the blogosphere: Help a 17-year-old girl in Kansas City get medical care

UPDATE

She's acquired transportation on her own, it seems. All it took was a few hours of A. on the phone brainstorming her options with her, as well as stressing the importance of getting medical care. She's perfectly internet savvy, but he needed to get her step-by-step directions from her school to the closest Planned Parenthood, for instance. She needed to get her priorities straight. It also seems that he's convinced her she should be on contraception longer-term, which while I know doesn't solve all problems (e.g. STDs) but should help prevent future scares to some degree.

=====================================
This request is urgent as time is of the essence.

My husband, A., is an avid player of MMPORGs. He is also an excellent listener, and people, especially teenagers, seem to really open up to him. He has become good friends with one particular 17-year-old girl who lives in Kansas City, Missouri.

She had unprotected sex last night. A. has spent some time talking to her over the last few hours. He's managed to get the conversation moving from self-slut-shaming to the need to do something.

She needs to get appropriate medical care. But she needs non-judgemental support and a ride to the clinic.
The only time she can make it is tomorrow (Monday) after school. Her school ends at 3pm. It's about a 20-minute drive from her school to the local Planned Parenthood clinic.

Also helpful would be someone willing to buy Plan B and drop it off at her house tonight.

Anyone who can help us with this situation would be greatly appreciated. You can leave a comment here or email me: doctorconfused@gmail.com

"Lesion" update

I had a midwife's appointment yesterday so I asked her to look at my cervix. Yes, I specifically said "please take a look at my cervix." She waaay over-apologized and over-warned as she greased up her speculum and inserted it, leading A. to believe that pelvic exams are painful (which, for me at least, they are not). And she saw... nothing. Nada. Zip. No "lesions." Well, she did see a Nabothian cyst, which she described as like a whitehead on my cervix.

She rolled her eyes at the emergency doctors, their diagnosis of lesions, and their insistence on me making sure I got follow-up care. I don't know; I really liked the doctors, though since they have to be such generalists I don't expect them to be particular experts on cervical changes in pregnancy. So it turns out all my extensive googling into possible causes of cervical lesions, and endometriosis, was for nought. At least if I had had endo, I would have been in good company.

We did some quick follow-up on my quad screen (screen negative for everything), and my ultrasound. The only thing she noted about the ultrasound was that it shows I have an anterior placenta. An anterior placenta is totally normal, though it can make fetal movement a little less noticeable, and there is a very small amount of evidence indicating that an anterior placenta may be associated with a posterior presentation. I guess I'll have to be pretty vigilant about following the posture recommendations at Spinning Babies.

I asked her if the ultrasound said anything about dates. She told me, but didn't seem happy about telling me. I found that slightly annoying. It turns out the ultrasound would recommend a due date six days before the one I have according to LMP. So, of course, I (and she) are choosing to ignore this. However, if it had recommended a later date, even by a few days, I would have asked the official EDD to be changed. It annoyed me that she seemed to think I didn't have the knowledge to interpret this data, and so didn't want to tell me at all.

She also recommended that we try to make appointments with other midwives in the practice. I thought I was seeing the same person (for every appointment but my first) on purpose. Apparently not. I'm glad she made that recommendation since I'm beginning to get frustrated with her. If there is anything I hate, it is being condescended to. Not that she's so bad I wouldn't trust her to help me birth a baby; she seems very hands off and relaxed, which I like.

Not as upbeat as it should be

Friday was 20 weeks. I had a post planned; it was going to marvel at how normally everything has been going this pregnancy. It was going to go into some detail on the screening ultrasound: the two kidneys, the heart with four chambers, A. getting teary, etc. It was going to discuss how in my opinion 20 weeks is not halfway through the pregnancy, since 1. Most first-time mothers go well after their "due dates" and 2. The pregnancy didn't really start at the beginning of my last menstrual period.

Instead of posting, I spent five hours in an emergency room on the other side of the country.

I was on a two-week long trip visiting a distant university. I helped run a workshop in my field for a few days and then was working with some colleagues on the project that's funding my postdoc position.

Two days before I was to fly home, I had a lovely dinner out at an Indian restaurant with my ex-boyfriend and his newly pregnant wife. I adore Indian food, but it makes me gassy. While waking the next morning, I had a ginormous fart. Really, an excellent fart. But during the fart, I also felt some liquid moving through my vagina. I'm not sure if my readers are familiar with this phenomenon; I certainly am. Whenever I get my period my farts do a lot of the work of getting the blood moving downwards.

Anyway, I figured it was just that extra cervical fluid so helpfully provided by pregnancy. But I'm your standard paranoid pregnant person, so without opening my eyes, I slipped a finger inside my vagina to gather some liquid and wiped it off on the white motel sheet next to me (oh yes, housekeeping loves me). I half-lifted my sleep mask and opened one eye.

Brown. What? Mask comes off, other eye opens, and I stare at the sheet. There's a clear brown fingerprint. I'm immediately up and into the bathroom, wiping myself vigorously and checking the colour and origin. There is no doubt that my vagina is leaking dark brown liquid.

I called my midwife's office back home and the nurse told me to go to the E.R.

They saw me very quickly, but then they wanted to monitor me for my initially high blood pressure (See the previous post, re white-coat hypertension) and then the OB/GYN department took 3 hours responding to a request for a consult.

Also there was a bit of confusion over my dates. I told them I was exactly twenty weeks. Twenty weeks is the borderline for whether they'll see you in the E.R. or send you to L & D for continuous fetal monitoring. Then the nurse brought out one of those wheels and told me I was nineteen weeks. I told her I was pretty sure I was twenty, but I wasn't going to argue with her when she decided she knew better. I spent the time waiting for the doctor double-checking my math (March 2+140 days=March 142=April 111=May 81=June 50=July 20. See? 20 weeks). Then the doctor came and did it on his PDA, and got the same answer I had. But they decided to see me in the E.R. anyway since I was there and right on the border.

They did an ultrasound and everything was fine, which I already mostly knew because I can feel fetal movement pretty frequently. Then they did a pelvic exam. The doctor saw two lesions on my cervix. To me, lesion is a somewhat frightening word. I associate it with bad things, like AIDS and cancer. However, it appears that it's medical speak for "damage" or "something looks a little funny." He asked about a pap smear: I had one in February and it was normal. He also asked about STDs; I was checked for all the common ones at the beginning of the pregnancy and they were all negative.

When the OB/GYN consult came back, it was suggested I might have endometriosis on my cervix. I have no idea how they came up with that; my googling indicates that cervical endometriosis is relatively uncommon. I haven't really had any symptoms of endo, although in retrospect I do have somewhat painful periods.

I didn't get a definitive diagnosis; they told me to follow up with my own care providers. I called my midwife's office today and lengthened my appointment; they gave me the last appointment of the day this Thursday. I'm worried that I should have instead gotten an appointment with the OB, since I'm not sure if midwives are trained to look at abnormal cervices.

The worst part was sitting there for 5 hours without food. I left as soon as I got up; I didn't have breakfast. I was smart enough to grab an apple on the way out and ate that in the waiting room. They asked me early on if I was lightheaded; good thing they didn't ask later. You don't leave pregnant women for 5 hours without food! The other bad part was poor A. back home. I sent him a quick e-mail (followed by a brief msn conversation) telling him I was going to the E.R. for vaginal bleeding; he didn't hear from me until almost 6 hours later.

Pregnancy update

• I'm still pregnant. 17 weeks now. I had a midwife appointment the other day, and there is still a heartbeat present. I used to scoff at people who bought home doppler ultrasounds. I know the American Institute of Ultrasound in Medicine is not a big fan of ultrasounds for other than indicated medical reasons, and I thought that people who disregarded such advice for their own reassurance were foolhardy at worst, merely silly at best. I'm not running out to buy a Doppler, but I now have much more sympathy for the people who do. Four weeks is a long time to wait between live-fetus checks. Especially when one is a big research-slut, aware of many of the things that can go wrong in a pregnancy at any point. But next week is the screening ultrasound, and fairly soon I expect to start feeling fetal movement on a regular basis. So this four weeks might just be the longest period I've had to go not being quite sure if there's a real live fetus in there.
• I'm not showing. I bought my first baby item last week: a Maya Wrap sling. I found it on craigslist. Plain black, my size (but not A.'s), with instructional DVD, and within short biking distance. Perfect. The couple I bought it from have a six-week old daughter who hates the sling. The father said to me "I hope... whoever you're buying this for... enjoys it!" So I guess, even when my behaviour indicates I could be pregnant, I don't look it. The midwife also mentioned me not showing. I told her A. can tell, when I'm naked. Apparently having one's husband think one looks pregnant while naked does not officially count as "showing."
• I have a definite case of white coat syndrome. Except that it's not doctors (or midwives) who necessarily freak me out. It's receptionists and nurses. I've always had a pretty significant social anxiety disorder (yes, professionally diagnosed), and it tends to be worse with "counter people" (retail workers, receptionists) and low-level authorities like nurses. I breathe deeply in the elevator while A. pats my arm, check in with the receptionists (whom I hate, for a combination of rational and irrational reasons), fiddle clumsily with the label for the urine sample I brought along, try to calm myself while flipping through a magazine in the waiting room, quickly get called by a nurse (since my midwife seems to do her appointments on time, and I refuse to show up any time either than exactly 5 minutes before my appointment), follow the (feared, but not hated) nurse into the exam room, and immediately get my blood pressure taken. High, of course. This time I got the midwife to take it at the end of the exam as well, at which point it was comfortably in the normal range. I'm worried that they'll want to induce me later for PIH, which will really just be social anxiety. Maybe I can convince them to let me take my own readings over 24 hours before they make any decisions.
• I'm gaining weight like crazy. It worries me. If I continue gaining at this rate, I will gain 50 lbs over the course of the pregnancy.
• We asked the midwife if she knew any Bradley instructors. She mentioned a couple of names, that A. had already found in his research. She also said that she liked them because they didn't make their clients "hostile." She described the "hostility" as "vestigial." A. was impressed with her choice of vocabulary. I was slightly disturbed by her dismissal of the consumer-education portion of the classes. It seems she measures an instructor by their tendency to have complacent students. I guess I shouldn't expect any differently, since she would be on the receiving end of the "hostility." I think she thinks it's no longer needed since she and her colleagues no longer routinely shave their patients, give enemas, separate the parents, etc. But I'm still worried about other decisions: to not have an IV, to eat and drink, to delay cord cutting, and to have the baby never ever leave the room.
  
• A. finds me extra-sexy when I'm pregnant. He told me he's even finding himself attracted to other pregnant women, which hasn't been a factor for him before. I'm enjoying the attention, since I have the typical worries about how pregnancy is changing my body.
  
• I still haven't told my boss I'm pregnant, and only one labmate knows. I figure the boss should be first. She's been out of town for a few weeks. I may have to tell her at a workshop we have out-of-town in about a week. I'm nervous. She does not like children. She's always felt, I think, that I've been one of the few people she can confide in about her dislike of children, and her annoyance when events she has to attend turn out to be child-centred. On the other hand, I know she strongly identifies as a feminist, and I don't think she's going to try to make my life hell for choosing motherhood. She knows that it's much easier for men to choose fatherhood at this stage (or any) in their careers, and I know that her sense of fairness will win out in the end.