Wednesday, October 6th 2010
This is the second post of four on my experience with IVF and pregnancy, and my thinking on its broader meaning to the public and to anthropology. Find the first post here.
A few weeks after the positive blood test, I had my ultrasound where we saw a tiny little bean and a beating heart. During this time I was having what felt like bad menstrual cramps. The nurse told me this was quite normal, but I still spent a lot of mental energy fretting over it. The rest of the first trimester was pretty uncomfortable. In addition to being exhausted, I was nauseous. I didn’t want to eat vegetables. In fact, all I really wanted was toast (gluten free, of course). I concocted a pretty awesome smoothie that I would drink once or twice a day, made of chocolate almond milk, peanut butter and ice cubes. It settled my stomach, and it’s probably because of those smoothies that I only lost four pounds.
At this point we also transitioned from medical doctor care to a midwife. At first we were just given to the next available midwife in our practice. But when it became clear that in order to stay in that practice we’d have to have a hospital birth, we transferred to the Cambridge Birth Center in Cambridge, MA and the midwives there.
Where to give birth and why
The Cambridge Birth Center is a stand-alone birth center associated with (and across the street from) the Cambridge Hospital. There are no doctors, but you can get into the OR in four minutes for an emergency C-section if you need to (yes, they practice and time these things). So I was completely confident that, if I had a straightforward, low-risk pregnancy and labor, I would be best suited to the birth center, and if anything went wrong I was minutes from a doctor.
We were a bit nervous about this decision, because of the stigma attached to IVF children. Do IVF pregnancies lead to more difficult pregnancies or labors? Are we going to have a child with greater or fewer limbs than the average? The reality is that, while the egg was fertilized in a rather special manner, a fertilized egg, then blastocyst, trophoblast, and so on that makes it to become a fetus, and then makes it trouble-free through the first trimester? That fetus is very, very likely to be healthy and normal.
The other reason we were firm in our decision is that a number of interventions that are automatic upon entering a hospital are not physiologically necessary, and even increase the risk of later interventions. Pubic hair shaving is still a common practice in some hospitals, which is just plain dehumanizing. More common are continuous fetal monitoring and putting in an IV immediately. Continuous fetal monitoring is more likely to find false positives, which means it’s more likely to find pathology in a fetal heartbeat that goes up or down but resolves on its own naturally. IVs restrict movement and lower the barrier for a doctor to suggest, and a woman to agree to, pharmaceutical interventions. This is in addition to the many other criticisms I could launch but won’t because I find it all so exhausting.
The biggest issue, for me, is that if you walk into a hospital you have at least a 33% chance of having a Cesarean section, and the reasons behind that are largely related to the ratcheting up of interventions as one intervention necessitates the next one. A C-section is major abdominal surgery. It takes a long time to recover. It is hard to breastfeed, it is hard to pick up your child, and you spend more days in the hospital. These are days when your sleep is more disrupted than when you’re home, and you increase your and your child’s chances of infection by being in a hospital, and extra days when you as a family could be figuring out a routine at home to make sure the mother isn’t the only one bonding to the new baby.
Then there are indications that C-sections create health concerns for the baby as she gets older. Babies of C-sections have higher rates of allergy (i.e., Roduit et al 2009), asthma (i.e., Davidson et al 2010) and Celiac (gluten intolerance) (Decker et al 2010). I am a C-section baby myself and I have severe allergies, allergy-induced asthma, and gluten intolerance (a trifecta of awesomeness!). Given that I’ll be passing on some of the genetic proclivities for these things, I wasn’t too keen on giving my child the environmental components that would also increase her risk if I could avoid it.
So we started seeing a midwife, and I got to know a different part of Cambridge better than I’d known before. I really fell in love with Inman Square.
Throughout my pregnancy, I devoured popular books on pregnancy (good: anything by Sheila Kitzinger, bad: What to Expect When You’re Expecting) but also searched for a lot of information on PubMed and kept an Endnote library devoted to my results. I read about the craptastic relationship between symphysis-fundal height measurements (this is when they use measuring tape to measure the size of your belly) and birth weight (i.e., Johnstone et al 1996) – even in those studies that found a statistical correlation, SFH often explained very little of the variance in birth weight. I read about exercise during pregnancy (de Groot et al 1994) – and I played soccer through my first trimester, jogged through my second, and worked out five days a week through the whole pregnancy, up to the day before my due date. I read about meconium, I read about fetal monitoring, I read about maternal stress. When I wasn’t working I was reading, and when I wasn’t reading I was exercising. All the other time I was in prenatal appointments or sleeping.
Of course, as excruciatingly long as the pregnancy felt, as boring and normal and yet delightful as it was, it did eventually come to a close. Family flew in from out of town to be around for my due date, and there was a lot of pressure – joking, but pressure nonetheless – to produce offspring before everyone left. When my due date brought with it the occasional half-hearted contraction, nothing I hadn’t felt before, I went to bed disappointed.
The next morning I woke up, got out of bed, and my water broke all over the bedroom floor.
* * *
Next time, I’ll talk about the joys of drug-free labor.
Davidson, R., Roberts, S., Wotton, C., & Goldacre, M. (2010). Influence of maternal and perinatal factors on subsequent hospitalisation for asthma in children: evidence from the Oxford record linkage study BMC Pulmonary Medicine, 10 (1) DOI: 10.1186/1471-2466-10-14
Decker, E., Engelmann, G., Findeisen, A., Gerner, P., Laass, M., Ney, D., Posovszky, C., Hoy, L., & Hornef, M. (2010). Cesarean Delivery Is Associated With Celiac Disease but Not Inflammatory Bowel Disease in Children PEDIATRICS, 125 (6) DOI: 10.1542/peds.2009-2260
de Groot LC, Boekholt HA, Spaaij CK, van Raaij JM, Drijvers JJ, van der Heijden LJ, van der Heide D, & Hautvast JG (1994). Energy balances of healthy Dutch women before and during pregnancy: limited scope for metabolic adaptations in pregnancy. The American journal of clinical nutrition, 59 (4), 827-32 PMID: 8147326
Johnstone, F., Prescott, R., Steel, J., Mao, J., Chambers, S., & Muir, N. (1996). Clinical and ultrasound prediction of macrosomia in diabetic pregnancy BJOG: An International Journal of Obstetrics and Gynaecology, 103 (8), 747-754 DOI: 10.1111/j.1471-0528.1996.tb09868.x
Roduit, C., Scholtens, S., de Jongste, J., Wijga, A., Gerritsen, J., Postma, D., Brunekreef, B., Hoekstra, M., Aalberse, R., & Smit, H. (2009). Asthma at 8 years of age in children born by caesarean section Thorax, 64 (2), 107-113 DOI: 10.1136/thx.2008.100875