Thursday, March 13, 2008

Perspective

For a while now, I've been certain, but without evidence other than intuition, that this baby will arrive early. I've been told several times by the nurse-midwives at the birth center that first babies have a tendency to be overdue, so I shouldn't be surprised if nothing has happened by my due date.

On Monday at my appointment, I got the first hint of evidence that I might possibly be right: the cervix is still closed, but has gotten softer and thinner (a process called effacement), and the baby is positioned fairly low in my pelvis, with her head down. Neither of these things necessarily mean that labor will start soon, but they're some of the preliminaries. I asked when I would be considered far enough along to deliver at the Birth Center, and the answer is "it depends." If there are no complicating factors whatsoever, they'll allow it at 36 weeks - a milestone that I just passed yesterday. If the mother is positive for Group B Strep and will therefore need antibiotics during labor, they require 37 weeks or better. I haven't gotten my culture results yet to know whether GBS will be an issue or not, but I'll soon find out.

I was excited both by the news that pre-labor changes are starting to happen, and that if labor did start early, I might be able to deliver at the Birth Center earlier than I thought. On Tuesday morning, it seemed that labor might actually be imminent - the baby had shifted even lower, and I was getting cramps that felt a lot like menstrual cramps. Braxton-Hicks contractions, probably; there was no distinct pattern to them. The intensity would vary, but I couldn't distinguish the beginning or ending of individual contractions. By the afternoon, the cramps had faded, and by the next morning, the baby had shifted position slightly so that she didn't seem to be pressing downward as much.

Although I knew that I should be feeling relieved, I was mostly just disappointed. It's difficult to be patient at this point, even though it's irrational to want to hurry things up - physically, it's almost certainly easier to be pregnant than to be recovering from childbirth and dealing with a newborn. But that didn't stop me from being cranky and wondering how I can possibly make it through another month - possibly even six weeks - of the various discomforts, plus the waiting and wondering if every cramp or backache just might be the start of the real thing.

Sitting at my computer and looking, I guess, for commiseration, I did a google search for "tired of being pregnant." As it happened, one of the first things I came across was the opposite of what I was looking for. It was a blog post written by a labor & delivery nurse, about how she is tired of pregnant women whining at 34 or 36 or 38 weeks that they're tired of pregnancy, ready to get the baby out, and want to be induced or c-sectioned. She raged against women who don't seem to realize or care that an early baby is more likely to have trouble breathing, trouble nursing, trouble fighting off infections, and convince their doctor to give them an early delivery. She held that women who carry their babies full term should be thankful for it, and think of all the women whose babies were premature and didn't make it, or had serious problems because of it. The post ended with "Go ahead readers...flame away at me over my opinions on this subject []", but the long, long string of comments that followed was almost entirely from moms who agreed, because they'd had a premature baby themselves, or been induced early because of pre-eclampsia or other complications. Many of them said something like "I would have given anything to be pregnant for longer, and it drives me crazy when women who stay pregnant for the full term complain about it!"

It made me feel guilty about wishing that mine would be early, even though I would never have an induction or elective c-section to bring it about. I don't feel too guilty about it, though, because every woman who's getting close to term gets impatient. But that dose of perspective did make me realize that I shouldn't feel too sorry for myself - I'll take all the pains and annoyances of late pregnancy over coping with a baby that's not ready for the outside world yet.

Thursday, February 21, 2008

Brains and guts

One thing that came up during my first Birth Center prenatal appointment, while going over my general medical history, was that I have a few episodes of depression and/or anxiety in my past. No huge drama, no hospitalization, not even any medication for it, but still it's there. The nurse-midwife cautioned me that women who have such a history are more likely to suffer from post-partum depression than women who haven't had past problems. That doesn't mean I will have PPD, but that I should be alert to the possibility. She said that many women have trouble recognizing the signs because there's so much else going on at the same time - sleep deprivation, the physical recovery from birth, sore breasts from starting to breastfeed, body image issues, the sense of huge new responsibility, and the list goes on. With all that, it's hard to say what's "normal."


I wondered whether that might happen to me - would I be able to tell if I was having problems more than just the usual adjustment period to being a new parent? Thinking about it made me realize that at least for me, mental health is nowhere near as self-evident as physical health. I know at any given time whether I'm in a good or a bad mood, but if it's a bad mood I can't say whether it will go away in an hour, or a day, or whether it might drag on for much longer. I can tell after a specific stressful event that it caused a stress reaction, but if it's the more ongoing, long-term kind of stress, I can't easily say whether it's getting to be too much, or if I'm coping well. I can't tell by "asking myself" whether I'm just having a bad day or a bad week, or if it's something that I need to take steps to fix.


Then I realized that I do have an excellent built-in barometer of my overall mental health: my stomach. I may feel stressed or moody, but if I'm eating normally, that's a good indicator that it's nothing too serious, and will resolve itself soon. When I lose my appetite or feel sick to my stomach and there's no obvious physical cause, it's a probable sign that there's something that I'm having trouble dealing with. In particular, during a few times in my life that were especially stressful, I thought that I had some mysterious stomach ailment; eventually I figured out that I was having panic attacks, but without the stereotypical hyperventilating and heart-pounding.


So for me, as for many people, a "gut reaction" is a not just a metaphor. It's an interesting example of the inseparability of mind and body. I wonder whether this tendency to physically express mental turmoil evolved for some reason - can there be any possible advantage to having physical symptoms of unhappiness? Or is it just a side effect of the fact that the physical brain is part of the body, and that having thoughts and emotions is a chemical process, and is not independent of the rest of the body's workings? It just seems funny that for all its power, the brain isn't very good at identifying and troubleshooting its own problems.

Thursday, February 7, 2008

Unintended consequences (long post)

Two weeks ago, Vlad and I went to a "tour for expectant parents" at Abington Hospital. I suppose such tours are intended to familiarize couples with the layout of the hospital, and reassure them that the hospital is a wonderful place to deliver a baby. I went to the tour assuming that's exactly what I would get out of it.

I was wrong.

Let me go into some background first, then I'll explain.

When I first found out I was pregnant, my general practitioner recommended Abington Hospital, which is one of the largest hospitals in the area. I hadn't been thrilled with my prenatal experience at the UPenn Hospital during my first (brief) pregnancy, so I thought okay, I'll try Abington. The first or second ultrasound showed that I had a low-lying placenta, which can cause problems in delivery. Before I found out about that, I was mulling over the idea of delivering at a birth center instead of a hospital. But with the low-lying placenta issue, I put those ideas on hold and remained at Abington through the first and second trimesters, because a birth center will typically only accept low-risk pregnancies with no complications.

About 6 weeks ago, when I last had an ultrasound, the placenta had moved up and was no longer a concern, and everything else looked fine. I was delighted, and although I didn't get around to it right away, I soon called the Birth Center at Bryn Mawr (a suburb of Philly) hoping to transfer there. They took a week to get back to me, and then it was only to tell me that they were booked for April, and weren't accepting any more patients due then. I sighed and figured that I'd just resign myself to having the baby at the hospital, like a normal person - and anyway, hospitals offer epidurals and most birth centers don't. Who wants to face a painful experience without at least having the option of some heavy-duty pain relief at hand? I wasn't sure I did, even if "birth center" does evoke a much more warm and fuzzy image than "hospital."

So, back to the tour. We arrived early, and I was impressed by the big atrium in the lobby, complete with a fountain - it looked almost more like a large hotel than a hospital. The conference room in which all the new parents gathered was also very sparkly-modern. So far, so good. I was pleased, and looking forward to the tour. But then our tour guide, a perky blonde RN, started to talk. With nearly everything she said, I could feel my stress level ticking higher. EFM, IV's, pitocin, alarms, c-sections, NICU, bathroom privileges (privileges?!). The supposedly "home-like decor" of the labor and delivery room consisted of a few pastel watercolor pictures on the wall, one of which turned out to be a clever hiding place for an array of medical instruments. At one point she mentioned a birth plan, asked how many couples there had one. About a fifth of the audience raised their hands. Vlad whispered to me, "What's a birth plan?" I indicated that I'd explain it later. On our way out, I told him through clenched teeth that a birth plan is a document intended to make a woman feel as if she has some control over what happens once she walks through the hospital doors. Everything I had heard made me feel certain that whoever would be in control, it wouldn't be me. And I didn't like it. At. All.

My own reaction took me by surprise. I've never considered myself anti-hospital, anti-Western medicine, anti-authority, anti-technology, or anything along those lines. When it comes to alternative therapies, I'm interested but skeptical - it drives me crazy to hear people talk about herbal remedies as if they're inherently safe because they're natural. If natural equals safe, go snack on some Atropa belladonna. Likewise, I distrust anyone who says that because birth is natural, it is safe.

So why then did the hospital tour leave me foaming at the mouth and ready to bite anyone in a white coat who'd come near me? I'm not sure, but I think it has to do with having some pre-existing exposure to the idea that the way hospitals approach childbirth is not necessarily ideal for the mother or the baby. Without specifically looking for such information, I had come across various arguments that the fewer interventions, the better, unless a specific situation required otherwise.

I learned when we did the hospital tour that my opinions and feelings are a lot stronger than I thought. I knew I wanted a minimum of medical intervention, but I didn't fully realize that if I went to the hospital, I would immediately have an IV stuck in my arm, and an electronic fetal monitoring device strapped to my belly - that these weren't merely available options, but pretty much mandatory. I hadn't thought about the fact that if I am sick or injured, I'm fine with handing over control to the medical establishment, but birth is not an illness, and shouldn't automatically be treated as such. At the same time, I'm aware that the birth process doesn't always go smoothly or safely, so I don't want to be too far away from all that fancy medical technology should it be needed.

So I started looking into other options in our area, and found the Wilmington Birth Center. They will provide the happy medium that I'm looking for - the freedom to move around as much or as little as I want, to eat and drink if I feel like it, to give birth in whatever position feels the most comfortable. The freedom to wear my own clothes and not a hospital gown, to go to the bathroom when I damn well feel like it, to have a calm environment free of the hospital's hurry and noise. And importantly, the support of a certified nurse midwife who can reassure me that everything is going well, and knows what to do if it isn't. They have arrangements with St. Francis Hospital (just a block away) and Christiana Hospital so that if necessary, they can quickly transfer a patient.

One of my worries was that perhaps birth centers aren't as safe as hospitals - they are, after all, less equipped to handle emergencies on the spot. I thought about various scenarios, mulled it over. Then I realized I don't have to rely on intuition and guessing - I have access to all sorts of primary medical literature, so I looked up some numbers.

A 1989 study of birth center outcomes for 11,814 women, published in the New England Journal of Medicine, found that there were no maternal deaths, and a neonatal mortality rate of 1.3 per 1000 - which is less than the overall rate of around 4.5/1000 as of 2003. Cesareans were 4.4%, compared with a recent national statistic of almost 25%. Another study in Australia with data from 1999-2002 had very similar perinatal mortality numbers, and a few smaller studies also found that birth centers are quite safe.

Just to confirm what I was already fairly sure of - that I'd be happier and just as safe at a birth center - I asked some questions of my ob/gyn at Abington at my appointment last Thursday. Found out that yes, I would be hooked up to an IV as soon as I was admitted, and not allowed to eat. Next, I asked about electronic fetal monitoring - that too would be required as soon as I was admitted, and I was surprised by what the ob/gyn said next. "Bad things happen to unmonitored babies, we've seen bad things happen. Not long ago we had a woman who didn't want monitoring, so we basically sent her to a birth center instead because we're not comfortable with that." Wow. Scary-sounding, yes?

As far as my research has been able to uncover, her statement does not hold up. Electronic fetal monitoring hasn't been shown to improve outcomes for the baby, especially in low-risk births, but it does increase the likelihood of a c-section. I couldn't find a single study that showed any real advantage to it. Even the American College of Obstetricians and Gynecologists, a rather conservative organization, states that intermittent monitoring by handheld Doppler or electronic fetal monitoring can be used, and they do not recommend one over the other. So was the obstetrician lying to me? Or was she misinformed? Either way, it further reinforced my feeling that Abington wasn't right for me.

I had my first visit to the Wilmington Birth Center yesterday, and what a difference! In the waiting room, there's a large bookshelf full of books about pregnancy, birth, childcare, and women's health - you can borrow books by signing them out. Any place that has its own lending library has already made a big leap towards earning my respect, bookworm that I am. The nurse-midwife who examined me took plenty of time to explain how the birth center does things, and to ask and answer questions, whereas at Abington I always felt like the doctor had one foot out the door already when they asked if I had any questions. And she sent me home with a hefty binder full of information about pregnancy, labor and birth, and postpartum care of mom and baby. Now, much of this information I had already found on my own - but definitely not from my doctors!

Several people, upon hearing that I plan to give birth without an epidural, have expressed sentiments that I'm either really brave, or crazy, or some combination. Crazy I may be, but brave has nothing to do with it. It's simply that I'm more afraid of the hospital than of birth pains.

If you've read this far, you probably have at least a little bit of interest in the subject of childbirth. If that's because you (or someone you're close to) might have a baby at some point in the near future, don't be like me and wait until trimester 3 to think seriously about this stuff! Early on, maybe even before conceiving, find out the options available to you, and decide for yourself rather than letting the path of least resistance decide for you.

Friday, January 25, 2008

Finances - A wealth of books

Some people, on discovering a need to learn about a subject that's currently a mystery to them, will ask people they know. Some will take a class. Some will rely on the internet. Some will read a book. And some will read ALL the books.

I'm one of those who will tend to read all the books, or at least as many as I have access to, and time for. Fortunately for my budget, I've learned not to buy such books unless I'm certain that they'll be useful beyond the first reading. Mostly, I borrow from the library, and spend an occasional evening at a bookstore perusing their books.

As I mentioned in my previous post, money is one of the three major things I'm thinking about these days (the other two being my MA thesis, and the baby I'm carrying), and my interest in the topic has resulted in a reading binge; I've borrowed quite a number of books from the library and from my dad's bookshelf.

Here are some of the books I've read thus far, with nano-reviews of each.

Rich Dad, Poor Dad This is one that if I had bought, I'd be embarrassed to admit it - there's a lot of salesmanship and pseudophilosophizing here. But it's less boring than a lot of books out there, and makes some interesting points. The main point is that many of the attitudes that people hold about money (including the reluctance to even think about it) prevent them from becoming wealthy. Useful for: thinking "outside the box", getting started thinking about money in general.

The Average Family's Guide to Financial Freedom One that's written by a "normal" couple, not some financial planner or hotshot investor. Lots of practical advice on frugality, debt reduction, and conservative investing. Useful for: getting started, living below your means.

Leg the Spread A riveting adventure story about the high-risk world of futures trading, focused on the few women who participate. Not a how-to, although you pick up some of the terminology along the way. Useful for: entertainment, and an inside look at part of "the Market" and the people that make a living by trading.

How the Stock Market Works A guide to the mechanics and behind-the-scenes happenings that make up what we think of as "the Market." Goes into a fair amount of detail about what actually happens when you place a trade order, or when a company makes a public offering of stock. On my first read, a lot of it was too detailed for me and/or went over my head, but I will likely read it again. Useful for: It's like a book explaining what happens inside your car when you're driving, and how road systems are developed and maintained, as opposed to giving you advice on how to drive.

Two for the Money Co-written by twin brothers, both professional financial advisors but who differ sometimes in their approaches and opinions. Aimed at "baby boomers" but has a good all-around overview of dealing with personal finances, from the basics of getting organized to the complexities of choosing investment vehicles for retirement, college savings, and so on. Useful for: covering the breadth of personal money management without getting too bogged down in the complicated stuff.

The Undercover Economist If you read Freakonomics and liked it, this book is in a similar vein, but not quite as sexy. Has some interesting stuff about a wide range of topics, from how grocery stores price their goods to global trade economics and the environment. Useful for: thinking about "everyday economics" and pondering the economic aspects of politics and environmental issues.

Die Broke I couldn't resist the title, especially since right next to it on the library shelf was another book called "Don't Die Broke." Unlike many personal finance books that try to use fear to put you on the path of the money-righteous, this one aims to reduce fear. The main points are 1) Don't make yourself panicky by setting some arbitrary date for retirement, many people are actually happier and healthier if they keep working. Just go at your own pace, building up assets that will support you once you're no longer able to work or no longer want to. 2) The ideal of passing on an inheritance is outdated; it's much more efficient (because of estate taxes) and much more enjoyable to pass on your wealth while you're living. Useful for: some contrarian ideas on retirement planning.

This is Not Your Father's Stockpicking Book Actually, I did borrow it from Dad. But anyway, it uses lots of examples to show how cues from everyday life, that most people don't think have anything to do with stocks, can be used for investing ideas. The weather, politics, television shows, fads, and advertisements are the main signal sources discussed. Useful for: learning about some of the things that affect stock prices.

The Warren Buffett Way It's impossible to take even a passing interest in investing without hearing about Warren Buffett. This book isn't written by the guru himself, but is about him - it is a sort of biography focusing on his business and investment decisions. Useful for: An insight into the life and strategies of the most successful investor in recent history.

And here are some other books that I'm currently reading, or plan to read in the near future, and why:

Unconventional Success: A Fundamental Approach to Personal Investment - Why most mutual funds are not a good place for your money. Right now nearly all my investments are in mutual funds, so I'm curious what this guy has to say about them that's so bad.

Rule #1 - A system for picking individual stocks, mostly based on the fundamentals of the companies. A mass-marketed, sometimes tacky, but understandable approach to applying a Warren Buffett-like investment strategy.

The Bogleheads' Guide to Investing - I've heard it's a good "getting started" book.

Your Money and Your Brain - What is going on, neurobiology-wise, when you make investment decisions. Why people tend to make dumb moves when investing, even when they know better.

The Alchemy of Finance - A lofty-minded tome by famous successful investor George Soros.

Wednesday, January 23, 2008

Goals, 2008

I've never been one for resolutions. Not at the new year, or really any other time. The cynic in me says that if the resolution-maker (whether it's me or someone else) really has both the desire and the ability to change, they would already have done it, and not waited until January 1.

But the idea is firmly entrenched in our culture that the transition from one calendar year to the next is an ideal time to take stock of where you've been, and where you're going. 2006 and 2007 were eventful years for me, with a lot of changes that I would not have foreseen. At the beginning of 2006, I was a graduate student in Kansas, working towards a PhD in ecology, living in an apartment, with no near-term plans of buying a house or starting a family. The end of 2007 found me in Pennsylvania, employed at UPenn in a cell biology research lab, while simultaneously making gradual progress on a Master's, discovering the joys and pains of homeownership, and expecting a baby girl in April.

So, they're not exactly resolutions along the classic lines of "lose weight, quit smoking, spend more time with family." But I do hope to achieve certain goals for 2008:

- complete my Master's degree at KU
- increase my salary
- add $8000 to our savings/investments
- write to one friend or family member each month

These are the primary goals, and I figure that with a new baby that will take up much of my time and energy, that is plenty. There are numerous lesser goals or related aims that I could also list (get more organized, get parts of the thesis published, get various things fixed or improved around the house, and so forth), but I'm sticking with goals that are quantifiable, so that at the end of the year I can easily say whether or not they were achieved.

Many people that know me might be surprised to see that two of my goals are financial in nature. In the past, I was never especially interested in money. As long as there was enough to meet our immediate needs, and preferably to put some into a savings account as well, I didn't care how much we earned, or how much we spent. But owning a house and preparing for parenthood have changed my perspective. As the one who does most of the banking and bill-paying, I had become vaguely aware that since we bought the house (almost exactly a year ago), our bank account wasn't shrinking, but it also wasn't growing. It occurred to me that this was a worrisome state of affairs if our expenses were slated to increase and/or our income would decrease. I decided that a more proactive approach was needed, and that I should learn something about managing money other than "don't spend more than you have." So, I used Quicken to help me collect data on our spending, and I started borrowing books about personal finance from the local library. Together we started talking about planning for the future (farther ahead than next month's bills), about budgets and saving and strategies for investing. So far, we're only two months into our efforts to be more financially responsible, but I think we've made a lot of progress. We've set up a budget that should be workable when the baby arrives, and that includes saving up some money. We're still pondering what to do with our savings once it has been set aside; I still feel like I have a lot to learn about investing. Overall, the plan is to keep some in savings, and to invest some. The allocation to each, and the types of investments we make, have yet to be decided.

Wednesday, November 21, 2007

Have a geeky Thanksgiving!

Maybe you're the sort of person who has always wondered what cranberry sauce looks like if you let the juice crystallize, then look at it under a microscope. Or maybe you get a thrill from saying "Please pass the Meleagris gallopavo!" Or perhaps you're just attracted to bright colors and shiny objects. If any of these apply to you, go check out this article at Wired.com.

http://www.wired.com/science/discoveries/magazine/15-11/st_thanksgiving

In other non-Thanksgiving related geeky cheekiness, I recently found decorations for our little one's room when they move out of the nursery. Every child has to learn their ABC's, right?

http://www.tiffanyard.com/nerd.htm

Tuesday, November 20, 2007

Names

Here is a list of the first names that we're presently considering, in alphabetical order. Comment on which ones you like or don't like, and why. The middle name will probably be Rose, after her dad's grandmother.

For those of you looking at this list and wondering where the "interesting" ones are, do not fear. They're just posted on a different blog.

Amalia
Annika
Anya
Eleanor
Eliana
Eva
Evelina
Lily
Maia
Miriam
Stella
Sylvia