Distance

Some people complain that health care providers do not care enough. They seem distant. I have learned there is a very good reason for this distance.

Today at work a little boy who looked 8 but was actually 12 came in. He had tetratology of fallot with a pulmonary stenosis. Lots of big words that basically mean very serious congenital heart condition. He seemed fine in triage but when I brought him and his mom to their room he started to get very nervous. The kid has spent so much of his life in a hospital. He knows the deal. Its going to suck. His panic gripped me in a way I rarely feel at work. I told him that his mom had total control over what was going to happen. He said ok but then through his little tears said, no pokes right? I replied that I couldn't guarantee it, then walked out of the room and cried. This is why you want hospital people to be distant. If you see one or some of the people taking care of you crying about you.. it would not be comforting.

Thankfully, this is my last weekend of work until I have the baby. I can only handle so much of the world's sadness while pregnant.

Are you excited?

Another common question. Not a bad one .. just not quite right. A common mistake for English speakers speaking Spanish is to ask "estas excitada?" which does not translate to are you excited. It translates to are you aroused. "Estas emocionada?" is the correct way to ask.. are you emotional? This seems like a better question. Yes, I feel emotional -- full of emotion -- many different ones.

Here is my pregnancy metaphor:

Imagine one day, you and your beloved go to an art auction. On a whim, you decide to bid on a piece of art, and you win. This is no regular auction however. All you know about the art you have purchased is that it is art. You don't get to see it before buying. It can be from any era -- modern, renaissance, early Egyptian -- and take almost any form -- an installation, a painting, photography, furniture. You have no idea. You get home from the auction and you freak out. What if the art is too big for your house? You need a new house. What if you don't like it? There are no refunds and no returns.

Time passes and the auction house calls to say your art is almost ready. You go to a gallery and sit with your partner in front of a large black curtain. They can't tell you exactly when they will lower the curtain so you can see what you have bought. You just have to wait. While you are waiting, they remind you that you (the female) will have to complete an obstacle course before you get to take the art home. You'll experience the worst pain of your life.. there is also a small chance that you won't complete the course in a satisfactory manner so you won't get to take the art home .. and ( they're sure they mentioned this earlier) there is an really small chance, you'll die on the course.

But you knew that when you bought the art.

Plus, you're a person of faith and you've taken a basic stats course, so you're pretty sure you'll make it. So there you are waiting. Are you excited? Well, sure, that would be one of many, many emotional states you feel as you sit in front of your black curtain. You'd also probably feel terrified, thrilled, honored, a zen-like acceptance at how little control you have in life, doubtful, confident, strong, weak.. everything .. all at once. Emocionada.

There is one thing you know because you have friends who participated in similar twilight zone art auctions. No matter what work of art you get, you'll love it. Even if its 5 big screen tvs playing matthew barney's latest cremaster series and you've never really thought he was that great, all of a sudden, now that its yours, its genius. Why didn't you appreciate his art before? What did you ever do without it? You can't remember. Because once you have this art, you will protect it with your life and you will never be the same.

Baby Shower

This weekend we had a baby shower. Since we didn't really have a traditional wedding, I have not ever done the registry thing or the open presents in front of lots of people thing. As I said at the shower, I was fairly reluctant to have one. I feel like its strange to have a party where people give you presents, and I am also sort of superstitious and reluctant to count my little chicken before it is hatched. However, I now understand why we have this tradition. Its so great to gather friends and family to celebrate a big shift in your life. In fact, I wish we would have showers for a wider array of occasions -- retirement, a new job or a lost job ... I suppose we have birthday parties.. but its not really the same.

In any case, I highly recommend having a baby shower before you have a baby. It provides a wonderful reminder that you have a community supporting you as you begin a difficult but remarkable journey.

History of Childbirth

A couple of months ago I started to have time to think about the pregnancy. At the same time I also noticed two strange phenomena: the news is filled with stories of pedophiles, and everyone seems to have a story of a birth gone very, very badly. While I have been reading the New Yorker for years, I have never noticed a story on childbirth and its risks but this week, there just happens to be an article on the very topic.

The article is written by a physician -- Atul Gawande. He went to Harvard Medical School, did a surgical residency, and I believe he is now a professor at Harvard. Before medical school, he was a Rhodes scholar and studied philosophy at Oxford. I have always enjoyed his writing and so, I was compelled to read this one.

Everyone knows the history of childbirth is not pretty. Gawande weaves a story of a physician giving birth in New York today with the ways in which the profession of obstetrics has "evolved". As recently as 100 years ago, there were "dozens of maneuvers" -- from forceps to fracturing the baby's collar bones -- used to get a baby out. Around the 1930s, standards for training and cleanliness were set in hospitals but still a mother's chances of dying were 1 in 150. The baby's chances were 1 in 30.

He then credits the improvement of infant mortality rates to a physician named Virginia Apgar -- anyone who has had a child or works in medicine knows the Apgar score rates an infant's vital signs at birth. He seems to credit the improvement in maternal rates to caesarian surgery, and the "industrialization" of birth. Today in the US, a full term baby dies in every one of 500 births, a mother dies 1 in 10,000.

It is impossible to argue that conditions for women have not improved over the last 100 years. However, Gawande implies that Caesarian may one day replace a natural birth -- right now 1 in 3 women gives birth this way. He acknowleges that the only scale used to determine if the birth is successful is the Apgar for the baby. There is no similar scale for how the woman feels or recovers. If she lives, then all is well.

This is so troubling. Why is pregnancy treated like a medical disaster waiting to happen? Litigation? Fear? A desire to control women? I have no idea. The irony of it all is the more medical intervention you have during your labor, the more likely you are to have more intervention. Pitocin leads to surgery 50% of the time. And surgery is filled with complications and a long recovery .. I'd rather not deal with either.

Preggers

When are you due? What are you having? I answer these two questions between 10 and 50 times a day. I have a hard time feigning enthusiasm anymore -- 33 weeks, we decided not to find out. At the end of a shift at work, when I have answered these questions closer to 50 times than 10, I started saying 33 weeks, and I know its not a monkey. People laugh and say, no really. And I say, really, it's not.

Being pregnant is such a mixed bag of experiences. It's the closest experience I'll have to being famous. People smile at me; they want to talk to me; they do things for me. At work, patients are nice to me. From a feminist perspective, I feel like its all a little strange. Fundamentally, our society loves women who are vulnerable, weak and doing what they are supposed to. I think the roots of our comfort with pregnant women are the inspiration for the extremely freaky Margaret Atwood classic, The Handmaid's Tale. From a biological perspective, child bearing and rearing are very expensive for a woman. My immune system is weaker. If my blood vessels do not dilate appropriately during my pregnancy, the fetus will release a protein that strips the lining of my vessels to get the nutrients it needs. This can lead to preeclampsia which will kill me if the baby is not delivered immediately. (great new yorker article on the subject). The fetus does what it must to survive, and this is hard on a woman's body.

At the same, creating a human being is clearly an awesome and powerful event. From the time of fertilization to the formation of a full term baby, there are an estimated 1 trillion cell divisions. Given world population calculations, this process has basically worked as it's supposed to more than 6 billion times in the last 100 years... with an estimated 3% "error" rate. (My midwives say that 3% of babies and kids have "challenges" -- but that all depends on definitions and cultural norms ) And I control none of it consciously. None of it. I control the creation of this child as much as you control your digestion.

I called this blog the baby monkey because that is what I call our little fetus-baby. Isn't baby monkey cuter than fetus-baby? It also has roots in the its-not-a-monkey joke. We did call it fifi the fetus for a while but that wasn't very gender neutral. I plan to write about the end of the pregnancy, labor, then the first year... mainly so I can remember it but also so I can share the experience with my community.. hoping that will alleviate some of the anxiety and isolation that seems to be part of the American parent story.