Archive | birth

MsDiagnosis, or, what’s in a name?

rx-prescription-padistock-prv.jpgK’s sister was rushed to the hospital last week because in her twenty-first week of pregnancy, there’d been some complications that, as it turns out, are going to result in bed-rest for the duration of her pregnancy. While she was in the hospital, she’d had to stay in bed with her heels higher than her head for forty-eight hours, and she’d had a stitch put into her cervix (cerclage) in order to prevent her cervix from dilating further.

Scary stuff, absolutely–and as many of us are all too aware, while bed-rest might initially seem like a dream come true, it very quickly (like overnight) becomes a nightmare, all too reminiscent of Charlotte Perkins Gilman’s The Yellow Wallpaper (the heroine in that story, you remember, ends up crawling along the floorboards of her attic, over the body of her unconscious husband, peeling off the wallpaper as she crawls).

But I’m not actually going to write about scary pregnancy stories, or about women slowly being driven insane by the medical establishment. Instead, I am going to write about the diagnosis given to K’s sister: she has an “incompetent cervix.”

Seriously.  That’s the medical definition given to this condition–a diagnosis that throws us right back into the 19th century, when women were, in fact, deemed incompetent, fit only to have babies, and when to be female meant that you were always on the brink of hysteria, a word that originates from hyster, the Greek word for “womb.” 

K., in telling me about her sister, posed a key question: why is it that her sister’s cervix is “incompetent,” but a man who can’t get it up is deemed to have “erectile dysfunction” or to be “impotent”?  True, impotence means a loss of power, but to be incompetent, according to the first definition in the dictionary, is to be “not legally qualified.”  And if you’re not legally qualified, you have no standing in the eyes of the law – you’re a non-person.

Do you think Viagra would be such a best-selling drug if it were sold as a treatment for an “incompetent penis”? What man would cop to such a diagnosis?  And–further–could there really be only one pill to cure that condition? Especially when there are so very many ways for a penis to be incompetent (not the least of which is its inability to aim a stream of urine accurately into a toilet bowl).  Fixing an incompetent penis would necessitate an entire cocktail of drugs, I think, and several months of sensitivity training for the body attached to said incompetent organ.

But I digress. K’s sister’s diagnosis makes me wonder if, on some level, the days of The Yellow Wallpaper aren’t so far away after all.

(Let’s not even get started on the whole Stupak thing, yet another attempt to keep women from being legally qualified to govern their own bodies, and which in turn raises the question of how it is that the Right can, on one hand insist that the government stay out of individual lives and, on the other hand, insist that government get right inside the most intimate act a body can perform. Hmm).  

Oh dear, that was another digression. I seem to be getting all hysterical about who has access to my hyster…

Seriously, though, what if we re-diagnosed K’s sister’s condition? What if we said she had a “flexible cervix,” or a “forgiving cervix,” or–perhaps most appropriate–a “tired cervix”?

Yes. That’s it.  A “tired cervix.” Because you know what? Doing something as personal and as powerful as growing a baby? It’s exhausting.

Continue Reading · on November 25, 2009 in birth, Feminism

Five, alas…

2004_0828_155321AA.JPGCaleb turns five today. In fact, he was born almost exactly five years ago right now: 10:56 pm on August 24. He doesn’t want to be five–or rather, yesterday he didn’t want to be five, but this morning he woke me up (6:43) to say that “today is my birthday and i love you mommy and where are my presents?” 

Getting pregnant with Caleb felt a little bit miraculous (after all, I’d had a preemie, a miscarriage, and was pushing forty) and I was hell-bent on the process being as “normal” as possible. I was going natural childbirth, VBAC all the way. I thought about getting myself a varsity letter jacket with those letters across the front, but it was August and too damn hot.

Because of those risk factors, though, when I first got pregnant, I was a mess. I had ongoing nightmares about dead babies and I was sure it meant that Caleb had died in utero: a dream in which a long line of people trolled through shallow waters, looking for a drowned child and then a man came wading towards me, a crumpled boy-body in his arms; a dream in which  I had to watch Liam get electrocuted; a dream in which the baby was falling out the window and I couldn’t quite grasp the hem of his little undershirt as he slid through my hands. Those kinds of nightmares: the kind where you have to tiptoe into the room of your sleeping child to make sure he’s breathing. The kind of nightmares that felt so ominous I called the long-suffering, amazing Sylvie, who let me come into her office without an appointment so that I could listen to Caleb’s hummingbird heartbeat and be reassured that he was still alive and thriving. 

When I finally went into labor,  I didn’t know what it was. I hadn’t gone into labor with Liam, so I thought at first I was just having standard pregnant-lady digestive issues, the details of which I will leave to your imagination. Finally–after a long night on the couch wondering what the hell was wrong with me, I figured it out: oh right….I’m having a baby. So we were very excited and Husband I and went off to the hospital, sure that in a few hours, we’d have our new little baby and all would be right with the world.

Well okay, so you’d think we’d have learned from almost four years of parenting that nothing goes as planned: Caleb didn’t come. He didn’t come and I figured out that the whole natural childbirth thing doesn’t work if, like me, you’re a chickenshit about pain. After an hour or so of contractions, I was all hell yeah, let’s get that epidural!  Which I did, and then I spent a lovely five or six hours flipping through magazines, and watching the monitor indicate that I was having a contraction. I even apologized to Husband, who had been prepared for a more active role than that of fetcher-of-Vogue.

And then I don’t know what happened–the epidural wore off, maybe? Or maybe what I experienced–the physical enactment of the sound velcro makes when it’s peeled apart–was birth on epidural, which means that women who give birth with no drugs are heroic, amazing creatures who could probably do sword-swallowing in their free time. Six oclock, seven oclock, eight oclock, no baby. Then somewhere in the depths of all those squishy birthing sounds, I heard a sharp crack, and then, finally, finally, Caleb came into the world.

My early pregnancy nightmares came back to haunt me one more time, that night, after I’d been wheeled into my hospital room and Caleb had been whisked off to the nursery. Drifting into sleep, I heard two nurses walk by, talking about a problem with my baby. I clambered out of bed and staggered to the nurses station like a lunatic, insisting that something was wrong with my baby. The nurses–perhaps used to this sort of insanity–walked me to the nursery and showed me my little burrito, wrapped in his hospital blanket, sound asleep. I’d completely hallucinated the entire conversation.

The hallucinations didn’t return, but it took me a long time to recover from that sharp cracking noise I’d heard during labor: my almost nine-pound child had broken my tailbone in his push to be born, which apparently happens more than you might think. And you know what can be done for a broken tailbone? Absolutely nothing. I now know without a shadow of a doubt that you cannot, in fact, put your ass in a sling.

My tailbone recovered, my nightmares went away, and now here we are, in another hot sweaty August. Caleb doesn’t have much toddler left in him, anymore; he’s gotten longer this summer, lithe and agile. It’s unsettling to look at the set of his shoulders or the curve of his cheek and see glimmers of the man he’s going to be–and when he settles into my lap and puts his head on my neck, I realize how much I miss the warm heft of a baby’s body, the soft curl of fingers around a hand.

Today Caleb didn’t mind that he was turning five–but I did.

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Continue Reading · on August 24, 2009 in birth, Children

In Praise of Midwives

IMG_0364.JPGA fact: a gynecological exam is never going to rank up there with gelato, foot rubs, or clean sheets on the “life’s pleasures” lists. Even the word “speculum” can make a gal wince.

And while I am certainly not a fan of those exams, I have to say that I look forward to my annual visits to my “lady doctor,” who also tended to me during my two pregnancies (and one miscarriage).  I found Sylvie a long time ago, in a faraway land called Beingingraduateschool. I spent a year or so in that land using NYU’s fabulous “health services,” a walk-in clinic that played fast and loose with the ideas of both “health” and “service.” (Imagine sitting in the communal waiting room for the gynecologist, clad only in your paper “robe.” At least it was a women’s only waiting room – a small concession – but the door opened onto the main waiting room, where I every now and then caught sight of my undergraduate students. Truly a lovely experience.)

Sylvie – the first midwife I’d ever met outside of books – had a comfy chair for pre-exam conversation in her office; the cold metal stirrups on the exam table were gloved with potholders, so as not to chill tootsies; and most importantly, she gave my questions all the time they needed. 

I suppose as with everything, there are good midwives and mediocre midwives; I just seem to have found a really good one. Proof? In a city like ours, where just about every decision gets made on the basis of which train you’d take or if it’s possible to get a cab, I stayed with her from an office close to NYU’s campus, up to the Upper West Side, and now to Columbus Circle. In short, I’ve followed her uptown and cross-town.

Women always used to use midwives when they had babies, but in the late 19th century, as obstetrics become a more “scientific” profession, women were pushed out of the field and midwifery became a marginalized and denigrated occupation. Women who could afford it were encouraged to have their children in the “twilight sleep” of anesthesia, to be attended by a staff of (male) doctors, and to have their children in the safe space of a hospital. Midwives were dismissed as the last refuge of ignorant women, and midwife training programs all but died out.

In recent decades, however, that trend has shifted: there are now a number of midwife programs, including one at Columbia, and there are several midwifery practices in the city. Some studies say that the rate of unnecessary c-sections is significantly lower if a midwife is in attendance at a birth – but there is still a significant bias against midwives in the medical profession.

I felt that bias when I was pregnant with Liam. I’d gone to Sylvie for a regular check-up and she’d put her hands on my not-very-big belly and said “hmm…you know, let’s just be sure and have you get an ultra-sound.” She suspected, without any fancy instruments, that perhaps my pregnancy wasn’t proceeding as it should.

Sure enough, the ultra-sound proved that in fact, Burbage (as we called Liam in utero), wasn’t growing as he should, which the ultra-sound doctor brilliantly summarized as my having “a crappy placenta.” This paragon of bedside manners, after so bluntly dismissing my inner organs, went on to ask me who my obstetrician was and when I said I had a midwife, she looked at me as if I’d said that my pregnancy was being attended by a veterinarian. “Oh,” she said, after a long pause. “A midwife.” As Sylvie, somehow, were at the root of what was wrong with my baby.

The doctor who eventually performed the very necessary c-section that saved Liam’s life had a different opinion: it was Sylvie and her good hands, he said, who was responsible for Liam being as healthy as he was – she caught the problem early and made sure that we were monitored carefully.  Sylvie delivered Caleb, too, and watched with me through gestational diabetes, through a due-date that came and went, and then a labor process that, even with pitocin, took WAY longer than it should have (and broke my tailbone – yes it can happen).

She’s followed the growth of each boy and those annual checkups (still on a table with potholder-covered stirrups) have become conversations about our respective children, about life in New York, about her thriving practice, and whatever good book we’re currently reading.

Yesterday, Liam and I went to Prospect Park to celebrate the 1000th baby delivered by Midwifery of Manhattan (MOM, get it?). Spread out under the green fluffy trees of Nethermead field were M.O.M’s children: from kids on the verge of college to newborns, including Sylvie’s first grandchild.  Liam didn’t really appreciate the celebration (or the lack of ice cream), but I thought it was amazing.

In light of the wanton destruction of Dr. Tiller last week, the celebration of 1000 births seemed also an affirmation of a woman’s right to her own body: the births being celebrated were wanted birth; the parents wanted to be parents.

I don’t know what numbers Liam and Caleb are in the count to 1000, but having them be in that number (like the saints!) makes me think that they have a guardian angel watching over them from somewhere in the vicinity of Columbus Circle.

Continue Reading · on June 8, 2009 in birth

Diagnosis

liam_birth_feet.gifThis election – and maybe all US elections going forward, until we institute serious voting reform measures – will occur in the long shadow of What Happened in Florida in 2000 (and, to lesser degree, in Ohio in 2004).

Much of what happened in 2000, however, I didn’t realize until I saw the HBO movie “Recount,” which is a fabulous – and maddening – dramatization of the grand-scale theft of Gore’s victory (and concomitant disenfranchisement of who-knows-how-many US citizens).

It’s not that I didn’t want to pay attention to what was happening while it happened; it’s just that I was distracted. I was about thirty weeks pregnant in early November; my baby was due in early January, everything was going swimmingly, absolutely according to plan. And then, suddenly, all our careful plans went kaflooey. November 18th marks Liam’s 8th birthday, but he began to be born, in a fashion, the day before Election Day 2000, with a doctor who clearly failed “Bedside Manner 101” in medical school.

So now imagine that rippling effect you get on soap operas when they segue to a flashback – come with me, if you will, to a dark ultrasound room somewhere in midtown Manhattan, where I’m flat on my back, blue goo smeared on my six-months pregnant belly, and a doctor is about to interpret the flickering bluish picture on the ultrasound screen.

“Basically, you have a crappy placenta,” the doctor said, snapping off her rubber gloves.

Pregnancy had been astonishingly easy thus far, so it took a while for her words to penetrate my mushily gravid brain.Crappy placenta? Howzzat?

“So you need to be on bed rest.” Bed-rest? Wasn’t that something for 19th century heroines, or maybe that crazy lady in “The Yellow Wallpaper,” who by the end of the story is crawling around the attic attempting to escape her “rest cure”? But now? in the 20th century? ME?

“Starting now. For at least ten days, and then we’ll see. Who’s your doctor?”

I gave her the name of my midwife. “Oh,” she said after a long pause. “You have a midwife.”  As if somehow that explained the crappification of my placenta.
 
(Just for the record, the ob-gyn who ultimately delivered my tiny baby in an emergency c-section credits my midwife, the amazing Sylvie Blaustein, with catching the problem early – Sylvie was the one who sent me to the ultrasound and who, at the risk of sounding dramatic, may have saved Liam’s life with her knowledge of babies and women’s bodies. If I were ever to move out of New York, I would probably travel back from wherever I was in order to have Sylvie be the person I go to for checkups and all that lady-plumbing stuff. Midwifery of Manhattan – MOM, get it?)

The idea behind bedrest, as near as I can tell, is to give over all your bodily resources to the entity that has nested inside it (in much the same way that all financial resources will be given over to this entity once it’s born). And yes, bedrest seemed like a great idea – sprawl against the pillows, be waited on hand and foot – for about ten minutes. Then the itchy, scratchy, maddening reality set in: I was allowed to walk to the bathroom, but that was about it. I had to beg Sylvie for permission to leave the bed in order to vote, and she only said yes because the polling place was literally around the corner from our apartment.

So on the second day of bedrest, I shuffled to the polling place, pulled the lever, then shuffled home to my pillowed prison, certain that in the next twelve hours Al Gore would become the next president.

The next ten days – the next two months – were an astonishingly surreal convergence of the body politic with my maternal body: both in suspension, both hostage to forces beyond their control. I had no way of knowing if my horizontality was helping “Burbage,” as we called the blob inside me (a name courtesy of Dick and Nancy Horwich).

Bed-rest rubbed my face in the hardest part (for me, anyway) of being a parent: the part where, basically, you’re not really in control. I mean, you might think you’re in control because there are rules about this or that, or because you can take away “privileges,” or because your children think you can magically cure the pain of a boo-boo. But it’s all a charade: they are their own people from the moment they first breathe air. 

Parenting is more like lion-taming, you know? The trainer gets in there with the whip and the stool and the occasional treat of raw meat, and the lions kind of go along with it because, well, frankly, what the hell else do they have to do? But at any moment the lions could totally take over. The trick is not to let them know that they outnumber the trainer … (this analogy holds true, by the way, even if you are the parent of only one child. One child is more than a match for two parents, which is why those of us in two-parent households should bow down and worship in awe at the feet of single parents).

A week passed. Still no president, still no baby – but an increasingly angry electorate and an increasingly angry mommy-to-be. I was FINE and bed-rest was STUPID and there was nothing WRONG.

Ten days of bed-rest later, still no president, still no baby. Husband and I go for a follow-up ultrasound (not with the “crappy placenta” doctor but with the perinatologists at Babies Hospital). In the tiny exam room there is barely room for a table and the technician, who announces that she can’t “see” the baby with the conventional ultra-sound tool so she brings out … The Probe. And boy, that’s just a whole lot of fun. Makes me hope I’m never abducted by aliens.
Thumbnail image for vaginalprobe.jpgSo she’s probing and looking concerned and not answering my questions. She calls in a bunch of doctors and if I hadn’t been so terrified, I would’ve laughed: in this tiny room there are four doctors, the technician, me, and Husband, although we were clearly last on the list of priority: the doctors only wanted to see the ultrasound screen.

Suddenly we got a whole new set of vocabulary words to match the other new set generated by the election – to hanging chad and butterfly ballot, we added S/D ratio, doppler, deceleration.

The doctors talked about whether to induce labor, to wait, to do a c-section…a blur until someone told me that I needed to be admitted immediately so that they could monitor the fetus.

So boom! there I am in the hospital, with the central question being whether this now thirty-two week-old baby would be better off in the NICU or in me. At 33 weeks, babies are considered “full term” but this baby was only the size of a twenty-five week old baby – and they weren’t sure how he would fare, were he to be delivered that small.

To my host of aches, pains, and anxieties, steroid shots were added, to help develop the babie’s lungs. “You know, his lungs are like little smears of jelly right now” said a particularly jolly resident. Lovely. Thanks for that image.

The  residents tied themselves in knots trying to figure out what was wrong with me. Usually IUGR (intra-uterine growth restriction, which is apparently the fancy name for “crappy placenta”) happens to people with high blood pressure – or to drug addicts, alcoholics, and prostitutes. As I answered no to all their questions – no high blood pressure, no alcohol, no placenta abruption, no placenta previa, kicked that nasty heroin habit years ago – I imagined  the residents madly flipping through the medical textbooks in their brains, trying to figure out what was wrong with me.

And the answer is…medical anomaly. There is NO REASON for what happened, other than the fluke of a crappy placenta that refused to nourish Burbage the way it was supposed to.

You know, like the t-shirt says, Shit Happens.

Liam was born before the presidency was decided – and I promise that I made no bargain with the gods about exchanging the country’s well-being for the well-being of my baby. Promise.

When Liam was born, at dawn on November 18, in an emergency c-section because the doctors saw that his heart-rate was decelerating, he weighed 1 pound, 10 ounces, a little bit more than a full-size loaf of bread. He looked like Gandhi, like Yoda, like the most fragile baby bird you’ve ever seen in your life.
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They wheeled Liam away in the little plastic shoebox where he would spend the next two months and we were given a long list of the potential afflictions that such a tiny body might face: respiratory problems, heart problems, liver and kidney problems, developmental delays.  He simply wasn’t ready to be in the actual world, poor thing, so we held our breath and prepared for the worst.

But in spite of everything he became the tiniest, healthiest baby in the NICU. He flourished. Would that I could say the same for the country.

Liam turns eight in a little less than two weeks; his days as a medical anomaly are – I hope – behind him. And at the risk of stretching a metaphor to the breaking point, perhaps tomorrow’s election will demonstrate that the previous two elections were not part of a systemic infection but were in fact anomalous: the crappy placenta that may yet give birth to something amazing. 

108.JPG*Oh, and those teensy feet at the beginning of this very long post? Liam’s, the day he was born. In actual fact, the footprint is slightly less than two inches long. And yet he STILL had toenails. Miracle.

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Continue Reading · on November 3, 2008 in birth, Politics, preemies

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